Posts from — November 2009

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Congo Chronicles October 2008 -

Fishing boats at dusk, Lake Kivu, Democratic Republic of Congo

Standing in the middle of a battalion of Chinese soldiers on line at the Rwandan side of the Congolese border, apprehension tickles my belly as I contemplate the active end of the assault rifle resting over the shoulder in front of mine. Sent by Harvard Humanitarian Initiative to work at Panzi Hospital in Bukavu in the conflict-rife Eastern region of the Democratic Republic of Congo, I will myself to stay the course, thus far entailing 17 hours of flight time followed by a 5 hour ride from the airport in neighboring Kigali, Rwanda to the bordercrossings at which I now stand. Everywhere, dozens of troops in fatigues murmur in Chinese dialect.  Chuckling amongst themselves, exchanging cigarettes and places in line, their smug presence is a mystery that remains unsolved for the entirety of my time in this place.   Panic flirts all the way to the front window, with cultural disorientation and unrelenting challenges to personal space my only refuge.  New York-ing my way to the front of the line, the Rwandan customs officer brusquely dispenses me to the second half of this crossing, a 50 yard taxi ride over one rickety foot bridge overstuffed with  heavily burdened pedestrians crossing back and forth between Rwanda and the Democratic Republic of Congo (DRC). 

The road serves as sidewalk to an endless two-way stream of humanity afoot under bundles and burdens of all shapes and sizes- huge bags of mangoes, towering stalks of bananas, all manner of wood, hand pulled carts loaded with stones, school children with books, almost all of which is transported by head – for instance ten 14 foot long stripped sapling trees balanced on the head of a 12 year old, each end extended 7 feet beyond and behind his wafer thin frame. There is no time to contemplate the skill and grace required to maneuver such cargo through a packed crowd of fellow travelers, so distracting is my passenger’s view of the incessant near-contact between the car I’m in and pedestrians passing inches away on all sides- left, right, front and behind.

Safely over the footbridge,  piercing cries outside my car window, rivet my gaze to the sight of a Congolese policewoman smacking away at the face of a local peddler, on whose head perches a bundle of mangoes, again and again and again.  Gun waving in her other hand, the officer smirks at her victim’s unsuccessful attempts to alleviate her wrath.  No one dares help, the stream of burdens and bodies barely stopping to glance her way as she stumbles under the blows.  I cannot breath, cannot look away, cannot speak as she falls to her knees. My car pulls up another 5 yards where the scene disappears as quickly as it came, stopping in front of the muddy wood-framed Congolese customs house- part two of the border crossing.    Following the driver, the dim-lit dirt floored room harbors a table covered with filthy, crumpled Congolese currency being counted by a woman barely visible behind the shoulder-high pile of cash.  Hustled into a back room, my visa and letter of introduction to Panzi Hospital is scrutinized and stamped with flourish, and I am back in the car for another 5 yard ride to the “gate”.  Said gate, a comical 4 feet wide in the middle of an enormous road, is manned by two plainclothes guards, both of whom argue ferociously with the driver as he adeptly negotiates  the impromptu “gate fee”. 

On the short drive to Panzi Hospital, the driver shows me the sites of Bukavu, situated on a five-fingered peninsula jutting into Gran Lac.  Bukavu’s history as boating resort to the colonialist Dutch is difficult to envision as we bob in and out of endless unpaved, deeply rutted roads the color of Tennessee red clay and trundle through enclave upon enclave of wooden shack houses.. Passing an enormous, prison –looking building replete with window bars, I am informed that it is neither prison nor an armory, but rather a bank, a bank without money.  The treasury printing presses, I am told, were destroyed by rebel forces some years ago, and with no new money and no bank security, the bank, open for business, has no business to tend to. This tidbit fails to surprise me, as if all taking place on the other side of a looking glass.  Fifteen minutes on the other side of this glass is all that’s necessary to comprehend the difficulty of everything in the Democratic Republic of Congo.  

All the way to the hospital gate, dozens of mobile phone kiosks spill over with customers between stretches of boarded up shops.  Most commerce takes place roadside, merchandise displayed in neat rows on open sheets of cloth, tarp and plastic.  We dive headlong, no horn, no braking, into endless rivers of pedestrians battling bravely with the occasional private car, overstuffed commuter van or diesel transport truck for the prized sections of flat road. Monty the taxi driver, speaking just enough English to compensate for my utter lack of French or Swahili, barrels inscrutably through the crowds on his mission to deliver the Mzungu (Swahili for white) doctor to her destination. The 5 hour drive from Kigali to the border pales in comparison to the bravado and driving dexterity with which the driver, talking non-stop, wends his way to the hospital itself, where I am to spend the night before beginning the next week’s work. 

