Episode: "The Conflict"

Searching for Cachexia in the Congolese Bush

In this episode, we follow logistician Peter Rietveld and nurse Maria Kantilli on an exploratory mission to Lolongolokonga, a remote area of the Democratic Republic of Congo (DRC) referred to by locals as “the land of the living skeletons.” The region has seen almost no outside visitors in the last 16 years, but the few people who have been to Lolongolokonga have reported a large population of severely emaciated inhabitants – the “living skeletons” in question.

In MSF exploratory missions, the main goal is not to provide immediate medical care. Peter and Maria have been assigned to locate the emaciated people, investigate the cause of their physical state, and determine whether it is a problem that MSF can and should address with an expanded presence in the region.

MSF’s assumption is that the people are probably suffering from a condition known as cachexia. Cachexia is a wasting syndrome directly resulting from chronic malnutrition, which leads over time to a complete lack of muscle-mass. The chronic malnutrition, however, can result from a number of factors – factors that MSF would clearly want to address with any medical intervention that might result from Peter and Maria’s research.

On their exploratory mission, Peter and Maria find many skinny people, but none of the diseases – HIV/AIDS, tuberculosis, sleeping sickness – that would explain a large concentration of people with the condition.

The Bigger Picture: Three Years of War and Neglect

The bleak portrait of life in the Lolongolokonga region that we witness in this episode is not an exception to the rule in the rural territories of the DRC. It is the rule.

Years of war in the Democratic Republic of Congo (DRC) have led to one of the most devastating human crises of our era, with millions of deaths and displacements of people linked directly or indirectly to the ongoing conflict. (Read civilian testimonies collected by MSF in the DRC)

Despite a series of peace talks aimed at ending the fighting, conditions have continued to deteriorate for much of the civilian population. Millions have been forced from their homes by violence: around 2.3 million inside the country and nearly 350,000 in neighboring countries. Since 1998, organizations such as the International Rescue Committee have estimated that the deaths of more than 3.5 million Congolese can be attributed to the conflict – a toll on human life comparable to that of World War II for the United States, the United Kingdom, Japan, and Italy combined.

In recent months, fighting has flared up in the Ituri region, close to the provincial capital of Bunia, following the withdrawal of Ugandan troops from the area under the terms of the latest attempt at peace. Roughly 500 people were killed in the month of May, according to UN estimates, and tens of thousands others, the vast majority civilians, were forced to flee their homes.

Buffeted by waves of violence for years on end, the country’s infrastructure has effectively collapsed. People living in rural areas like the Yahuma region, where Lolongolokonga is located, are seriously affected by combat throughout the country whether or not they experience direct violence on a frequent basis. They are isolated from food and health care, while nearby armed groups demand taxes of food and recruit civilians for forced labor.

Project Update: Escalating Aid to the Most Isolated

After this episode was filmed, lab samples from patients identified by Peter and Maria were tested at the local MSF headquarters. Although no one disease seems to be the cause of the cachexia found in Lolongolokonga, the results of the tests were telling. Out of six patients with the cachexic syndrome, all six had malaria, Loa Loa, and River Blindness (both parasitic diseases caused by intradermal worms). All six also suffered from different types of intestinal parasites.

Perhaps most revealing, all six had similar stories to tell about their lives. They were orphans, or children of parents who were too sick to work or who had been crippled by violence and disease – social factors that, from an early age, would have made it even harder for them to find enough to eat.

Based on these results, Peter and Maria were able to reach a conclusion. The emaciation found in Lolongolokonga was affecting people whose exposure to disease and parasitic infection was compounded by their position at the bottom of the social ladder in their communities. In an isolated community suffering the effects of prolonged war, there are many such people, who lack a support structure of family and friends to feed them and take care of them.

In response to the needs Peter and Maria discovered, MSF made good on Peter’s promise to “come back” to Lolongolokonga. Later in 2002, MSF set up a medical base in the Yohuma region, and a monthly mobile clinic visits the surrounding isolated jungle communities by motorcycle offering treatment for malaria, river blindness and other diseases common to the area.

In addition, a new therapeutic feeding center provides nutritional care for the region’s malnourished inhabitants, recently benefiting from a donation of 600 kilograms of seeds (rice, beans, corn, soya, etc.), agricultural tools, kitchen utensils, and 1500 blankets from humanitarian agencies UNICEF and Caritas.