Friday, December 12, 2008
The New York Times
Unfortunately the conflict is continuing and shaking up Eastern Congo again as can be found here in a video by the New York Times.
Sunday, November 23, 2008
Sombre République Démocratique du Congo
La situation s'assombrit dans les provinces de l'Est du Congo, les Kivus. Des milliers de déplacés n'ont plus de foyer. Les conflits reprennent de plus belle, malgré la résolution de l'ONU. Tant que les richesses minières seront exploitées, autant l'instabilité sera nourrie dans la région par toutes les factions, nourries par l'appétit occidental des minerais, du coltan pour l'électronique, des diamants. On parle maintenant d'une génération au complet qui a grandi dans les Grands Lacs sous guerres et génocides.
Saturday, August 16, 2008
Triage
Dr. James Orbinski was a founding member of MSF-Canada in 1990 and the president of Médecins Sans Frontières international council from 1998 to 2001 and went to the podium for the Nobel Prize for Peace in 1999. He lived through the Somalia disarray and Rwandan genocide in the 90's. He has now his own NGO called Dignitas.
He now has an NFB movie called Triage - see here. Unfortunately no screening in Montreal yet - will have to wait for the NFB to edit it in DVD.
Monday, April 7, 2008
Postérité
Bill Moyers' Journal on humanitarian work in the Democratic Republic of Congo aired on PBS April 4, 2008. It is now here on the PBS website.
They filmed us in Shamwana back in November, during the cholera outbreak in Kishale, amongst all other things. Very complete reportage. I'm featured at the beginning of part 2 (at about 25 minutes into the episode).
They filmed us in Shamwana back in November, during the cholera outbreak in Kishale, amongst all other things. Very complete reportage. I'm featured at the beginning of part 2 (at about 25 minutes into the episode).
Saturday, March 22, 2008
Farewell Shamwana
The end of mission was somewhat messy. It is only now, a little more than a week later, that things have been digested and that I can narrate it. Greetings hence from the foot of Mount Kilimanjaro, where I have a few days to sit down and recount the last precipitated weeks before attacking the mountain if the weather gods are favourable.
Initially, the plan was for me to leave on March 7 from Shamwana, to meet up with a group of expats from Dubie to go to Zambia on March 10 for a week to hang around Victoria falls. The plane was preponed to March 6, at which point, we decided to prepone the big goodbye party which was thus planned for Saturday March 1. Two hospital nurses already had a big male goat ready for the feast. Cans of beer and sodas had been planned 6 weeks in advance on a truck from Lubumbashi that thankfully made it on time. I had specially requested the infamous Bifwebe, the traditional bush dancers and black magic sorcerers from Monga.
Then, on February 29, the strangest day of the year so far, we heard that the plane ex-Shamwana wasn’t going to make it. That meant that Lucas, the current acting project coordinator-logistician, wasn’t going to make it out for his vacation. It was decided by capital – and to this day this appears as a knee-jerk, poorly planned decision – that he would go down to Lubumbashi by car whilst my replacement the new expat doctor would make his way up by car as well. And because Lucas leaving left us 2 women first-missioners alone in the project, it was decided that all the Shamwana expatriates would have to evacuate the next day to the ‘safety’ of Dubie where there was another male and multi-missioner. Of course, there is NO security issue in the Shamwana region whatsoever, things are in the rebuilding phase. We learned all this the evening right before the big goodbye party. I had done the evaluations for most of my medical staff and had started my end-of-mission report. But to learn at 16h00 that you’re evacuated the next morning at 6h00 for 5 days to Dubie for very dubious reasons is for the least destabilizing; particularly when this is the end of your mission, and you’ve got things to wrap up, and a party to plan. I was seething with anger; it was not a pretty sight. I could not stay in place, had to call the Head of Mission to ask for explanations, and was overall quite irate. The national staff who were ready for the party were also quite disappointed. After a few hours of ranting I finally calmed down and resigned myself to the unpleasant situation. After all, I do believe in to making the best of what life throws at us (but I should also be allowed to complain and whine before!). So the next morning, I jumped into the car with a sigh and faced another adventure on the roads of Katanga.
Of note was the bloodred sunset that stained the sky like a bushfire, to add to the overall strange, out-of-this world atmosphere of February 29.
We got stuck four times on the road to Dubie, predictably as this is the end of the rainy season. It took us almost nine hours to get there.
Très sérieux embourbement! L’Unimog nous a tirés de là comme une voiture-jouet, c’était beau à voir.
The few days in Dubie were uneventful, if not boring. After a few hours of soulsearching, I made the right decision to postpone the vacation to Zambia and be out-of-sync with the group of friends in order to do a proper handover and finish the work well in Shamwana, as well as having a nice goodbye party for the national staff. After all, this was it for me and Shamwana, and for all these Congolese friends that in likelihood I will never see again, unlike the expats with whom it’s much easier to keep in touch (vive Facebook!). J’ai tout simplement refusé de partir comme une voleuse et d’honorer correctement le beau travail fait pendant les derniers sept mois à Shamwana.
In Dubie, we were confined to the MSF compound, played volleyball games, and I caught up with my two PPD companions and sisters from August 2007 in Amsterdam. Always being afraid of running out of food, I stocked up on quasi-expired security rice and more beer and alcohol for the upcoming party. The expat group from Lubumbashi, ie our project coordinator, mental health officer and F the new doctor were late by a day coming to Dubie and arrived on Wednesday March 5 to Dubie, after five harrowing days on the roads. Ironically the plane had been reinstituted on Tuesday and flew right over us. We finally all returned back to Shamwana on Thursday March 6 for my last four short days there, just enough for a decent handover to Dr. F. Poor Sir W, my lovely Congolese colleague - whom we’ve come to call that way because he is so considerate and proper - had been working alone (yet again) for a week and he looked quite tired.
The goodbye party was worth the wait. The Finco from capital had paid us a surprise visit for the week-end so he got to attend these ceremonials. The Bifwebe traditional dancers from Monga came for the afternoon and performed on the football field. They started with drawing a magic protective circle around the area where they were to perform; then they danced and tam-tam’d for a good two hours; they were again in trance and the atmosphere was full of sorcery. The whole village was watching. It started raining so they performed an anti-rain dance. Believe what one may, whereas most afternoons see a big thunderstorm fall down on us, on that day, it rained only very lightly over the football field where the Bifwebe were under two mango trees; the storm and showers hit a few hundred meters away. Comme Sir W le dit si bien, “nous ne vivons pas dans leur monde donc il nous est impossible de comprendre leurs pouvoirs” – all I can say is that it was odd and to an certain extent, disconcerting.
There was way too much food! (Of course that is a good thing!) At the last minute, the nurses had decided that one goat was not enough and that they should slaughter a second one; given as I had supplied twice the quantity of rice and drinks as usual, there was plenty of room for meat. In the end, we had too much food and everybody got to take some home. The evening continued with the obligatory floral speeches and Congolese music to which everybody danced. Sir W read his speech where he commented on my speediness – ‘Mayani, comme un TGV’. (Mayani has become my natural name in Shamwana, given by the children - it means ‘grass’ in Congolese Swahili). We finished the party much later than usual, it went on until 23h00, and then the expats continued until 2 in the morning. It was a lovely evening.
Sir W and Dr Mayani posing for the pictures
Lovely ladies in their best outfits at the party
My last Sunday in Shamwana was spent being on call, and spending the afternoon discussing Congolese politics, culture and beliefs over some fried chicken at Sir W’s. A patient with bad bowel obstruction walked into the hospital but in the end, she was not eligible for surgery. "A l’hôpital, c’est la routine", like we say in the morning meetings. We watched part of Season 4 of 24 as usual. Dr. F started working; he is experienced and will for sure do a very good job.
Monday March 10 was the definitive dreaded departure date. The last four days were incredibly intense, taking it all in, as if hours slowed down, one minute at a time. I filmed the daily morning meetings, packed, said a whole bunch of goodbyes and we all went to the plane. For someone who sheds tears less than once a year usually, I cried a handful of times in those four long days. The farewells at the landing strip were solemn and I couldn’t help but explode in tears on the airstrip. The medical team, all male, were all very sad and even one of them was wiping his eyes. To see a burly forty year-old Congolese man hide his tears is indeed very touching. These guys really got to my heart, a part of which is now left in Shamwana...
Hospital crew on my last day
Base crew on my last day
Farewell crew at the Shamwana airstrip, my view from the plane
The original AirServ pilot who first dropped me in Katanga in August 2007 – well, he’s back from Halifax and he also flew me out! Here he is, refueling the plane.
Chatting and goodbyes to the expats in Dubie while the plane gets refueled
So that was it. A lifetime of seven months in the Congolese bush. Goodbye Shamwana, now forever gone in time and place as it was for me. Such an intense and beautiful experience leaves indelible memories.
A la question qu’on m’a posée, si j’ai trouvé ce que je cherchais au Congo? Je crois que oui: des tonnes de bonheur et d’émotions et des moments inoubliables.
And to the question, will I do another MSF mission? From where I stand right now, it’s impossible that I won’t. I understand the converts now. When we are on the field, life is so rich and real, time so slow, and the heart just feels so much. We sense that what we do matters, that we have the chance of not just skimming the surface of life, and that we make a difference ever so slightly. So yes, I would do it again, in time. But who knows what lies ahead on the next turn...
Ciel et brousse du Katanga
Initially, the plan was for me to leave on March 7 from Shamwana, to meet up with a group of expats from Dubie to go to Zambia on March 10 for a week to hang around Victoria falls. The plane was preponed to March 6, at which point, we decided to prepone the big goodbye party which was thus planned for Saturday March 1. Two hospital nurses already had a big male goat ready for the feast. Cans of beer and sodas had been planned 6 weeks in advance on a truck from Lubumbashi that thankfully made it on time. I had specially requested the infamous Bifwebe, the traditional bush dancers and black magic sorcerers from Monga.
Then, on February 29, the strangest day of the year so far, we heard that the plane ex-Shamwana wasn’t going to make it. That meant that Lucas, the current acting project coordinator-logistician, wasn’t going to make it out for his vacation. It was decided by capital – and to this day this appears as a knee-jerk, poorly planned decision – that he would go down to Lubumbashi by car whilst my replacement the new expat doctor would make his way up by car as well. And because Lucas leaving left us 2 women first-missioners alone in the project, it was decided that all the Shamwana expatriates would have to evacuate the next day to the ‘safety’ of Dubie where there was another male and multi-missioner. Of course, there is NO security issue in the Shamwana region whatsoever, things are in the rebuilding phase. We learned all this the evening right before the big goodbye party. I had done the evaluations for most of my medical staff and had started my end-of-mission report. But to learn at 16h00 that you’re evacuated the next morning at 6h00 for 5 days to Dubie for very dubious reasons is for the least destabilizing; particularly when this is the end of your mission, and you’ve got things to wrap up, and a party to plan. I was seething with anger; it was not a pretty sight. I could not stay in place, had to call the Head of Mission to ask for explanations, and was overall quite irate. The national staff who were ready for the party were also quite disappointed. After a few hours of ranting I finally calmed down and resigned myself to the unpleasant situation. After all, I do believe in to making the best of what life throws at us (but I should also be allowed to complain and whine before!). So the next morning, I jumped into the car with a sigh and faced another adventure on the roads of Katanga.
Of note was the bloodred sunset that stained the sky like a bushfire, to add to the overall strange, out-of-this world atmosphere of February 29.
We got stuck four times on the road to Dubie, predictably as this is the end of the rainy season. It took us almost nine hours to get there.
Très sérieux embourbement! L’Unimog nous a tirés de là comme une voiture-jouet, c’était beau à voir.
The few days in Dubie were uneventful, if not boring. After a few hours of soulsearching, I made the right decision to postpone the vacation to Zambia and be out-of-sync with the group of friends in order to do a proper handover and finish the work well in Shamwana, as well as having a nice goodbye party for the national staff. After all, this was it for me and Shamwana, and for all these Congolese friends that in likelihood I will never see again, unlike the expats with whom it’s much easier to keep in touch (vive Facebook!). J’ai tout simplement refusé de partir comme une voleuse et d’honorer correctement le beau travail fait pendant les derniers sept mois à Shamwana.
In Dubie, we were confined to the MSF compound, played volleyball games, and I caught up with my two PPD companions and sisters from August 2007 in Amsterdam. Always being afraid of running out of food, I stocked up on quasi-expired security rice and more beer and alcohol for the upcoming party. The expat group from Lubumbashi, ie our project coordinator, mental health officer and F the new doctor were late by a day coming to Dubie and arrived on Wednesday March 5 to Dubie, after five harrowing days on the roads. Ironically the plane had been reinstituted on Tuesday and flew right over us. We finally all returned back to Shamwana on Thursday March 6 for my last four short days there, just enough for a decent handover to Dr. F. Poor Sir W, my lovely Congolese colleague - whom we’ve come to call that way because he is so considerate and proper - had been working alone (yet again) for a week and he looked quite tired.
The goodbye party was worth the wait. The Finco from capital had paid us a surprise visit for the week-end so he got to attend these ceremonials. The Bifwebe traditional dancers from Monga came for the afternoon and performed on the football field. They started with drawing a magic protective circle around the area where they were to perform; then they danced and tam-tam’d for a good two hours; they were again in trance and the atmosphere was full of sorcery. The whole village was watching. It started raining so they performed an anti-rain dance. Believe what one may, whereas most afternoons see a big thunderstorm fall down on us, on that day, it rained only very lightly over the football field where the Bifwebe were under two mango trees; the storm and showers hit a few hundred meters away. Comme Sir W le dit si bien, “nous ne vivons pas dans leur monde donc il nous est impossible de comprendre leurs pouvoirs” – all I can say is that it was odd and to an certain extent, disconcerting.
There was way too much food! (Of course that is a good thing!) At the last minute, the nurses had decided that one goat was not enough and that they should slaughter a second one; given as I had supplied twice the quantity of rice and drinks as usual, there was plenty of room for meat. In the end, we had too much food and everybody got to take some home. The evening continued with the obligatory floral speeches and Congolese music to which everybody danced. Sir W read his speech where he commented on my speediness – ‘Mayani, comme un TGV’. (Mayani has become my natural name in Shamwana, given by the children - it means ‘grass’ in Congolese Swahili). We finished the party much later than usual, it went on until 23h00, and then the expats continued until 2 in the morning. It was a lovely evening.
Sir W and Dr Mayani posing for the pictures
Lovely ladies in their best outfits at the party
My last Sunday in Shamwana was spent being on call, and spending the afternoon discussing Congolese politics, culture and beliefs over some fried chicken at Sir W’s. A patient with bad bowel obstruction walked into the hospital but in the end, she was not eligible for surgery. "A l’hôpital, c’est la routine", like we say in the morning meetings. We watched part of Season 4 of 24 as usual. Dr. F started working; he is experienced and will for sure do a very good job.
