Menno-Santé website launched

http://mennosante.flexkb.net

Unlearning

Our supervisor Suzanne asked us what we learned during our trip. It was really hard to answer her. It felt like we did more unlearning than learning. This isn’t actually unusual, but what’s unusual is for me to admit this, even to myself. Sometimes after I get back from a trip, I focus on writing down all the ideas which give me a comfortable feeling of certainty. For example, I feel confident that a rural hospital in DRC can make some progress at plugging its leaks, losing less potential revenues, and becoming more sustainable. It seems like in our trip reports, I focus on such comforting islands of truth, while ignoring the raging sea of confusion all around them. Here are a few examples of areas where I feel like I know less than I did before.

1. How involved should we get in church politics?

Both CMCO and CEFMC (Congo’s two major Mennonite church denominations) have been going through a certain amount of upheaval recently. Different people tell us different things, and most people’s point of view makes sense – until we hear the next person’s version. Sometimes I think we don’t have enough understanding of the situation to take sides. However, we do take sides in a way, through our actions: in a general way we support lay initiatives, and involvement of laypeople in church decisions, rather than unilateral top-down decisions. We support free movement of information and informed debate by sharing information when we can. We also require clear reporting and accountability for money that we give to others, no matter who receives the money. And we try to share information about what MCC is doing in Congo, always including specific dollar amounts, even before people ask, so as not to give anyone a chance to use knowledge about MCC as a way of holding power over others. But beyond this, we try to stay fairly uninvolved.

I have quite a lot of ambivalence about whether we should get more involved, or not. By not getting more involved, are we empowering some in the church at the expense of others? Would that happen regardless of how involved we got? Are we taking ourselves too seriously if we think that MCC’s involvement actually makes a difference to anyone here? Or are we underestimating the effect that our involvement, or lack of it, has on the situation? Will we look back in five years and conclude that staying relatively uninvolved helped contribute to more dysfunctional, authoritarian leadership? And yet, how can we possibly refuse to work with rural hospitals just because some faraway, high-up leadership is involved in a conflict or isn’t publishing transparent financial data? These questions continue to niggle at me.

2. We saw first-hand that it’s not a good idea for a hospital to replace an accountant with a cashier, while letting the cashier continue to be a cashier, essentially supervising himself. That is a conflict of interest. But, how does knowing that prevent it from happening anyway?

3. Theft happens. Medications can be stolen right from under the nose of an excellent medical director. Fortunately, the theft was discovered and a new system was instituted in which the pharmacy doesn’t collect money from patients directly. The next month, sales in this pharmacy almost doubled, reaching levels never attained since the beginning of the project. Was this a coincidence? How much other theft is happening that we are unaware of? It’s likely that detailed analysis of pharmacy revenue patterns helped us to discover this theft. That feels kind of good… I guess.

4. It’s better when different donors don’t support the same beneficiary at the same time and in the same way. E.g. WHO giving medications to Kajiji hospital when they already have plenty of medications. Perhaps the recipients of the double gift can be convinced that they don’t need more WHO medications and that other health centres can benefit from these. But the larger question is, how can hospitals here deal with the reality that different donors will always be choosing to give them things, based on their own priorities, and without necessarily consulting the hospital? How should they organize their pharmacy to deal with medications from a variety of sources and with a variety of prices? Technically, this problem is solvable, but only if there is a good, collaborative relationship with the Health Zone office. If that is lacking, then a lot of things will continue to stagnate.

5. When a church’s sound system is turned up too loud, I will no longer endure sitting in special visitors’ chairs right next to the main loudspeaker. I will get up and move to the back of the church, where things are a lot more interesting anyway. The woman next to me will whisper questions and explanations, I get to practice my Lingala, and smile at beautiful babies. The downside is that someone might make a comment from the pulpit about our decision to move to the back, and everyone might stare at us. But after some reflection and consultation with various people, we have determined that we are not deeply offending anyone, and so we will choose to take care of our ears first. In some ways we can fit in, but in other ways we will always stick out.

6. It’s a lot of fun to play “Big Boss, Little Boss” (a card game) with hospital staff, as long as you change the game a little so that the top position is “medical director” and the bottom is “travailleur ordinaire” (i.e. the grass-cutter, sweeper, or cleaner at the bottom of the salary scale). People got really into this game where everyone competes for the top position, everyone gets to heap abuse on the person at the bottom, roles are constantly shifting but things are rigged to keep the top person at the top, and you can complain all you want to about the injustice of it all, in the presence of those people with whom you work every day. It was a good reminder to me that there are many things we don’t understand about how power works in a rural hospital.

7. The air in Kinshasa is extremely polluted. We noticed this from the airplane when, several kilometers outside the city, we flew into a thick white cloud. At first we thought it was a fog or mist, but the pilot explained that we were just back in Kinshasa smog. It’s worse than usual now, at the very end of the dry season. As soon as we arrived, both John and I got headaches that persisted into the next day. Coincidence? Dr. Benza asked John once what impressed him in Europe during our vacation. John said, large trucks that drive quietly with no emissions. We all laughed loud and long at this bizarre concept. In any case, we and our fellow Kinois are all waiting eagerly for rain.

Maybe on this trip I learned that it is OK to stay afloat on the messy sea of uncertainty, rather than docking on an elusive piece of solid ground and holding on for all I’m worth. Or maybe I learned that the ground really isn’t that solid anyway.

The road from Kajiji to Kahemba: a personal reflection on rural community development

During our last visit to Kajiji and Mukedi, I tasked myself to take a closer look at the cell phone enhancer packages that these two hospitals had purchased. They are both well outside the range of the cell towers in nearby towns, so the only means of communication is the two-way radio which is expensive and inconvenient for most of the population. We had great success with the cell phone enhancer in Nyanga so we thought we would try in Mukedi and Kajiji. Unfortunately, it hasn’t been easy. Until recently, we weren’t able to find a location where the enhancer could pick up a signal.

In Kajiji, I suggested that we take a motorbike with the equipment and a battery to test some other locations closer to the cell phone tower. What started out as a mostly technical task ended up being a great (mostly) non-technical experience for me for which I am grateful.

On one of our testing trips, I learned that the owner of the motorbike I was riding with was a young woman who drove all the way from Angola for her fistula operation. Think about that for a moment – bumping around with that condition for days on a motorbike and having to maintain concentration just to hold on, not to mention dealing with the border crossing and dangerous diamond routes. In understand that Kajiji hospital serves many patients from Angola.

 

Makupa and a family at our first location which happened to be a honey processing plant.

 

I also had lots of time to take in the scenery as we whizzed along as I wasn’t driving. I saw kilometer after kilometer of lush growth and fruit trees all along the 50km stretch we were on. We passed through several small villages with lots of children and adults together. Without stopping, Makupa (the nurse-turned-antenna-installer-and-excellent-driver) yells out the status of our mission to the curious onlookers who asking whether we’ve got a signal yet. I wondered what in the world we were trying to do with this antenna. What good would it do anyway? The basic physical needs of the population aren’t being met, and we’re essentially installing a phone? I began to think that although this phone and internet connection would offer a link to the outside world for some and that would be good, that perhaps there were other more significant benefits of us taking a couple of days to explore the options. I thought that maybe the connection with people along the way was a very good thing for me and perhaps for them too.

We had a flat tire a couple of times. This actually turned out to be a good thing! One time, we were quite close to a village and so Makupa suggested with a smile that I could test the antenna while he fixed the tire. There were several families sitting in the shade under a giant mango tree so we pulled over there. As we assembled the pieces for the antenna and asked someone to climb up the tree to hold the antenna, I sat and observed some of the many small children who were obviously curious about the presence of a white man who couldn’t speak and had appeared out of nowhere. I tried waving to some of them and some came to shake my hand. Another small boy who must have been about 2 years old was terrified of me and hid behind an older friend or family member and peered out from time to time to make sure I wasn’t moving in his direction. The uncle laughed and laughed at the boy for being so timid and then we all started to laugh. We got what seemed to be a very good cell connection but unfortunately our amplifier wasn’t strong enough to send back a signal to the tower (3 watts is the maximum strength for consumer products in North America). So after taking the wheel apart twice and reinforcing the gaping hole in the rear tire, we packed up the antenna pieces and started again on our way to the health center. The other day we had a signal there and we were hopeful to have enough of a signal to make a call.

 

Flat tire, turns into 5 bars (but no usable connection)

 

We arrived a few minutes later at the health center which had been recently painted on the outside. We quickly unpacked the equipment and found a long bamboo pole to attach the antenna to. In a room close to where we test, there is a bare room with a single red maternity bed. Presumably, the woman who came to Kajiji for a fistula operation gave birth on a bed similar to this one and as obstructed labor is purported to be the leading cause of fistula onthis continent it is quite possible that during childbirth she developed her fistula. As we walked to a second location close to the building a large group of barefooted children followed us in anticipation of something, anything happening with this weird man (me) and this even weirder metal box and black cable. Unfortunately, I noticed a lot of hospital waste as we walked: used needles, empty glass vials and paper garbage. I’ve found this to be typical of the hospitals we work at and haven’t understood why the waste isn’t at least thrown into a pit and burnt. This, the apparent lack of sterilization, and the more general disinterest in keeping health centers clean and safe remains a mystery to me. At some point, we decide that the signal here isn’t strong enough to make telephone calls. So we are disappointed as this was the ideal spot (after the hospital) to set up the antenna. But, we try not to think of this as a failure. At least, I’m thinking that it was worth the effort to try.

