February 17, 2011

DRC 2010 © JP Amigo / MSF

The MSF mobile clinic team working to reach people whose access to medical care has been proscribed by pervasive fighting in eastern DRC.

Tom de Kok’s first field mission for Doctors Without Borders/Médecins San Frontières (MSF) was in Pakistan after the earthquake there in 2005. He has since worked for MSF in Darfur and Iraq and has completed two field missions in the Democratic Republic of Congo.

He recently returned from serving as a project coordinator in North Kivu, in eastern DRC, where violent conflict persists between government forces and an array of military groups. Around the town of Pinga, the frontlines between different armed actors constantly shift, trapping local people in the middle. Displaced from their villages by the fighting, they often hide in makeshift shelters in the forest, unsure of where the next danger will come from and cut off from all medical care.

“I met people whose villages had been burnt to the ground by one military group or another,” de Kok says. “They had run into the bush and were living with trees over the top of them and no mosquito nets. The malaria – I’d never seen anything like it.”

For some people in the area, even travelling to town for provisions as basic as salt is too dangerous, as they run the risk of robbery, extortion and harassment. “In one village I came across, people had no salt,” recalls de Kok. “We’re a medical organization, but we can still barely imagine that people are desperate to get salt.”

Huge Health Needs

In such an insecure and unstable environment, where many lack the most basic of necessities, people’s health needs are huge. Despite the enormous challenges of working in a conflict zone, across shifting frontlines, MSF is running a therapeutic feeding center for malnourished children in Pinga, supporting two health centers in the surrounding area, and carrying out mobile clinics on motorbikes. MSF staff in Pinga carried out a total of 40,000 consultations in 2010.

“Most people, even old people, don’t know what it’s like to live without conflict,” says de Kok. “It has always been part of daily life. But still, the people who live in Pinga town have a far different experience from somebody who lives just five kilometers [three miles] away, on the other side of the frontline. Whole villages are often burnt to the ground by non-government militias to deter nearby government forces from advancing and occupying them. When this happens, the villagers are forced to hide in the forest in makeshift shelters, without mosquito nets.”

It is no surprise that in the hot, rainy, densely forested hills around Pinga, malaria is endemic. In 2010, the team in Pinga treated more than 6,500 cases. Children with malaria are particularly likely to have life-threatening complications, but getting these children to a doctor in town is far from straightforward.

Crossing the Frontline

To get medical care or reach the hospital in Pinga, de Kok says, villagers “have to cross frontlines and land controlled by different military groups.” It is anything but an easy journey, he adds. “They are accused by all sides of being sympathizers. If they follow the main road they’ll run into checkpoints. And if they take a back road through the woods, they’re going to run into the military, either government or non-government forces. And then they’ll be forced to explain why they’re travelling on the back road, and it will look even more suspicious.

“When there’s all-out fighting, the military suspects everybody,” he continues. “These are serious cases. These are parents with a dying infant who has got malaria, maybe, with anemic complications. They’ll move, they’ll get harassed, they’ll turn around [and go back], and the result is their child won’t make it.”

Mobile Clinic by Motorbike

With so many people unable to reach a doctor, MSF’s mobile teams are crossing the frontlines themselves, travelling on motorbikes into the bush to find the sick and traumatized people so desperately in need of help. “Road conditions are horrible,” says de Kok. “We do our mobile clinics with motorcycle convoys because cars can’t go there.”

For many patients, on-the-spot treatment is not enough, and they need to be transferred to the nearest hospital, which may require crossing two frontlines and territory controlled by three different warring groups. In these cases, says de Kok, “the endeavor of trying to transfer a patient is about as lifesaving as the medical care itself. We cannot just transport sick patients on motorbikes for hours over rough terrain. Children cannot hold on. Neither can pregnant women. We fill out a referral form and try to get them to meet us at the checkpoint so we can cross together with them. We tell the armed men at checkpoints the names of those patients who will attempt to cross that day, and we tell them we will follow up on these people. But, still, some never arrive at our clinics on the other side of the frontline.” MSF teams are trying to find ways around these difficulties.

Treating Rape Survivors

MSF also provides specialized medical care to women and girls who have been raped. Treatment includes post-exposure prophylaxis, which can help protect against the HIV virus and other sexually transmitted infections. Sexual violence is a terrible part of the war in eastern Congo that is perpetrated by military groups on all sides of the conflict. Many women are afraid to seek treatment because they fear being stigmatized by their families or enduring further harassment, or even attacks, when attempting to cross military checkpoints in search of medical care. In 2010, the team provided specialized medical care to more than 200 women and girls who managed to reach MSF’s clinics against all the odds.

Maternal Healthcare

Providing maternal healthcare is another major priority, as women living in the bush who suffer complications during pregnancy and childbirth have no access to doctors or trained midwives. In and around Pinga in 2010, MSF carried out 4,000 antenatal consultations and 65 babies were delivered within an MSF facility.

MSF’s Added Value

Despite the difficulties of travelling by motorbike on muddy jungle tracks, being held up at checkpoints, negotiating access across frontlines, and having to deal with various armed groups, MSF is accustomed to working in these conditions. “Our reputation on the ground is better than good,” says de Kok. “We’ve got the maximum amount of space you could have under these difficult circumstances. We are still reaching people in need and our work is respected across the lines.”

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