Monday March 10 was the definitive dreaded departure date. The last four days were incredibly intense, taking it all in, as if hours slowed down, one minute at a time. I filmed the daily morning meetings, packed, said a whole bunch of goodbyes and we all went to the plane. For someone who sheds tears less than once a year usually, I cried a handful of times in those four long days. The farewells at the landing strip were solemn and I couldn’t help but explode in tears on the airstrip. The medical team, all male, were all very sad and even one of them was wiping his eyes. To see a burly forty year-old Congolese man hide his tears is indeed very touching. These guys really got to my heart, a part of which is now left in Shamwana...
Hospital crew on my last day
Base crew on my last day
Farewell crew at the Shamwana airstrip, my view from the plane
The original AirServ pilot who first dropped me in Katanga in August 2007 – well, he’s back from Halifax and he also flew me out! Here he is, refueling the plane.
Chatting and goodbyes to the expats in Dubie while the plane gets refueled
So that was it. A lifetime of seven months in the Congolese bush. Goodbye Shamwana, now forever gone in time and place as it was for me. Such an intense and beautiful experience leaves indelible memories.
A la question qu’on m’a posée, si j’ai trouvé ce que je cherchais au Congo? Je crois que oui: des tonnes de bonheur et d’émotions et des moments inoubliables.
And to the question, will I do another MSF mission? From where I stand right now, it’s impossible that I won’t. I understand the converts now. When we are on the field, life is so rich and real, time so slow, and the heart just feels so much. We sense that what we do matters, that we have the chance of not just skimming the surface of life, and that we make a difference ever so slightly. So yes, I would do it again, in time. But who knows what lies ahead on the next turn...
Ciel et brousse du Katanga
Monday, February 25, 2008
Shamwanesqueries, shamwanoddities
Shamwanesqueries
Resteront gravées, pour la postérité...
Les nuages sur les collines au petit matin, lorsque je cours sur la piste d’atterrissage, et le brouillard qui se lève.
Toutes les petites filles qui pilent du manioc. La femme congolaise de brousse travaille de l’aube au soir, et tient tout de la bête de somme aux yeux des hommes.
Les orages-moussons presque prévisibles en saison des pluies, la pluie tambourinant sur notre toit de tôle.
Les absurdités de Shamsterdam. Conséquences de nos désastres logistiques dûs à la bureaucratie de la capitale: le fait qu’on ait à racheter à la population locale la farine de maïs distribuée gratuitement par Concern (via le Programme d’Alimentation Mondiale de l’ONU) pour... nourrir les patients à l’hôpital suite à nos ruptures de stock. Le fait que la majorité de notre staff national, les urbains de Lubumbashi, ne consomment pas le manioc local et donc aussi rachètent la farine de maïs (il y en a même qui se mettaient en ligne chez Concern à la distribution, alors qu’ils constituent clairement la haute bourgeoisie de Shamwana).
Vue du nouvel hôpital, vers la salle d’op
* * *
Shamwanoddities
This is pretty much my last mass e-mail from out here as I am now flying out of Shamwana on March 6th - it keeps on being preponed! And who knows if I’ll ever get to meet my replacement as the flights are as unpredictable as ever – and more out of incomprehensible coordination problems, not weather issues.
The last week was a busy one. I thought that I would commit it to staff evaluations and end-of-month and end-of-mission reports... but instead, it was time to go back to the operation theater!
After a few months of normal deliveries, we’ve had a string of obstetrical disasters again. Our deliveries in hospital have increased to about 30 a month from less than 10 when I first arrived in August. Last week, a woman was sent from Kisele, one of our peripheral villages, with a dead baby and a roaring infection of her uterus. Our midwife had to use the vacuum to pull it out and, I’m told, the stench was palpable. The patient now has a vesiculo-vaginal fistula, to be expected, that is, a permanent connection of scar tissue between her bladder and her vagina. It means that she is now incontinent of urine. Fortunately, the fistula surgeon will be back in Dubie sometime this summer so she might be eligible for surgical correction.
Then last Thursday, our new Congolese midwife (who used to be a mental health counsellor), called us urgently to the delivery room. A woman no taller than 1m40 was on the table, visibly diaphoretic and talking. Upon taking the vitals signs, her blood pressure was... absent. I verified by checking her radial pulse... absent as well. True shock, and yet, there she was, still talking and crying! She had been in labor at home for one or two days, and was finally transferred to Shamwana on a bicycle as usual. Her contractions had stopped; her cervix was fully dilated, but there was no fetal heart. This kind of scenario spells a disaster: a probable full uterine rupture. After crossmatch and an IV line, we went straight to surgery. The uterus was completely ruptured and attached to its lower third by a mess of organized clots and necrotic tissue circumferentially. The baby had been dead over a day – its skin was literally falling off and it was hard to grab it to take it out. Talk about stench and sight again! I assisted my Congolese colleague in performing a total hysterectomy; we couldn’t even salvage the adnexae or the ovaries. We were in there for a mere... four hours. I came out exhausted. But... she is alive, stuffed silly with antibiotics, and received almost two units of blood. Surely, she would have died of haemorrhage or overwhelming sepsis with a decomposing baby in there. Yikes.
Who said that green wasn’t a good colour for me??? :)
As well, we hadn’t used our blood bank for a while, and then we got a string of children sick with malaria causing severe anaemia. I encountered the lowest haemoglobin that I’ve ever met: 14. For comparison, my own haemoglobin probably hovers around 140. Again, the child was defying all medical knowledge: he was still breathing and crying, in spite of having 10% of one’s normal oxygen-carrying capacity. Unfortunately he did not survive in spite of the transfusion that we gave him – he could not compensate any further. Human resilience does not cease to amaze me, and few of these disastrous cases ever make it to the literature. Nobody teaches you this in medical school!
* * *
More Shamwana pictures around the hospital
Seriously cute kids!
J, our burn patient, the one who had seized. He’s now into his third month at the hospital but is getting so much better. We actually discharged him earlier today
Our last set of twins – Kyungu (=oldest twin) was the sick one, whereas Kabange (=younger twin) was the fat one at 2 kg.
* * *
Sur ce, je vous souhaite une bonne continuation. Je vais rouler ma bosse sur le continent avant de rentrer pole pole à la maison quelque part en avril. Je serais sur des plages tanzaniennes, sur le Kilimanjaro, et à Amsterdam chez une certaine psychologue. Portez-vous bien et on se revoit à mon retour!
Resteront gravées, pour la postérité...
Les nuages sur les collines au petit matin, lorsque je cours sur la piste d’atterrissage, et le brouillard qui se lève.
Toutes les petites filles qui pilent du manioc. La femme congolaise de brousse travaille de l’aube au soir, et tient tout de la bête de somme aux yeux des hommes.
Les orages-moussons presque prévisibles en saison des pluies, la pluie tambourinant sur notre toit de tôle.
Les absurdités de Shamsterdam. Conséquences de nos désastres logistiques dûs à la bureaucratie de la capitale: le fait qu’on ait à racheter à la population locale la farine de maïs distribuée gratuitement par Concern (via le Programme d’Alimentation Mondiale de l’ONU) pour... nourrir les patients à l’hôpital suite à nos ruptures de stock. Le fait que la majorité de notre staff national, les urbains de Lubumbashi, ne consomment pas le manioc local et donc aussi rachètent la farine de maïs (il y en a même qui se mettaient en ligne chez Concern à la distribution, alors qu’ils constituent clairement la haute bourgeoisie de Shamwana).
Vue du nouvel hôpital, vers la salle d’op
* * *
Shamwanoddities
This is pretty much my last mass e-mail from out here as I am now flying out of Shamwana on March 6th - it keeps on being preponed! And who knows if I’ll ever get to meet my replacement as the flights are as unpredictable as ever – and more out of incomprehensible coordination problems, not weather issues.
The last week was a busy one. I thought that I would commit it to staff evaluations and end-of-month and end-of-mission reports... but instead, it was time to go back to the operation theater!
After a few months of normal deliveries, we’ve had a string of obstetrical disasters again. Our deliveries in hospital have increased to about 30 a month from less than 10 when I first arrived in August. Last week, a woman was sent from Kisele, one of our peripheral villages, with a dead baby and a roaring infection of her uterus. Our midwife had to use the vacuum to pull it out and, I’m told, the stench was palpable. The patient now has a vesiculo-vaginal fistula, to be expected, that is, a permanent connection of scar tissue between her bladder and her vagina. It means that she is now incontinent of urine. Fortunately, the fistula surgeon will be back in Dubie sometime this summer so she might be eligible for surgical correction.
Then last Thursday, our new Congolese midwife (who used to be a mental health counsellor), called us urgently to the delivery room. A woman no taller than 1m40 was on the table, visibly diaphoretic and talking. Upon taking the vitals signs, her blood pressure was... absent. I verified by checking her radial pulse... absent as well. True shock, and yet, there she was, still talking and crying! She had been in labor at home for one or two days, and was finally transferred to Shamwana on a bicycle as usual. Her contractions had stopped; her cervix was fully dilated, but there was no fetal heart. This kind of scenario spells a disaster: a probable full uterine rupture. After crossmatch and an IV line, we went straight to surgery. The uterus was completely ruptured and attached to its lower third by a mess of organized clots and necrotic tissue circumferentially. The baby had been dead over a day – its skin was literally falling off and it was hard to grab it to take it out. Talk about stench and sight again! I assisted my Congolese colleague in performing a total hysterectomy; we couldn’t even salvage the adnexae or the ovaries. We were in there for a mere... four hours. I came out exhausted. But... she is alive, stuffed silly with antibiotics, and received almost two units of blood. Surely, she would have died of haemorrhage or overwhelming sepsis with a decomposing baby in there. Yikes.
Who said that green wasn’t a good colour for me??? :)
As well, we hadn’t used our blood bank for a while, and then we got a string of children sick with malaria causing severe anaemia. I encountered the lowest haemoglobin that I’ve ever met: 14. For comparison, my own haemoglobin probably hovers around 140. Again, the child was defying all medical knowledge: he was still breathing and crying, in spite of having 10% of one’s normal oxygen-carrying capacity. Unfortunately he did not survive in spite of the transfusion that we gave him – he could not compensate any further. Human resilience does not cease to amaze me, and few of these disastrous cases ever make it to the literature. Nobody teaches you this in medical school!
* * *
More Shamwana pictures around the hospital
Seriously cute kids!
J, our burn patient, the one who had seized. He’s now into his third month at the hospital but is getting so much better. We actually discharged him earlier today
Our last set of twins – Kyungu (=oldest twin) was the sick one, whereas Kabange (=younger twin) was the fat one at 2 kg.
* * *
Sur ce, je vous souhaite une bonne continuation. Je vais rouler ma bosse sur le continent avant de rentrer pole pole à la maison quelque part en avril. Je serais sur des plages tanzaniennes, sur le Kilimanjaro, et à Amsterdam chez une certaine psychologue. Portez-vous bien et on se revoit à mon retour!
Friday, February 1, 2008
Pour Damien Lehalle
Official MSF press release about the tragedy: three MSF-Holland workers killed in bombing in Kismayo, Somalia, Jan 28 2008
* * *
Le monde humanitaire et plus particulièrement, les travailleurs MSF, sommes tous sous le choc face aux décès de nos collègues expatriés Damien Lehalle, logisticien de France et Victor Okumu, chirurgien du Kenya, lors d'une attaque contre une Land Cruiser de MSF-Hollande à Kismayo, en Somalie, lundi dernier le 28 janvier 2008.
Damien était le logisticien de Dubié en août 2007 lorsque je suis arrivée au Katanga. Je l'ai rencontré brièvement lors de la réunion médicale d'août qui s'est tenue à Dubié. C'était un mec joyeux de vingt-sept ans, souriant, au sens de l'humour clownesque, et qu'on n'oubliait pas facilement. Il se promenait avec ses pantalons en pagne et un grand sourire brillant. Tout le monde de la mission l'adorait. Lors de notre réunion médicale, il y avait trop de visiteurs à Dubié, et donc il avait prêté sa chambre. Il dormait paisiblement à la belle étoile sous un moustiquaire sur le terrain de volleyball. Dubié a été sa première mission pendant quatorze mois et il était au premier mois de sa deuxième mission à Kismayo lorqu'il a été tué. Lorsqu'il a quitté Dubié en octobre, il a dit ses adieux à toute la mission sur la radio HF; comme j'étais moi-même en route pour Kishale dans une Land Cruiser, je lui ai souhaité un bon voyage et une bonne continuation. A Dubié, on l'aimait tellement que tout le village est venu à sa fête d'au-revoir (arrosée de fruits de la passion, m'a-t-on relaté), et le staff national l'a transporté physiquement jusqu'à l'avion le jour de son départ. Sa vie a été brutalement interrompue; ses parents ont perdu leur fils unique. Nous sommes tous en deuil.
De tels évènements nous rappellent que malgré toutes les meilleures intentions du monde, la violence est constante et imprévisible dans le monde humanitaire. Tout travailleur MSF est bien mis au courant des risques possibles d'une mission. Mais nos personnalités fortes nous font croire à une certaine invincibilité. On tente de gérer le risque en choisissant un pays moins armé qu'un autre, mais le chaos et le danger sont toujours possibles là où MSF choisit de travailler. Que l'âme de Damien repose en paix. Nous, qui avons croisé son chemin, avons été chanceux. Nous accompagnons tous en pensée sa famille et ses proches durant ces moments difficiles.
* * *
The humanitarian world in general and MSF workers in particular are devastated by the deaths of Damien Lehalle, French logistician and Victor Okumu, Kenyan surgeon, in a MSF-Holland Land Cruiser that was bombed in Kismayo, Somalia last week.
Damien was the logistician in Dubie in August when I arrived, and I met him shortly during the Katanga medical meeting. He was a fun-loving, energetic, popular, tongue-in-cheek, joyful 27 year-old guy, and was well loved by everybody in the mission. I remember his twinkling eyes and beautiful smile. When we held our medical meeting in Dubie, we were out of tukuls for all the visitors, so he had parked a bedcamp and a mosquito net under a tree next to the volleyball court and slept there happily under the stars. His first mission had been Dubie, for fourteen months, and he had been for only one month in Kismayo for his second mission when he was killed. When he left Dubie in October, he said his goodbyes on the radio to everybody in the Katanga mission; as I was en route for Kishale in one of the Land Cruisers, I wished him good luck and a good continuation. He was so loved that all of Dubie attended his goodbye party and the national staff carried him to the plane on his day of departure. His young life has been cut short; his parents in France have lost their only son. We are in mourning.
It is a harsh reminder that no matter how good our intentions are, it's a hard world out here. MSF workers are fully warned of the risks of leaving on mission, but I believe that we somewhat sin in invincibility in a way or another. Of course, risk can be to some extent managed by picking a less gun-prone country vs. another, but the risk of chaos is present in most places that MSF chooses to work. May Damien's soul rest in peace. Those of us who have had the luck of crossing his path were all blessed to have known him. May his family and loved ones bide well during this hard time.
