Monday, March 26, 2007

Wounds of War in Congo

Hello again, this time from the town of Bukavu, on the far eastern side of the Democratic Republic of Congo, near the border with Rwanda.

It is staggeringly beautiful here - tropical forests, vibrant flowers and sparkling lakes. But this landscape is scarily deceptive.

The past week I’ve spent a lot of time listening to women and young girls - listening to stories, horrific stories, trying to fathom what they’ve experienced, and thinking about how we help them get what they need to rebuild their lives.

DRC is seething with the after-effects of a decade-long civil war - widely viewed as Africa ’s worst modern conflict - which claimed the lives of nearly four million people and displaced two million others.

In 2003, the country formed a transitional government, and just a few months ago, held its first democratic elections in 46 years. That was a big step, no doubt about it. But the outside world has generally viewed the elections as a much-awaited reason to turn away and move onto the long list of other pressing geopolitical concerns.

The fact is, in many ways the war here never ended. Violence is pervasive, and for the people of northern and eastern DRC in particular, elections and peace accords are largely window dressing. This area is overrun by rebel groups and militias who are terrorizing villagers and fighting for control of the country’s vast reserves of diamonds, gold and other resources.

If anything, the humanitarian crisis here is mounting. DRC’s health infrastructure has been destroyed, with more than a third of the population lacking access to even the most basic health care. What’s more, there is little electricity and few roads outside major cities. According to the Human Development Index, DRC, a country the size of Western Europe , ranks 167th out of 177 countries.

International Medical Corps began working in DRC’s most volatile region of North and South Kivu Province in 1999 and is the only international relief agency that has maintained a permanent presence here. We're supporting 59 health facilities and 19 nutrition centers, serving an overall population of about 330,000.

One of the biggest challenges is access; most routes consist of unpaved dirt roads covered in mud and boulders, and rife with enormous potholes. Navigating these roads at around 10 miles an hour means it takes a full day to reach any given village. We – and when I say “we”, I mean IMC’s Country Director, Birame Sarr , and his phenomenal staff - spent a good two hours a day digging ourselves and other trucks out of the mud, or trying to get our tires back on the planks of a hastily constructed bridge.

Security, obviously, is the other big problem. IMC’s local staff are in regular contact with the warring factions, who seem to appreciate the care we’re providing and have allowed us to continue without much incident. But things are unpredictable, to say the least.

To get a painfully vivid snapshot of what’s happening here, you need look no further than the women and young girls – girls as young as two. The Kivu provinces have produced some of the highest numbers of sexual violence victims in the world. You can literally see the trauma on their faces, and in their medical charts.

Their stories are appalling, and there is a sinister, sickening uniformity to the details of these stories, i.e. who the perpetrators are and the acts they’re committing.

Take one young woman named Bingi whom I met at a health facility IMC supports in the remote village of Chambucha . She told me she’s 17, although our staff members think she may actually be 15. This angelic-faced girl shyly described for me the night four months earlier when uniformed men with guns broke into her home. They beat her husband, took her to the woods, and raped her repeatedly over several days. She was eight months pregnant at the time. A month later, she delivered her child still-born.

Subsequent to the attack she has suffered a condition that has become a pernicious marker of the violence and absence of adequate pre- and post-natal health care in DRC: a severe gynecologic injury called fistula. Thousands upon thousands of Congolese women suffer from its devastating physical and emotional effects. There’s no polite way to describe fistula, a vaginal rupture that causes urine and feces to seep down the woman’s legs and that causes her to smell. As painful as it is and difficult to treat, women with fistulas doubly suffer from the stigma associated with it. They are often referred to with the pejorative “baqua,” Swahili for “rape”. They are frequently ostracized by their families and communities and many are forced to leave their homes. Even those who remain find it near impossible to perform the already back-breaking daily tasks of carrying 50- to 100-pound loads of water, food and supplies to their homes.

Bingi was comparatively fortunate: her husband has not cast her out, and she did not have to travel far for treatment. In fact, she is one of the first women to undergo fistula repair surgery at Chambucha, through an IMC-supported program that provides medical personnel and training on this complicated procedure, and then careful monitoring and follow-up. That was a huge step forward.

But most women in this sprawling region are forced to get themselves to Bukavu and a highly sophisticated facility called Panzi Hospital - the only one in the region with the ongoing surgical capacity to treat a condition as complex as fistula. The hospital is run by a heroic surgeon, Dr. Denis Mukwege, who recognized early that fistula cases in his homeland were skyrocketing, single-handedly took on the problem by training doctors around DRC to treat it, and has performed thousands of surgeries himself – including the one for Bingi in Chambucha.

Outside Panzi Hospital, I met legions of women and young girls, some from as far away as Rwanda and Burundi , who had come seeking medical help. Hundreds of them sit on long benches in an open-air “warehouse” and wait. And wait. And wait.

While the first 72 hours after a woman has been raped are critical toward treatment and prevention of sexually transmitted infection as well as fistula, many rape survivors are held captive for days, weeks, months. And those who are able to escape soon after their attacks either cannot access treatment quickly, or are too ashamed to do so. Most of the women I met outside Panzi Hospital were just such cases.

Thirty-year-old Jeanine told me that for two weeks she was held captive about 30 miles away, in South Kivu’s Kahuzi-Biega National Park , where rebel armies frequently hide. She was repeatedly raped by the four uniformed men who kidnapped her. She has a large gash on her forehead and cuts all over her arms from the beatings. Jeanine’s three children were also kidnapped. One has been found and is living with her sister; the others, she has no idea where they are. Jeanine arrived at Panzi two days ago and is now awaiting the results of an HIV test; she also has begun to experience crushing pain in her lower abdomen that may signal fistula.

She is hoping to see a doctor soon. Through a translator I ask if it’s at all helpful for her to be here with other women who’ve suffered similarly and be able to talk about their ordeals. She says, “No, we don’t talk about it.” That encapsulates much of the problem: stigma is so entrenched and it’s difficult to educate communities – men and women - on ending sexual and gender-based violence.

So in addition to treating these women’s physical wounds, IMC is helping to provide counseling, community education programs, as well as income-generating activities to help them get back on their feet, whether they return to their homes or not.

It’s impossible not to be overwhelmed by the medical and psychological needs across this region. And yet without us, it would be so much worse; those most vulnerable to the violence and lack of health care would have almost nowhere to turn. So we keep building medical facilities one brick at a time; providing food to malnourished children one cc at a time; delivering clean water one liter at a time; and helping plant vegetable gardens, one seed at a time.

There is no other way.

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