It’s a crazy world!

March 13th, 2009

7th February 2009

With seamless fluidity the earth and plants of Congo flow into one another, lacking order but possessing an authority, a wild one, which I have never seen before. Nothing here is moderate; it is a country of exaggerations where nature appears determined to conquer all. It is utterly beautiful.

After a four day trek through stations, airports, taxis, cars and briefings, I walked across the border from Rwanda to DRC, which somehow makes it more voluntary. I thought about looking over my shoulder, but didn’t. As with most things troublesome, it is incredibly easy to get into.

A paradoxically merry parade of officials waved me through, touchingly thanking me for coming, with eye contact, whilst a bundle of semi-deflated UN soldiers lolled their heads at me from a toy-like truck. From this small border station spews forth volcanic Goma, mucky grey and littered with NGOs and debris. It looks in fact, like someone upturned their dustbin and waited for the wind to blow. Look to your left, however, and you ’ll see gentle Lake Kivu, punctuated by young swimmers splashing the cholera waters with total abandonment (which once you’re in you may as well, I suppose). Tropical flowers and the last escarpment of the Great Rift Valley frame the view like some kind of paradise. Turn the corner and cove after beautiful cove run for miles before you reach a small town called Sake. It is breathtaking and for all the wrong reasons. Thousands of people have scraped together the few branches, banana leaves, paper and plastic sheets available to them and bedded down there, literally running until they hit water.

As it turns out, the water is likely to hit them right back. Torrential rainfall and landslides make life not just difficult but threatened – more of which later. But let me just say that I have never literally been up to my knees in mud before, never been in a conflict zone before, never thought I would reach out a hand for help to an armed man, nor put my hand as firmly as possible on a strangers’ bottom to push her up a mud-bank. Yet, all of this happened on the way to Masisi as we abandoned the cars in cavernous holes and attempted a few kilometres by foot, while the cars towed themselves out of the slop. (And girls, if you want a rock solid bottom, the third world fitness programme is for you. I gasped. She roared with laughter; hard labour’s revenge!) It was surreal fun with all participants giving a running commentary (Elle ne peut pas le faire, oui elle a déjà, mais monsieur là, non, attention, papa! Aksante, mama! Habari muzungu? etc)

After the mud came the tranquillity of cows grazing on velvet mountain slopes, priests making some cash on the side from churning out cheese and the twirling depths and heights of villages once abandoned but now filtering back to ‘normality’. Masisi is a convoluted town of mud huts and shacks, spiralling from around 1800m to 1000m depending on where you are within in it. We are about half way up or down. It’s a little bit like surfing – the floor always seems to be moving, the view is spectacular and your nerves never quite leave you. Our houses and office, hospital and health centre are

scattered around one level of the town so the pleasing morning traffic of elasticated children, stringy chickens and dozy goats is all around. I have swapped my two and a half hour commute for a 1-minute clamber up a rocky mud bank to the health centre, where over 3000 medical consultations are given each month by six incredible nurses. Along the road is a 150 bedded hospital offering all the services you would expect of a general hospital along with a nutritional centre of 80 beds. On a hidden hill, 300 metres away is Masisi ’s camp for displaced people.

I suppose we have all seen the photos and anyone who has done any degree of ‘proper’ travelling (which exceptionally includes French campsites) can recall the pungency of snug living and minimal water. I was expecting to be shocked at first sight – romantic, humanitarian musings and all that. I was underwhelmed in fact; so few shelters and I had thought 5000 people lived in the camp. Then I was shocked – 5000 people do live in such a scarcity of tents and shacks. Seven or so people will share the space of a family car, sleeping on mud floors, protected from tropical storms and mountain nightfall temperatures by one tarpaulin.

On my second day here there was a mudslide in the camp. Rain pushed the earth from the top of the mountain onto the camp, demolishing nine houses, injuring three people and killing eight children. When they were dug out their arms were outstretched, their mouths open from crying for help and trying to breathe. It’s as though everything that could be against people here, is.

Fortunately, people don’t seem to be set against MSF. In fact as we neared Masisi two women on the road stopped walking, all earthly belongings still on their heads, and clapped our car. I’m sure they know of and value the free healthcare we provide but I sense they were more clapping the direction the car was heading in – towards their needs not away from them as have so many cars.

The irony is that our security amid the insecurity comes from weathering the storm, from being so present that our motives are evident and our services invaluable. If we weren’t here there would be no healthcare. I saw a woman in the health centre who has been bleeding for four years. She was in a camp in Goma when her son called her and told her we were in Masisi. So she walked the 80 km here, bleeding, for a free consultation. Sadly I’m not sure there is much we can do for her, but we can at least bring her some comfort.

Most of the people who come to the health centre have what one might simply call diseases of poor living conditions and violence. There is an endless, screaming queue of children with diarrhoea, respiratory infections and the worrying bronze frizzy hair indicative of moderate malnutrition. Adults come with varying degrees of stress-related illnesses, aching in mind and body and sometimes are out of their minds from trauma. Women come with cuts and bruises from beatings and even babies with machete wounds to their heads.

I thought after a year of running a sexual violence clinic in Burundi nothing would surprise me, however, I have now cared for a nine month old girl who was ‘raped by mouth’ in the bush, with torn gums and a rampant fungal infection to show for it.

Because MSF is committed to treating according to need and staying neutral we have armed men bringing their children to us as well – tearful dads leaving their guns at the door, perfectly gentlemanly and so grateful for that great invention, the antibiotic. It’s a crazy world!

The geek in me is delighted to see truly tropical diseases too – leishmaniasis, buruli ulcers, ringworm and more. We treat big bellies galore for parasitic infections and children with acute abdominal pain following traditional medicine. Fortunately we are so high up there is very little malaria. Indeed it is so isolated that in my first four days I have reassured three women that they are not ill, they have something called the menopause of which they had never heard. It’s hard to imagine how worrying it must be to have a body change so drastically if you don’t understand the basics, which we take for granted.

For many people the least and most we can do for them is to be here, to listen, to acknowledge what they are going through and they seem to appreciate that. For many more we can also treat them, give them good quality medicines, daily wound dressings, emergency surgery and proper ante and post natal care – for free. Not least we vaccinate them. Next week we will go to the camp and vaccinate as many as we can against measles, tetanus, TB, diphtheria, whooping cough and polio.

Four days a week we see 300 women for antenatal consultations. We protect them against anaemia, malaria and tetanus. We explain that they can come to the hospital to deliver where the conditions will be clean and the service free. We identify the most at risk and bring them to our ‘Welcome village’, a safe house for vulnerable women be they raped, socially abandoned or with at ‘at-risk’ pregnancy. These clinics are, for me at least, joyful. Giggling chatter fills the stinking, crowded waiting room as life goes on. The mamas are gorgeous and there is something to look forward to. Nature fights back!

Tags: Kivu, Medical