* * *
Le monde humanitaire et plus particulièrement, les travailleurs MSF, sommes tous sous le choc face aux décès de nos collègues expatriés Damien Lehalle, logisticien de France et Victor Okumu, chirurgien du Kenya, lors d'une attaque contre une Land Cruiser de MSF-Hollande à Kismayo, en Somalie, lundi dernier le 28 janvier 2008.
Damien était le logisticien de Dubié en août 2007 lorsque je suis arrivée au Katanga. Je l'ai rencontré brièvement lors de la réunion médicale d'août qui s'est tenue à Dubié. C'était un mec joyeux de vingt-sept ans, souriant, au sens de l'humour clownesque, et qu'on n'oubliait pas facilement. Il se promenait avec ses pantalons en pagne et un grand sourire brillant. Tout le monde de la mission l'adorait. Lors de notre réunion médicale, il y avait trop de visiteurs à Dubié, et donc il avait prêté sa chambre. Il dormait paisiblement à la belle étoile sous un moustiquaire sur le terrain de volleyball. Dubié a été sa première mission pendant quatorze mois et il était au premier mois de sa deuxième mission à Kismayo lorqu'il a été tué. Lorsqu'il a quitté Dubié en octobre, il a dit ses adieux à toute la mission sur la radio HF; comme j'étais moi-même en route pour Kishale dans une Land Cruiser, je lui ai souhaité un bon voyage et une bonne continuation. A Dubié, on l'aimait tellement que tout le village est venu à sa fête d'au-revoir (arrosée de fruits de la passion, m'a-t-on relaté), et le staff national l'a transporté physiquement jusqu'à l'avion le jour de son départ. Sa vie a été brutalement interrompue; ses parents ont perdu leur fils unique. Nous sommes tous en deuil.
De tels évènements nous rappellent que malgré toutes les meilleures intentions du monde, la violence est constante et imprévisible dans le monde humanitaire. Tout travailleur MSF est bien mis au courant des risques possibles d'une mission. Mais nos personnalités fortes nous font croire à une certaine invincibilité. On tente de gérer le risque en choisissant un pays moins armé qu'un autre, mais le chaos et le danger sont toujours possibles là où MSF choisit de travailler. Que l'âme de Damien repose en paix. Nous, qui avons croisé son chemin, avons été chanceux. Nous accompagnons tous en pensée sa famille et ses proches durant ces moments difficiles.
* * *
The humanitarian world in general and MSF workers in particular are devastated by the deaths of Damien Lehalle, French logistician and Victor Okumu, Kenyan surgeon, in a MSF-Holland Land Cruiser that was bombed in Kismayo, Somalia last week.
Damien was the logistician in Dubie in August when I arrived, and I met him shortly during the Katanga medical meeting. He was a fun-loving, energetic, popular, tongue-in-cheek, joyful 27 year-old guy, and was well loved by everybody in the mission. I remember his twinkling eyes and beautiful smile. When we held our medical meeting in Dubie, we were out of tukuls for all the visitors, so he had parked a bedcamp and a mosquito net under a tree next to the volleyball court and slept there happily under the stars. His first mission had been Dubie, for fourteen months, and he had been for only one month in Kismayo for his second mission when he was killed. When he left Dubie in October, he said his goodbyes on the radio to everybody in the Katanga mission; as I was en route for Kishale in one of the Land Cruisers, I wished him good luck and a good continuation. He was so loved that all of Dubie attended his goodbye party and the national staff carried him to the plane on his day of departure. His young life has been cut short; his parents in France have lost their only son. We are in mourning.
It is a harsh reminder that no matter how good our intentions are, it's a hard world out here. MSF workers are fully warned of the risks of leaving on mission, but I believe that we somewhat sin in invincibility in a way or another. Of course, risk can be to some extent managed by picking a less gun-prone country vs. another, but the risk of chaos is present in most places that MSF chooses to work. May Damien's soul rest in peace. Those of us who have had the luck of crossing his path were all blessed to have known him. May his family and loved ones bide well during this hard time.
Monday, January 28, 2008
Tunnel Vision
Retour sur Shamwana après les vacances. C’est drôle, autant que j’avais hâte de revenir, autant, après quelques jours, je me sens essoufflée. On ne se rend compte qu’après les vacances à quel point on est fatigué. Je ne regrette pas d’avoir prolongé ma mission ni d’être revenue, mais en même temps, le départ en vacances (repoussé loin dans la mission) était aussi un avant-goût des adieux qui seront le 10 mars, nouvelle date officielle. Quelque part, les oeillères sont tombées. Je commence à voir au-delà de Shamwana et de son quotidien. Entrent dans mon champ de vision d’autres lieux, d’autres latitudes, une autre vie, un retour en terre industrialisée, une réhabitude à l’anonymat dans une grande ville urbaine occidentale, des possibilités d’hiver québécois et de grisaille pluvieuse. J’ai le pied à moitié sorti d’ici mais en même temps je sais que je dois savourer chaque heure maintenant car la finitude arrive et se fait pressentir.
En trois semaines, beaucoup de choses ont changé dans mon village de brousse. La saison pluvieuse est définitive, les orages-moussons sont prévisibles tous les après-midis après quelques heures de canicule. Nous avons déménagé de notre grande tente à la bâtisse définitive de l’hôpital, ce qui ôte un peu son charme au projet, mais ce qui bien sûr est bien plus pratique et bénéfique aux patients. De par notre nouveau laboratoire et notre salle d’opération, nos chiffres restent élevés – dire qu’en août nous étions tombés à 9 patients, rarement plus de 20, et maintenant on hospitalise couramment 40 patients. La clinique externe ne dérougit plus. On trime, sans aucun doute.
Autant mon souvenir était d’être débordée avant de partir, maintenant que le travail m’est familier, il me semble y avoir beaucoup de temps libres. Et les sources de divertissement sont vite épuisées – aller courir, prendre une marche, entamer une autre conversation avec les collègues expat (les sujets commencent à s’épuiser!), pitonner sur l’ordi, classer ses photos et sa musique. Il est vrai que les situations d’urgence se sont stabilisées, la rougeole persiste (11 morts maintenant, qui auraient pu être prévenues, mais nous n’avons toujours pas l’autorisation du gouvernement congolais de commencer les vaccinations d’urgence), et le choléra semble avoir disparu. Et je connais mon travail donc j’en dérive plus d’efficacité.
* * *
Another day at work. This child had a supracondylar fracture of the humerus for four days, had been treated with straw splints and traditional herb ointments that macerated his skin before showing up to our facility.
Desquamation and depigmentation post-measles
Too weakened by kwashiorkor to drink, hence need for a feeding tube
Kwashiorkor so severe that the face swells up
En trois semaines, beaucoup de choses ont changé dans mon village de brousse. La saison pluvieuse est définitive, les orages-moussons sont prévisibles tous les après-midis après quelques heures de canicule. Nous avons déménagé de notre grande tente à la bâtisse définitive de l’hôpital, ce qui ôte un peu son charme au projet, mais ce qui bien sûr est bien plus pratique et bénéfique aux patients. De par notre nouveau laboratoire et notre salle d’opération, nos chiffres restent élevés – dire qu’en août nous étions tombés à 9 patients, rarement plus de 20, et maintenant on hospitalise couramment 40 patients. La clinique externe ne dérougit plus. On trime, sans aucun doute.
Autant mon souvenir était d’être débordée avant de partir, maintenant que le travail m’est familier, il me semble y avoir beaucoup de temps libres. Et les sources de divertissement sont vite épuisées – aller courir, prendre une marche, entamer une autre conversation avec les collègues expat (les sujets commencent à s’épuiser!), pitonner sur l’ordi, classer ses photos et sa musique. Il est vrai que les situations d’urgence se sont stabilisées, la rougeole persiste (11 morts maintenant, qui auraient pu être prévenues, mais nous n’avons toujours pas l’autorisation du gouvernement congolais de commencer les vaccinations d’urgence), et le choléra semble avoir disparu. Et je connais mon travail donc j’en dérive plus d’efficacité.
* * *
Another day at work. This child had a supracondylar fracture of the humerus for four days, had been treated with straw splints and traditional herb ointments that macerated his skin before showing up to our facility.
Desquamation and depigmentation post-measles
Too weakened by kwashiorkor to drink, hence need for a feeding tube
Kwashiorkor so severe that the face swells up
Thursday, January 24, 2008
En attendant
Faute de mots ici, images des quelques derniers mois...
Shamwana alias Shamsterdam
Promenades autour de Shamwana
Dubie en août et en novembre
Shamwana alias Shamsterdam
Promenades autour de Shamwana
Dubie en août et en novembre
Thursday, December 20, 2007
Masks
The R&R and its Lubumbashi shopping spree for my Congolese friends at the hospital has come and gone already. Yet the fatigue stays – we have been tackling so many epidemics lately, and the measles is now a thorn on my side, as some of you know.
Vaccination campaigns in the Congo are traditionally supported by the big NGO’s and UN offices. The vaccines are donated by UNICEF and significant sums are provided to the Ministry of Health to carry out the campaign. Unfortunately, most campaigns in DRC see their funds deviated towards a few, deep, pockets. Children in rural, less accessible areas miss all the routine immunizations. Here in Shamwana, the coverage has been at best episodic for the last decade. Hence the epicentres of measles shaking up here and there. But the Ministry of Health is often reluctant to start emergency vaccinations because it would implicitly suggest that its previous, well-funded campaigns, were not effective.
When the first cases of measles happened a month ago, we started vaccinating in the affected villages, according to our MSF protocols, using the Ministry’s vaccines. In the context of an epidemic, MSF widens the age of immunization up to 15 years whereas the routine government vaccination is only until 18 months old. We made the mistake to inform our Lubumbashi office about our extended coverage right away. Because they were trying to get provincial Ministry of Health approval for our extended emergency campaign, everything had to come to a halt to show the goodwill of MSF to cooperate with the Ministry. We were told to stop all vaccinations at once. The negotiations on our side, in the field, with the local Médecins Chefs de Zone, were successful – it helped that both came by motorbike and saw the extent of the measles epidemic, with the extra tents and set-up already overwhelmed. But at the higher capital level, where the MSF Lubumbashi people were also lobbying, the approval for the emergency coverage was not obtained. Instead, we were instructed by the Médecin d’Inspection Provinciale not to do an emergency extended campaign, because the International Rescue Committee was to support another provincial Campagne de Rattrapage in January, with the associated funds. With, I mumble, the expectation to be as ineffective as the last one. So even if we have the approval of our local Bureau Central de Zone, they were forced to bend to the capricious decision of the provincial authorities.
Simply put, 4600 doses of unused vaccines from the previous mass routine campaign held in August are now sitting in our fridge in Shamwana and waiting for their expiry date. In the meantime, we have had 164 cases of measles in six different villages, and new cases keep on coming on a daily basis. To say the least, out here in the field, we are... rabid. Had we not informed the MSF capital office so swiftly initially, and simply gone through our regular channels through the Bureau Central, there might have been a window whereby we could still have gone forward with the extended vaccination. Because the local MoH was in agreement with us; and with the Congolese context of delays in communication and habits of long political discussions, the provincial level might have been informed much later, thus giving us a window of opportunity. Our Bureau Central people now think that the carpet was pulled from under their feet because of the prompt intrusion of the provincial authorities inadvertently facilitated by our Lubumbashi MSF office. Moreover, to vaccinate the measles-affected villages is feasible here with the current logistical equipment. The provincial Ministry of Health in Lubumbashi is de facto taking the children hostages by refusing to authorize our emergency vaccination, which does not cost anything. All this because it does not bring any supplementary funds to his office – I mean pockets, of course... We have to watch helplessly the measles spread and use up material and human resources, all the while knowing that the epidemic was altogether avoidable. The principle of international aid can be a pretty mask hiding an ugly reality when there is not much follow-up in the field. One must take into account the corrupted, tribal, ego-driven political infrastructures that are rampant on this continent. Ah, the arcaneness of dealing with Congolese officials and African realities! The road to hell is certainly paved with good intentions...
I now know next time to play dumb and to take advantage of the slowness of bicycle-driven messages used by the Ministry of Health to communicate with its hierarchy. We are all having fantasies of hiding in the night to go secretly vaccinate all these villages against measles. Historically, MSF had been known to defy Ministry of Health decisions or inertia, but there have been consequences. MoH’s have been known to denounce MSF on public radio, or even, we have been kicked out of some countries. With more experience and chaos in the humanitarian world, we are aiming for a better collaboration with the local medical authorities, but it can be a delicate issue that is difficult to take on.
* * *
Parading on AIDS day in Shamwana on December 1st...
My absolutely fantastic medical team
* * *
Sur ce, j’aimerais quand même tous vous souhaiter une bonne saison des Fêtes et une bonne année 2008! Que la joie et la paix soient dans votre coeur et que le nouvel an vous amène tous les souhaits auxquels vous aspirez!
Best wishes of health, warmth, luck, happiness and love for the holiday season! May 2008 bring you joy and fulfillment!
Vaccination campaigns in the Congo are traditionally supported by the big NGO’s and UN offices. The vaccines are donated by UNICEF and significant sums are provided to the Ministry of Health to carry out the campaign. Unfortunately, most campaigns in DRC see their funds deviated towards a few, deep, pockets. Children in rural, less accessible areas miss all the routine immunizations. Here in Shamwana, the coverage has been at best episodic for the last decade. Hence the epicentres of measles shaking up here and there. But the Ministry of Health is often reluctant to start emergency vaccinations because it would implicitly suggest that its previous, well-funded campaigns, were not effective.
When the first cases of measles happened a month ago, we started vaccinating in the affected villages, according to our MSF protocols, using the Ministry’s vaccines. In the context of an epidemic, MSF widens the age of immunization up to 15 years whereas the routine government vaccination is only until 18 months old. We made the mistake to inform our Lubumbashi office about our extended coverage right away. Because they were trying to get provincial Ministry of Health approval for our extended emergency campaign, everything had to come to a halt to show the goodwill of MSF to cooperate with the Ministry. We were told to stop all vaccinations at once. The negotiations on our side, in the field, with the local Médecins Chefs de Zone, were successful – it helped that both came by motorbike and saw the extent of the measles epidemic, with the extra tents and set-up already overwhelmed. But at the higher capital level, where the MSF Lubumbashi people were also lobbying, the approval for the emergency coverage was not obtained. Instead, we were instructed by the Médecin d’Inspection Provinciale not to do an emergency extended campaign, because the International Rescue Committee was to support another provincial Campagne de Rattrapage in January, with the associated funds. With, I mumble, the expectation to be as ineffective as the last one. So even if we have the approval of our local Bureau Central de Zone, they were forced to bend to the capricious decision of the provincial authorities.