 

This is a tree close to the clinic

 

 

The maternity bed at the clinic

 

The other day, I was at the clinic and I saw a wonderful patch of color on the ground. These were beans drying in the sun. These beans are an excellent source of protein and, if I understand correctly, this particular variety of bean was developed over time from missionaries who brought different varieties of beans from Canada in the 60s and 70s. These beans, tomato sauce, garlic and local rice with a little bit of red pepper is one of my favorite Congolese meals.

 

Colorful beans, a great source of nutrition and one of my favorite meals

 

Our next and final stop for the last day of testing is about seven kilometers away from the clinic. We must first pass over a river on a small canoe with our motorbike. At first it looks like bit risky, but the boat driver expertly and seemingly effortlessly guides us over. This time there are several older men playing cards and enjoying several very small fish that have been smoked over a small fire nearby. By small, I mean 1 cm by 5 cm. The last time we crossed this river, Makoupa said to me that he was afraid of the water. When I asked him for more details, he says he was afraid of the children fishing in the water. I asked him again, “Why are you afraid of the children? Will they come and tip our boat (and your motorbike) into the water? Do you know how to swim?” He says “no, that’s not the problem”. I wait a bit, sensing that he wants to say something further, and ask him again “So why are you afraid? I don’t understand what you mean.” He pauses and then tells “I had a child who was fishing just like that, near the current, and he drowned.” I say that I’m sorry and we are silent for a moment as we look over the quickly moving current.

 

Canoe crossing with Makupa

 

We climb out of the marshy river area and up over a small hill – probably 100-200 meters high. But this is the hill that was blocking our signal from the clinic, I think. On top of the hill we find the church again and in the heat of the middle of the day, we try once again. This time we know it should work because it worked last time. But the first test renders nothing. I’m beginning to wonder if this will ever work. Then we move a few feet away and try again. This time it works! I make a few calls to test and the signal is good. I’m sweating in the blazing sun without any cover except for my black hat. I quickly take out my computer and plug in a 2G modem to test the Internet. It works, barely – and so this might be a location where the hospital staff can come and send reports and receive written feedback. But at the very least, they’ll save time and fuel by avoiding 40 km more of travel or 120 km if they go all the way to Kahemba and back. When we’re all packed up, we snack on some left-over pancakes and a couple of bananas from breakfast and are satisfied with the fruits of our labor. Makupa seems still optimistic that we can make the antenna work at the clinic. I’m happy he seems to have taken an interest in this project.

 

The antenna works near a church building project 32km from Kakjiji

 

As it is so hot, and we have at least 90 minutes of road ahead of us to return to Kajiji, we pack our things up and return to Kajiji. This time the guys at the river refuse to take us back as we have forgotten to bring money. We wait for a while on the canoe while the river guy explains that he will not move until we pay something. Fortunately, I have a banana in my bag which is readily accepted. In fact, the boat owner and Makupa have a hearty laugh over my improvised payment. As I pass over the water, I wish I could dive in take a swim, but alas we have no time nor do I have any extra clothes with me.

On our way home we pass by a little house – actually just a roof with poles. Makupa tells me this where the men drink palm wine. “They are drinking,” he says as we pass by. Palm wine comes directly from a palm nut tree a little like maple water.
I continue to reflect about what we’re doing on our way back. The chances of this antenna actually being set up and maintained are pretty low – even though hundreds of people could make use of it. It is true that it has the potential of connecting a remote part of the world with family and friends and medical supply depots for the hospital. Perhaps I don’t realize how important that is. In any case, I’ve enjoyed this task and getting to know Makupa – who is now confident enough to continue testing on his own.
On our way back, Makupa, who is also a nurse at the Kajiji hospital, recognizes a young woman who waved to him. She was a recent surgical patient at Kajiji hospital and Makupa stops to say hello and asks how she is doing. I’m delighted because she looks healthy and hopeful.

Makupa also points out several spots where there has been a recent motorbike accident in the sand. I am thankful that we did not have accident. Driving on dry sand can be dangerous as the only viable technique requires driving above a certain speed in order to kind of ski your way through.

When we arrived back in Kajiji (no flat tire this time) I learned that the local ANR (the Congolese version of the CIA) had told the hospital that they would have to cough up $300 to have the privilege to set up such an antenna. I couldn’t believe it – I felt myself getting very angry at the injustice of it. How can anything good happen here if the government clobbers every initiative before it even gets off the ground? I have to choose not to do anything or say anything at this time, because I can’t think straight. After our visit in Kajiji came to an end, the fistula patient, now terribly weak and in post-op pain, flew back to Vanga with us and had to wait an extra 40 minutes waiting for the migration police and other airport officials to clear our plane for takeoff even though they had done the same checks just a few hours before. The usually calm and collected MAF pilot returns to the plane clearly frustrated from the egotistical behavior of the airport officials.

 

The road back to Kajiji

 

Although our trip wasn’t exactly an amazing technical success, I am grateful for the opportunities I had to explore the countryside near Kajiji. I am also now more aware of the difficulties – some technical but I think mostly political and behavioral – that remote communities such as Kajiji face in their efforts to make life better for themselves. After almost a hundred years of paternalistic colonialism and nepotistic Mobutuism, communities like Kajiji struggle to survive and develop their identity in this new era of opportunistic neo-colonialism. I look forward to visiting Kajiji again in June 2011 when we have our next scheduled hospital visit. Maybe this time I’ll go swimming.

-John

All in a day’s work: How we and the medical supplies get to the hospitals these days

Anicka and I visit each hospital at least every six months. We do this at the same time the hospitals order supplies so we can take advantage of the flights and avoid the very long trek by jeep. As usual, we traveled first to Kikwit where the supplies are ordered from a local pharmacy depot and carefully weighed and put in boxes with handwritten packing slips. Then, when everything is ready and hopefully everything the hospital ordered was available, we put all the boxes in a city bus called a “City train” and head off to the airport where we hope that our MAF charter will land in an hour or two. Many government officials such as the DGM (in-country migration police), ANR (secret police/CIA), TVA (airport tax people), and representatives of the Congolese air force crowd in for the inevitable “official” verifications and taxes they require before giving us their blessing to take off. Of course, everyone knows we are a humanitarian organization working under the official national organization of churches with an official mission to visit hospitals, and that there is no doubt that what we are transporting are medications and supplies. However, this is one of their few opportunities to make some extra cash with the implied (and sometimes stated) threat of refusing us the right to use the airstrip. So while we wait for all the paperwork to be done, Mr. CIA with his large sunglasses and almost-permanent scowl of suspicion (except for the fake smile when he starts asking for bribes) and his fellow government agents who all look overfed and under-worked stand around anticipating their cut in the fees. Needless to say this isn’t exactly the most fulfilling part of our work.

 

MAF dropping off medications & supplies, and picking us up in Kajiji. The children are always the first to greet us and the last to say goodbye.

 

Once that’s out of the way and we’ve optimized the amount of payload we can bring with us on this flight we say our goodbyes and thank yous and jump on board for a 90 minute flight to our first stop: Mukedi.  We land and drop off about half the supplies and our personal baggage and in a few minutes, Dr. Gaspard continues on the same flight to Nyanga with their supplies and his motorbike. We’ll stay in Mukedi for a week to visit with hospital staff and help them validate and analyze their financial documents and hospital health indicators.

After a week at Mukedi we catch a smaller MAF flight to Kajiji about 500 km to south of Kikwit. This time we go with Dr. Benza who is making a supervision visit for the Kajiji hospital.

 

MAF dropping off medications & supplies, and picking up a patient to take to a larger better-equipped hospital in Vanga

 

Then the plane full of meds comes and drops off the meds and picks us up for the return flight. This time we have enough room to bring a couple of passengers. One passenger is a young woman who traveled all the way from Angola (over a 100km away) by motorbike with her husband for treatment for fistula. She was operated on at the Kajiji hospital and the operation didn’t go well so she was referred to a larger hospital in Vanga where the plane happens to be going. This flight makes a 5-6 day journey into a 3 hour journey. Unfortunately, we had to stop in Kikwit on the way and are harassed by the government officials for 40 minutes before we can continue on to Vanga and she can be admitted to the hospital. She has spent many days already recovering from surgery and has lost a lot of weight. We hope that she survives.

