South Kivu reportage: Numbi & Lulingu
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South Kivu: Marathon journeys to access basic medical care

Moulasi, a mother-of-eight living in South Kivu, in eastern Democratic Republic of Congo (DRC), is tired. She has walked for two days to reach the Médecins Sans Frontières (MSF) hospital in Lulingu, trekking for 40 kilometres from her village, Byangama, to reach the place that she had heard was offering free healthcare. A walk of this length would be arduous for anyone, but even more so for Moulasi: she is also eight months' pregnant.

Her story is not an unusual one. In South Kivu, as in most of the rest of the vast Democratic Republic of Congo, paved roads are rare and health facilities are few and far between. For many people living outside cities and urban areas, it is normal to have to walk dozens of kilometres for access to even the most basic medical care. For us, meanwhile, transporting staff and supplies and referring patients is a challenge – the most feasible forms of transport are by motorbike or on foot. These challenges only grow during the rainy season, when trails that can normally be traversed by motorbike become rivers of mud, sometimes doubling the length of journeys that were already measured in days rather than hours.

South Kivu reportage: Numbi & Lulingu
MSF teams descend the High Plateau area on their way back from Numbi. Numbi is a small town located 2,000 metres above sea level, in one of the most remote areas of South Kivu province. All the provisions for the local community have to be carried on foot or delivered by motorbikes. During the rainy season, roads become impassable, even for off-road vehicles.
Marta Soszynska/MSF
South Kivu reportage: Numbi & Lulingu
The hospital centre supported by MSF serves the population of Lulingu and nearby villages. People often walk for hours to reach the hospital, but many delay the decision to seek medical care due to insecurity.
Marta Soszynska/MSF

The lack of infrastructure across South Kivu is not merely an inconvenience: it can have life-threatening consequences for patients like Moulasi. She suffered from complications during her previous pregnancies, and her doctor was adamant that this time she must give birth in the hospital.

But she is among the group of people – pregnant women and children – who are the least able to make the arduous journey and are therefore most at risk. With a population of close to 6 million people across South Kivu, this leaves many thousands of people vulnerable to disease and illness, and with almost no recourse to treatment.

South Kivu reportage: Numbi & Lulingu
Moulasi, 8 months' pregnant, had to walk for couple of days to reach the Lulingu hospital. She walked for 40 kilometres from her village Byangama. This is her ninth pregnancy, and she always had complications before so the doctor was adamant she needs to give birth in the hospital this time.
Marta Soszynska/MSF
South Kivu reportage: Numbi & Lulingu
18-year old Fatouma awaits delivery in the Lulingu hospital. It’s her first pregnancy. She is new and does not deny being nervous. As opposed to most of the women in this area, Fatouma was able to go to school for a couple of years and she understands French. But when fighting between armed groups became more frequent, all of the teachers fled, and the school stopped functioning. This is the reality for most of the children in the area today.
Marta Soszynska/MSF
Delivering without medical assistance poses risks to both the mother and the child’s health, but most women simply have no choice as the journey is too difficult to make by foot in their condition. Luz Linares, Field Coordinator in Lulingu

It is not only women and children who suffer as a result of the poor infrastructure in the region: many men caught up in the sporadic conflict that takes place in South Kivu require treatment for wounds sustained during clashes. These clashes also provoke displacement among the population, so that journeys to access healthcare become still longer, or leave people with no knowledge of where to seek treatment.

Moreover, diseases like malaria and cholera are endemic in the region, and can kill if left untreated. All of these factors combine to form a perfect storm for patients, who are exposed to high levels of risk from multiple sources and with few possibilities of accessing quick treatment.

South Kivu reportage: Numbi & Lulingu
This 18-year old man has been brought to the MSF hospital in Lulingu with a gunshot wound in his leg. He is a victim of recent fighting between armed groups. He says, still lying on the hospital stretcher, that armed men entered his house and then they left. It was his uncle who brought him to the hospital.
Marta Soszynska/MSF
South Kivu reportage: Numbi & Lulingu
Loabauma (left) was displaced 10 years ago from her village Ziralo to Numbi. She now hosts newly displaced families who arrived after the recent wave of fighting broke out in North Kivu. “We have little food and it’s very hard to share it, but it’s a fair thing to do. I haven’t forgotten how it feels to be displaced. These people need help.”
Marta Soszynska/MSF
South Kivu reportage: Numbi & Lulingu

We continue to treat all patients who manage to arrive at our health centres, while referring urgent cases to larger urban areas, taking on the transport costs. But without improvements in the most basic infrastructure, without paved roads and links to remote communities, vulnerable patients will be forced to continue making the long and hazardous journeys to access healthcare.

South Kivu reportage: Numbi & Lulingu
Most of the poor families in Numbi live in the area by the river with no sanitation and very little resources. Many of them have no land and barely earn enough money to feed their families.
Marta Soszynska/MSF
South Kivu reportage: Numbi & Lulingu
Eight-year old Severine (centre) with her mother and older sister in Lulingu hospital. She has been diagnosed with the most severe form of malaria: cerebral malaria, which can cause serious damage to the brain, especially for patients who, like Severine, arrived late for treatment. “She used to be the best student in her class, now she doesn’t understand anything. I don’t know what will become of her” says her mother. Severine has been receiving treatment but she will probably never recover from serious neurological damage that the disease caused to her brain.
Marta Soszynska/MSF
South Kivu reportage: Numbi & Lulingu
A health promoter directs the songs of 25 young mothers and pregnant women in a primary health centre in Tshonka, one hour drive from Lulingu. Many have had to walk for hours and will have to do it again when the time comes to give birth. These songs are part of the health promotion sessions that are vital for sharing nutrition messages and how to detect complications and anticipate them. Singing and dancing are used by local midwives to pass messages on healthy pregnancy practices and the importance of prenatal care. In a country without infrastructure, the distance to access care is calculated in days. And it can mean the difference between life and death for mothers and their babies.
Marta Soszynska/MSF

MSF has been working in South Kivu since 2007 to provide healthcare in the area, and our emergency teams are ready to respond throughout the province in the event of an epidemic, natural disaster or conflict.

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Interview 14 February 2019