Watch this space for updates.

Warmest Regards,
Crystal Baugus

Dear Crystal,

Thank you so much for your comment on my blog from DR Congo. It seems your heart for the Congolese people is just as full as mine so it is me who should be thanking you for going out of your way to learn more about their terrible situation. It is truly a privilege to do the work that I do and I am grateful to have the skills that can take me to the centre of the conflict.

I have been back from DR Congo for several months now which has given me the necessary time to reflect on the good and the difficult of my time there. In Masisi, where I was writing from, MSF was the only organisation working. Further away from the conflict, towards the capital of North Kivu, Goma, there are many organisations also doing good work. To name a few for your research: Save the Children, Solidarité and the International Committee of the Red Cross. Although there were others (plenty in fact) I did not come into contact with their work and would therefore not feel comfortable making assumptions about it.

In terms of further supporting the people caught up in the crisis, there are many ways in which you can make an impact on their behalf, from North Carolina! Firstly, carry on doing what you’re doing - comment on blogs, ask questions, link relevant articles through social networking sites like Facebook or email them to your friends. (My emails home seem to go much further than I ever imagine they can!). Trying to catch people’s attention to something so far removed from their daily reality which barely impacts them is hard. But if we all cover all bases we can make in-roads into their awareness.

Secondly, financial support is a fantastic way to help. I know that sometimes it can feel a bit cold or brief an action, but the cost of Masisi, for example, for one year is around €3m or US$4.5 approximately. We achieve an awful lot with that, but we do need people’s support to raise it. MSF is quite unusual, financially. The proportion of our funds that come from the general public is far above the average for the industry - around 85-90% per year typically. We insist upon such a percentage because the countries we want to work in are often fraught with political unrest and to use government money for our work not only threatens to compromise the security of our teams, but crucially. the access we have to the worst affected areas and the most in need. By using independent funds, we gain permission from all authorities and warring parties to work in conflict areas - exactly where we want to be. We justify their faith in us by treating all sides and showing them the medical quality and worth of our actions. That is our security. And it is the public that affords it for us.

Thirdly, you can contact the US office of MSF, known as Doctors Without Borders, and ask them what you can do locally to raise funds or awareness for them. I’m sure they would love to hear from you. Contact details can be found on their website: http://www.doctorswithoutborders.org/

As you can see from my sign-off below I work for MSF as both a nurse and a fundraiser. If there are any other questions that I can answer for you or help can offer, I am only too happy to.

And thank you, Crystal, for your compassion and concern.

Very best wishes,

Fiona

As we waited at one of the numerous roadblocks, a woman approached us and said she needed to be transported immediately to hospital, as she had been raped the day before (it is important to receive medical treatment within 72 hours).

We asked her some more questions, and it turned out that this was not the case, but that she knew that if she said she had been raped, that a medical NGO would straight away take her to the town.

One of the things you always have to consider when doing an assessment, and when starting up a new project, is also the negative impact that your assistance can have. It is easier to see the needs, sometimes glaringly obvious, but it is harder to see the longer term effect that your presence or your aid can have.

In a place like Kitutu, which has received very little external assistance, we have to be careful that if we provide a medical response, it will not only help the most vulnerable population in the short term (like the displaced population) but also that we don’t weaken the health care system in the long term.

As we put together our project proposal back in the office in Bukavu next week, we will have to do a good analysis of how are assistance can be as effective and beneficial as possible.

Au total, 1,036 enfants atteints de la rougeole ont été recensés dans la région depuis le début de l’année, dont 85 ont perdu la vie. Le bilan pourrait toutefois s’avérer plus lourd, les complications de la maladie entraînant la mort, parfois plusieurs semaines après l’infection.

MSF vaccine les personnes à risque

Les flambées de rougeole peuvent être particulièrement mortelles dans les pays qui traversent une situation de conflit. Dans certaines zones de Masisi, l’insécurité ne permet plus aux services de santé d’offrir une vaccination systématique et la concentration d’un grand nombre de familles qui ont fui dans des camps accroît considérablement le risque d’infection.