Then we continue on the same flight all the way back to Kinshasa where we are greeted by a thick cover of smog and the regular (and more pleasant) government officials at the N’dolo airport. We are grateful to MAF for their friendly and professional support.

-John

Reflections about empty churches, independence optimism, and hospital inefficiencies

I returned from our trip with lots to contemplate and reflect on. Here are a few of my thoughts.

Missionaries, mines and malnutrition in Nyanga

During this visit I was able to experience Nyanga a little more than on previous visits, because I was there on a Sunday, and because I was able to walk around Nyanga a little with Ida. In the past we had usually been too busy working at the hospital to really get out and about. I am glad to have learned more about Nyanga, but sad that what I learned was almost uniformly depressing.

One morning I accompanied Ida on her trip into the village to buy food for the day’s main meal. As we walked along the main avenue, we came across the occasional stall set up outside someone’s house, where a few basic items were being sold: toothbrushes, soap, sugar, coffee. One stall sold second-hand clothes. Fresh vegetables were extremely scarce. I saw one basin of corn flour, one basin of rice, one small table of pilipili peppers, one tiny table with a couple of tomatoes and a pineapple, and two stands with dried fish. I also caught sight of some garlic and onions. There was also a house that sold palm wine, freshly tapped, from a row of gourds suspended on a stick. As we went along we eventually arrived at the actual “market” – a few empty tables in a clearing. Ida assured me that this market was no better stocked than the avenue, and that there was no actual market day. When compared to the overflowing markets in Mukedi and Kajiji, Nyanga, with a similar population, seems a wasteland. I learned from Ida that finding an accompaniment to the daily fufu is a real challenge. Sometimes people come to her house to sell pondu (manioc leaves) or to tip her off that a cow is about to be slaughtered. But more often than not, she relies on her own chickens and rabbits for a reliable supply of meat, and gets her husband to bring whatever he can from Kikwit or Tshikapa.

Ida and Gaspard’s situation is relatively good because they are among the few who have access to cash to purchase the food they need – but most inhabitants of Nyanga have to make do with the bare minimum; children may end up eating just fufu and salt. When I talked with the Médecin chef de zone (health zone director) stationed in Nyanga, he told me that Unicef’s latest survey showed a 14% rate of severe malnutrition among children under five in the Nyanga health zone – a very high number even for Congo. As I walked through the village, I saw several small children sitting listlessly on the ground, looking sick – something that I had not seen in other villages.

Why is Nyanga’s situation so bad? According to Dr. Gaspard, because Nyanga is located in a diamond region, people had gotten into the habit of surviving off artisanal diamond mining and had never developed a farming culture. Now that the diamond market has crashed, they are in trouble. In addition, while many families would produce at least some corn and manioc, people often choose to sell their food for cash instead of consuming it, or convert it into local alcohol for sale. The little bit of money received doesn’t pay for many essentials at Nyanga’s high prices – all goods have to be transported from Tshikapa, 100 km away, by bicycle, motorcycle, boat or large truck. Recall that in Tshikapa, a loaf of bread worth 100 FC in Kinshasa sells for 250 FC; add a markup for the transport, and the salary of a typical nurse at Nyanga hospital who is paid about 8000 FC a month doesn’t stretch very far at all (of course, people in Nyanga don’t buy bread because fufu is cheaper – but the same idea applies to other products).

As Nyanga’s situation started to sink in, Sunday arrived; this was my first time being in Nyanga over a weekend. That morning I got up expecting church to start around 9. I had been told it could start between 9 and 10. That day, it was 11 before anything started happening. Dr. Gaspard and I went, while Ida stayed home. In the back of the church was a big pile of sand. There were wooden benches, which were filthy and had to be wiped off before we could sit on them. The benches were obviously not frequently filled. The church felt like an old, empty, echoing shell. There were less than 30 people present, including only 5 children, in a building designed for about 500. Singing was half-hearted. After living in Congo for a while, I now know that such a situation is highly unusual. Run-down church buildings are commonplace, but are always compensated for by attendance, music and charisma. All the churches I have visited until now, which the exception of one other CMCO church in Mukedi, have been full, with a strong group of children, several choirs even on the most ordinary of Sundays, and energetic, lively singing. As I sat in this church listening to the sole choir accompanied by an out-of-tune guitar, with memories of Nyanga’s “market” and its starving children still fresh in my mind, I started to become angry. Dr. Gaspard tells me that “this is what is happening in all our churches”, that is, they are being deserted by the youth. However, in Nyanga, apparently no churches are well-attended, not even the Église de réveil (Independent churches that have exploded in Congo). Again according to Dr. Gaspard, churches have emptied because people have gotten fed up with their pastors practicing adultery and witchcraft. As I sat there, I asked myself how the people of Nyanga became so bewildered, shiftless, unanimated and dysfunctional. Nyanga has had a large share of missionaries and development workers, including many MCC workers. I wondered what these people would say if they could see this church and this village now. I wish someone would tell them that the churches are empty, the former rabbit projects promoted by missionaries have ground to a halt, and the people of Nyanga are struggling to survive while surrounded by fertile land. I want the situation to be widely known, not so the missionaries will come back and do more of the same, but to promote some serious reflection about what exactly was going on here during the missionary period, that led to so few tangible results.

After the service, I poured out my thoughts Dr. Gaspard and we sat and talked for about an hour. He said that former missionaries sometimes visit Nyanga, but because their visits are announced in advance, the churches usually fill up – there are plenty of former members out there who can be rustled up and can sing a mean hymn, apparently. So outsiders might not know what the reality is really like. And on the topic of missionaries, in his opinion the missionaries didn’t invest sufficiently in people, and in preparing people to truly take over responsibility for churches, schools, hospitals and other structures after the missionaries left. Moreover, he feels that the missionaries taught hypocrisy, by preaching against drinking while drinking surreptitiously in their homes.

I asked him if he thought that contact with the West should end. He answered that none of us are sufficient to ourselves: we all need each other. Perhaps if all missionary and development assistance ceased, people would wake up one day and realize that they need to take responsibility for themselves. But though that would be a good thing, Dr. Gaspard insists that there should always be exchange. The important thing, though, is to promote true exchanges. In his own words, “the hand that gives is bigger than the hand that receives,” and in the past, exchanges tended to be unequal. He doesn’t want to see any more exchanges where one side is always asking for more, hand outstretched. An ideal relationship would focus on investing in people and in their capacity and their ability to manage themselves.

Two weeks later, thoughts about Nyanga keep on circling in my mind. I feel angry, sad, and frustrated, without knowing whom exactly I am angry, sad and frustrated with, and what exactly I should do about it. Disseminating better information seems like the first step, and Dr. Gaspard encourages me to do so … but where to go from there?

June 30th celebrations – a glimmer of hopefulness for the DRC

You can listen to a great Congolese independence song, composed pre-1960, here. This song played over and over again on TV on June 30^th. One delightful evening program showed several “traditionally built” women interviewing some of the original performers and composers of this song, and then dancing to this tune with them, clad in 50^th anniversary print pagnes.

In Kikwit, John watched a huge parade from the balcony of his guesthouse and even managed to sneak a few photos. There was no parade in Nyanga, but since Dr. Gaspard and Ida have one of the few televisions around, several of their friends joined us to watch the celebrations in Kinshasa. It looked like a grandiose day, and following months of roadwork in Kinshasa, the capital was looking better than ever. I was interested in the eight prayers spoken by the leaders of Congo’s eight main religious confessions: Kimbanguist, Muslim, ECC (union of protestant churches to which the Mennonites belong), Salvation Army, Revival Church, Independent Church, Catholic, and Episcopalian. Several asked forgiveness for Congo’s sins; all prayed for protection for the president and his family, and a couple mentioned the problem of corruption. President Kabila gave a long address which we all listened to attentively; he covered a lot of ground and said all the right things, though without much charisma. The parade following his speech was impressive and long. It was curious that the speeches started late because of the late arrival of Paul Kagame, Rwanda’s president, and that the microphone, which had worked fine for all the prayers, suddenly went quiet when Kabila stepped up to it – the first minutes of his speech were marred by loud feedback and frequent cutting out. Later in the day the TV broadcast an excerpt of Lumumba’s fiery 1960 Independence Day speech – the minute it came on, Dr. Gaspard’s attention was riveted, and he kept saying, “That’s a real speech!” I invite you to listen to it (audio only with English subtitles) here.

My feeling is that many Congolese people felt doubtful of what the June 30^th celebrations would amount to, but that most were pleasantly surprised when the day came. I feel a tiny current of hopefulness about Congo’s future that wasn’t there before. When we returned to Kinshasa, the chauffeur who picked us up at the airport took us along the new Boulevard Triomphale – I commented that it looked great, and he replied, “You haven’t seen anything yet, just wait until the next part – this is a real boulevard!” It was the first time I had heard such pride in anyone’s voice about their city or country. I can’t help feeling a little hopeful myself, though it is marred with shame when I read about Canada’s (fortunately unsuccessful) blockade of debt relief to Congo because it might threaten the former’s mining interests.

