A Day in The DRC

I wake at 6.30 in the MSF ‘house’, an abandoned motel just outside Bunia. My en suite bathroom is rather spoilt by the cold muck that comes out of the taps. I try to remember not to brush my teeth in it – you can almost see the Giardia.

After breakfast we leave at 7.45 for short drive in the “shiny white Landcruiser” to the hospital, accompanied by Corinne, our medical co-ordinator. Corinne is French, highly experienced, speaks English with exaggerated ‘Allo ‘Allo accent and reminds me rather of Dawn French at her Vicar of Dibley bossiest. She thinks I am mad because I laugh when she ticks me off for not following MSF protocols. In the car with us is Katrin our nurse. Katrin is German, immensely efficient (well she would be, wouldn’t she?), unassuming, helpful and humorous. Sometimes we are accompanied by Maliza, another nurse, Belgian by nationality but Romanian/Congolese by birth and a good natured beauty who seems unaware that the locals stare at her agape, never having seen anyone mixed race before.

I start my ward round either in paediatrics – which we have converted from an abandoned warehouse - or in the cholera tents, depending on the overnight admissions. Then I plough on through anything from 30 to 60 patients interrupted by new admissions, calls to Out Patients or, my biggest dread, a summons to the Therapeutic Feeding Centre, Corinne’s fiefdom. If a nurse with years of African experience can’t solve the problem what hope have I?

Usually I am accompanied by Maguy, a young Congolese doctor who is invaluable because of her local knowledge but tends to tire easily. She lives in town and is often kept awake by gunfire and fear of marauding militia. Floribert, my even younger translator is more alert because he has the sense to sleep in the refugee camp alongside the hospital. About halfway through the morning I pack Maguy off to Out Patients (OPD) where she is happier and ease of communication means she is a lot more efficient than me.

Difficulties in communication do slow things down. If the patients speak French I often find that even my appalling French is quicker than Floribert’s rather tortured translation. If not, and Swahili or one of the other local languages enters the exchange, the conversation can take an age. An example is “How old are you?” Four words inviting a two word answer. What actually happens is that the question itself takes up several sentences. Doc puzzled and even more so when patient clearly also puzzled. The reason being that the question was put as “The muzungu doctor wants to know how old you are. Now you know, and I know, that you have no idea but if you could come up with a rough approximation I think that would satisfy him”. This bothers the patient who is not very good at abstract concepts like approximations and involves his relatives, the rest of the ward and any spare staff in the calculation. Doc makes mental note never to ask that one again and quickly learns a load of others to avoid, such as how long a particular symptom has been present (never more than 3 weeks in someone who is obviously chronically ill), what past illnesses he or she might have had and whether a symptom is worse or better – it is never either but always there.

So, by midday I’m exhausted, but this is a Francophone mission and thankfully everything stops for lunch. Then more of the same in the afternoon, including a spell in OPD – a tent with no sound insulation, shouting nurses, wailing infants, searingly hot and outside the roar of transport aircraft revving up for take-off on the UN airstrip across the road. All this plus the clatter of helicopters overhead and it feels like the set of MASH, although unfortunately without Hot Lips.

Out Patients is polished off with a Staff Health clinic, another one of my dreads because I know I can’t meet their expectations, which are not of days off (I tried that one but it didn’t work and upset Corinne) but antibiotics, preferably by injection, for the common cold. Does one ever weaken? Sorry, professional secret.

Then a trickle of late arrivals till around 7.0 p.m. Sometimes, if not busy I help the surgeon - Italian, resourceful (has to be) - often with some ghastly obstetric complication or gunshot injury. One night I hung around too long and was bled a pint by the anaesthetist - Polish, multilingual - for a young woman with a ruptured uterus.

Then back home for a quick supper and an early bed after a hectic day. Once we could go into town where an optimistic Frenchman had newly opened a restaurant, generally considered a front for money laundering as the area is a centre for diamond smuggling. This week there has been more militia activity in the vicinity and we are confined to base listening to the nightly firefights, thankfully the other side of our 3 metre perimeter wall.

These usually follow a set pattern. About 20 minutes of small arms fire around 9.0 p.m. Then silence and 5 minutes later (never earlier) the UN APCs trundle down the road, rummage round a bit and return to base. Activity over for the night – usually. And I go to sleep dreaming of cosy Ealing.

The next day…….much the same, an endless variety of disease and trauma, smiling national staff with varying levels of experience but always calm, always helpful. Luckily for me the paediatric nurses are brilliant. If I say an infant with severe malaria and anaemia needs a blood transfusion, I blink and the drip is up, a relative cross-matched and bled and the transfusion running within 30 minutes. It would have taken me all morning just to get the needle in the vein.

Sick children, and even adults, have a disconcerting habit of recovering when you think all is lost and, sadly, of doing exactly the opposite for no discernable reason. But the quiet dignity of the parents is nearly always impressive. The elderly parents of a 9-year-old with meningitis sat patiently by his side for a week as he gradually came out of a deep coma, which I was sure would leave him severely brain damaged. His name was Dieu Donne and I guessed he was an only child but, in fact, he turned out to be the last of twelve so the name seemed appropriate either way. Ten days after admission he seemed almost fully recovered and his parents took him home, a little earlier than I preferred but there was fighting near their village and they wanted to be with the rest of the family.

It is tragic that, with all its mineral resource, what should be the richest country in Africa is such a chaotically dangerous place. One has to hope that one day the good guys will prevail but in the Congo that day seems an awful long time coming.

Photos by Juan Carlos Tomasi

Richard Sturge is currently on mission with MSF in the Caucasus.