I did not keep my promise to you and write timely posts about my trip to the DRC. Life got busy. I also decided to take a different approach in what I'm going to post, presenting what I learned during my trip. So today I'm starting with Public Health. Eventually I also hope to write to you about the DRC, my Doctoral Research AND myself.
As a refresher I was in the DRC working on a review of humanitarian assistance between 2006 and 2016. If this post troubles you I invite you to consider donating to MSF (specifically to their hospital in Masisi) or to Heal Africa in Goma.
http://www.msf.ca/en/donate-now
http://www.healafrica.org/donate_to
My initial role on the review team was as the Public Health
Expert, although methodological lead was later added to the list of my
responsibilities. I was invited to fill this role not because of my extensive
education in Public Health but because of my general experience around public
health policy including the social indicators of health and helping to run the
health clinic at KW Reception House. Fortunately, the review didn’t require any
knowledge of the biological and epidemiological components of public health
because then we would have been in trouble.
As the Public Health Expert on the team it was my job to
interview individuals engaged in public health work. This included local chief
medical doctors, nurses, nutritionists, project coordinators for international
NGO’s and sometimes their heads of missions. I also visited numerous health
centres and hospitals, camps for internally displaced people and NGOs. It was
extremely eye opening.
Over at least the last 15 years most of the health centres
and hospitals have been run with the support of international health partners.
They are often operated by local doctors and nurses but their programs and
access to medicines are funded by international partners. As a result of this
support, they have been able to offer free medical assistance and medications
to the local population in part and in whole. However, recently because of
donor fatigue and the redirection of funds to new crises such as South Sudan many
international health organisations have reduced or completely cut their
assistance to health sectors across Ituri, North and South Kivu where the local
population is now being asked to pay for medical assistance. This worried many
of the local health care practitioners who I spoke with who indicated that much
of the local population could not afford to pay the nominal fees that they were
now being charged by the health centres and hospitals. This is particularly
concerning because the primary causes of death in the region (malaria,
respiratory infections, cholera and TB) are highly contagious but treatable
illnesses. Lack of access to treatment could easily lead to the spread and
possibly epidemics of these diseases resulting in a significant increase in
mortality, particularly among vulnerable people including children and IDPs.
I also observed the conditions at the medical centres and
hospitals. There were two examples of best practices. The first was the
hospital in Masisi which we visited at the beginning of the trip. The hospital
is funded by MSF and has extensive wards for malnutrition, trauma, maternity
and pediatric care, it also has a well stocked pharmacy. All treatment
delivered at the Masisi hospital is free. Unfortunately, the week we visited
the malnutrition ward in the hospital was over flowing because desperately needed
food aid wasn’t reaching its recipients because of corruption in the supply
chain. The other strong example was the Heal Africa hospital in Goma. Like, the
Panzi hospital in South Kivu where I visited in 2016, the Heal Africa treats
and supports victims of sexual and gender based violence. The hospital is
extensive and offers both medical and social services to its patients.
These two hospitals were very much the exception to what I
saw. The most troubling cases I visited were health centres in Ituri, both
which had recently lost funding. When I asked for a tour of the first health
centre near Komanda I was shocked to see that the birthing room consisted of an
examination table with a hole cut into it and a basin underneath it to catch
the baby. The room was so dark, damp and dirty, I couldn’t imagine how giving
birth in such a place could reduce maternal or infant mortality (although it
apparently does, at least according to the statistics on their wall). The
second health centre I visited in Mangiva was in much better condition and
seemed to have more services available. However, that health centre had been
attacked and raided by militants three times in the past three years and during
the last attack the head of the centre, a young father, was briefly taken
hostage.
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| Mangiva Health Centre |
I also learned quite a bit how different diseases and
socio-economic conditions can interact with each other to exacerbate existing
conditions and contribute to elevated mortality. For example, someone who is
chronically malnourished is more likely to die as a result of a cholera infection.
People living in under-supported long-term IDP camps, without proper sanitation
structures such as the one in Kalite in the Masisi territory are very likely to
be affected by both. Further, when people flee fighting and war in the Eastern
DRC, they also spend days and weeks hiding in forests, or walking to seek
safety, where they are at much higher risk of being exposed to Malaria.
Sub-standard living conditions and nutrition can also increase susceptibility to
respiratory infections, as can HIV infections which is spread by the scourge of
sexual and gender-based violence.
I was also exposed the complexity of sexual and gender based
health in the DRC. While I was there I spoke with a counsellor at a counselling
centre for victims of sexual and gender based violence who didn’t know that she
could use condoms to prevent unwanted pregnancies. I also met a priest who was
prepared to distribute condoms to his parishioners in order to prevent
malnutrition cases being caused by women conceiving too soon after giving birth
(I gave him $20 to buy condoms). Finally I learned that, an well-known international
health NGO has started offering free abortions to women who need them, despite
the fact that abortions are illegal in the DRC.
When I was in the first year of my Ph.D. I read an article
by Marriage (2013) which argued that international health NGOs should stop
providing free health care in the DRC because they were duplicating state
services and preventing the government from taking full responsibility for the
sector. The Congolese government is not taking responsibility for the health
sector (or most other sectors) and the local population cannot afford to pay
the fees associated with medical treatment in the East. Another example of this
was an HIV/AIDS advocate who shared with me that while the government provides
free Anti-retroviral treatment for AIDS patients they don’t cover the cost of
medication for opportunistic infections which could kill them and be spread to
other parts of the population. Many people in the East with HIV/AIDS are too
sick or stigmatized to work and so obviously can’t afford these medications.
To conclude, a full pull-out by international medical
organisations would result in an overwhelming health crisis, which is already
reflected in recent cholera outbreaks which have occurred across the East. More
money needs to be directed back into the DRC to ensure that the most vulnerable
people continue to have access to urgently needed medical care.