Hidden leaks at Mennonite hospitals

While in Nyanga I spent a large part of my time helping the hospital lab staff to analyze their lab, in order to determine whether it is breaking even or running at a loss. I had some idea what to expect, because John and I had done similar analyses at other hospitals. It turns out that each month, the lab loses about 67% of its potential revenue, or approximately 120$, because it offers free services to such a large number of patients. Interestingly, even given such a large loss, the lab manages to cover all but 25$ of its monthly fixed and variable costs with its meager revenues. This means that if the lab were to tighten up just a little on the number of free tests offered, it could not only break even but start to generate revenue that would bolster other services at the hospital.

The lab staff and hospital administration had a general awareness that they were losing money, but clearly had no idea of the details of their financial situation. It was interesting to talk it over with them and to see them start to understand their situation from a new perspective.

When something like this comes to light, one way to interpret it is to compare it to a beam in a house that seems firm, but that crumbles when you touch because it’s being eaten by termites from within. But I think it is more accurate, as well as more positive, to say that we have simply gained a better understanding of some of the intangible staff benefits that motivate people to keep working in hospitals even though they aren’t paid a living wage.

A missionary recently told us that he feels sick when he hears people talk about sustainability in hospitals in Congo – he says that first, health care is not a business and cannot be sustainable, and second, churches in the West are well-off and have the obligation to help poorer brothers and sisters, indefinitely if need be. I sympathize with his point of view, but can’t help thinking that hospitals could be a whole lot more sustainable than they currently are, and that such changes would be only advantageous to all concerned. It seems a little condescending to assume that people are incapable of helping themselves and need outsiders to pay all their hospital operating costs; the reality as it seems to me is that outsiders’ dollars are often creatively diverted anyway, that ongoing losses at the hospital are due to mismanagement, inefficiency and lack of follow-up, not just to the poverty of the population, and that when subsidies inevitably end, people will be no better off than before if they haven’t been encouraged to manage the little they have as efficiently as possible. At least, this is the approach that we and the coordinating doctors have chosen to take. Perhaps this sounds condescending too?

A six-stop trip: Kikwit, Kanzombi, Mukedi, Kajiji, Nyanga, and Vanga (June 21-July 9)

What a trip!

It started on June 21st, when we traveled to Kikwit. We stayed there together until the 28^th, for a busy week that included our quarterly meetings with the coordinating doctors, and several visits to Kanzombi hospital. Both doctors were also busy preparing their July medication orders, and we spent some extra time at Zenufa, the pharmaceutical depot, observing the preparation of bills and packing slips.

A few days into our stay we started hearing rumours that travel would be restricted around the 30^th of June, DRC’s grandiose 50^th anniversary independence celebration. Since we had a flight booked for the 29^th, we were a little nervous. In the end, the flight had to be moved to the 28^th at the last minute, though even the flight provider wasn’t given official notice of the closure until just a few days before.

On the 28^th, John and I separated for a week; I accompanied Dr. Gaspard to Nyanga (300 km away), via Mukedi (200 km), with the medication delivery flight. Meanwhile, John stayed in Kikwit and worked with Gogol, Dr. Benza’s assistant, on reporting and computer training, and did some more work at Kanzombi hospital. At the end of the week he flew to Kajiji (1000 km away) with the medication delivery, and stayed overnight to help set up a cell phone signal enhancer antenna – unfortunately without success. The next day, accompanied by Kajiji’s medical director, he flew to Nyanga where Dr. Gaspard and I embarked and we all ended up in Vanga, a Baptist mission with a large hospital where the ultrasound training would be held. Two other doctors joined us there after traveling by road from Kikwit (about 100 km).

We stayed in Vanga three days, just to be present for the first few days of the two-week training and to make sure that everything was progressing smoothly. John and I were graciously hosted by three brothers in a Protestant order (one of whom is a doctor and is teaching the four Mennonite doctors how to use their new ultrasounds). We enjoyed some German- and Swiss-style meals and a beautiful evening Communion service with these men. Our trip ended on July 9^th with an uneventful flight back to Kinshasa.

I find myself feeling very tired and unable to face our regular responsibilities. Fortunately we have a few days off to rest and process the events of the last three weeks. As I look back, I see a higher-than-usual quota of stressful and unexpected events, along with a good dose of intensely thought-provoking conversations and discoveries, punctuated with a few delightful moments.

Unexpected and stressful

Dr. Gaspard hurt his foot (little toe bent backwards after hitting a root while on motorcycle; entire foot swollen) so he arrived in Kikwit a day later than expected after a gruelling and painful day of motorcycle travel.

Dr. Benza and his young daughter both got sick during our time in Kikwit, and had to leave earlier than expected to Kinshasa because of June 30^th closures; we lost a lot of the time with Dr. Benza that we had been counting on.

The cell phone signal enhancer antennas that we tried to set up in Kajiji and Mukedi haven’t worked yet; in both places our arrival to help set up the antennas was unexpected and our stay was too short (1 hour for me and Dr. Gaspard in Mukedi, about 20 hours for John in Kajiji) to be able to really test the devices. For example, in Mukedi, a pole was hastily put together, with the antenna at the top; Dr. Gaspard oversaw a frantic testing session while I reminded him that the pilot was waiting for us at the airstrip and that we were already overdue for departure…

The price to pay for a delicious snack of BBQ pork eaten in a local bar with Dr. Gaspard on the evening before our trip to Nyanga was a bout of food poisoning with fever, diarrhea, nausea and fatigue that overshadowed my first several days in Nyanga. Dr. Gaspard got sick too, though less acutely, but John, who barely touched the pork, was luckily unscathed.

The ultrasound training, tentatively scheduled for the end of July, ended up needing to happen about two weeks earlier; this required us to move very quickly to get manuals printed in Kinshasa, despite looming independence closures, to approve the budget more hurriedly than we would have liked, to deal with a sudden need for cash that we hadn’t planned for, to make lots of convoluted plans to circumvent our cash flow problems, and to make last-minute changes to travel plans to ensure that doctors could all make it on time. Fortunately, it all came together, and the training has gotten off to a great start.

And, saving the worst for last: on the evening of our arrival in Vanga, we realized that we had left several thousand dollars in our guesthouse room in Kikwit two days earlier. The room had already been cleaned and was being occupied by another guest… Fortunately, after some frantic phone calls, the money was retrieved, but not before we had had a really good scare! And even though the money was secure in Kikwit, we still had to deal with the fact that we didn’t have that money in Vanga where it was needed. It all gets very complicated when one lives in a cash-based society where large and small payments are all made with wads of 100-dollar bills or bricks of Congolese francs.

Ahhh… I am relieved that we made it through each of these frustrations, but realize that their cumulative effect has been to wear me out more than usual!

Delightful

During my visit to Nyanga, Ida (Dr. Gaspard’s wife) made delicious donuts that included lemon zest, eggs, sugar, oil, flour, yeast and baking powder. We sat and cut them out together on a low wooden table outside as the sun set, and fried them in palm oil.

The Ghana match was such a disappointment. But sitting and watching World Cup soccer with a dozen of Ida’s and Dr. Gaspard’s friends and colleagues, palm wine in hand, was delightful, and watching the Netherlands beat Brazil was especially so!

I really enjoyed talking with the pharmacy manager at Nyanga hospital. He is exceptionally detail-oriented and is doing several checks on his own initiative to follow the medications more closely. For example, every day he checks the theoretical revenue from medication sales with the money in the cash box (kept by a different person), even though MCC has never asked him to do so. He also does a mini-inventory several times a week of medications kept in the night nurses’ office for midnight emergencies, and keeps track of any discrepancies that would indicate that medications had left the cabinet without being paid for.

In Kikongo, where our return flight made a brief stop, we saw a kitten playing with a clawless river otter cub (an endangered species)! Both animals (along with an antelope and a few alligators) are being raised by a missionary couple. See this article for more details.

Thought-provoking

I’m still thinking… see the next post for some more in-depth reflection about some of the things we experienced on our trip.

John waking up at Kikwit guest house

In Dr. Benza’s office for our quarterly meetings

In Kajiji, trying to set up the antenna

30 June parade in Kikwit

Anicka with lab staff in Nyanga

Lab staff and hospital administrator in Nyanga

Mud bricks being dried for a new building at Nyanga hospital

A nurse administers an IV drip to a child with malaria

Nyanga Mennonite church

Nyanga Mennonite Church from the pulpit

Nyanga Mennonite church, Dr. Gaspard in the back

At Dr. Gaspard’s house on the day of the flight to Vanga

Anicka in the very back of C206 on Nyanga-Vanga flight

Vanga hospital (a major regional hospital) – location of ultrasound training

Learning some theory about ultrasound in Vanga

Trying out the ultrasounds for the first time

Starting to feel comfortable with the ultrasound

John, Anicka, Dr. Nikez, Dr. Friedhelm, Dr. Gaspard, Dr. Shatambi, Nurse Léon, Dr. Ngangula

Congo clawless otter in Kikongo

Twice-paid sandals

About two months ago, we experienced our first theft. Somebody walked into our parcelle, opened our screen kitchen door while we were eating in the dining room, and stole two pairs of sandals and one phone. We were especially sad to lose John’s new Birkenstocks (just a few months old), because all he had left to wear after that were these old ones:

People in Congo highly value being well-dressed and wearing well-polished shoes. It was embarrassing for John to walk around in these old things, and recently he went right through the sole so one of his feet was always touching the ground. We were tentatively planning a trip to the Grand Marché this weekend to see what we could find in the way of shoes, though we expected it to be pretty challenging to find them in a large enough size.