Simply put, 4600 doses of unused vaccines from the previous mass routine campaign held in August are now sitting in our fridge in Shamwana and waiting for their expiry date. In the meantime, we have had 164 cases of measles in six different villages, and new cases keep on coming on a daily basis. To say the least, out here in the field, we are... rabid. Had we not informed the MSF capital office so swiftly initially, and simply gone through our regular channels through the Bureau Central, there might have been a window whereby we could still have gone forward with the extended vaccination. Because the local MoH was in agreement with us; and with the Congolese context of delays in communication and habits of long political discussions, the provincial level might have been informed much later, thus giving us a window of opportunity. Our Bureau Central people now think that the carpet was pulled from under their feet because of the prompt intrusion of the provincial authorities inadvertently facilitated by our Lubumbashi MSF office. Moreover, to vaccinate the measles-affected villages is feasible here with the current logistical equipment. The provincial Ministry of Health in Lubumbashi is de facto taking the children hostages by refusing to authorize our emergency vaccination, which does not cost anything. All this because it does not bring any supplementary funds to his office – I mean pockets, of course... We have to watch helplessly the measles spread and use up material and human resources, all the while knowing that the epidemic was altogether avoidable. The principle of international aid can be a pretty mask hiding an ugly reality when there is not much follow-up in the field. One must take into account the corrupted, tribal, ego-driven political infrastructures that are rampant on this continent. Ah, the arcaneness of dealing with Congolese officials and African realities! The road to hell is certainly paved with good intentions...
I now know next time to play dumb and to take advantage of the slowness of bicycle-driven messages used by the Ministry of Health to communicate with its hierarchy. We are all having fantasies of hiding in the night to go secretly vaccinate all these villages against measles. Historically, MSF had been known to defy Ministry of Health decisions or inertia, but there have been consequences. MoH’s have been known to denounce MSF on public radio, or even, we have been kicked out of some countries. With more experience and chaos in the humanitarian world, we are aiming for a better collaboration with the local medical authorities, but it can be a delicate issue that is difficult to take on.
* * *
Parading on AIDS day in Shamwana on December 1st...
My absolutely fantastic medical team
* * *
Sur ce, j’aimerais quand même tous vous souhaiter une bonne saison des Fêtes et une bonne année 2008! Que la joie et la paix soient dans votre coeur et que le nouvel an vous amène tous les souhaits auxquels vous aspirez!
Best wishes of health, warmth, luck, happiness and love for the holiday season! May 2008 bring you joy and fulfillment!
Wednesday, December 12, 2007
Masques
When I feel like contemplating, I read James Maskalyk’s blog on his mission in Sudan earlier this year, and my friend DC’s mass e-mails on her mission in Côte d’Ivoire at the halfway mark. It is an easy game, to compare experiences with other first missioners, to see if we all go through the same phases. James talks about a woman with retained placenta who dies of overwhelming sepsis and anaemia. He says: “No death is easy, if it starts to become that way, one should change professions.“ A colleague pronounced the exact same sentence earlier this year at home when I reacted with great passion to a young woman’s death. But somehow, tonight, such noble sayings make me express cynicism. Some deaths are easier than others. In the business of managing sickness, repetitive pattern recognition shows us that some deaths are sought for if not, even, deserved. We have a case of fulminant hepatitis. I was scratching my head about the reasons why – until he vomited a large amount of strong-smelling palm wine. The same happens back home, when the cirrhotic alcoholic comes in for the umpteenth time with bloody vomiting after a drinking binge. “What a waste of time and resources”, emergency room workers think but don’t say. “He looked for it.” Whether in the Canadian emergency department or in the Congolese bush hospital, doctors and nurses can’t help but express judgment at self-inflicted morbidities. The judgments offer an explanation to the unexplainable, and yes, some deaths sure feel easier than others. It is not a truth that we healthcare workers will admit publicly because it is so politically incorrect. But it would be preposterous to deny that we become more callous with time. Still, when death and sickness hit the innocent and the destitute – then, I certainly hope to always react with great passion.
This blunt political incorrectness is the product of a lot of fatigue... multiple apologies. The rainy season and its corollary of logistical nightmares have arrived in full force. For seven days last week, I was designated the acting project coordinator and logistician, because both were gone. And my bipolar karma went into a manic phase and spilled over to the non-medical responsibilities. The interim position, meant for a week-end, stretched to a week due to plane delays. And trucks got stuck in mud and decisions had to be taken with regards to immobilized precious fuel on the road, as well as significant plane delays. Challenges in communication with our capital team and a tense exchange with the local Ministry of Health were the cherries on top. The upcoming R&R this week-end will bring back my cheery self, I hope.
* * *
Bébé Kalobwa, the one who was born at 900 g, being carried by her half-sister. Kalobwa is now 6 months old and... urmh... 3500 g, which still isn’t much. But at least she is holding her head that is now full of nice thick hair!
* * *
Notre psychologue est partie, à ma grande tristesse. Pour son départ, on avait préparé en catimini l’invitation d’une troupe folklorique locale. La fête a été un franc succès. Les danseurs, vêtus de costumes de paille et de masques un peu effrayants, ont performé pendant une heure et demie. Leurs musiciens étaient aux tams-tams, en continu, sans arrêter. Le bidon d’alcool de palme et le chanvre parfumé partagés par les musiciens ont clairement contribué à l’atmosphère de transe et de magie noire qui flottait.
On a su par la suite que les Bifwebe, tels qu’ils s’appellent, sont aussi considérés sorciers et n’étaient pas venu à Shamwana depuis avant la guerre en 1999. La population les révère et les craint à la fois à cause de leurs soi-disant pouvoirs de magie noire. Ils sont les gardiens des vieilles traditions de brousse. Chaque danse performée racontait une histoire mythique: chasse, querelle de famille, apprentissage. Lors des danses, un des leurs ramassait sans faute chaque miette de paille tombée des costumes. A certains moments, les danseurs se fouettaient avec des branches de feuilles. A mes questions perplexes, notre watsan congolais a répondu que les brindilles tombés se faisaient transformer en gri-gris (amulettes traditionnelles de cuir, portées à la ceinture), ce qui, tout comme les flagellations, a pour but de préserver force et énergie vitale. Observer les faciès de nos employés congolais lors du spectacle relevait de l’expérience anthropologique. Selon leurs origines soit rurales soit urbaines, certains étaient effrayés ou du moins inconfortables, alors que d’autres se joignaient à la danse en rigolant et en prenant des photos. Quelle belle illustration du schisme entre le Congo païen tribal précolonial et le Congo éduqué chrétien (mais tout aussi tribal sous le vernis)... Devinez qui étaient les inconfortables? Pas les gens d’ici, habitués aux Bifwebe et à la magie noire! C’étaient les gens éduqués de Lubumbashi. Pour la peine, tout le village de Shamwana s’était regroupé à nos portes et notre palissade de paille a été complètement détruite par les attroupés qui voulaient voir le spectacle. Disons que le départ de notre psychologue s’est fait en grand et aura été inoubliable – il a laissé ses traces de destruction à la base!
This blunt political incorrectness is the product of a lot of fatigue... multiple apologies. The rainy season and its corollary of logistical nightmares have arrived in full force. For seven days last week, I was designated the acting project coordinator and logistician, because both were gone. And my bipolar karma went into a manic phase and spilled over to the non-medical responsibilities. The interim position, meant for a week-end, stretched to a week due to plane delays. And trucks got stuck in mud and decisions had to be taken with regards to immobilized precious fuel on the road, as well as significant plane delays. Challenges in communication with our capital team and a tense exchange with the local Ministry of Health were the cherries on top. The upcoming R&R this week-end will bring back my cheery self, I hope.
* * *
Bébé Kalobwa, the one who was born at 900 g, being carried by her half-sister. Kalobwa is now 6 months old and... urmh... 3500 g, which still isn’t much. But at least she is holding her head that is now full of nice thick hair!
* * *
Notre psychologue est partie, à ma grande tristesse. Pour son départ, on avait préparé en catimini l’invitation d’une troupe folklorique locale. La fête a été un franc succès. Les danseurs, vêtus de costumes de paille et de masques un peu effrayants, ont performé pendant une heure et demie. Leurs musiciens étaient aux tams-tams, en continu, sans arrêter. Le bidon d’alcool de palme et le chanvre parfumé partagés par les musiciens ont clairement contribué à l’atmosphère de transe et de magie noire qui flottait.
On a su par la suite que les Bifwebe, tels qu’ils s’appellent, sont aussi considérés sorciers et n’étaient pas venu à Shamwana depuis avant la guerre en 1999. La population les révère et les craint à la fois à cause de leurs soi-disant pouvoirs de magie noire. Ils sont les gardiens des vieilles traditions de brousse. Chaque danse performée racontait une histoire mythique: chasse, querelle de famille, apprentissage. Lors des danses, un des leurs ramassait sans faute chaque miette de paille tombée des costumes. A certains moments, les danseurs se fouettaient avec des branches de feuilles. A mes questions perplexes, notre watsan congolais a répondu que les brindilles tombés se faisaient transformer en gri-gris (amulettes traditionnelles de cuir, portées à la ceinture), ce qui, tout comme les flagellations, a pour but de préserver force et énergie vitale. Observer les faciès de nos employés congolais lors du spectacle relevait de l’expérience anthropologique. Selon leurs origines soit rurales soit urbaines, certains étaient effrayés ou du moins inconfortables, alors que d’autres se joignaient à la danse en rigolant et en prenant des photos. Quelle belle illustration du schisme entre le Congo païen tribal précolonial et le Congo éduqué chrétien (mais tout aussi tribal sous le vernis)... Devinez qui étaient les inconfortables? Pas les gens d’ici, habitués aux Bifwebe et à la magie noire! C’étaient les gens éduqués de Lubumbashi. Pour la peine, tout le village de Shamwana s’était regroupé à nos portes et notre palissade de paille a été complètement détruite par les attroupés qui voulaient voir le spectacle. Disons que le départ de notre psychologue s’est fait en grand et aura été inoubliable – il a laissé ses traces de destruction à la base!
Sunday, November 25, 2007
Epi
Arrivée
Il aura fallu trois mois pour que je m’extirpe de ma bulle de voyageuse et que je me pose vraiment ici, à Shamwana. Le sentiment d’être ici, de me sentir chez moi, que ça devienne mon familier, vient d’atterrir doucement. Je reconnais chaque membre du staff national à sa démarche, son timbre de voix, voire même son ombre. Distinguer un Congolais la nuit n’est pas tâche facile - pourtant maintenant je reconnais chacun d’entre eux quelle que soit la pénombre. Lorsque je suis partie en réunion médicale à Dubié la semaine dernière pour discuter avec les collègues de l’avancement de nos projets respectifs, je me suis sentie en terrain complètement étranger. Shamwana, c’est vraiment mon quotidien maintenant. Je me suis attachée à ce petit morceau de terre africaine comme je n’y aurais pas cru. C’est difficile à admettre pour quelqu’un qui a activement cultivé le nomadisme pendant les quatre dernières années. Mais ça fait tout chaud au coeur, tout simplement, finalement.
Nyombo, notre patient le plus malade de l’épidémie de choléra de Kishale, maintenant admis chez nous pour malnutrition. C’est l’enfant le plus bavard et le plus mignon qu’il m’est venu de voir. Même complètement déshydraté, en choc hypovolémique, il multipliait les sourires, enterrés sous ses cernes oculaires de choléra. Maintenant, c’est mon petit pot de colle, il m’appelle "Muzungu!!!" et me suit partout à l’hôpital, entre les tentes. Je caresse secrètement des fantaisies de l’adopter, mais sa mère protesterait, sans doute...
Inauguration de notre nouvelle salle d’op juste à temps pour la visite du chirurgien expat. Les murs sont émeraude, bien agencés aux draps et aux tuniques...
* * *
Of epilepsy and fires
Apolline, whom I had mentioned a few months ago, tragically died in Lubumbashi. She did not survive the skin grafting procedure. In developing countries, burns and epilepsy come hand-in-hand: the twinkling lights of cooking fires trigger the seizures that make children fall into the flames.
J looks around ten years old although his father states that he is past fifteen. He fell into a fire during an epileptic fit two weeks ago. He suffered extensive second and third degree burns to his arms, legs and trunk, but fortunately not to his face. He was brought to Shamwana by the outreach team a few days after the event. His burns were still seeping and by the time he arrived, were producing a greenish exsudate. Thanks to those who have responded with regards to the vinegar dressings for Pseudomonas aeruginosa. In the end, a few days of oral cipro did the trick, but we are preciously keeping the vinegar for the next one.
I helped out with a dressing change of J last week. While we were taking off the dressings, he was crying in pain, calling “Kaka” (big sister in Kiluba), and begging any sorcerer to enchant him to not have to go through the procedure. Through the tears, he was still answering "Présent!" to his name when I gently called. But once the dressings were off, while we doctors were inspecting his wounds, something strange happened. All of a sudden, he became silent, grabbed my wrist and stretched stiffly. His eyes emptied and took the colour of terror; his breath shortened. Only when he started walking on all fours in circles on the bed, on his exposed burns, did I realize that he was having an atypical seizure in front of us. I had only seen the classical generalized tonic-clonic kind. J’s fit really looked like possession: panicked eyes, fixed face, erratic, animal-like behaviour. We had to hold him tightly and softly call his name. Finally, after a few minutes, he came to, as if nothing had happened. The crying started right back on the note where it was interrupted, and he continued calling for his mother and sister and answering "Présent!" to his name again. Witnessing such an odd event made me reflect on the notions of black spells and possession that are rampant in African lore. It is hard not to believe in it when one sees the absence in the eyes of an epileptic during a fit, when one has no medical understanding of the disease.
* * *
Of Shamwana, epicentre of epidemics
We seem to be collecting field experience straight out of Manson’s Tropical Diseases textbook. Apparently, with us Canadians, all sorts of adrenaline-charged events landed in a previously sleepy Shamwana. Since September, we’ve had an influx of tuberculosis cases, the bane of cholera in Kishale, an outburst of twin pregnancies, threats of a meningitis outbreak, and now... measles has arrived. I make sick jokes that the only diseases missing are the bubonic plague or, God help us, Ebola. (No worries for those back home, I would get evacuated pronto if Ebola was to appear here. People much more capable than me would handle it.) It’s truly the full MSF experience, complete with all epidemics!
