Sunday, May 18, 2008

Hidden Epidemic in Democratic Republic of Congo

Hi, all.

It’s been a year since I was last here in eastern Democratic Republic of Congo. Anyone who’s heard me talk about DRC knows how much I love this place, the intensity of the landscape and the people, their generosity and strength.

They certainly need that strength.

The sad truth is that violent conflict is still raging, particularly in the North Kivu Province, where government forces (called the FARDC) and the various rebel groups (like the predominantly Rwandan FDLR, CNDP forces, and the Mai-Mai) are constantly going at each other. Civilians, as always, are caught in the middle.

Over the summer, the conflict intensified in North Kivu, forcing hundreds of thousands from their homes. And despite a ceasefire reached in January, the region remains chronically unstable. Since late 2006, an estimated 850,000 have been displaced in this province alone, and that number is expected to increase in the coming months as the FARDC attempts to retake areas held by the FDLR.

Much has been said and written about the epidemic of sexual violence perpetrated against women and children. Frankly, no amount of words is enough. But there is another epidemic here that has not captured the spotlight: during the 1998-2003 war, and the resulting humanitarian catastrophe, most of the estimated 5.4 million deaths have come from hunger and disease. The most vulnerable are the children.

That’s where an 18-month-old boy named Ivote (pronounced EE-vote), comes in. He was named in honor of DRC’s historic elections in late 2006. He very nearly didn’t make it to his first birthday.

Last October, Ivote’s parents and his three brothers fled from their village near Masisi, where some of the worst fighting has taken place. Already, two of his siblings had been killed.

For months, Ivote had been suffering from diarrhea and malnutrition. No doctor or traditional healer was able to help him. By the time he and his family had made the 40-mile journey south to Mugunga displacement camp, outside Goma, he was near death – a skeletal child who could not stand, could scarcely speak, and his limbs frozen stiff. At the age of 11 months, he weighed just over two pounds.

His mother, Sophia, tells me she had lost all hope that he would live.

International Medical Corps is running primary health care clinics and supplementary feeding centers in Mugunga and other nearby camps, serving more than 300,000 people. IMC immediately transferred Ivote to Virunga Hospital in Goma, where we treat about 100 new cases of severely malnourished children a month.

Ivote suffered from a type of severe malnutrition called marasmus. Most of us are familiar with what this looks like from the images that emerge during famine: shockingly skeletal children, who are weak and cry unconsolably. Children with marasmus are literally starving and can’t possibly be fulfilled by any amount of food; they finish and want more and more. But if they’re allowed to eat all they want, they can overdose and vomit from the excess food in their stomachs. So the amount of food they eat has to be calculated carefully and meted out in three-hour intervals.

Marasmus is actually relatively uncommon in North Kivu. Ninety percent of children here suffer from what’s called kwashiorkor (kwash for short). With kwash, the baby is bloated, with fat feet and cracked skin. In the most severe cases, the skin bursts and the child is covered in large swaths of bloody sores. Babies look like burn victims. It is wrenching. The difference with kwash is the children don’t want to eat; it’s difficult for them to eat. Here in North Kivu, families often must flee fighting and hide in the bush. They go many days without food or with only protein-deficient food like cassava that causes children’s bodies to bloat with water. By the time they reach the camps, they have stopped eating entirely.

The vast majority of the children we’re treating at Virunga Hospital have come from the camps, where they are identified by IMC for more intensive treatment. When they arrive, they often suffer from other complications, like diarrhea, anemia and respiratory infection, which must be treated immediately so that they can better recover from the malnutrition.

The children and moms – often the siblings as well, who can’t be left alone in the camps – move into the center, where they are clothed and fed a diverse diet, including maize flour, beans, oil and salt.

IMC’s recovery rate at Virunga Hospital is 95 percent. For most children, recovery time – if they suffer from no other maladies – takes around five weeks, after which they are discharged back to the camps and are monitored at IMC’s supplemental feeding centers.

For Ivote, recovery took two months. Today, his chubby cheeks and bright eyes make him unrecognizable as the same child in the photos when he arrived. He toddles around the hospital grounds like a typical 18-month-old. Upon recovery, he weighed 14 pounds.

As I’m leaving the center, the IMC van arrives with a new batch of severely malnourished children. A father, seeing me taking pictures, hoists his feeble daughter up to his shoulder and asks me to take hers. Her legs are covered in cracked, bloated skin. Her right eye is sealed shut from conjunctivitis. It is heartbreaking to look at her – and her father’s anguish at her condition.

The only consolation I can find is that in all likelihood, in a month’s time, she, like the scores of other children here, will be fully recovered and headed back to her home in the camp. That is my hope.

**Note: The photos of Ivote and some of the other severely malnourished children are graphic and difficult to look at. Many of you might not wish to see them pop up in my blog gallery so I chose not to include them. But I’m happy to email them to any of you who are interested.


kerry said...

It's 2008 and we are one world. What's going down in Africa should not be happening. I wish more people knew about IMC and the amazing work they do. Can you leave a link to the photos on your blog?

Marge said...

Hey, Ker.

My first-ever comment! Thanks!

Absolutely. I'll be leaving up the pics, which you can click on to go to the gallery full-screen.
I head to Kenya this week and will add more from there!


Shin said...


The cynical truth is, stories like Ivote's all start to sound the same. There are so many with the same sad background and not much hope.

But I think we need to keep hearing these stories and seeing the faces of people who would otherwise just disappear.

I'm so impressed with the work that you and the IMC are doing. Thanks.