Today I was on foot in nearby Kintambo-Magasin, buying a few groceries. Suddenly my eyes were caught by that exact pair of Birkenstocks that we had lost, being polished by a young boy. They clearly belonged to a money-changer sitting a few feet away. I went right over and asked him where he had found those shoes. He claimed he had bought them in a large market a few months ago. It might be true and it might not. What are the chances that this was another pair of Birkenstocks identical to the first? Pretty slim.

Fortunately, this guy Georges was willing to sell them off his feet. I called John and he came over and negotiated for a while, and ended up paying 30$. Since we paid over twice that for them in the first place, we felt like it was worth it. So now John is walking around in these again:

Internet service provider review for Kinshasa, DR Congo

Over the past year we’ve had the chance to test several ISPs in and outside of Kinshasa. Several people have asked what types of services are available and their respective prices. Here is a list of the ISPs we’ve used and some specifics about their pricing, speed, and reliability. This isn’t an exhaustive list.

Microcom

Client connection: Fixed antenna on house connected to modem and wireless router
Advertised speed: 140kb/s upload
Actual speed: varies greatly 30-180kps down, 60kps up
Locations tested: Gombe
Price/package: ~$160/month with unlimited usage
Notes: When the network is running normally, this is a very good connection. However, it is expensive and browsing can be extremely slow. Skype (even video) works well almost all the time.
Disadvantages: Mandatory fixed antenna, so no mobility. Expensive.
Customer support: Good. Technicians are available and come when there is a problem.
Website: http://www.microcom.cd
Coverage: Kinshasa and some other cities

iBurst (Recommended)

Client connection: Propietary iBurst modems (USB or Desktop both with external antenna plug)
Advertised speed: upto 1Mb/s upload
Actual speed: varies greatly, but comparatively very fast 200-600kb/s, 80kps up
Locations tested: Gombe, Kintambo-Magasin
Price/package: $0.16 – 0.10/Mb without time restriction OR $0.03 – $0.05 if used within a month OR ~$500/month unlimited usage. You buy prepaid cards and activate them online as needed. The modem costs about $100-120 and antenna about $20.
Notes: iBurst definitely offers the best speed and the best price per Mb. No blacklisted IPs on this network.
Website: http://www.iburstafrica.com
Coverage: Kinshasa and some other cities, connection rates vary greatly even in Kinshasa depending on location. For instance, in Kintambo-Magasin we’ll definitely need an external antenna, and in one location in Gombe we also need an external antenna.
Bottom line: Cheapest and fastest option (unless you continually download torrents)

Vodacom

Client connection: Huawei E220 HSDPA 3G modem, or 2G stick modem
Advertised speed: 120kb/s
Actual speed: unknown, but nowhere near 120kb/s (not fast enough for voice Skype)
Locations tested: Gombe, Kintambo-Magasin
Price/package: $0.40-$0.29/Mb OR a little cheaper using prepaid specials OR ~$400/month unlimited. The modems cost $50 for 2G and $180 for 3G (both use 2G technology).
Notes: Vodacom is the only affordable choice with a very large coverage in the DR Congo.
Website: http://www.vodacom.cd
Coverage: Everywhere there is a Vodacom cellphone signal (largest coverage)
Customer service: Not too great. However, there are many stores all over the DR Congo.
Bottom line: Recommended for use outside of Kinshasa because of best coverage

Standard Telecom

Network type: CDMA Hybrid, with fibre optic infrastructure in Kinshasa
Client connection: EC226 CDMA 2000 USB modem
Advertised speed: 140kb/s upload
Actual speed: ~130kb/s down, 60kp/s up
Locations tested: Kintambo-Magasin, Gombe (Much better reception in Gombe)
Price/package: $125/month with unlimited usage, Modem costs about $180. For $200 you can buy a wireless router/modem, but that is $200/month. You can also buy a faster USB service for $250/month.
Notes: Unfortunately, the network IPs are blacklisted by many mail servers because Standard has not effectively handled SPAM originating from its clients (presumably from e-mail viruses on client computers). I and others have talked with them about this problem, but they have not done anything about it. This means that most outgoing e-mail gets a very high SPAM score and is likely to end up in a junk mail folder or worse, silently rejected and deleted.
Customer support: OK, until you have a problem, so terrible. Complaints are postponed and shuffled, and no one seems concerned about customer care or loyalty. Their advertising is sometimes misleading.
Public IP(s): 217.194.152.1 (presumably one of a few IPs shared behind a proxy)
Website: None
Coverage: Kinshasa and some other cities
Bottom line: If you want to download torrents 24/7, this is way to go. However expect a lot of your e-mail to get spammed.

General notes about internet in DR Congo

1. All ISPs in Congo actually just buy satellite bandwidth and share it via cell towers or other local wireless technology. There is no fiber optic cable (yet).
2. I’ve seen people with computers bought in the USA with wireless cell network modems pre-installed and that seem to work well with the Vodacom network. You just buy a Vodacom SIM here and add credit to it. So you can use the internal antenna in most good laptops that is superior to the external USB modems that you buy from Vodacom.
3. I haven’t experimented with a a USB capable router. However, I have successfully shared a USB-modem through a basic wireless router using Windows Internet sharing. However, the best solution so far is with a free program called Connectify (requires Windows 7) — no router required, it simply sets up your host computer as a wireless access point.

Avoiding extortion on the way to get groceries

Bottom right: Traffic police in training; Middle-left: The spot where I was stopped

Today was grocery day as are most Fridays for us. Anicka gave me a list of groceries and in the morning I left our house to drive to the downtown core with an itinerary. Going downtown in a vehicle can be quite a draining experience and usually involves a lot of patience (or I end up getting angry).

On my way to my second stop, I noticed (with some amazement) the nice white fresh lane lines and pre-intersection arrows that help guide traffic. I was driving in the right-most lane and steered slightly towards the left to give extra space for the pedestrians that were crowed on the sidewalk — and notably 5-6 bulky traffic police and a police motorbike. One of the chubbier police officers jumped in front of my car to stop me while another one came to my passenger door and tried to get my attention by hitting the window and repeated attempting to open the door. Another police officer came to my window and made up some false accusation that I was too far left (remember I was trying to give them extra room). I rolled down my window half way (because some police have the habit of reaching in, unlocking the door, opening it, and hanging on until you give them your documents which they use to keep you hostage) and tried to calmly talk with him. Clearly I had done nothing wrong and they were just trying to extort me for money.

So, I made a quick decision and decided to use my “colonel” card which means I pull rank on him and say that I’m amount to call a very high up official in the police hierarchy. I don’t actually have the colonel’s number, but I do know his name and I also know that the police know that if the colonel were to talk to the police they would be harshly reprimanded. Meanwhile, I’m becoming extremely agitated and angry about these very well fed guys hanging off my car. But, shortly after my threat and my closing of the window and pulling out of my phone, the police get out of the front of my car and wave at me to pull over so we can “discuss”. I take this opportunity to drive away and spend the next few minutes trying to recover from my feelings of anger.

This isn’t an uncommon experience for most drivers in Kinshasa – especially visible minorities (expats). And I’ve listened to many, many stories of similar intimidation and extortion. It is a common topic of discussion at mealtimes and we all laugh about how ridiculous it is or how the police got reprimanded etc. In the first few months of our stay in DR Congo, these discussions allowed us all to vent how we were feeling and share strategies. However, these discussions are becoming predictable and aren’t edifying – and so I must find other ways to deal with the anger.

This is just one small level of corruption that we see daily. But it is really only the tip of the tip of the iceberg. The organization (MAF) we use for air travel to the interior, says that they spend half of their operating costs to the various government officials in order to get the necessary documents they need to keep their planes in the air. This money is supposed to go into funding the aviation regulation and facilities like airstrips and airports. Sadly, none of the money is accounted for and we see little evidence of improvement. Another friend who worked for the government as a tax consultant tells us that most import taxes on goods shipped into the country (including humanitarian aid) are collected by tax officials, but never officially accounted for as national revenue and so is never spent for the general population. This probably amounts to hundreds of millions of dollars each year that the poorest of the poor never see.