Measles spreads like bushfire. If national vaccination programs were carried out properly, it would not be an issue. Unfortunately, our remoteness does not allow the Ministry of Health to deliver the vaccines with the appropriate cold chain, so children have not been vaccinated for a long time. Measles is extremely infectious. Once there is a confirmed case, we must declare an outbreak. It is a clinical diagnosis: fever, rash (hard to distinguish on ebony skin), conjunctivitis, and coryza. Young children are usually affected, and the older they are when they catch it, the worse it is. The complications can be severe: malnutrition, blindness, severe respiratory disease, death. The children look miserable, burning with fever, sunlight hurting their wincing, swollen, purulent eyes. The measled, the miserabled. Measles spreads faster than lightning. One child can infect 17-20 others. During my four-day absence to Dubie, an outbreak of 29 cases of measles exploded in Monga, one of our villages. Isolation is key in handling a measles outbreak. We have sent a tent, medications, heaps of vitamin A, and a nurse to Monga in order to isolate them all. The numbers seem to have reached a plateau at 41. I’ve now seen a handful of Koplik’s spots, the pathognomic blue or white spot on the palate or buccal mucosa which I’d only seen in books. Overall, a measles outbreak isn’t as resource-intensive as a cholera outbreak, but it spreads more rapidly so fast action is still required. Vaccination is key to the containment of measles. However, with our limited resources, it hasn’t been possible, and the red-tape filled response from the Ministry of Health has been reticent and yet capital told us to respect it. So for now, we just have to sit back and see what happens...
* * *
Pictures from a little week-end in Dubie, where I arrived atop a massive truck called a Unimog...
Children in Dubie on giant termite mounds
Doing the laundry under the bridge in Dubie
Il aura fallu trois mois pour que je m’extirpe de ma bulle de voyageuse et que je me pose vraiment ici, à Shamwana. Le sentiment d’être ici, de me sentir chez moi, que ça devienne mon familier, vient d’atterrir doucement. Je reconnais chaque membre du staff national à sa démarche, son timbre de voix, voire même son ombre. Distinguer un Congolais la nuit n’est pas tâche facile - pourtant maintenant je reconnais chacun d’entre eux quelle que soit la pénombre. Lorsque je suis partie en réunion médicale à Dubié la semaine dernière pour discuter avec les collègues de l’avancement de nos projets respectifs, je me suis sentie en terrain complètement étranger. Shamwana, c’est vraiment mon quotidien maintenant. Je me suis attachée à ce petit morceau de terre africaine comme je n’y aurais pas cru. C’est difficile à admettre pour quelqu’un qui a activement cultivé le nomadisme pendant les quatre dernières années. Mais ça fait tout chaud au coeur, tout simplement, finalement.
Nyombo, notre patient le plus malade de l’épidémie de choléra de Kishale, maintenant admis chez nous pour malnutrition. C’est l’enfant le plus bavard et le plus mignon qu’il m’est venu de voir. Même complètement déshydraté, en choc hypovolémique, il multipliait les sourires, enterrés sous ses cernes oculaires de choléra. Maintenant, c’est mon petit pot de colle, il m’appelle "Muzungu!!!" et me suit partout à l’hôpital, entre les tentes. Je caresse secrètement des fantaisies de l’adopter, mais sa mère protesterait, sans doute...
Inauguration de notre nouvelle salle d’op juste à temps pour la visite du chirurgien expat. Les murs sont émeraude, bien agencés aux draps et aux tuniques...
* * *
Of epilepsy and fires
Apolline, whom I had mentioned a few months ago, tragically died in Lubumbashi. She did not survive the skin grafting procedure. In developing countries, burns and epilepsy come hand-in-hand: the twinkling lights of cooking fires trigger the seizures that make children fall into the flames.
J looks around ten years old although his father states that he is past fifteen. He fell into a fire during an epileptic fit two weeks ago. He suffered extensive second and third degree burns to his arms, legs and trunk, but fortunately not to his face. He was brought to Shamwana by the outreach team a few days after the event. His burns were still seeping and by the time he arrived, were producing a greenish exsudate. Thanks to those who have responded with regards to the vinegar dressings for Pseudomonas aeruginosa. In the end, a few days of oral cipro did the trick, but we are preciously keeping the vinegar for the next one.
I helped out with a dressing change of J last week. While we were taking off the dressings, he was crying in pain, calling “Kaka” (big sister in Kiluba), and begging any sorcerer to enchant him to not have to go through the procedure. Through the tears, he was still answering "Présent!" to his name when I gently called. But once the dressings were off, while we doctors were inspecting his wounds, something strange happened. All of a sudden, he became silent, grabbed my wrist and stretched stiffly. His eyes emptied and took the colour of terror; his breath shortened. Only when he started walking on all fours in circles on the bed, on his exposed burns, did I realize that he was having an atypical seizure in front of us. I had only seen the classical generalized tonic-clonic kind. J’s fit really looked like possession: panicked eyes, fixed face, erratic, animal-like behaviour. We had to hold him tightly and softly call his name. Finally, after a few minutes, he came to, as if nothing had happened. The crying started right back on the note where it was interrupted, and he continued calling for his mother and sister and answering "Présent!" to his name again. Witnessing such an odd event made me reflect on the notions of black spells and possession that are rampant in African lore. It is hard not to believe in it when one sees the absence in the eyes of an epileptic during a fit, when one has no medical understanding of the disease.
* * *
Of Shamwana, epicentre of epidemics
We seem to be collecting field experience straight out of Manson’s Tropical Diseases textbook. Apparently, with us Canadians, all sorts of adrenaline-charged events landed in a previously sleepy Shamwana. Since September, we’ve had an influx of tuberculosis cases, the bane of cholera in Kishale, an outburst of twin pregnancies, threats of a meningitis outbreak, and now... measles has arrived. I make sick jokes that the only diseases missing are the bubonic plague or, God help us, Ebola. (No worries for those back home, I would get evacuated pronto if Ebola was to appear here. People much more capable than me would handle it.) It’s truly the full MSF experience, complete with all epidemics!
Measles spreads like bushfire. If national vaccination programs were carried out properly, it would not be an issue. Unfortunately, our remoteness does not allow the Ministry of Health to deliver the vaccines with the appropriate cold chain, so children have not been vaccinated for a long time. Measles is extremely infectious. Once there is a confirmed case, we must declare an outbreak. It is a clinical diagnosis: fever, rash (hard to distinguish on ebony skin), conjunctivitis, and coryza. Young children are usually affected, and the older they are when they catch it, the worse it is. The complications can be severe: malnutrition, blindness, severe respiratory disease, death. The children look miserable, burning with fever, sunlight hurting their wincing, swollen, purulent eyes. The measled, the miserabled. Measles spreads faster than lightning. One child can infect 17-20 others. During my four-day absence to Dubie, an outbreak of 29 cases of measles exploded in Monga, one of our villages. Isolation is key in handling a measles outbreak. We have sent a tent, medications, heaps of vitamin A, and a nurse to Monga in order to isolate them all. The numbers seem to have reached a plateau at 41. I’ve now seen a handful of Koplik’s spots, the pathognomic blue or white spot on the palate or buccal mucosa which I’d only seen in books. Overall, a measles outbreak isn’t as resource-intensive as a cholera outbreak, but it spreads more rapidly so fast action is still required. Vaccination is key to the containment of measles. However, with our limited resources, it hasn’t been possible, and the red-tape filled response from the Ministry of Health has been reticent and yet capital told us to respect it. So for now, we just have to sit back and see what happens...
* * *
Pictures from a little week-end in Dubie, where I arrived atop a massive truck called a Unimog...
Children in Dubie on giant termite mounds
Doing the laundry under the bridge in Dubie
Sunday, November 11, 2007
Little pleasures, little treasures
Un arc-en-ciel parfait
dans son demi-cercle
entre les nuages de plomb
et un ciel éclatant
a accompagné la première écoute
qui a été à la hauteur de l’attente.
Mes proches me sauront profonde inconditionnelle de Radiohead. Leur dernier album In Rainbows vient de sortir sur Internet et on a réussi à l’obtenir (via la France et une nouvelle capital-log efficace) un mois plus tard. C’est un plaisir que le logisticien français et moi partageons, même s’il les a découverts une décennie plus tard que moi. Jusqu’à la fin de nos missions respectives, nous serons branchés sur la même musique sur nos Ipod Shuffle.
Au début de mon séjour à Shamwana, je ruminais sur la paucité matérielle comme remède au malaise existentiel inhérent à la vie moderne – une des raisons inavouées pour lesquelles on s’engage dans une mission MSF. A l’arrivée, l’écriture et la réflexion distillées ont sainement occupé l’espace vacant laissé par l’adrénaline familière (à l’urgence, toujours dans un avion, sous l’eau) et la techno-dépendance. Contempler de la musique, sentir les paysages de brousse en courant le matin, et jongler avec les mots sont revenus comme plaisirs tout simples et vrais à savourer. Tout cela a aussi aidé à réaccorder un peu d’harmonies intérieures.
Mais maintenant la paucité gastronomique nous pèse. Nos réserves de bouffe fraîche ont tari et on mange des saucisses hot-dog en conserve sauce tomate avec du riz mal cuit depuis une semi-éternité. La gastrono-gourmande que je suis se surprend à presque sauter des soûpers par manque d’appétit. Une autre raison inavouée de partir en mission, en tout cas pour une fille, c’est de perdre quelques kilos sans effort. J’espère que ça va m’arriver, car le prix d’inappétance est déjà payé! Les conversations de table, autrefois épicées et amusantes, tergiversent présentement autour de la nourriture. Lorsque je regarde des épisodes de Six Feet Under, je remarque avec envie les rosbifs maison de Mrs. F ou le take-out sushi de Brenda. Même les métaphores des discussions quotidiennes semblent vaguement alimentaires. “C’est grrrave”, diraient les Congolais en roulant joliment leurs ‘r’.
En tout cas, les mangues ne manquent pas...
Pont typique de la région et les problèmes qui s'ensuivent
* * *
Work is sinning by its abundance in contrast to our bleak food choices and means of distraction. Our hospital admissions for the month of October have jumped up by 60%. I practice hunting and fishing at the base for patient materials. Mattresses, wooden bed bases, bednets and blankets. Pills and injectables, in constant rupture. The cholera epidemic in Kishale has thankfully abated, giving a little bit of rest to our nurses. However, cholera reared its ugly head “chez nous ici à Shamwana” with a single case in Kabusonji, the village next door, so we have to dedicate one of our tents as a Cholera Treatment Unit just in case. Moreover, the expat surgeon is here and monopolizing my Congolese colleague (who loves to cut) and needing an extra tent for post-op patients, so I am rounding alone on the busy ward. Hence the tardiness in my monthly statistical reports and bimonthly e-mails, apologies.
My latest butt-in with an ancient disease was dramatic. In Western folktales, one should not walk in horse dung or on rusty nails because of tetanus. We now know that the spores of Clostridium tetanii are heat-resistant and can be found in most soils – nothing to do with metal or horses. Back home, people are vaccinated against tetanus in childhood and whenever they end up having to go to the hospital for wounds or sutures. Here, oh well, here... “c’est le Congo”, with dismal rates of vaccination and wound infections, which is really one catches tetanus. The tetanus toxin binds to nerve endings and stimulates muscle contraction spasmodically. It was a seven-year old boy who was referred from a village. The story will never be clear: the parents said that they brought him to the traditional guérisseur after the signs started, but traditional practices usually consist of herbs and scarring, which could have constituted the point of entry. The child came with generalized stiff spasms, crying between episodes. The image of the nurse placing him on the bed, rigid as a wood plank, is embedded in my mind. Straight from Harrison’s Textbook of Internal Medicine once again: the spine curving abnormally backwards ie. opisthotonos, the taut facial spasms ie. risus sardonicus, the impressive lockjaw ie. trismus. I had seen a case in Cameroun, but not nearly as severe. I learned that any stimulus, sound or light or voice, can trigger the dreaded spectacular spasms. One can only imagine the suffering behind a body that has gone out of control. Without batting an eyelid, the excellent nurses knew to place him in isolation, in a dark and quiet room away from the noisy paediatric ward. Poor child. We emptied our stock of tetanus immunoglobulin and were generous with the muscle relaxants. A day later, he was finally eating mango and fufu, a respite after four days of lockjaw-induced starvation.
* * *
Earlier this year, there was a BBC news clip from Congo-Brazzaville where a concert of music from all local ethnic groups was held. Pygmies were invited, but instead of hotel rooms, they were offered huts at the zoo. Throughout Africa, pygmies exist in most countries at this latitude. They are widely segregated against and viewed as only semi-human. In Rwanda and Burundi, during the conflict between the Tutsi and the Hutu, because they belonged to neither group, they were spared by the génocidaires. Here in Katanga, the Mai-Mai rebels hunted them like animals because they were thought to have collaborated with the government army.
Yesterday, along with the expat surgeon, we went to meet our local pygmies. In the village of Nsangwa, a mere kilometer North of Shamwana, lives a pygmy group of about 13 families. They call themselves Semi-Bantu or Batembo, and have their own language, Kitembo. Longstanding mixing with the not-so-tall local Baluba made them taller than expected – but still slightly shorter than the Baluba. Nonetheless, their physionomy is definitely distinct. And their way of life is completely different from the Baluba. Most pygmies throughout the continent are hunter-gatherers and experts in the bush – which is why the Mai-Mai accused them of helping the army in our region. They are nomadic and travel in groups of a few families. In Katanga, where they are few, they form their own quartier of a few houses right outside of an established village and stay there for a few months or years, until there is no more bushmeat to hunt. They work the fields for the villagers, getting paid with a few handfuls of manioc flour or clothes. The poverty they live in is staggering: they had absolutely nothing but the rags that they were wearing. Children played in sand. Babies were naked. Men wore torn shirts the colour of dirt. Huts appeared fragile and overcrowded. Because of the segregation, they are reticent to send their children to school or to benefit from the free MSF-supported health care. Yesterday, we discussed with their leader how shy they are to send their children to the school in Nsangwa. He said, word for word, that he did not know if the teacher would allow his children to class because they are Batembo. Moreover, teachers must be paid by parents because the government salaries haven’t been delivered in years, so poorer families have less of a chance. Yet, because the chief of Nsangwa insisted on it, all men of the village, including the Batembo, are to contribute voluntarily to the building of the new school, supported by the materials of Concern our neighbouring NGO. It leads to the paradoxical situation whereby the pygmy families worked on the school building but cannot send their children there. I’ll go speak to the people at Concern about that. And maybe we should somehow create a Save the Pygmy Fund...(Ah, for once I just wish that this last statement wasn’t just irreverence...)
Batembo family
Papa Chef Batembo
dans son demi-cercle
entre les nuages de plomb
et un ciel éclatant
a accompagné la première écoute
qui a été à la hauteur de l’attente.
Mes proches me sauront profonde inconditionnelle de Radiohead. Leur dernier album In Rainbows vient de sortir sur Internet et on a réussi à l’obtenir (via la France et une nouvelle capital-log efficace) un mois plus tard. C’est un plaisir que le logisticien français et moi partageons, même s’il les a découverts une décennie plus tard que moi. Jusqu’à la fin de nos missions respectives, nous serons branchés sur la même musique sur nos Ipod Shuffle.