MSF a donc décidé de soutenir le système de santé en s’assurant que les malades atteints de rougeole puissent être isolés et recevoir à temps les médicaments nécessaires. Les équipes médicales se concentrent sur les cas sévères, ceux qui ont développé des complications telles que des infections respiratoires, la diarrhée, la déshydratation ou encore la malnutrition.

Dans le même temps, des équipes vaccinent tous les enfants âgés de six mois à 15 ans dans 32 aires de santé. Une campagne de grande ampleur : plus de 165.000 enfants ont été vaccinés entre le 14 octobre et le 29 octobre 2009. Un nombre qui aurait pu être plus élevé si sept sites de vaccination des zones de Ngomashi et Kimua n’avaient servi d’appât à une offensive de l’armée gouvernementale contre combattants des Forces Démocratiques de Libération du Rwanda (FDLR), le 17 octobre. A cause de ces violentes et inacceptables attaques, les patients comme les équipes ont dû fuir les combats. Depuis lors, les activités ont été interrompues dans cette zone particulièrement sensible pour le moment.

Des zones difficilement accessibles

Aujourd’hui encore, une partie de la population, vivant dans des régions difficiles d’accès, n’a pas ou peu accès aux soins de santé primaire.

« L’épidémie de rougeole sévit un peu partout et l’accès aux villages peut difficilement se faire en voiture. Masisi est une zone montagneuse », décrit Joseph Kishimba, responsable d’une des équipes de vaccination MSF. « Nous devrons nous adapter, être inventifs. Il faut utiliser des motos, voir transporter tout le matériel à pied jusqu’au site. Nous sommes en pleine saison des pluies ce qui rend cette vaccination encore plus difficile», estime John Kiumbe, logisticien pour MSF.

La rougeole, une maladie mortelle

« La rougeole est une maladie très contagieuse et qui tue de nombreux enfants ici », explique Fabrizio Ferri, responsable médical des activités d’urgence de MSF. « Les formes les plus sévères de la rougeole apparaissent chez le jeune enfant souffrant de malnutrition. L’enfant ne meurt pas directement de la rougeole mais de ses complications, telles que l’encéphalite, les diarrhées sévères ou la pneumonie. C’est pour cela que nous délivrons un supplément en vitamines A associé au vaccin contre la rougeole, et que nous surveillons l’état nutritionnel des patients durant cette campagne », reprend Fabrizio Ferri.

Il n’existe à ce jour aucun traitement spécifique pour traiter cette infection virale et la vaccination est le meilleur traitement préventif actuel.

I asked them why so few of their people visit the health centres here (some health facilities are only used by about 10% of their target population).

Apart from the obvious answer about the high fees, there is also the fact that once someone has paid for their consultation, there are often no drugs in the health centre to treat the patient. Instead, they have to visit a private pharmacy and pay more money.

There is also the problem of the quality of the health services. What woman wants to deliver in a health centre where there is dried blood on the mattress?

(Photo: Operating theatre in Kitutu general hospital. The watering cans are used to clean the surgeon’s hands before he starts the operation.)

None of them had time to take anything with them, they just had time to flee. One man showed me the knife wounds on his face and arms where he had been attacked by one of the armed men.

Some of the families have been displaced several times in different villages before arriving to Kitutu. In one house, we found five families living together under the same roof, in a mud house that would normally sleep only five people. In these conditions, and with such limited access to clean water in Kitutu, it won’t take long for communicable diseases like diarrhoea to spread.

One of the big problems related to the recent insecurity is that people are finding it hard to cultivate their land, as it is too dangerous to go to their fields, even in the daytime. Just yesterday, a woman visiting her fields 5 km from Kitutu was raped by armed men.

This was the second time that this woman had been a victim of rape. After the first time, her husband threw her out of their home.

Sadly that is a common practice here in Congo. It just makes it even harder for the woman to come forward for assistance if she knows she will be ostracized by her community and even her family.