Panzi Hospital,  Democratic Republic of Congo, South Kivu

The low, flat buildings of the hospital grounds are a well kept, and tranquil oasis, reminiscent of an empty church on a hot Saturday afternoon, that sudden, soothing presence of something bigger than yourself.  Within the fenced-in hospital campus the generic tenor of suffering is buffered with solace and hope.  Various people live on the grounds, workers and patients.  Female patients with live “in the back”, down a hill in a wooded area of encampment.  There is a large, covered hangar style room with tables.  The women’s clothing is hung on branches and rock piles to dry after laundering.  These are the fistula women and the female war victims. 

Women living on the grounds of Panzi Hospital

My colleague, Dr. Julia Van Rooyen, is gathering gender-based violence data on these victims de guerre as part of her fellowship with Harvard Humanitarian Initiative and it is she who sent me here, to help with the surgical overload created by decades of political chaos and the current brutalization of the populace by competing rebel forces.  In the clinic, the women with childbirth fistula carry medical booklets labeled “VVF” for vesicovaginal fistula, and those of the women with rape-induced fistula are labeled “PTG” for post-trauma de guerre.

VVS = Fistula due to obstructed labor – PTG = Fistula due to rape trauma

Next morning, I am introduced to my colleague Dr. JeanBaptiste Yunga, a relentless, wiry thin surgeon with impeccable skills and compassionate work ethic to match. This place, perpetually short on supplies, is run as efficiently as any military operation. Sutures that are used for one knot in the States are used to close an entire incision here. The Panzi Hospital turn-over time between cases is minutes – back home, halves of hours, often more than one, are spent waiting for the lumbering paperwork beauracracy to move the patient from waiting area to operating room and then finally to rest on the operating table.  Here there is no such thing as informed consent – just patients who want to be dry, want to be normal, want to go home again, trusting the doctors and staff to make it happen for them.  We operate – fistula upon fistula, story upon story, one blending into the next til the surgical technician declares the list finished, the day over, and it’s time to go home. And you wonder, you hope, you imagine, that you made a difference, even the tiniest dent, in this tsunami of suffering.

 Dr. JeanBaptiste de Yunga, center, and the Panzi Hospital OR team

 Welcome to DR Congo.  This central African country is the former Zaire and the current site of extensive, complicated rebel activity, Interhamwe, Mai Mai, and interminable political gang rivalry, that predate my arrival by many years, all of it brutal. Beyond imagination- men, women, and children routinely suffer the most heinous of atrocities for reasons that seem to have only one common underpinning- utter chaos makes for more profitable rape of the land itself- a legacy harking back to the Belgian colonialists. With avocadoes, bananas, and mangoes dripping year-round from every tree, Democratic Republic of Congo is truly The Garden of Eden meets Hell on Earth. 

 Apparently, the rebel forces, and there are several in this unclean fight- residual ex-pat Rwandan rebels known as the Interhamwe, Congolese in-fighting between fractious camps with presidential aspirations, and skirmishes triggered by global industries devoted to demineralizing the landscape for obscene profit margins, are particularly fond of the weapons available under the umbrella we call “sexual trauma’.  Women, men, children, raped, mutilated, held captive for months, some for years, “tending” to the rebel camps in slavery, subjected to physical and psychological carnage that would make Caligula pause. 

The stories terrify.

Women made to cut out the unborn baby of a live village-mate, leaving the mother to die as they are forced to cook, and then eat, said baby while the rebels taunted and beat them- parents made to watch as their children’s fingers were cut off, knuckle by knuckle, bleeding to death slowly, eviscerated at the last minute, dogs attacking the fresh intestines, as the parents were hauled into the bush to serve the rebels for months before they escaped with only their unimaginable story to show for it.  And rape, all sorts of rape, if you can imagine it, it’s been done to these people, and by people I mean everyone – the sexual mutilation is not restricted to women. My third morning, as I inhale a mandatory morning coffee and hover over a precious few minutes access to the unreliable internet, a query unlike any other interrupts my focus: “When a man’s penis is cut off, does that make him stutter?”  Distracted, I lift my gaze to meet the wide-eyed Brandi Walker,   red-headed, cracker jack American administrative coordinator. Hailing from the backwoods of Georgia with masters degrees in English and Public Health and a fierce devotion to the women of Eastern DRC- I ask her to repeat, and so she does.  “You know, if man’s penis is cut off, can it mess with his voice?  Make him stutter?  Can it affect the coordination of his tongue, make it hard to form words? A local man just burst into Dr. Mukwege’s office – he’s been walking for days, escaped from the Interhamwe.  They cut off his penis.  He couldn’t get his words out. He was shaking all over and no one could understand him.  So I was wondering, is there a connection?”  Apparently, male dismemberment is one of the latest trends of these self-proclaimed warriors, and I am told that most of those who do not perish immediately from the mutilation go on to commit suicide.