Au début de mon séjour à Shamwana, je ruminais sur la paucité matérielle comme remède au malaise existentiel inhérent à la vie moderne – une des raisons inavouées pour lesquelles on s’engage dans une mission MSF. A l’arrivée, l’écriture et la réflexion distillées ont sainement occupé l’espace vacant laissé par l’adrénaline familière (à l’urgence, toujours dans un avion, sous l’eau) et la techno-dépendance. Contempler de la musique, sentir les paysages de brousse en courant le matin, et jongler avec les mots sont revenus comme plaisirs tout simples et vrais à savourer. Tout cela a aussi aidé à réaccorder un peu d’harmonies intérieures.
Mais maintenant la paucité gastronomique nous pèse. Nos réserves de bouffe fraîche ont tari et on mange des saucisses hot-dog en conserve sauce tomate avec du riz mal cuit depuis une semi-éternité. La gastrono-gourmande que je suis se surprend à presque sauter des soûpers par manque d’appétit. Une autre raison inavouée de partir en mission, en tout cas pour une fille, c’est de perdre quelques kilos sans effort. J’espère que ça va m’arriver, car le prix d’inappétance est déjà payé! Les conversations de table, autrefois épicées et amusantes, tergiversent présentement autour de la nourriture. Lorsque je regarde des épisodes de Six Feet Under, je remarque avec envie les rosbifs maison de Mrs. F ou le take-out sushi de Brenda. Même les métaphores des discussions quotidiennes semblent vaguement alimentaires. “C’est grrrave”, diraient les Congolais en roulant joliment leurs ‘r’.
En tout cas, les mangues ne manquent pas...
Pont typique de la région et les problèmes qui s'ensuivent
* * *
Work is sinning by its abundance in contrast to our bleak food choices and means of distraction. Our hospital admissions for the month of October have jumped up by 60%. I practice hunting and fishing at the base for patient materials. Mattresses, wooden bed bases, bednets and blankets. Pills and injectables, in constant rupture. The cholera epidemic in Kishale has thankfully abated, giving a little bit of rest to our nurses. However, cholera reared its ugly head “chez nous ici à Shamwana” with a single case in Kabusonji, the village next door, so we have to dedicate one of our tents as a Cholera Treatment Unit just in case. Moreover, the expat surgeon is here and monopolizing my Congolese colleague (who loves to cut) and needing an extra tent for post-op patients, so I am rounding alone on the busy ward. Hence the tardiness in my monthly statistical reports and bimonthly e-mails, apologies.
My latest butt-in with an ancient disease was dramatic. In Western folktales, one should not walk in horse dung or on rusty nails because of tetanus. We now know that the spores of Clostridium tetanii are heat-resistant and can be found in most soils – nothing to do with metal or horses. Back home, people are vaccinated against tetanus in childhood and whenever they end up having to go to the hospital for wounds or sutures. Here, oh well, here... “c’est le Congo”, with dismal rates of vaccination and wound infections, which is really one catches tetanus. The tetanus toxin binds to nerve endings and stimulates muscle contraction spasmodically. It was a seven-year old boy who was referred from a village. The story will never be clear: the parents said that they brought him to the traditional guérisseur after the signs started, but traditional practices usually consist of herbs and scarring, which could have constituted the point of entry. The child came with generalized stiff spasms, crying between episodes. The image of the nurse placing him on the bed, rigid as a wood plank, is embedded in my mind. Straight from Harrison’s Textbook of Internal Medicine once again: the spine curving abnormally backwards ie. opisthotonos, the taut facial spasms ie. risus sardonicus, the impressive lockjaw ie. trismus. I had seen a case in Cameroun, but not nearly as severe. I learned that any stimulus, sound or light or voice, can trigger the dreaded spectacular spasms. One can only imagine the suffering behind a body that has gone out of control. Without batting an eyelid, the excellent nurses knew to place him in isolation, in a dark and quiet room away from the noisy paediatric ward. Poor child. We emptied our stock of tetanus immunoglobulin and were generous with the muscle relaxants. A day later, he was finally eating mango and fufu, a respite after four days of lockjaw-induced starvation.
* * *
Earlier this year, there was a BBC news clip from Congo-Brazzaville where a concert of music from all local ethnic groups was held. Pygmies were invited, but instead of hotel rooms, they were offered huts at the zoo. Throughout Africa, pygmies exist in most countries at this latitude. They are widely segregated against and viewed as only semi-human. In Rwanda and Burundi, during the conflict between the Tutsi and the Hutu, because they belonged to neither group, they were spared by the génocidaires. Here in Katanga, the Mai-Mai rebels hunted them like animals because they were thought to have collaborated with the government army.
Yesterday, along with the expat surgeon, we went to meet our local pygmies. In the village of Nsangwa, a mere kilometer North of Shamwana, lives a pygmy group of about 13 families. They call themselves Semi-Bantu or Batembo, and have their own language, Kitembo. Longstanding mixing with the not-so-tall local Baluba made them taller than expected – but still slightly shorter than the Baluba. Nonetheless, their physionomy is definitely distinct. And their way of life is completely different from the Baluba. Most pygmies throughout the continent are hunter-gatherers and experts in the bush – which is why the Mai-Mai accused them of helping the army in our region. They are nomadic and travel in groups of a few families. In Katanga, where they are few, they form their own quartier of a few houses right outside of an established village and stay there for a few months or years, until there is no more bushmeat to hunt. They work the fields for the villagers, getting paid with a few handfuls of manioc flour or clothes. The poverty they live in is staggering: they had absolutely nothing but the rags that they were wearing. Children played in sand. Babies were naked. Men wore torn shirts the colour of dirt. Huts appeared fragile and overcrowded. Because of the segregation, they are reticent to send their children to school or to benefit from the free MSF-supported health care. Yesterday, we discussed with their leader how shy they are to send their children to the school in Nsangwa. He said, word for word, that he did not know if the teacher would allow his children to class because they are Batembo. Moreover, teachers must be paid by parents because the government salaries haven’t been delivered in years, so poorer families have less of a chance. Yet, because the chief of Nsangwa insisted on it, all men of the village, including the Batembo, are to contribute voluntarily to the building of the new school, supported by the materials of Concern our neighbouring NGO. It leads to the paradoxical situation whereby the pygmy families worked on the school building but cannot send their children there. I’ll go speak to the people at Concern about that. And maybe we should somehow create a Save the Pygmy Fund...(Ah, for once I just wish that this last statement wasn’t just irreverence...)
Batembo family
Papa Chef Batembo
Thursday, November 1, 2007
Sueurs
Notre coordonnatrice de projet a dit: “Ces médicaux, ils sont malades. Ils ne sont heureux que lorsqu’il y a une crise ou un désastre.”
En effet, ces derniers temps, c’est le délire absolu. Des conditions parfaites pour que je m’épanouisse tout en maudissant les maux d’estomac causés par les excès d’adrénaline et le manque de sommeil. Tout d’abord, à Shamwana, l’hôpital est débordé. 37 patients dans un hôpital prévu pour 20: l’engorgement – une situation bien familière au bercail. Il y a plus de patients admis qu’il n’y a de lits! On a eu au moins une naissance par jour, dont des triplés, et au moins six paires de jumeaux. Malheureusement, nous ne sommes pas équipés pour traiter les enfants prématurés ou à faible poids donc on en a aussi beaucoup perdu. Les paroles d’un collègue montréalais résonnent dans ma tête: ‘I could never deal with the death of a child’. Oulà, s’il savait ce qu’on vit ici. J’ai vu des trucs qu’on ne voit que dans les livres: une syphilis congénitale sur une paire de jumeaux, des naissances par siège à gogo, des déshydratations ‘au plan C’, ie. plus de 15%. On a opéré sur une grossesse ectopique alors que la patiente n’était que sous kétamine – pas recommandé pour garder un beau champ opératoire puisque les anses intestinales ont toutes débordé lorsqu’on a ouvert, une vraie éventration. Pour la première fois de ma vie, j’ai manqué perdre connaissance lors d’une chirurgie. Il faut dire que c’était dans une salle d’op surchauffée, à deux heures du matin après une grosse journée de travail au camp de choléra, totalisant cinq heures de Land Cruiser. Mon excellent collègue congolais, que j’assistais à opérer, a eu la gentillesse d’être patient. On a été en salle d’op pendant cinq heures au beau milieu de la nuit. C’est la vie! En tout cas, c’est “l’MSF”, comme ils disent ici!
En plus il y a l’urgence choléra à Kishale depuis trois semaines maintenant. Depuis le début de l’unité le mois dernier, ma compatriote l’infirmière de cliniques mobiles et moi en avons assuré la supervision. Or, le grand total de nos connaissances sur la gestion d’une épidémie de choléra se résume à une soirée où on a imprimé les ‘guidelines MSF’ sur le choléra et on les a potassés: “Cholera for Dummies”. Un vrai mode d’instruction, tout y était: tableau clinique, diagnostic et traitement, épidémiologie du choléra en région rurale, construction d’une unité de choléra, mobilisation et sensibilisation de la population, investigation des sources d’eau et du mode de transmission. Nous sommes devenues des borgnes dans un monde d’aveugles. Chez les expats, ni notre watsan, ni notre logisticien n’avaient de l’expérience choléra non plus. On a tous appris et improvisé: c’est ça, “l’MSF”. Heureusement, il y avait quelques infirmiers congolais de l’hôpital de Shamwana qui avaient travaillé pour MSF-France aux urgences choléra: ils ont constitué notre nouvelle expertise. Depuis une semaine, l’unité choléra a pris forme, une deuxième tente est apparue, les seaux de chlore à différentes concentrations sont utilisés correctement, les procédures d’isolement sont en place, et tout le matériel est là. L’épidémie suit le cours prédit: 2 à 3 nouveaux cas par jour, 24 cas totaux en date d’aujourd’hui, troisième semaine maintenant, pic des admissions prévu la semaine prochaine. Et, preuve que “Cholera for Dummies” a été bien appliqué et que nos experts travaillent fort, on n’a eu aucun décès dans les hospitalisations. On écrit des rapports à la capitale, on nous envoie du renfort, on espère avoir 5 nouveaux patients par jour, ce qui nous qualifierait pour le ‘kit d’urgence choléra MSF’. La PC a raison: ils sont malades, ces médicaux :).
Tentes, seaux de chlore et hygiénistes – résultats de la lecture de "Cholera for Dummies"
Un lit de choléra – trou pédiatrique de 12 cm par 12 cm, selon nos nouvelles instructions ... les enfants tombaient dans les trop grands trous des derniers lits!
* * *
In February of next year, be on the watch for Bill Moyers' journals on PBS. I was just filmed and interviewed by the crew today in Kishale. They were mostly here to film Concern and the topic of the show is "How to deliver humanitarian aid in remote settings". They stumbled upon us and our little cholera camp. I do expect that they will edit me out or make me sound much sillier than I already am. But if you do catch it on TV, let me know, and please try to tape it ;)
* * *
A friend requested the following as input for a presentation. He may have done his talk to medical students by now, but I figured that I might as well share the thoughts already written, to the risk of sounding pedantic.
Top ten things it takes to be an MSF doctor, fresh off the cuff, live from Shamwana.
1) A sense of humor. It’s never enough. In situations of stress, or in front of medical and moral challenges – one must be able to compensate by being light and putting things into perspective. The ability to laugh at oneself is precious out here. And a good, hearty laugh eases communication in all languages.
2) A sense of adventure. Self explanatory. Comfort creatures such as myself must forgo the warm baths, the soft beds, the air conditioning or even the fans, the 24 hour electricity and even basic hygienic work conditions. But living in the Congolese bush has its perks: wonderful sunsets, beautiful children’s songs and laughter, nightly tam-tams, and miraculous recoveries defying any of Harrison’s or Nelson’s predictions.
3) Flexibility. We do not decide who our fellow expatriate teammates are. Yet they become as close as family, for better and for worse. MSF life pushes camaraderie, territoriality and rivalry to the extreme. We get to know each other to the level of discomfort, and the crises situations distill out the worse and the best traits in each of us. And generally speaking, MSF life attracts the strongheaded kind, which predictably leads to sparks and tension.
4) The ability to think outside of the box. Nobody teaches us the medicine that is practiced in MSF settings, not even tropical medicine courses. Every mission has different tools and technologies. There is quite a bit of improvisation involved. One must suddenly become creative out of lack of means!
5) Open-mindedness. Cross-cultural understanding is key in our settings; the teams are international, but also, working with national staff requires a lot of sensitivity to cultural issues and perceptions.
6) Communication skills. To speak to patients, to connect with sick children, to be understood by the national staff whom we supervise, and to talk to teammates and report to capital team...
7) Endurance. MSF life is hard. It’s been described by a colleague as “treading water, one day bleeding into another”... The initial excitement and sense of exoticism wear off quickly and give way to hard, long days with not much means of distraction.
8) Common sense. Paramount and yet not always there. Emotional stability and being reasonable go a long, long way.
9) Introspection. Most of us have an idea why we want to do this work – there are, of course, both conscious and unconscious reasons. But the challenges that we face and the situations that we participate in take us to places and headspaces that we had never thought of. The injustice, the inequalities, the unfairness, the teamwork, the deaths – MSF work changes one’s view on life and humanity and there is no return after that.
10) Humility. MSF work can make one feel powerless and angry in front of inevitable medical outcomes that would be correctable elsewhere. My count of dead children, a medical near-impossibility back home, has multiplied since my arrival. One had no say in where or when he was born, yet that is the only difference between the expat and the Congolese staff, or even worse, between the expat and the victim of trauma. And one comes to admire the living conditions and the discipline of the locals who can plow through long days of hard work with incredibly few tools and a meager pay, if any at all. It is easy for the expat to fall into the trap of neo-colonialism, complacently allowed by a lighter skin tone. The superiority complex of the Muzungu (White Person) is tempting and one should assiduously avoid it.
Ordinary day for a local
Happy to be sent home, less malnourished, and on tuberculosis medications.
Not so happy about leaving the Muzungu and not giving her the daily hug.
Saison des mangues
En effet, ces derniers temps, c’est le délire absolu. Des conditions parfaites pour que je m’épanouisse tout en maudissant les maux d’estomac causés par les excès d’adrénaline et le manque de sommeil. Tout d’abord, à Shamwana, l’hôpital est débordé. 37 patients dans un hôpital prévu pour 20: l’engorgement – une situation bien familière au bercail. Il y a plus de patients admis qu’il n’y a de lits! On a eu au moins une naissance par jour, dont des triplés, et au moins six paires de jumeaux. Malheureusement, nous ne sommes pas équipés pour traiter les enfants prématurés ou à faible poids donc on en a aussi beaucoup perdu. Les paroles d’un collègue montréalais résonnent dans ma tête: ‘I could never deal with the death of a child’. Oulà, s’il savait ce qu’on vit ici. J’ai vu des trucs qu’on ne voit que dans les livres: une syphilis congénitale sur une paire de jumeaux, des naissances par siège à gogo, des déshydratations ‘au plan C’, ie. plus de 15%. On a opéré sur une grossesse ectopique alors que la patiente n’était que sous kétamine – pas recommandé pour garder un beau champ opératoire puisque les anses intestinales ont toutes débordé lorsqu’on a ouvert, une vraie éventration. Pour la première fois de ma vie, j’ai manqué perdre connaissance lors d’une chirurgie. Il faut dire que c’était dans une salle d’op surchauffée, à deux heures du matin après une grosse journée de travail au camp de choléra, totalisant cinq heures de Land Cruiser. Mon excellent collègue congolais, que j’assistais à opérer, a eu la gentillesse d’être patient. On a été en salle d’op pendant cinq heures au beau milieu de la nuit. C’est la vie! En tout cas, c’est “l’MSF”, comme ils disent ici!
