Working for hope

Dr. Likuela Beligo is taking a long, long time to think. After the uneasy laughing in the little room has died down, he rubbs his chin and stares hard at the sewing machine. Come to think of it... When was he and his colleagues last paid a salary?

In Kondima health centre, a mud-hut suburb of Kisangani, thick red dust has gathered atop the sewing machine and a nearby television set, deposited on a shelf in the director’s tiny office. These items, pawned years ago as payment for hospital treatment, are reminders, Dr. Beligo says, of "the days when we were living."

Today, even the health centre is barely alive: it has no safe water source, it last saw electric light three weeks ago and supply of drugs is running dangerously low. So too, is personnel morale - in direct relation to the question which for so long has distracted the good doctor. "Maybe in June 1998?" he suggests. Members of the senior staff agree: When the ousted president Mobutu gave way for Laurant Kabila in May 1997, the country was feverish with optimism of a return to a "proper life" of monthly salaries, paving the way for consumer goods and the vanity of taking a future for granted.

For almost a year, civil servants were actually paid their salaries – something they hadn’t experienced for a long, long time. But, during the summer of 1998, once again things fell apart. In August 1998 Kabila’s former allies, Rwanda and Uganda, turned on him, invaded the country and installed rebel groups fighting for Kabila’s downfall. Hardly anywhere in Congo has the devastation of dreams been more dramatic as in the jungle city of Kisangani, the country’s third largest. Internal fighting amongst the rebels and amongst their foreign masters has three times turned the city’s residential areas into killing fields. "And every time there is a war, soldiers come to the health centres and steal whatever we have left of drugs or equipment," says the doctor.

The Kondima health centre serves a population of 12,000, which has no other health service to turn to. Problems are enormous: malaria is endemic as is diarrhoea, respiratory infections and malnutrition. "We have lots of cases of typhoid and tuberculosis is rapidly increasing, as hardly anyone are being vaccinated," says the doctor.

No doubt about the need for the centre, as is witnessed by a steady flow of patients. But how does the staff survive, when they are not being paid? The doctor’s wife sells vegetables from their garden and her children make soap and sell the bars on the street. He himself teaches at the local university. There, teachers, like any other civil servants, are not paid salaries either, so the students are contributing financially to the teachers. In a similar way, patients at the health centre are paying a tiny fee for consultations and for drugs. Last month, the centre was able to divide US $150 amongst the centre’s staff of 16 members as an important morale booster.

This is where foreign aid plays a major role. After the first two "wars of Kisangani" in 1999 between the invading forces from Uganda and Rwanda, the local protestant churches Eglise du Christ au Congo (ECC), a member of the ACT alliance, launched a programme funded through an ACT appeal. For six months, from January to June 2000, it succeeded in renovating 10 centres, supplying them with basic examination equipment, mattresses, beds, and – most important – essential drugs for the most taxing diseases. The aid had a triple effect: it ensured that patients could be properly treated and secondly, it upgraded the centres. And, thirdly, as word spread, that the centres were better equipped with drugs and implements, the flow of patients increased adding to the tiny supplementary financial donation it could give its staff. "Help came at a very crucial time," says Robert Agidi, ECC programme coordinator, "because it really motivated the personnel. The outside help installed in them a feeling of working for a larger purpose, of having a certain perspective, of not being abandoned".

"Unfortunately, it ended in total devastation," he adds. On June 6, the Ugandan and Rwandan forces in Kisangani clashed for the third time, in what was to be the bloodiest of their confrontations. When their "war of six days" was over, more than a thousand civilians had been killed, seven thousand were severely wounded and thousands of houses was destroyed. Many health centres had lost in a few days of fury what had been painstakingly built up for months. Since then, the ECC has been unable to rebuild what was lost. "We feel abandoned by the world," says Agidi. "Nobody is helping us anymore. But it was not us who provoked the fighting or even took part. We are victims of a foreign aggression, and we have no way of ending it."

Today the need for helping the centres is greater than ever. "It is absolutely imperative to keep the existing health centres as functional as possible," says Sonja van Osch, mission chief for the Belgian doctors’ organisation Medicins Sans Frontiers (MSF) one of the few international health organisations which has persistently assisted the population of Congo. She estimates that the health of the Congolese has deteriorated so badly, that it is rapidly approaching the pre-industrial state: "Epidemics are rampant: Cholera, aids, measles, typhoid, tetanus, TB – conditions are ideal for the plague. Everywhere people are lacking drugs, most personnel are disillusioned, and in most places the population has not been vaccinated against life-threatening diseases for up to 20 years," she says. Luckily, "Congo is graced with a well-educated health staff, and up till now most of them have managed to keep up morale, in spite of immense difficulties. But if the personnel does not have anything with which to help the population, they themselves will start loosing faith, and then the last barrier will fall. We have to keep up the hope until the day when peace will return, and the health system can be reestablished".

In Kisangani itself, "a very large part of the population is physically sick and an even larger proportion has psychological problems" estimates ECC’s Dr. Beligo, explaining that "following the wars hundreds of families were split, they are not only worried for their health, but are lacking clothes, food and a home."

Outside the cities, where entire health zones are inaccessible due to ruined roads or war, conditions are even worse. There, "health conditions in upper Congo are probably just as bad now, as when Stanley arrived," says van Osch, referring to the explorer, who in the 1870’s was the first white man to travel through these tracts. Following a UN-sponsored peace treaty, Uganda and Rwanda have withdrawn their troops from Kisangani, and a 200 kilometer wide zone now separates them. Since then, calm and hope has returned to Kisangani.

Recently, ACT has appealed for urgent assistance to help ECC rebuilding the lives of the people of this "Martyr city of Congo," as it has become known. The main part of the appeal will be earmarked for 15 of the city’s health centres, in an attempt to stem the further slide of its population’s health towards inhuman conditions. And who knows: Maybe one day soon, a dusty sewing machine will be reclaimed, exchanged for cash for a hard strapped health centre – and returning to a family in peace, where it will be making new clothes in one of the thousands of needy homes in Kisangani.  

 Peter Tygesen is a Danish journalist currently working on a book on the crisis in D.R. Congo