Without access to their fields, the people here lose their main livelihood. How can a family who has lost their means of trading on the market gather the money to pay for a medical consultation when their child is sick?

Etat critique a rapporté ces histoires dans des vidéos, des photos et des témoignages, au cours de l’année écoulée. Des milliers de visiteurs du monde entier ont regardé, écouté, lu ces récits et y ont répondu.

Le dernier dossier, intitulé “Blessures”, est maintenant mis sur le site. C’est une invitation à entendre de nouveaux témoignages sur les souffrances du peuple congolais et à laisser un message de solidarité et de soutien.

Le conflit se poursuit. Les habitants de l’est du Congo continuent à être attaqués, violés et victimes de pillage, ils fuient toujours l’insécurité. Ils perdent leurs proches et leurs vies continuent d’être menacées. Des blessures, physiques et morales, leur sont régulièrment infligées.

MSF dispense des soins de santé et apporte une aide humanitaire aux habitants de l’est du Congo. MSF continuera à communiquera sur la terrible réalité à laquelle ses équipes sont confrontées.

Etat critique restera en ligne en archive. Partez à la découverte du site et dites à votre entourage ce que vous y avez vu.

Nizeiyman, 21, fled to the outskirts of Kitchanga in North Kivu province when his village came under attack. He has joined a group of woodcutters in Mungote camp for displaced people.

They have pooled their resources to buy some basic woodcutting equipment. By selling planks they earn just enough to supplement the food handouts from aid organisations and provide themselves with a sense of independence.

“My name is Nizeiyman. I come from Butare. My father died in the war. Three of my brothers were killed, too. After that, I fled to Mungote camp. It’s two years now that I live here, I was one of the first ones who started the camp. I couldn’t bring anything with me; even my blanket was given to me here. When I saw that there wouldn’t be enough to eat I came and joined the woodcutters.

“I had just recently married when we had to flee. My wife became pregnant and gave birth here in the camp. Most days I work in other people’s fields, and also do this work as a woodcutter. We sell planks to buy food. If there’s anything left, we buy another tree to saw. I live with my mother. She is a widow and so when I work I have to feed her as well as myself. Whatever I earn, I share it with my mother. The only income we have is from selling wood planks.

Watch a video about Bahati, a woodcutter who works with Nizeiyman.

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“We have lived through some terrible things. But here we found a little bit of stability in the camp. Some humanitarian aid groups gave us food and cooking pots. We have a little to eat, but we realized that we’d need to supplement that with our work as woodcutters. And so we keep on working.

“I’m terrified - all the gunshots I heard and all the blood I saw. There were lots of gunshots and when we fled we had to jump over dead bodies to get away. I saw five dead bodies with my own eyes, and my three brothers too. Some were killed by bullets, some by machetes. I saw my brothers’ corpses and I was frightened. When we saw that, we fled this war. We fled for our lives and came here to this camp.”

Photo Gallery

MSF runs a mental health programme in Kitchanga. Many of the people they see are women who have suffered physical or sexual violence. This woman, 54, recounts what happened to her a week before first coming to see MSF:

“I was out with a group looking for food, when we heard gunshots coming from all sides. We ran, and dispersed into the woods. I was with two young people and they were killed right there in front of me.

“As I threw myself to the ground they were killing the people behind me. They kept chasing, firing their guns. I fell to the ground, and when they caught me, they raped me.

“When they had finished, one of them made to shoot me, but the others stopped him, and cut me with knives instead. Now I have cuts all over me, even on my legs. When they had finished, they were about to kill me, but one of them said not to.

“When armed groups started coming to our village, we would spend the night in the bush. They always came at night, and they would beat everyone. My husband was badly beaten, and some people even died from beatings.

“When we saw that they were coming every day, we left our houses, and we were like animals living in the bush.

“When they saw that we weren’t sleeping in the village any more, they started to hunt us down in the bush. If you had nothing to give to the bandits, you’d be killed. Every day people would talk about someone they knew being beaten or stabbed to death.