En plus il y a l’urgence choléra à Kishale depuis trois semaines maintenant. Depuis le début de l’unité le mois dernier, ma compatriote l’infirmière de cliniques mobiles et moi en avons assuré la supervision. Or, le grand total de nos connaissances sur la gestion d’une épidémie de choléra se résume à une soirée où on a imprimé les ‘guidelines MSF’ sur le choléra et on les a potassés: “Cholera for Dummies”. Un vrai mode d’instruction, tout y était: tableau clinique, diagnostic et traitement, épidémiologie du choléra en région rurale, construction d’une unité de choléra, mobilisation et sensibilisation de la population, investigation des sources d’eau et du mode de transmission. Nous sommes devenues des borgnes dans un monde d’aveugles. Chez les expats, ni notre watsan, ni notre logisticien n’avaient de l’expérience choléra non plus. On a tous appris et improvisé: c’est ça, “l’MSF”. Heureusement, il y avait quelques infirmiers congolais de l’hôpital de Shamwana qui avaient travaillé pour MSF-France aux urgences choléra: ils ont constitué notre nouvelle expertise. Depuis une semaine, l’unité choléra a pris forme, une deuxième tente est apparue, les seaux de chlore à différentes concentrations sont utilisés correctement, les procédures d’isolement sont en place, et tout le matériel est là. L’épidémie suit le cours prédit: 2 à 3 nouveaux cas par jour, 24 cas totaux en date d’aujourd’hui, troisième semaine maintenant, pic des admissions prévu la semaine prochaine. Et, preuve que “Cholera for Dummies” a été bien appliqué et que nos experts travaillent fort, on n’a eu aucun décès dans les hospitalisations. On écrit des rapports à la capitale, on nous envoie du renfort, on espère avoir 5 nouveaux patients par jour, ce qui nous qualifierait pour le ‘kit d’urgence choléra MSF’. La PC a raison: ils sont malades, ces médicaux :).
Tentes, seaux de chlore et hygiénistes – résultats de la lecture de "Cholera for Dummies"
Un lit de choléra – trou pédiatrique de 12 cm par 12 cm, selon nos nouvelles instructions ... les enfants tombaient dans les trop grands trous des derniers lits!
* * *
In February of next year, be on the watch for Bill Moyers' journals on PBS. I was just filmed and interviewed by the crew today in Kishale. They were mostly here to film Concern and the topic of the show is "How to deliver humanitarian aid in remote settings". They stumbled upon us and our little cholera camp. I do expect that they will edit me out or make me sound much sillier than I already am. But if you do catch it on TV, let me know, and please try to tape it ;)
* * *
A friend requested the following as input for a presentation. He may have done his talk to medical students by now, but I figured that I might as well share the thoughts already written, to the risk of sounding pedantic.
Top ten things it takes to be an MSF doctor, fresh off the cuff, live from Shamwana.
1) A sense of humor. It’s never enough. In situations of stress, or in front of medical and moral challenges – one must be able to compensate by being light and putting things into perspective. The ability to laugh at oneself is precious out here. And a good, hearty laugh eases communication in all languages.
2) A sense of adventure. Self explanatory. Comfort creatures such as myself must forgo the warm baths, the soft beds, the air conditioning or even the fans, the 24 hour electricity and even basic hygienic work conditions. But living in the Congolese bush has its perks: wonderful sunsets, beautiful children’s songs and laughter, nightly tam-tams, and miraculous recoveries defying any of Harrison’s or Nelson’s predictions.
3) Flexibility. We do not decide who our fellow expatriate teammates are. Yet they become as close as family, for better and for worse. MSF life pushes camaraderie, territoriality and rivalry to the extreme. We get to know each other to the level of discomfort, and the crises situations distill out the worse and the best traits in each of us. And generally speaking, MSF life attracts the strongheaded kind, which predictably leads to sparks and tension.
4) The ability to think outside of the box. Nobody teaches us the medicine that is practiced in MSF settings, not even tropical medicine courses. Every mission has different tools and technologies. There is quite a bit of improvisation involved. One must suddenly become creative out of lack of means!
5) Open-mindedness. Cross-cultural understanding is key in our settings; the teams are international, but also, working with national staff requires a lot of sensitivity to cultural issues and perceptions.
6) Communication skills. To speak to patients, to connect with sick children, to be understood by the national staff whom we supervise, and to talk to teammates and report to capital team...
7) Endurance. MSF life is hard. It’s been described by a colleague as “treading water, one day bleeding into another”... The initial excitement and sense of exoticism wear off quickly and give way to hard, long days with not much means of distraction.
8) Common sense. Paramount and yet not always there. Emotional stability and being reasonable go a long, long way.
9) Introspection. Most of us have an idea why we want to do this work – there are, of course, both conscious and unconscious reasons. But the challenges that we face and the situations that we participate in take us to places and headspaces that we had never thought of. The injustice, the inequalities, the unfairness, the teamwork, the deaths – MSF work changes one’s view on life and humanity and there is no return after that.
10) Humility. MSF work can make one feel powerless and angry in front of inevitable medical outcomes that would be correctable elsewhere. My count of dead children, a medical near-impossibility back home, has multiplied since my arrival. One had no say in where or when he was born, yet that is the only difference between the expat and the Congolese staff, or even worse, between the expat and the victim of trauma. And one comes to admire the living conditions and the discipline of the locals who can plow through long days of hard work with incredibly few tools and a meager pay, if any at all. It is easy for the expat to fall into the trap of neo-colonialism, complacently allowed by a lighter skin tone. The superiority complex of the Muzungu (White Person) is tempting and one should assiduously avoid it.
Ordinary day for a local
Happy to be sent home, less malnourished, and on tuberculosis medications.
Not so happy about leaving the Muzungu and not giving her the daily hug.
Saison des mangues
Thursday, October 18, 2007
Traversées
Traversées verticales
On est entre la saison des papayes et celle des mangues (en plus de celle des serpents, des scorpions et des pluies). Le mois dernier, le papayer sur le terrain de la base nous a donné quelques beaux fruits. Le hic, c’est d’aller les chercher. Les papayes, sans doute de 1 à 2 kg, sont perchées à environ 10 m du sol, confortablement haut dans leur arbre. Il faut prendre une longue tige de bambou et les décrocher, au risque de se taper une bonne commotion cérébrale. Notre gentil log-forage anglais s’était mis à la tâche pour nous dénicher du dessert. Après deux papayes un peu vertes qu’il a agilement attrapées manière rugby, une papaye bien mûre lui a éclaté dans les mains, le couvrant de jus visqueux et odorant. Nous n’avons pas pu retenir les esclaffades de rire. Quel sacrifice quand même! Disons que la salade de papaye verte a été excellente ce jour-là.
Maintenant ce sont les mangues qui jouent à Sir Isaac Newton. Dans nos pérégrinations en Land Cruiser, j’admire les lourdes branches de manguiers qui se penchent au-dessus de la route. Les chauffeurs les évitent avec soin. A ma perplexité, on m’a répondu qu’une mangue verte qui tombe est un dangereux projectile auquel les pare-brise ne résistent pas. Il faut donc faire attention, car remplacer un pare-brise nous coûterait de précieux délais en visites de village.
Lourdes mangues
En termes d’autres fruits, on vient de découvrir que les grands arbres à l’entrée de la base sont des goyaviers. Tous les jours, des enfants y sont grimpés et se pourlèchent les doigts; pourtant, pas l’ombre d’une goyave au grand marché du centre-ville shamwanais. Il semblerait obligatoire de défier les lois de la gravité pour profiter des goyaves roses et parfumées. Avec un peu de chance, j’arriverais peut-être à fabriquer un bon petit sorbet de goyave, comme je les aime tant l’été à Montréal sur le Plateau... Il faut bien pouvoir rêver un peu ;)
* * *
Traversées horizontales
Every week brings new challenges. The approaching wet season is acquainting us with another old disease. Just like tuberculosis, cholera has been living with humankind for a long time. But unlike tuberculosis, it does not have a protracted course of chronicity. Rather, it uses the method of killing by numbers to spread fast. The cholera bacterium, Vibrio cholerae, is found in bodies of stillwater. In small quantities, it produces a nondescript gastroenteritis. But if the bacteria are ingested in large amounts, cholera kills very rapidly by producing a toxin that adheres to the intestinal wall and makes a human lose all its water from both ends. People die of dehydration and hypovolemic shock within a matter of a few hours: it’s typically a ‘rice-water diarrhea’. The incubation period can be anywhere from a few hours to five days, and the human secretions produced are highly infectious. Hence the potential for epidemics. The bacteria is known to have originated from the Indian subcontinent, where there is enough human density to sustain ongoing epidemics and mutations. The last world pandemic started in Bengal in 1991 and was carried all the way to Latin America. I vaguely remember the story of people dying after eating oysters on a South American airline crossing the continent. In Africa, where the water supply is generally unsafe, cholera epidemics are chronic.
In our region, the cholera usually comes from lake Mwero where Kilwa sits, a few hundred kilometers away. The way to deal with cholera is simple: the patient must be given back all the water that he is losing. If treated in time, recovery is close to 100%. But the disease moves fast. As soon as there is a case of cholera, we must set up cholera treatment centres. CTCs consist of a building with individual rooms, each with a cholera bed. The principle of the cholera bed is that it has a hole in the middle to gather the secretions that fall into a bucket right underneath. Patients are so sick that they cannot make it to the latrine. It is not unusual to give over 10 liters of intravenous fluid per day to a cholera patient. And the watsan (water-sanitation) people play a large role in the management of a cholera outbreak: large amounts of chlorine are used to disinfect the secretions, corpses if any, and to ensure isolation. The MSF protocol is complex and involves three concentrations of chlorine with specific uses.
Last week, our outreach team was flagged down from the road and brought a cholera patient to the health centre in Kishale, where we had set up a cholera treatment centre after a single case earlier in the year. However, more patients appeared this week. I was dispatched with the outreach team to investigate the new cases and report whether an epidemic was starting. The objectives were to contain the outbreak, verify the functioning of the cholera treatment centre, and to trace the contacts or contamination.
Arrived in Kishale, we looked at the cholera treatment centre and followed up on the patients. Both were now doing well. The centre consisted of a simple tent with dividers and cholera beds inside; our cholera beds are simply metal foldable bedframes and plastic tarp with the hole right over the bucket underneath. Basins with chlorinated solution were placed at all entrances of the tent, for shoe soaks. The nurse was reasonably well trained. Then, we investigated the movements and possible contacts of both patients, and visited their originating villages, as well as the road that they travelled. Quite the Sherlock Holmes enquiry, to research a cholera outbreak. We looked at the water sources, the river and the traditional wells used by the villages. It was quite interesting, as people move quite a bit, and it is virtually impossible to trace all contacts.
After much questioning and discussing with the chefs de village, the family members of the patients, and the Croix-Rouges, the local health workers, the puzzle solution slowly emerged. The index case had brought the cholera from lake Mwero at the village of Pweto, where he had gone to sell palm oil last week. He had had diarrhea the whole way back on the road to Kishale. Case number two probably travelled the same road around the same time and must have come in contact with his secretions. He died on the way to the health centre a few days later. Case number three crossed the same village as case number two on the same day, on her way to get some salt in another village. She then became sick on her way back home two days after. Case number four is a household contact of case number four. Crisscrossing paths in time and place, village after village, along roads and rivers – and cholera spreads. For the time being, we do not think that the water sources have been contaminated. But since the traditional wells are unprotected shallow spring water holes in the middle of the bush, it would be easy. Then we would have to teach all families to do bucket chlorination, which is a logistical watsan nightmare in our context. Let’s just hope that it doesn’t have to go that way. So for now, we remain on cholera watch.
Shamwana-in-the-bush
Little girl with mortar, pestle and manioc. Girls start working at a very young age. When I took this picture and filmed her earlier today, boys her age who were running around gathered around me and wanted to look at the footage. They were all laughing, at which point I reminded them that she was working and they weren’t. They sheepishly answered: “Ah, c’est vrai...”
On est entre la saison des papayes et celle des mangues (en plus de celle des serpents, des scorpions et des pluies). Le mois dernier, le papayer sur le terrain de la base nous a donné quelques beaux fruits. Le hic, c’est d’aller les chercher. Les papayes, sans doute de 1 à 2 kg, sont perchées à environ 10 m du sol, confortablement haut dans leur arbre. Il faut prendre une longue tige de bambou et les décrocher, au risque de se taper une bonne commotion cérébrale. Notre gentil log-forage anglais s’était mis à la tâche pour nous dénicher du dessert. Après deux papayes un peu vertes qu’il a agilement attrapées manière rugby, une papaye bien mûre lui a éclaté dans les mains, le couvrant de jus visqueux et odorant. Nous n’avons pas pu retenir les esclaffades de rire. Quel sacrifice quand même! Disons que la salade de papaye verte a été excellente ce jour-là.
Maintenant ce sont les mangues qui jouent à Sir Isaac Newton. Dans nos pérégrinations en Land Cruiser, j’admire les lourdes branches de manguiers qui se penchent au-dessus de la route. Les chauffeurs les évitent avec soin. A ma perplexité, on m’a répondu qu’une mangue verte qui tombe est un dangereux projectile auquel les pare-brise ne résistent pas. Il faut donc faire attention, car remplacer un pare-brise nous coûterait de précieux délais en visites de village.