But I am not there to re-fashion dismembered penises, I am there to fix fistulas.  Childbirth fistula, the bain of women since time began, is a hole, an abnormal connection caused by a wearing away of skin and connective tissue that separates the bladder from the vagina (vesico-vaginal fistula) or between the rectum and vagina (rectovaginal fistula). 

Fistula due to obstructed labor in childbirth was a problem of Europe and North America too, until the advent safe anesthesia in the late 1800’s and the discovery of penicillin in the 1940’s turned cesarean section from a last ditch effort to save a baby from the belly of a dead mother into a routine procedure, single-handedly plummeting maternal mortality and obstructed labor-related vaginal fistula rates to near-zero.  New York City was host to the world’s first Fistula Hospital, located on the site of the Waldorf Astoria on Park Avenue until it was rendered obsolete by the advent of modern obstetrical practices.

In many poor nations lacking in civil infrastructure and modern medical care, the likelihood of dying as a result of pregnancy is no different than it was in 1800, as high as 1 in 7 pregnancies.  In Europe, North America and other wealthy regions with double-digit cesarean section rates, this child-bearing related death rate is 1:400,000 – an obscene difference beautifully exposed  by Dr. Lewis Wall, Director of the Division of Urogynecology and Reconstructive Pelvic Surgery at the Washington University School of Medicine in St. Louis, MO and Founder of the WorldWide Fistula Fund.  It’s simple, really.  In our natural state, babies tend to get stuck in labor, such mothers may die, stuck babies die, and women who don’t die from such labors where the baby is, literally, “stuck” in the soft-tissues of the vagina for days on end, survive the nightmare only to birth a dead baby and find themselves constantly leaking urine, feces, or both through the vaginal fistula holes located where normal healthy vaginal tissues used to be. 

A lucky, 18 year old fistula mother – her fistula was reparable and her baby survived.

A history professor once impressed me with the fact that resistance always starts in the lap of oppression, where to my naive mind it made the least sense.  I thought that the people in the safest areas with the most resources should recognize exploitation and iniquity in whatever form – slavery, racism, corporate corruption, caste systems, child prostitution, whatever – reaching out from their positions of privilege and strength to end the suffering of those less fortunate.  To  understand why the Civil Rights movement started in the deep South, why Toussaint L’Ouverture battled decade upon decade until the people of Haiti were freed to create the first black Republic in the Western Hemisphere, and years later, why the Berlin Wall had to come down from the inside out, not the outside in, remains one of the highlights of my formal education.  

And no less inclined to seek its own solution is this place, where the rebels are the oppressors and the indifferent are the government leaders of Congo, neighboring Rwanda and the world-at-large. This seed of resistance comes in the form of Dr. Denis Mukwege, a Shaquille O’Neal-sized son of the Congo, born in Bukavu, a few miles from this hospital in Panzi.

Dr Denis Mukwege  www.panzihospitalbukavu.org

Standing like an elm tree in a hurricaine, Dr. Mukwege , champion of his people, holds fast to his boyhood home with its memories of water skiing and international visitors coming to the lakeside resort that Bukavu used to be.  Now, the post office is inhabited by feral chickens and homeless families and his boyhood school sits abandoned on the point of a cliff overlooking stunning, and empty, Lake Kivu. 

I’ve worked in other fistula repair centers, but this is different.  Yes, as in other fistula-prone places, there are women from villages who speak their native tongue only, no French, no English, no reading, no knowledge of anatomy, no clue that the fistula is not their fault and not the results of evil spells.  But here in Bukavu, where all manner of NGO (non-governmental organizations) and UN Peacekeeping Forces cruise around in LandRovers and the unpaved roads turn to torrential rivers of mud during the daily downpours of the 9-month rainy season, the burden of conducting normal daily functions requires a resilience and fortitude that I’ve encountered in no other place.  If you can make it happen in DR Congo, you can make it happen anywhere.  Sorry, Frank, but this place makes Niger look palatial, and compared to New York?  Fuggedhaboudit.