“The bandits said that the forest belonged to them, not us. They told us that the night belonged to them, too. So we gathered all our possessions and came here to the camp.

“Since then, I’ve been living here in the camp. My heart is always beating too fast. I’m terrified whenever I go to collect food – how could they do this to me?

“There are so many people here getting wounded that I’m still frightened they might kill me. The day before yesterday some women went to dig for roots in their fields. They were chased away with bullets and the bandits took everything they had gathered. No one now dares to return home.

“I have given birth twelve times. Eight of these children are already buried.

“I spend sleepless nights and then I’m tired in the mornings. I think about many things. I think about the people I’ve lost and those who are still around. I think about my children who have died. I think about my child, who is still missing, and I don’t know whether he’s alive or dead.

“Whenever I’m with my friends I end up talking about the rape, about what happened to me. They help me, giving me food sometimes, and if they can’t give me anything, it’s because they don’t have anything themselves.

“Some of my friends have given me cups to drink from, food to eat, or a wrap to wear. And one woman who suffered the same things I did told me to come to see MSF. As soon as she told me about MSF, I came straight here.”

I thought I’d write a piece about Congolese luck. I had a good example of this the other day when I was called by a smaller neighbouring hospital who wanted to refer a patient to us here in Masisi.

When I got there, I found a young man alone in a filthy all but empty ward, with a heavily bandaged leg. The nurse told me the story. He had been in the market in broad daylight when one of the soldiers posted there ostensibly for the security of the population tried to rob him.

He ran, and the soldier opened fire, hitting him four times in the leg, shattering his femur. He was obviously in great pain, so I gave the strongest pain medication I had with me and placed an inflatable splint to immobilise his leg. With a broken limb every movement is agony and to get back to Masisi we had to go over 4 hours of the bumping rutted tracks which pass for roads here.

In the event, after we had got stuck in the mud and had to dig the car out, it was 5 hours before we got back and I could hand him over to the surgical team for the emergency surgery to try and save his leg.

Afterwards, as we were packing up to go back to the base, I chatted to Carianne, the MSF supervising doctor here. Tall, elegant, and one of the most highly skilled and humane doctors I’ve worked with, like me she has worked before in the Congo.

‘He’s lucky,’ she explained, ‘He’s arrived on the same day that the Surgeon supervisor is making a visit from Brussels. He’s really experienced, especially in bullet wounds, so he’s going to do the surgery.’

‘Oh great’, I said, brightening up despite being tired from nine hours on the road, ‘that is a piece of luck’. Then I thought about this. ‘Well I suppose that’s Congolese lucky anyway. Most places in the world we’d say it’s pretty unlucky to get shot in the first place, but here in Congo we regard him as lucky coz OK, he got shot, but he got shot when the big chief of surgery is in town’.

We both reflected on this for a moment. ‘Yes’, said Carianne, and we went back to our respective tasks.

For similar reasons, I sometimes worry about being referred to as a humanitarian worker, when the only reason why I’m here is because humanity seems to be in short supply.

We see famines or war on the television, and then usually an interview with one or another of the aid agencies. Problem solved; someone like me is there to run a feeding centre or provide war surgery for the injured, and we all congratulate ourselves on being a humane and caring society.

Congolese luck – you get shot, or starve, but at least someone is there to patch things up. But most famines don’t happen without political interference, and wars don’t happen without domestic and international political support and connivance.

After two missions in DRC, I can see signs of hope here. The majority of the country is at peace after years of war, and in 2006, elections which were held to be broadly free and fair by the international community, for the first time since 1960. Progress is clearly possible.

But here in North Kivu, things remain tense, and they’re getting more so. Recently, I asked a respected Congolese colleague what he thought the future held for Masisi. He looked at me with a tired face. Here, he said, things are cyclical.

Condition Critical may be winding up, and soon I’ll be going back to my safe and comfortable life in Britain, but he’ll still be here, waiting for the next flare up of violence and displacement.

And no doubt we’ll be there to patch things up, but remember that it’s not a sign of how humane we are as a society, just a bit of Congolese luck.