MSF's return to Congo-Brazzaville's Pool region sees the 'ears of the hippopotamus'

© Steve Harris/MSF Click image for full size On August 20, 2003, MSF was the first international NGO since the end of the war to reach Kindamba in the north of the Pool region, close to the seat of the Ninja rebels. A once sprawling town of 26,000 people now is an empty shell of wrecked buildings. With the number of IDPs returning to Pool increasing over time, also the number of patients MSF is seeing in the hospital has been increasing steadily. The main reasons for admission are malnutrition and deliveries. MSF is also running a TFC in the hospital along with a supplementary feeding programme, and carries out nutritional screening and mobile clinics in the region and along the Pool/Bouenza border.
The Pool region in Congo-Brazzaville - an area previously inaccessible for humanitarian organisations for over a year - has allowed greater humanitarian aid to reach into the region following a cease fire in April of this year. An MSF facility that started under an MSF emergency programme has had substantial growth in its first months as people gain confidence, and awareness extends into the area. Last June, at the start of the intervention, the team saw 1,677 patients in Kinkala Referral Hospital in southern Pool - by August the figure had increased to 2,177. In April this year the Pool region finally became accessible for humanitarian aid after having been shut off from the outside world for one year. A cease fire agreement between the government and Ninja rebels ended a period during which some 50,000 people had fled the area, with 12,000 ending up living in camps for displaced people and some 20,000 in host families in the capital, Brazzaville. As Pool has just opened up - and most of the Ministry of Health staff fled the region during the war and some have still not returned - many people have had no access to health care for over a year, and still have no access. "The main focus of MSF since the opening of the region has been to assess the medical needs of the people and to provide free quality health services and drugs," Dr Steve Harris, of the MSF Mobile Clinic Pool Emergency Programme. "Step by step we discover new areas where no, or hardly any, health care is available. Many people have died here in the past months for reasons that could have easily been prevented had they been able to see a doctor. "It is obvious people have suffered a lot, many people who return find their houses looted or burnt and many are missing relatives. On paper the war may have ended in March, but on the ground the two sides don't talk, villages are empty and their habitants live in the surrounding bush too afraid to return." On August 20, 2003, MSF was the first international NGO since the end of the war to reach Kindamba in the north of the Pool region, close to the seat of the Ninja rebels. A once sprawling town of 26,000 people now is an empty shell of wrecked buildings. © Steve Harris/MSF Click image for full size
The old hospital which once offered surgery, obstetric, medical and laboratory services attempts to function on a skeleton staff. "The nutritional situation appeared precarious with one in ten children under five suffering from malnutrition. Food and medicines are available in small quantities in the market but only to those with enough money. MSF ran two days of mobile clinics and saw over 250 children. As the local expression goes, this was only the 'ears of the hippopotamus' and below the surface bigger problems lurk," said Harris. MSF hopes to start hospital support, set up a therapeutic feeding centre (TFC) in the town and start mobile clinic activities in the surrounding areas before the end of this month. Since mid-May, MSF has been supporting all departments of Kinkala Hospital including surgery and maternity. The main morbidities here are malaria and respiratory infections. In total, 643 patients have been admitted to the hospital since the start of the programme. With the number of IDPs returning to Pool increasing over time, also the number of patients MSF is seeing in the hospital has been increasing steadily. The main reasons for admission are malnutrition and deliveries. MSF is also running a TFC in the hospital along with a supplementary feeding programme, and carries out nutritional screening and mobile clinics in the region and along the Pool/Bouenza border. The mobile-clinic team has visited 11 villages and treated an average of 800 people each month since May 2003. The mobile team provides doctor consultations, systematic de-worming and vitamin A supplementation of children, health education, malaria prophylaxis and anaemia prevention to pregnant women. It also performs routine vaccinations, with an emphasis on measles vaccinations. A third MSF base in Pool is Mindouli. Here the organization is supporting a hospital as well, and also running a TFC and mobile clinics in the surrounding areas.