MSF nurse Alice Echumbe describes her experiences as supervisor at MSF's Jamaa Letu family health center.
DRC 2011 © Claudia Blume/MSF
Baraka, South Kivu, Democratic Republic of Congo (DRC)—In South Kivu, in the eastern part of the Democratic Republic of Congo (DRC), Doctors Without Borders/Médecins Sans Frontières (MSF) runs a hospital in the town of Baraka and three other health centers. These facilities provide primary and specialized services, including nutrition, reproductive health care, testing and treatment of HIV/AIDS and tuberculosis (TB). Last spring, nurse Alice Echumbe was appointed to open and run an MSF family health center called the Jamaa Letu.
I am the supervisor of the Jamaa Letu center, which in Swahili means "Our family." MSF opened this center in May 2011 to offer additional community services, especially to pregnant women who need to be close to the hospital just before birth to avoid a long travel from their villages. The center also welcomes patients who want a more private and confidential setting for their consultations in family planning, voluntary HIV/AIDS testing (especially for pregnant women), treatment of sexually transmitted diseases, and treatment for survivors of sexual violence. These survivors are not only women but [also] men and even children, some of them less than five years old.
I am a nurse by training and have worked for MSF since 2009, previously at MSF’s Baraka Hospital. I have done outreach work with mobile health teams, travelling to remote villages to raise awareness about health issues such as cholera, malnutrition, and TB. What our teams notice in the villages is that people often go to traditional healers when they are sick—for example if a child has malaria, one of the most common illnesses. But traditional medicine can sometimes lead to serious complications and can put patients at risk of dying, especially if they cannot get to a hospital in time. So we explain to the community and to traditional healers to recognize when it is necessary to seek help and send their patients to a health center. We also try to convince pregnant women to go to the rural health center or a hospital to give birth because those places have a skilled birth attendant, equipment, and drugs.
Another part of MSF’s outreach work is to organize consultations and treatment for survivors of sexual violence. At our mobile clinics, we often meet rape victims. The worst case was when we did a mobile clinic in June and there were more than 100 victims of sexual violence. Rapes often happen when people walk from their village to the market, or when they are on their way back. Armed men stop the villagers and separate them into groups—men, women, young girls. They steal their belongings and divide the women and girls between them. “I like this one, you can have that one,” they often say. Even the men and boys sometimes get raped.
When we hear about acts of sexual violence we contact the community and let them know how important it is to get medical and psychosocial help. We tell them we offer the morning-after pill, for example, treatment of sexually transmitted diseases, vaccination against hepatitis, and referrals to counselling services. Many survivors come to the rural health centers to seek medical treatment and psychosocial support. Husbands in the Congo often leave their wives when they learn that they have been raped. For this reason, survivors of sexual violence are reluctant to reach out for help. To avoid stigmatization, women can go to an MSF-supported rural health clinic or hospital where they can talk to staff behind closed doors, without other people knowing why they have come. This is one of the reasons why MSF set up the Jamaa Letu center, which offers more privacy for patients, away from the main hospital in Baraka.
I cannot be too emotional when I talk to patients who have been raped, because when I am discouraged, they become discouraged, too. But after I come back from a mobile clinic, at night, the stories I have heard during the day come back to haunt me. Sometimes I am scared, especially when I am travelling, but I try to remain strong. And when I arrive somewhere I simply get down to work. MSF has in the past sent psychologists from its office to support my colleagues and myself, and that has really helped me a lot.