So, I’ve been asking myself: how do we live in a good way inside this environment? If we are constantly angry with those “corrupt” people around us, we’ll probably get very tired very quickly. On the other hand, if we do nothing, we’re implicitly condoning the corruption. I’ve also been asking how one practically combats corruption – what process can we use to diminish it? Some people talk a lot about transparency as a tool that can be used. I think transparency has a lot of merit and certainly would help in many cases. However, it seems to me that in social systems where corruption is so ingrained and even rationalized in its ethos, transparency just won’t be enough to make a significant impact. I wonder if individuals and small cohesive groups must first be convinced of the necessity to be honest with each other and offer an alternative example to others.

Canada’s Governor General visits DRC

See these articles posted today covering Governor General Michaëlle Jean’s speech at the Palais du Peuple this morning

Article AFP (French)

Canadian Press article (English)

Toronto Star article (English)

As Canadians, John and I were invited to attend. I was excited just to get into the Palais du Peuple, where the Congolese Parliament meets, and hopefully to catch my first glimpse of President Joseph Kabila. The security to get into the gates was pretty straightforward – just a basic search of our vehicle, three searches of our bags, and two metal-detector searches. There were plenty of military people and other officials around, but they were mostly friendly and professional.

The building itself was very impressive – easily the nicest building I’ve been in yet. The entry-way is massive with ceilings about 4 stories high and several large chandeliers hanging down. It is well-constructed and well ventilated. Here in Kinshasa, I notice this kind of thing because it is so unusual. We went through some more security to sit in a large auditorium (capacity of about 1000-1500 people, I estimate). The front half was reserved for MPs (“députés nationaux”), senators, and other members of the government, secretaries, and other officials. There was a whole section for Canadians. It felt surreal to be greeted as we came in by a Québécois man from the Embassy who promptly gave us his card. Just hearing a Canadian voice almost made me cry. A little attack of patriotism, I suppose.

We wore some of our nicest clothes, but still felt pretty scruffy compared to most of the other Canadians (UN or private sector workers, at least the ones we talked to). There were eight UN casques bleus seated at the front of the Canadian section, and three UN volunteers. Then us, and lots more people behind us. It felt so funny to be sitting with all these compatriots, but to have relatively little in common with them. A good proportion of the UN workers were Québécois, and it was wonderful to hear their familiar accent, since Congolese French is so different. We talked for quite a while with a man on our left who was managing a private clinic in Kinshasa. We also learned that there are only five Canadians among the 600+ UN volunteers, and not many more than 8 Canadian peacekeepers.

After while, it got pretty boring, since we had arrived at 10:30 and the Governor General didn’t arrive until about 12. Between 10:30 and 12 there was endless adjusting of chairs up on the podium, lots of journalists frantically walking back and forth, and a brief power outage. Once it actually started though, things moved fast. We were all invited to stand to welcome the Governor General and President Kabila. They walked down the aisle not five feet away from us, preceded and followed by many other dignitaries. A man in an all-white suit then led us from the stage in an a cappella rendition of Congo’s national anthem. There was a brief word of welcome by the president of the parliament, and then Michaëlle Jean stood up to speak. She spoke quite quietly but was clearly audible. At the beginning, there were a lot of interruptions for applause, but these got fewer. At the end, we stood for an identical repeat of the Congolese national anthem, and then filed out. Outside, dignitaries and other big shots were getting into their big black cars with smoked windows, ready to shoot across town and disrupt traffic due to their automatic right of way, even in the middle of traffic jams. It felt strange to see such a high concentration of these untouchables and to think that they live and move in Kinshasa without having much contact with the frustrations that plague the rest of us.

Other analysts have already given their varied perspectives on the speech. Personally, I was somewhat surprised that she spoke only about gender equality and violence against women in the East. I appreciated her statements, but also, since I am cynical, wondered what the underlying agenda was for Canada. She emphasized how much Canadians empathize with Congo’s struggles – very diplomatic, but is there much truth to it? She talked about the need for better cooperation between Canada and Congo – what exactly does this mean and who gets to decide what is “better”? Does Canada really care about the DRC or are they just interested in its resources? I guess I get impatient with all the diplomatic hot air and wish someone would talk straight both about the unbelievable level of corruption in this country, and the less than altruistic motives of many of the outsiders who want to get involved.

For an article that does just that, I highly recommend this fascinating, in-depth article by Adam Hochschild (author of King Leopold’s Ghost, a must-read history of Congo), just published on the Mother Jones website. It’s a little long, but very worthwhile if you’re interested in a different, but historically very well-informed perspective on this country that Jean says is central to Africa’s hope for peace and stability.

30 ans

Cette année j’ai pu célébrer mes trente ans de façon merveilleuse.

Jeudi était mon anniversaire. Au petit déjeuner, John m’a surpris avec une carte (plutôt un livre) plein de petits mots d’amour de nos amis du Québec, de l’Angleterre, du Manitoba, de l’Ontario, du Pays-Bas et de l’Allemagne. C’était une vraie joie de me rappeler de tous ces amis et de toute cette famille précieuse qui me connaissent et qui m’aiment – d’autant plus qu’au Congo, je continue à trouver cela difficile de développer des amitiés profondes et d’être aussi bien connue par les gens autour de moi.

Au bureau, Suzanne a pris un temps spécial de pause-café. Avec Béatrice (la réceptionniste), John et moi nous avons bu du café et échangé des histoires ; Suzanne m’a aussi surpris avec un cadeau gentil.

Après le travail nous sommes allés nager un peu à TASOK comme nous faisons régulièrement ; j’ai pu faire des exercices d’aquaforme dans l’eau avec deux autres dames. C’était un bon moment de détente.

Nous avons terminé la journée en allant manger dans un restaurant que nous aimons beaucoup – « chez Philo ». Ils servent la nourriture française et quelques plats congolais, la qualité est très bonne et la bouffe est toujours servi très chaud. J’ai pris le liboke de capitaine. On peut aussi manger l’antilope, le crocodile, ou simple le poulet ou le bœuf. John et moi ont beaucoup discuté de tout et de rien – ce qu’on fait trop rarement, même si on est ensemble presque 24 heures sur 24. À la fin de la soirée on a fait un petit arrêt dans une crêmerie pour un cornet de glace artisanale – c’est un établissement vraiment unique à Kinshasa. C’est rare que nous faisons ce genre de sortie et cela nous a fait du bien tous les deux.

La fête ne s’est pas arrêté le 15, car on avait prévu une fin de semaine de camping juste après. Vendredi matin nous sommes partis avec six autres amis (deux couples et deux femmes seules) à Bombo-Lumene, un parc et réserve de chasse national. Ce n’est pas du camping très demandant là-bas – on reste dans des chambres avec lits, draps, toilettes et douches; on fait notre cuisine sur braise ou pétrole sous une paillote; le personnel nous aide en faisant la vaisselle ou en amenant du bois pour faire un grand feu le soir. C’est un endroit complètement tranquille, sans bruit, sans dérangement de la DGM ou d’autres personnes, avec un climat un peu différent par rapport à Kinshasa (on voit par exemple des arbres conifères). On peut aussi déscendre une piste à pente très raide pour arriver à la rivière Lumene où on peut se laisser flotter pour descendre une partie de la rivière. C’est un peu dangereux car non loin de là où on sort de l’eau il y a des rapides très puissantes où la fille d’un des employés du parc a perdu sa vie l’année passée. Le courant est aussi très fort; il faut être un nageur un peu expérimenté. Mais nous montons et descendons des dizaines de fois, même si ça nous donne un peu de la frousse, car c’est tellement merveilleux de se baigner dans cette rivière super propre, super belle, et en plus c’est tellement excitant!

Après une fin de semaine ensoleillée, remplie de nage, de bonne nourriture et de conversations intéressantes, nous sommes enfin rentrés cet après-midi, très contents de cette mini-vacance et très satisfaits de notre célébration.

Pause-café au bureau

Aquaforme

La descente à la rivière

Vue de la descente

La rivière Lumene

La vue de notre chambre

Dans notre jardin

Out of control

[Post written April 8]

[Disclaimer: This post gives you a view of some of my occasional inner ravings. Please bear in mind that I don’t feel this level of frustration all the time.]

In the oven there is a fragrant cinnamon bread roll complete with butter and dark brown sugar. After developing a little crust during the first five minutes of baking, it has now fallen flat due to the power outage that began immediately after. After spending several hours working happily on mixing, kneading and creating this loaf, it is now garbage – and for absolutely no good reason. Once again, we have a « coupure générale », a power outage that will last as long as it lasts, with no predictability.

We just got back from Mukedi where there is no power. It doesn’t bother me there to have to heat water on coals, or to have to light a generator every time we need to charge our computer. So why do power outages here in Kinshasa sometimes make me so frustrated?

