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Democratic Republic of Congo :: The struggle for care in Katanga Suffering from advanced cerebral malaria, the three year old girl died just after 10am after convulsing for about an hour. Having watched silently as the medical staff tried desperately to keep her child alive, when the moment finally came, the mother fell forward, bent double over the metal bed frame, and began crying hysterically into the mattress. "In Europe, the girl would have probably survived, but not here," explains Claire, an Médecins Sans Frontières doctor. 'Here' is Kilwa, situated in the Province of Katanga in the south east of the Democratic Republic of Congo. Unlike many areas of the DRC, the health zone of Kilwa does actually have a hospital as well 10 medical clinics. Médecins Sans Frontières works in the medical structures in partnership with the Congolese Ministry of Health. This means that the Ministry of Health provides staff, structures and salaries while Médecins Sans Frontières brings specific expertise, as well as providing medicines, materials, and paying staff a performance-related bonus. That at least is the theory. The reality is that the staff are fortunate to receive more than one month of their salary per year from the Ministry of Health. Much of the money available disappears into a black-hole before it reaches ground level. As such, while the staff continue to turn up to work in the forlorn hope that they will one day receive what is due, they are hardly motivated to work their fingers to the bone. When Béatrice, an Médecins Sans Frontières nurse, first began in the hospital, the standard of hygiene was atrocious. "Basic necessities like sterilisation of materials were not being done correctly. In fact, there wasn't even a sterilisation room. The room which we are now using looked like a filthy attic," she explains. Four months later the hospital, which has maternity and paediatric departments, as well as the capacity for surgery, seems to be running with a semblance of order. Although it is clear that there is much work still to be done.
Systems that would be taken for granted in Europe simply were not in place in the hospital. "There was no management of the pharmacy for example," Béatrice continues. "No one had any idea what drugs we did or didn't have, and before Médecins Sans Frontières arrived medicines that had expired in 1907- nearly a century ago- were still in stock." A further problem experienced by the Médecins Sans Frontières team is that patients come for treatment at Kilwa hospital when it is already too late. This can be partly explained by the miserable state of the transport infrastructure in the health zone. In fact, the phrase transport infrastructure is a misnomer. The main road snaking through the zone is a cavernously potholed mud track which is impassable for the first three months of the year and requires a sturdy vehicle for the rest. For the vast majority of the population whose sole means of transport are bicycle or foot, undertaking the journey when seriously ill is no small matter. But that the hospital carries out over 1500 consultations every month demonstrates that people do come. And many bring families who camp in the hospital grounds for months on end, providing food and support along with a plentiful supply of colour and noise. But Claire explains, "even in the village of Kilwa, people seem to see the hospital as a last resort." Why this is the case appears to stem from years of neglect of the health facilities combined with a strong attachment of the local population to traditional medicine. "While some forms of traditional medicine can be effective, we sometimes see children at the hospital who have been given 'cleansing' traditional potions made up of herbs and so on. Rather than curing, these treatments can be toxic and end poisoning the patient," she continues. Every night the village vibrates to rhythmic drumbeat signifying that a death has occurred. It is thunderous testimony to the work still to be done in Kilwa. James Lorenz
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