Update: Reinou and Adam in the Congo

For more than two months views of verdant mountains cloaked in fog and clouds; women in brightly colored garb either squatting by the rutted road selling bananas, avocados and homemade charcoal or hauling large baskets of produce or firewood; and children in tattered clothes who approach and whisper “bonjour muzungu” (good morning in French and white-man in Swahili) were part of our morning walk to the hospital.

                                                                           Photo: Chiels Liu

Certainly the press often reports on atrocities by armies and rebel groups: attacks and rapes and killings; conflict minerals; malnutrition and extreme poverty - but for us, the town of Masisi, in the eastern Congolese province of North Kivu, was relatively quiet. It was far from Heart of Darkness, Joseph Conrad’s novel set in the Belgian Congo. Instead, Reinou and I concentrated on providing and improving surgical and emergency obstetrical care for the local population.

                                                 Photo: Chiels Liu

From the middle of February until the end of April we were in the Democratic Republic of Congo (DRC), the country once known as the Belgian Congo and for a brief time Zaire, as part of an ongoing Médecins Sans Frontières (MSF) mission. (For those who may not be aware, MSF is the French name for the group, Doctors Without Borders).  An emergency mission began in 2007 during the height of the conflict and now with improved security and relative stability has transitioned into a long-term development program. MSF provides support to the Masisi General Referral Hospital, a 170 bed facility; the local health center; several surrounding health-posts; and conducts mobile clinics; all with the aim of improving the health of the local population.

                                                  Photo: Chiels Liu

As most of you know, I have been involved in this type of work for about 7 years; however, this was my first mission with MSF. When Reinou and I planned a joint mission (she was there to assist with obstetrical emergencies) we initially envisioned working in a hospital where we would do everything. Much to our delight, the emphasis of this program was on training the local staff and improving their capacity to provide care – something that is often more difficult, but which we felt very comfortable providing – basically the Surgeons OverSeas (SOS) model.

                                                                              Photo: Chiels Liu

The hospital is relatively nice by African standards: 2 operating rooms, an emergency room, a dressing room for minor wounds, and separate wards for pediatrics, internal medicine, surgery and obstetrics/gynecology. A small 3 bed “intensive care unit,” is where we sent the sickest patients, but with no ventilators and only limited specialty medications, the term “intensive” might be a bit grandiose. The surgical ward consisted of 35 beds and Dr. Jean-Paul, the Congolese doctor assigned to surgery really did a great job. My role was to assist him to independently perform emergency surgical procedures often seen at a district hospital in Africa.

                                                                           Photo: Nick Czernkovich

Luckily, the patients did a great job of complying. We had cases of perforations from duodenal ulcers and typhoid; obstructions from tumors, intussusception, Ascaris (worms), incarcerated inguinal hernias and a femoral Richter’s hernia; psoas abcesses and liver abscesses and a whole host of other abscesses that needed drainage. We had our share of trauma, although not as much as I would have hoped for (but I guess that’s better for the population so I won’t complain). A few of the highlights included: one patient with a high velocity gunshot wound through his stomach and large intestine, one with facial lacerations from a gorilla attack, another with a machete to the abdomen, and I was able to repair the tendons of a guy who walked 15 hours after having his forearm almost fully severed with a machete - through both bones - luckily he was able to leave the hospital moving all of his fingers. We also treated numerous children who were shot, burned or had tumors. We casted some broken bones and put other patients in traction; and one day we had 11 gunshot wound victims, many of whom needed treatment in the operating room.

                                                                      Photo: Nick Czernkovich

Reinou was kept busy working the Dr. Janine, the Congolese doctor responsible for obstetrics and gynecology. Together they dealt with difficult deliveries, resuscitated sick newborns and provided gynecologic consultations in the 50 bed maternity ward. As giving birth to many children (often 10 or more) was as popular as in Niger, she saw similar complications including: obstructed labor, ruptured uteruses, pre-eclampsia and a number of stillborn fetuses. Luckily no mothers died, in part due to a maternity waiting home where high risk women in their last month of pregnancy could stay until they delivered. The local doctors are very capable of independently performing caesarean sections and so she only had to help out occasionally; and therefore we could mostly sleep through the nights.

                                                                   Photo: Nick Czernkovich

As in most African hospitals, despite the severe limitations, the staff was wonderful and very capable of providing quality care. MSF has done an excellent job of proving material and salary support to the hospital and without such additions care would be much worse. As always it was amazing to realize what you don’t need to be able to still provide safe and appropriate care. We did not have x-rays and often there was no blood for transfusions, but there was an ultrasound machine and Reinou was able to image some abdominal tumors in addition to scanning pregnant women.

                                                                Photo: Chiels Liu

As for our living conditions, they were very basic but relatively comfortable; though austere might be a better term. There was warm water for bucket showers and a squat outhouse isn’t so bad once you get used to it. There was a cook who is fairly accomplished with western dishes so we didn’t lack in that respect. There are no mosquitoes being at an elevation of 3500 ft (1200 m) and the weather was comfortable with occasional tropical downpours, and not too hot. The MSF team was relatively large, averaging 15 expats including logisticians, administrators, doctors, nurses, a midwife and a pharmacist.

                                                                                      Photo: Chiels Liu

Reinou and I hope that all of you are well and as we will be back in Amersfoort, NL in May invite those of you who might want to visit. As for the next adventure, Reinou will be working in a real Intensive Care Unit in the Netherlands for 4 months starting in mid-May and for me, who knows.

Best to all,

Reinou and Adam