1. They are a symptom of corruption and injustice. Perhaps I could soothe my frustration over the waste of a good loaf of bread and several hours of work by telling myself that I’m living in solidarity with others – but that doesn’t make the power outage all right. There are many reasons, but none of them good, for why the SNEL lines are so overloaded, why the country’s hydroelectric potential has hardly been tapped, and why the SNEL workers are underpaid and unmotivated. The fact that Kikwit, a town of almost 1 million, is economically crippled because it only has generator power three evenings a week, is completely stupid, and after thinking about it for over a year, I still don’t see this any differently. Rampant corruption and greed are not good reasons for me to lose my loaf of bread and for millions of others to have to spend far more money than they can afford on charcoal and kerosene for cooking.

2. They are completely unpredictable. Just as I press the switch to heat up some water for a warm drink, out goes the power – and I now have to decide if I will fire up the kerosene stove and wait about half an hour for the same cup of water to come to a boil (it takes a long time to get a good flame going). I decide to skip the drink. As I stand in the shower in our windowless bathroom, out goes the power – goodbye water pressure and now it’s too dark to be able to keep track of where the cockroaches are, so I get out in a hurry. I collect clothes to iron, and out goes the power – still no wrinkle-free clothes to wear when we go out tonight. I turn off the lights to go to sleep, and out goes the power – no more white noise from AC, so now the neighbor’s dogs keep me up for hours. I remind myself that my sufferings are minimal compared to what others experience, but it doesn’t always help that much.

3. I am powerless to do anything about it. Powerlessness is so hard to accept. And of course I know that I’m not really powerless. I can get in the car and drive to the nearby swimming pool to cool off. I can turn on the generator and continue to work and send e-mails. I can go out to eat if the omelettes and instant noodles are getting too monotonous. I can iron clothes and do laundry at Suzanne’s house. Others are powerless, but not me. But I still feel powerless to stop the surge of anger that goes through me when I think of the waste of my loaf of bread. All around me, people try to scratch out a living and are prevented from succeeding because of corruption and greed. Their potential is being wasted just like my loaf. And just as I am powerless to fix the dilapidated power lines, there is very, very little that I can do about that frustrating fact.

Eleven thoughts about last week’s training

The training is over. From Monday to Friday, I thought of nothing else from my awakening at 6 am to walking slowly up the hill back to the guesthouse at 6 each evening. Now I have to ease back into the other obligations of regular life. This is a bit of a challenge, because I focused on it so single-mindedly, and spent so much time preparing for it over the last weeks and months. Overall, I would call it a great success. But to give you an idea for yourself, here are some of the things that were satisfying, and others that weren’t. Keep in mind while reading that the balance is clearly on the positive side.

Satisfying

1. Every day started with hot coffee, bread, and usually omelettes or avocadoes, eaten amid good-natured banter between participants. John and I joined them for breakfast each morning even though we weren’t staying at the same guesthouse – it was a nice way to start each day.

2. The two coordinating doctors’ assistants interacted with each other for the first time this week, and collaborated to enter data for one of the hospitals into the new computer.

3. I had a blast teaching my two sessions. I realized that I really miss teaching. It was so satisfying to be able to develop a rapport with participants, to see them grasp new concepts, and to help them discover things they hadn’t thought about before.

4. On Wednesday, everyone was hunched over a calculator, trying to figure out how much they would have to raise their medication prices in order to cover their delivery costs (currently subsidized by MCC). (You can try to do the calculation too: Mukedi hospital sells 850$ worth of medications each month, at cost price. Their delivery costs per 3-month trimester are 1050$. What percentage should be added to the price in order to allow Mukedi to cover the cost of both the medications and the delivery? – Answer to be announced in a future post).

5. Everyone became completely silent as they listened to Dr. Larry Sthreshley, Tuesday’s guest speaker, list ways that they can increase their efficiency and their revenue at minimal cost. Two of the ideas that people really latched onto were: improved welcome of new patients so that they feel more respected, and a rotation system for nurses so that each nurse gets to work in each different department (maternity, surgery, wards, etc.). This way, when one nurse is late or sick, others can fill in and the hospital doesn’t need to hire additional staff who constitute a huge drain on the institution.

6. People busily noted down information that they didn’t have access to before, as we filled them in on the various “hidden” subsidies that MCC is currently giving them. The most visible subsidy is the 500$ per month to help pay salaries for senior management staff. MCC also covers the medication delivery cost, which varies from 50$ to 1800$ per delivery, 60% of the cost of medications, and the cost of supervision travel for coordinating doctors and MCC coordinators. As we try to move toward sustainability, we agreed on a schedule of reduction for the various subsidies by project end (Feb. 2013). We hope to invest the money saved into other projects that will help the hospital become more self-sufficient, rather than continuing to subsidize operational costs. Future projects include the loan of money to the hospitals for the purchase of a portable ultrasound unit. Do you have ideas for future projects that won’t create dependency on MCC? Write them in the comments.

7. Afternoon coffee breaks time sometimes went unnoticed as people got so caught up in group exercises or in improving their latest reports. We had to remind them to take a break. We often left participants working outside to catch the last light when we left around 5:45 pm, and found them working in the morning when we arrived for breakfast.

8. Each day ended with a debriefing with the two coordinating doctors. It felt good to be working together with them and to be planning and carrying out this training as a team. Our impressions of the day were often similar and it was satisfying to feel that we were often on the same wavelength.

Unsatisfying

9. The per diem debate. There seems to be a strong culture associated with attending trainings here in Congo. Countless NGOs put on trainings, and most of them follow a similar system. This system includes paying what is called a per diem – in this context, that means a 5-10$ “motivation” for each day that a participant attends. (For a nurse, 5-10$ is the equivalent of an entire month’s salary). This is on top of covering meals, lodging, and transport. We at MCC-Congo have never felt comfortable with this concept. We feel that if someone needs to be paid before they will attend an all-expenses-paid training, we would rather not have them there. We’re afraid that a per diem ends up swelling the numbers of trainees just so an NGO can check off that x number of people were trained this year. We’ve had lengthy discussions about this with the coordinating doctors, and clearly if it were up to them, they would be paying a per diem at all trainings. However, they have agreed to go along with our feelings about it. They have both conducted trainings in their hospitals where no per diem was given out, much to hospital staff’s disgruntlement. Anyway – on the first day of our training, after Dr. Benza had presented the list of what would be covered by MCC (lodging, travel, meals), participants immediately reacted to the absence of per diem on that list. John, I, Benza and Gaspard had all we could do to move the conversation on to other things after responding fairly unequivocally that per diem was not part of the deal. I still feel a little uncomfortable about this, a week later. I regret that we didn’t warn participants before they came that no per diem would be included, and suggest that if that wasn’t OK with them, they could stay home. I also wonder whether we are really right to take such a hard line about this, or whether we should just go with the flow. But every time we think it through, we come to the conclusion again that giving out per diem only contributes to dependency. Perhaps we will change our mind in another year, once we’ve become more cynical…

10. All four of us trainers, as well as Larry, our guest speaker, found ourselves surprised and sometimes frustrated by the lack of basic mathematical skills among participants. It seems that hospital accountants and administrators, even though they produce financial reports and do calculations every month, are not that good at applying the math they know to new contexts. They fill out their reports by rote and rarely have the opportunity to hone their skills; they aren’t rewarded for taking initiative to do new kinds of analysis of hospital data. When I presented the price of an IV solution in a Kikwit pharmacy (1200 FC) and asked people to calculate the percent markup, assuming the product was bought for 630 FC, no one was able to come up with the right answer. People also don’t have a good grasp on common-sense error-checking. In the same example, people would give me an answer of 23%, without thinking through the fact that the product is being sold for twice as much as the purchase price, so the margin will be around 100%. The calculation of a basic average of medication consumption, which needs to be done regularly in order to make appropriate orders, also poses serious problems. We tried to address some of the common calculation errors by including checklists and reminders on the report forms – but the basic lack of mathematical savvy will continue to be a problem.

11. The heat. For several days, we had an incredible heat wave. It wasn’t just expatriates complaining while everyone else looked at each other knowingly. Everyone was complaining constantly. In church, I couldn’t focus on anything except when I would feel the next little breath of air. It was too hot to sit in front of my computer and check my e-mail some days. Even sitting outside with a glass of cold water, I was drenched in sweat. Fortunately we had a huge rain a few days in, and everything cooled off. Unfortunately, this also resulted in water flowing down the walls of our guesthouse room…

Overall…

I am very pleased with how the training went. I feel amazed at how quickly people accepted the idea that a sustainable project requires a reduction of subsidies and an increase in medication prices. One participant stated that he appreciated the fact that MCC and the hospitals were developing a more “responsible partnership”. It was worth the expense to bring people from all hospitals together in order to develop more consistency between hospital practices. Though I expect that calculation errors in reporting will continue, I feel like this training was a significant step forward to giving hospitals more responsibility for the project’s success.

Now we’re back in Kinshasa and have bought groceries, gotten the thick layer of black dust scrubbed off the various surfaces of our house, done laundry, and gone swimming a few times. We’re taking it easy for a few days; next week we’ll be back at the office, working through a big pile of reports and planning our next trip in April.