Lourdes mangues
En termes d’autres fruits, on vient de découvrir que les grands arbres à l’entrée de la base sont des goyaviers. Tous les jours, des enfants y sont grimpés et se pourlèchent les doigts; pourtant, pas l’ombre d’une goyave au grand marché du centre-ville shamwanais. Il semblerait obligatoire de défier les lois de la gravité pour profiter des goyaves roses et parfumées. Avec un peu de chance, j’arriverais peut-être à fabriquer un bon petit sorbet de goyave, comme je les aime tant l’été à Montréal sur le Plateau... Il faut bien pouvoir rêver un peu ;)
* * *
Traversées horizontales
Every week brings new challenges. The approaching wet season is acquainting us with another old disease. Just like tuberculosis, cholera has been living with humankind for a long time. But unlike tuberculosis, it does not have a protracted course of chronicity. Rather, it uses the method of killing by numbers to spread fast. The cholera bacterium, Vibrio cholerae, is found in bodies of stillwater. In small quantities, it produces a nondescript gastroenteritis. But if the bacteria are ingested in large amounts, cholera kills very rapidly by producing a toxin that adheres to the intestinal wall and makes a human lose all its water from both ends. People die of dehydration and hypovolemic shock within a matter of a few hours: it’s typically a ‘rice-water diarrhea’. The incubation period can be anywhere from a few hours to five days, and the human secretions produced are highly infectious. Hence the potential for epidemics. The bacteria is known to have originated from the Indian subcontinent, where there is enough human density to sustain ongoing epidemics and mutations. The last world pandemic started in Bengal in 1991 and was carried all the way to Latin America. I vaguely remember the story of people dying after eating oysters on a South American airline crossing the continent. In Africa, where the water supply is generally unsafe, cholera epidemics are chronic.
In our region, the cholera usually comes from lake Mwero where Kilwa sits, a few hundred kilometers away. The way to deal with cholera is simple: the patient must be given back all the water that he is losing. If treated in time, recovery is close to 100%. But the disease moves fast. As soon as there is a case of cholera, we must set up cholera treatment centres. CTCs consist of a building with individual rooms, each with a cholera bed. The principle of the cholera bed is that it has a hole in the middle to gather the secretions that fall into a bucket right underneath. Patients are so sick that they cannot make it to the latrine. It is not unusual to give over 10 liters of intravenous fluid per day to a cholera patient. And the watsan (water-sanitation) people play a large role in the management of a cholera outbreak: large amounts of chlorine are used to disinfect the secretions, corpses if any, and to ensure isolation. The MSF protocol is complex and involves three concentrations of chlorine with specific uses.
Last week, our outreach team was flagged down from the road and brought a cholera patient to the health centre in Kishale, where we had set up a cholera treatment centre after a single case earlier in the year. However, more patients appeared this week. I was dispatched with the outreach team to investigate the new cases and report whether an epidemic was starting. The objectives were to contain the outbreak, verify the functioning of the cholera treatment centre, and to trace the contacts or contamination.
Arrived in Kishale, we looked at the cholera treatment centre and followed up on the patients. Both were now doing well. The centre consisted of a simple tent with dividers and cholera beds inside; our cholera beds are simply metal foldable bedframes and plastic tarp with the hole right over the bucket underneath. Basins with chlorinated solution were placed at all entrances of the tent, for shoe soaks. The nurse was reasonably well trained. Then, we investigated the movements and possible contacts of both patients, and visited their originating villages, as well as the road that they travelled. Quite the Sherlock Holmes enquiry, to research a cholera outbreak. We looked at the water sources, the river and the traditional wells used by the villages. It was quite interesting, as people move quite a bit, and it is virtually impossible to trace all contacts.
After much questioning and discussing with the chefs de village, the family members of the patients, and the Croix-Rouges, the local health workers, the puzzle solution slowly emerged. The index case had brought the cholera from lake Mwero at the village of Pweto, where he had gone to sell palm oil last week. He had had diarrhea the whole way back on the road to Kishale. Case number two probably travelled the same road around the same time and must have come in contact with his secretions. He died on the way to the health centre a few days later. Case number three crossed the same village as case number two on the same day, on her way to get some salt in another village. She then became sick on her way back home two days after. Case number four is a household contact of case number four. Crisscrossing paths in time and place, village after village, along roads and rivers – and cholera spreads. For the time being, we do not think that the water sources have been contaminated. But since the traditional wells are unprotected shallow spring water holes in the middle of the bush, it would be easy. Then we would have to teach all families to do bucket chlorination, which is a logistical watsan nightmare in our context. Let’s just hope that it doesn’t have to go that way. So for now, we remain on cholera watch.
Shamwana-in-the-bush
Little girl with mortar, pestle and manioc. Girls start working at a very young age. When I took this picture and filmed her earlier today, boys her age who were running around gathered around me and wanted to look at the footage. They were all laughing, at which point I reminded them that she was working and they weren’t. They sheepishly answered: “Ah, c’est vrai...”
Tuesday, October 9, 2007
Eaux Libres
La saison des pluies se pointe petit à petit, pole pole, en Swahili. On a reçu vendredi un orage diluvien, où plein de petits torrents se sont formés sur le terrain de la base. Il y a même eu de la grêle, qui a ruiné la toiture fragile du centre de santé de Kampangwe. Avec la pluie, les bestioles apparaissent. Voici mon collègue congolais arborant fièrement l’intrus qui a osé déranger les patientes de la tente-maternité pendant la nuit suivant l’orage.
(Ce n’est pas un bâton, c’est un serpent!)
Parlant de bestioles, on nous a ramené de Kisele, à 30 km d’ici, un être étrange dénommé pangolin. Un expat quelconque de Shamwana en aurait réquisitionné un, et on lui en a ramené deux. C’est une forme de tapir ou de fourmilier, ou aardvark en anglais – le premier mot du dictionnaire, me dit l’infirmière de Nouvelle-Ecosse. Ça se roule en boule défensivement, c’est couvert d’écailles mais c’est un mammifère, ça se nourrit de fourmis et de termites, et ça se mange ici au Congo. Probablement de la famille des porcs-épics. “En tout cas vraiment”, comme ils disent si bien ici, ce n’est pas un de nous qui a demandé la bête puisque j’ai fait le tour de la base avec la question; de toute façon, c’eût été clairement contre les règles strictes de MSF-Hollande. Sans doute une idée étrange de nos voisins, les gens de Concern. Hmm... après réflexion, pas si étrange que ça. La famille Pangolin aurait pu remédier à notre problème de termites – deux pangolins familiers au lieu de la vague odeur d’huile de vidange qui flotte encore dans la maison et dans ma chambre...
Pangolin = a kind of aardvark = kibembe en kiluba
Pauvre petits pangolins – j’ai bien peur qu’il ne finissent dans les estomacs des gardiens de Concern. En tout cas, ils ne reviendront pas chez eux à Kisele...
C’est à Kisele que j’ai trouvé la maison la plus poétique qu’il m’est venu de voir:
C’est la maison de notre agent focal, toute neuve, avec une belle bâche. J’irai lui demander un jour quelle inspiration l’a piqué d’inscrire ces jolis vers libres sur son mur.
* * *
There isn’t much free water in this area, or in the region in general; we are not near the Congo river at all. In most villages, to obey MSF standards, the drilling and watsan teams have dug handpumps such as this one behind the health centre in Kisele.
The Congo is a poor old man sitting on a mound of gold. I had heard that expression about Peru when I was there for a project in 1994, but this country takes the saying to a different, exponential level. DRC is incredibly rich in mineral resources, well ahead of most African countries. This arises the concupiscence of neighbouring countries such as Rwanda, Uganda and Angola, which all have informally encouraged guerillas on Congolese soil. The mineral wealth has contributed to the foreign-supported strife that has been plaguing this land and impoverished it. The current conflict with the renegade Laurent Nkunda in the Eastern provinces, the Kivus, is said to be supported by Rwanda – although that has been officially denied. The simmering conflicts allow the neighbours to regularly raid the mineral riches of this underdeveloped country without any infrastructures to defend itself; and they create the vicious cycle of worsening poverty and violence that has been the history of the Congo of the last few decades. The movie Blood Diamonds was about Sierra Leone, but it could have been about DRC. Many external interests, and not the least, companies from rich countries such as Australia, the States, China and... Canada, exploit mines with minimal labor law. In the Southwestern part of Katanga, there is copper. The uranium used for the American nuclear bombs dropped on Hiroshima and Nagasaki came from the Belgian Gécamine mines in South Katanga. The South African soldiers of the MONUC UN forces are known to seek out mining opportunities as a sideline in the Kivus. In conflicted North Kivu, there are diamonds and gold. Lately, the rage is all about this Coltan metal alloy, used in microchips and Sony Playstation machines, which is found in the Kivus and probably here in Katanga as well.
Possessing such rich soil also has consequences on the water tables. I’ve had interesting conversations with our British drilling officer. His team and the watsan team have analyzed the water from the handpumps. The mineral water contents include lithium, cadmium, manganese, copper and other metals. Twice or more the 500 ppm acceptable for human consumption by WHO standards. “Maybe we should make batteries out of the water”, he said jokingly... So much that the water from the hospital handpump has been deemed too minerally rich for expat use.
Hence, our domestic water comes from the small river that runs behind Shamwana. Two days ago, I walked over there for the first time. It was a nice half-hour walk through the bush, with a few green hills as backdrop, strange bird sounds and crickets all around. At the river, people were doing their wash and kids were going for a swim, in an altogether muddy water. Young girls were carrying back clean dishes to the village.
Three times a day, local ladies are hired to hike down to the river to supply our washbasins, our shower and our cooking water (twice filtered and boiled). Here they are, crossing past the expat tukuls to fill our shower bucket on a Sunday afternoon:
Seeing so many people work for us at a minimal wages sits uncomfortably with my conscience. I realize how much energy and financial resources we expats use just to live and work here, compared to the locals. Even if by Western standards, we are leading a Spartan life. The water for our daily usage has to be brought from the river. The petrol feeding our vehicles and our generator, thus supplying the electricity to our computers, as well as the kerosene for our refrigerator and our lanterns – all must be driven here from Lubumbashi. At the same time, we are bringing health care and basic infrastructures to a region long forgotten and scarred by conflict. Children have not been vaccinated for over a decade. People are accustomed to use the services of the traditional healers and birth attendants, with disastrous consequences on morbidity and neonatal mortality. Moreover, the NGO’s are kickstarting the local economy by bringing employment and locally trading goods. It is a two-way street, this development business.
(Ce n’est pas un bâton, c’est un serpent!)
Parlant de bestioles, on nous a ramené de Kisele, à 30 km d’ici, un être étrange dénommé pangolin. Un expat quelconque de Shamwana en aurait réquisitionné un, et on lui en a ramené deux. C’est une forme de tapir ou de fourmilier, ou aardvark en anglais – le premier mot du dictionnaire, me dit l’infirmière de Nouvelle-Ecosse. Ça se roule en boule défensivement, c’est couvert d’écailles mais c’est un mammifère, ça se nourrit de fourmis et de termites, et ça se mange ici au Congo. Probablement de la famille des porcs-épics. “En tout cas vraiment”, comme ils disent si bien ici, ce n’est pas un de nous qui a demandé la bête puisque j’ai fait le tour de la base avec la question; de toute façon, c’eût été clairement contre les règles strictes de MSF-Hollande. Sans doute une idée étrange de nos voisins, les gens de Concern. Hmm... après réflexion, pas si étrange que ça. La famille Pangolin aurait pu remédier à notre problème de termites – deux pangolins familiers au lieu de la vague odeur d’huile de vidange qui flotte encore dans la maison et dans ma chambre...
Pangolin = a kind of aardvark = kibembe en kiluba
Pauvre petits pangolins – j’ai bien peur qu’il ne finissent dans les estomacs des gardiens de Concern. En tout cas, ils ne reviendront pas chez eux à Kisele...
C’est à Kisele que j’ai trouvé la maison la plus poétique qu’il m’est venu de voir:
C’est la maison de notre agent focal, toute neuve, avec une belle bâche. J’irai lui demander un jour quelle inspiration l’a piqué d’inscrire ces jolis vers libres sur son mur.
* * *
There isn’t much free water in this area, or in the region in general; we are not near the Congo river at all. In most villages, to obey MSF standards, the drilling and watsan teams have dug handpumps such as this one behind the health centre in Kisele.
The Congo is a poor old man sitting on a mound of gold. I had heard that expression about Peru when I was there for a project in 1994, but this country takes the saying to a different, exponential level. DRC is incredibly rich in mineral resources, well ahead of most African countries. This arises the concupiscence of neighbouring countries such as Rwanda, Uganda and Angola, which all have informally encouraged guerillas on Congolese soil. The mineral wealth has contributed to the foreign-supported strife that has been plaguing this land and impoverished it. The current conflict with the renegade Laurent Nkunda in the Eastern provinces, the Kivus, is said to be supported by Rwanda – although that has been officially denied. The simmering conflicts allow the neighbours to regularly raid the mineral riches of this underdeveloped country without any infrastructures to defend itself; and they create the vicious cycle of worsening poverty and violence that has been the history of the Congo of the last few decades. The movie Blood Diamonds was about Sierra Leone, but it could have been about DRC. Many external interests, and not the least, companies from rich countries such as Australia, the States, China and... Canada, exploit mines with minimal labor law. In the Southwestern part of Katanga, there is copper. The uranium used for the American nuclear bombs dropped on Hiroshima and Nagasaki came from the Belgian Gécamine mines in South Katanga. The South African soldiers of the MONUC UN forces are known to seek out mining opportunities as a sideline in the Kivus. In conflicted North Kivu, there are diamonds and gold. Lately, the rage is all about this Coltan metal alloy, used in microchips and Sony Playstation machines, which is found in the Kivus and probably here in Katanga as well.
Possessing such rich soil also has consequences on the water tables. I’ve had interesting conversations with our British drilling officer. His team and the watsan team have analyzed the water from the handpumps. The mineral water contents include lithium, cadmium, manganese, copper and other metals. Twice or more the 500 ppm acceptable for human consumption by WHO standards. “Maybe we should make batteries out of the water”, he said jokingly... So much that the water from the hospital handpump has been deemed too minerally rich for expat use.
Hence, our domestic water comes from the small river that runs behind Shamwana. Two days ago, I walked over there for the first time. It was a nice half-hour walk through the bush, with a few green hills as backdrop, strange bird sounds and crickets all around. At the river, people were doing their wash and kids were going for a swim, in an altogether muddy water. Young girls were carrying back clean dishes to the village.
Three times a day, local ladies are hired to hike down to the river to supply our washbasins, our shower and our cooking water (twice filtered and boiled). Here they are, crossing past the expat tukuls to fill our shower bucket on a Sunday afternoon:
Seeing so many people work for us at a minimal wages sits uncomfortably with my conscience. I realize how much energy and financial resources we expats use just to live and work here, compared to the locals. Even if by Western standards, we are leading a Spartan life. The water for our daily usage has to be brought from the river. The petrol feeding our vehicles and our generator, thus supplying the electricity to our computers, as well as the kerosene for our refrigerator and our lanterns – all must be driven here from Lubumbashi. At the same time, we are bringing health care and basic infrastructures to a region long forgotten and scarred by conflict. Children have not been vaccinated for over a decade. People are accustomed to use the services of the traditional healers and birth attendants, with disastrous consequences on morbidity and neonatal mortality. Moreover, the NGO’s are kickstarting the local economy by bringing employment and locally trading goods. It is a two-way street, this development business.
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