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
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
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
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.