Enormous Needs in Baraka

Baraka is a small town on the eastern edge of the Democratic Republic of the Congo, nestling on the shores of Lake Tanganyika. I arrived from Bujumbura, in neighbouring Burundi, and our route wound its way along a rough road of red earth through many small villages, homes made from red earth bricks. Women, clad in brightly coloured clothes, walk by in happy groups, cassava and wood carried in intriguing baskets on their backs. Every now and again, we get a glimpse of the small white sand beaches and traditional wooden fishing boats along the shores of the lake. To the east across the lake are the rolling green hills of Burundi and to the west mountains covered in lush vegetation. Being the rainy season, the landscape is vibrant and green. Some time later, I will travel across the lake in a large wooden boat from Tanzania, to the Ubwari peninsula. Fisherman stand out in the lake hauling in their nets by hand. Many children gather on the beach to meet the boat and lead us through the maze of small dwellings , passing by women pounding grain, to the village leader. The stunning beauty belies the suffering that the population has endured,. What I see does not marry up with what I have heard and what I will hear. This peninsula has been inaccessible for 7 years because of the civil war.

Sadly, the residents of such small villages in South Kivu have been terrorised by all the different troops that have passed through, just because they are there. Homes have been pillaged and then burned; women have been raped and men killed. The misfortune of the people in the Congo is to live in a land so rich in resources, which are wanted by others.

In such a lush and fertile land, food should be plentiful, but many still rely on the distribution of food supplements and malnutrition is a problem. Perhaps some became disheartened and abandoned growing food after their crops are systematically pillaged. Others had to flee for their lives and hide in the hills. For women, the fields have become dangerous places that they have become afraid to go to, as they have often been the scene of brutal rape and attack.

The town of Baraka has an air of recent abandonment, but which is now coming back to life as the population returns. Each day, I pass by a huge and imposing church , the faded pink and yellow paint of the exterior is peeling off following years of neglect, but beautiful singing can be heard resounding from inside.

I am overwhelmed by the warmth and friendliness of the local people. I am amazed at the gentleness of the Congolese staff, after living in an atmosphere of violent conflict for so long. At the same time, I observe a silent but tough resilience as they deal with the death of a sick child or the loss of an adult life. They have seen it too many times before. But the absolute grief of the mothers cannot be doubted. I will not easily forget the sound of wailing …

Although there is still a significant military presence in Baraka and along the road, the peace process is holding, albeit fragile. Each of the warring parties is now represented in the government. The wars have claimed the lives of over 3 million people and displaced many others. The infrastructure has broken down and people have been denied access to basic health care. The needs now are immense.

Médecins sans Frontières opened an emergency hospital in Baraka in July 2003. Work had begun to create the hospital in an old convent building before this time, but had to be abandoned as it was too dangerous for MSF to stay there. Fortunately MSF has now been able to return and work there without interruption since July. Services have been developed with a strong and committed national team and the hospital has become very busy, with activities increasing all the time. The hospital consists of paediatric and adult medical wards, an operating theatre, post-operative ward, a maternity and a laboratory. The 45-bed hospital has been running at double that bed occupancy, with 2 babies to a bed when I arrived.. During the day, all patients are admitted through the outpatient clinic. MSF has started to run mobile clinics on the Ubwari peninsula one day each week, but is hoping to increase this activity to 2 days a week. There are Health Centres supported by another NGO along the road going north from Baraka and ‘Action Against Hunger’ run feeding programmes in the area.
The ex-pat team consists of a project co-ordinator, logistician, a physician, two nurses (1 hospital-based, 1 community based) and a psychologist. An anaesthetist has been giving training at Baraka but also rotating between 2 programmes in Burundi. A Lab Technician provides training and quality control. My mission was short (2 months) as I was just filling a gap. There was only 1 nurse until recently. As a Midwife, my main focus was on the maternity services, but as the other nurse took holiday whilst I was there, I had some input into all areas.

As well as emergency operations, such as caesarean section, there is also the possibility to undertake some elective surgery. There is a Congolese surgeon and two nurses have been trained to give anaesthetics. There is also a daily dressing clinic for the dressing of burns, post-op wound care and some minor surgery. The medical wards are very busy. The highest mortality in infants is severe anaemia, as a complication of malaria, and acute respiratory infection. Blood transfusions are given, but too often it is just too late.

Although, it is an emergency hospital, it is hard to turn away chronic cases, which account for a high proportion of adult medical admissions. There is a National TB programme, but there has been a rupture in the supply of drugs to the Health Centres. MSF does not diagnose or treat TB at present, but if there is approval from the Ministry of Health, we will start to actively treat TB in Baraka, which will no doubt increase the in-patient numbers significantly. An HIV/AIDS programme does not exist at the moment, so HIV testing is not performed for ethical reasons. The diagnosis has been suspected when all others have been excluded. Hopefully, treatment will be available in the near future with more resources.

Maternity has over 100 admissions each month with between 50-60 deliveries. Although women are not encouraged to come to Baraka for normal delivery as this facility is available in the Health Centres, they would not be turned away. Others request to stay until delivery after a complication in pregnancy, such as malaria, or if they live a long way from the hospital or a functioning health centre. The caesarian section rate is high, near 25%, but this at least partly attributed to the fact that women with pregnancies ’at risk’ are encouraged to deliver at Baraka and are often referred from the health centres.

As a midwife, my biggest challenge was to try and convince the midwives to employ other tactics to facilitate normal delivery, before resorting to medical intervention and aggressive traditional practices.
A midwife had just started joining the mobile clinic team to perform the ante-natal consultations and I hope she may be able to extend her role as a health educator, in relation to sexual and reproductive health at the clinics.

Since August, there have been just over 600 reported cases of rape, including some male victims. Rape has been used as a weapon of war. MSF has set up a ‘Listening Centre’, as part of our response to this epidemic of sexual violence. The counsellors in the listening centre have been encouraged to extend their role to offer psychological support to all those who have suffered traumatic experiences, whatever the nature. MSF believes it is very important to listen to the testimonies of these men and women, as well as receiving medical treatment, as indicated. MSF speaks out against abuse of human rights and practices temoinage. On 1st April MSF is releasing a report which will contain some of these stories. (To download this report click here). MSF is not pointing the finger at any particular group as the perpetrators of these crimes, but only asking that they stop….now.

Fizi hospital, some 30km away, once a busy 120 bedded hospital now lies virtually empty, as a shell, having been stripped of almost everything during the years of war. A few committed health staff have remained or returned to deliver what health care they can with extremely limited resources. Medecins sans Frontieres have been supporting these staff at Fizi hospital with some essential medicines, but have been unable to get there recently as the road has either been impassable due to heavy rain or because it has been considered to be too insecure as tensions between the different armed groups continue. The nuns plan to return to their convent in 2005 and so it is envisaged that MSF will transfer their services to Fizi then.

At the moment, there is only a trickle of refugees returning from Tanzania, but an influx is anticipated in the near future. So, the needs are and will be immense.