Pre-training jitters

As I write this, John is training three people in basic computer skills. These are the assistants to the coordinating doctors, who live in Kikwit and Tshikapa and who will be increasingly involved in tasks related to Menno-Santé such as entering data and sending reports. We are in Kikwit, at the CEFMC (Mennonite Brethren church) head offices, in Dr. Benza’s spacious corner office. All the windows are open and there is just enough air to allow us to breathe. It’s an incredibly hot and muggy day and everyone is complaining about it.

I’ll try to post some photos shortly.

In a few minutes we’ll go have lunch at Dr. Benza’s house, where a group of women has been preparing fufu, pondu and pork.  Then the training will continue in the afternoon.

Since we arrived in Kikwit yesterday, we have been preparing for the one-week training that starts on Monday the 22nd. This training has been organized by Dr. Gaspard, Dr. Benza, and the two of us. The training covers key concepts in hospital and pharmacy management, and will put a major emphasis on ways to help the hospitals become more financially sustainable even after Menno-Santé funding comes to a close. It’s also the first time for staff of some of these hospitals to meet each other, since three of the four hospitals are in very remote areas. We hope that doctors and other management staff will be able to compare notes and inspire each other.

As we gear up for this big event, I’m feeling a little nervous. Will each of the trainers (including me) be sufficiently prepared and will we all communicate clearly (without contradicting each other)? Will the discussions we have with hospital staff be productive and positive (we’ll be discussing ways for hospitals to be more efficient – not always a popular topic with everyone)? Did I bring enough books to read during the long quiet evenings? Will we stay healthy and happy despite very limited opportunities for exercise?

We’ll keep you updated.

A crazy week of meetings

This last week was incredibly busy. We decided to take today off in order to recover. To help me process what happened, here is a journal of sorts.

Friday 15 January

We spent the day driving around Kinshasa and buying things both program- and house-related, making a dent in the list we had had for the last few months. Time is getting short since the budget year ends in February. While we were in the industrial area of the city, on our way to buy a foam mattress, Dr. Benza called to say he would be able to make it to next week’s meetings after all. We had planned Menno-Santé meetings with the coordinating doctors from 18-20 January, but had resigned ourselves to only Dr. Gaspard being there since Dr. Benza was stuck doing a vaccination campaign. So now it’s the weekend and we haven’t really planned our meetings with both doctors in mind.

Monday 18 January

Dr. Gaspard arrived at the office at 8:30 am with his suitcase. We started our meetings somewhat informally, waiting for Dr. Benza to arrive around noon. It was a national holiday so everything was very quiet and we were the only ones in the building. When Dr. Benza showed up, we realized we needed to eat lunch and our regular restaurant was closed, so we all went downtown for a shawarma sandwich. Back at the office, we discussed hard for about two more hours, and then called it a day. At home, we settled Dr. Gaspard into our guest room (Dr. Benza is staying elsewhere) and I made stir fry for supper. Made the mistake of putting in some unwashed sesame seeds right at the end – ended up being ½ sesame seeds and ½ grit: sand in every mouthful. Yuck.

Tuesday 19 January

We met at our house so as to avoid the traffic and distractions at the office. Morning meetings went well but discussions were intense. I already felt worn out by lunch. We drove to Suzanne’s house for lunch; she had made wonderful honey-baked chicken and had ordered fufu and beans from a nearby restaurant especially for the doctors. It turns out they both didn’t like the honey-baked chicken (one didn’t eat any, and one did but told me his thoughts later). And I thought the French were snobby about food! There was lots of discussion about politics during the meal, and especially the conflict in the East. It was a little stressful. After several more hours of meetings, Dr. Benza left and Dr. Gaspard and I went over reports. We got really into it and I suddenly jumped at 6 pm, realizing supper was not planned! We scrounged leftovers from the fridge: onion soup, more gritty stir-fry, some nice spagghetti. After supper and after Dr. G and John had both bathed, I wanted to have a shower but there was no more water! It turned out someone (perhaps the gardener?) had turned off the tap leading to our reservoir, so our tank was completely empty. No water until REGIDESO decided to send some (and they are far from reliable). There was about a third of a bucket of water in the bathtub – I bathed as best I could and went to bed with greasy hair, feeling anxious. John had a cold and kept getting up to try to do something about his cough.

Wednesday 20 January

I was up early and thrilled to discover that our reservoir had filled during the night. I started the day with a nice hot shower. Maman Régine came and cleaned the house today. I was so relieved and thankful for her help. I was feeling like I just couldn’t handle the responsibility of animating the meetings as well as thinking about feeding everyone. Our meetings today were the most intense yet. We had good discussions and came to agreement about most things. It just felt like there was so much to discuss, we were really pushing ourselves to get through it all and I had the unsatisfied feeling that we must have forgotten some important things. We grabbed lunch at the little restaurant at our church – fufu etc. Dr. Gaspard was distracted by a difficult situation at home in Nyanga, and we found out from Suzanne by phone that she had had to close the MCC bank account, because the bank was making her jump through so many crazy hoops in order to access MCC money. This means some uncertainty about our cash flow until we can open a new account. We finished our meetings and the doctors both left at 6, even though Maman Régine had prepared a lovely meal of fufu, beef and vegetables. In my mind this had been my attempt to end on a good note, food-wise – but Dr. Benza had already signed up for supper at his guesthouse, and Dr. Gaspard needed to make some visits before leaving the next morning. Just as they left, the power went off. John and I felt SO tired. We ate the fufu with a lot of satisfaction and then basically dragged through dishes etc. and fell into bed. Dr. Gaspard returned while we were falling asleep – he ended up eating some of the leftovers, at least. The power came back on in the night sometime.

Thursday 21 January

I was up at 5 to see Dr. Gaspard off. John slept longer since he was still struggling with a cold. We exchanged documents and reimbursed him for some of his expenses; due to our cash flow problems we can’t cover everything and will have to transfer the rest next week. We had arranged a ride to the airport for him and waved him out at 10 to 6. I managed to sleep a little longer. Around 8, Dr. Delphin (a CEFMC doctor based in Kinshasa) showed up while we were eating breakfast. Then Dr. Benza arrived and we set off for the Mutombo Marie hospital about an hour’s drive away. We had arranged a meeting with one of the hospital administrators who had developed an accounting system that we were interesting in seeing. It was an interesting visit and we all came away with some questions, which we discussed in the car on the way home. We dropped the doctors off in Bandal and drove on to the MCC office, where we picked up some cash from Suzanne and had a much-needed little debriefing with her. After that we had a quick lunch at a simple restaurant nearby and went home for a nap. Unfortunately, the power was off again and it stayed off until around midnight. We reheated some chickpea curry on our kerosene stove, watched an episode of Little Mosque on the Prairie, and tried to sleep despite heat, noise and barking dogs. The power came on around midnight, allowing us to turn on our A/C and get the welcome white noise that made sleep possible.

Friday 22 January

I was really hoping for a relaxing morning today, since I felt totally worn down from all the meetings and knew we still needed to meet with Dr. Benza in the afternoon. Maman Régine arrived at 9; we left at 9:30 to drop off some laundry at Suzanne’s and to visit Suzanne, Kendra and the beautiful twins (Suzanne and Tim’s son David and daughter-in-law Kendra recently adopted Desmond and Amari; see their blog). I could have spent all day with those babies; holding Desmond was so relaxing and made the stress of meetings start to fade. But we couldn’t stay, we had to rush on to do several errands. The main one was stopping to look at generators that we need to buy for the doctors’ offices. We found what we wanted, consulted with doctors by phone, and left ready to make an order. On our way to the next spot (swimming pool) I was talking on the phone when I saw a crowd of about 10 police start moving to stop us as we rode along Justice. We sped up and veered in order to avoid them; it felt like we were in a movie police chase scene! They were yelling at us and waving sticks, saying that we were “aventuriers”. We were a little perplexed and then shocked when we reached the next intersection and a very nice policeman stopped us and told us that section of Justice was now a one-way. After that we had to make a lengthy detour along the boulevard to reach our destination. I was so relieved to have escaped from the first set of police, because I knew we would have spent hours in negotiation with them; but the whole incident made me feel a little shaky and stressed. A swim helped. Back to pick up the laundry and then home for some lunch before Dr. Benza’s arrival for some more one-on-one meetings. The power was off AGAIN. This is highly unusual and we were starting to get really frustrated. I even started crying – a mixture of fatigue, stress, and simply feeling overwhelmed. I had a bit of a rest and read a book for a while until Dr. Benza showed up. He was really tired too, so we just had a very calm, low-key meeting and talked through a few reports. After he left we planned to go to Suzanne and Kendra’s for supper. I had been looking forward to it all afternoon. It was raining and traffic was almost completely stopped. We ended up sitting in traffic for about 1.5 hours and then passersby started saying that the road was closed; so we turned around, got some fast food, and went home. To our great relief the power was back on.

Saturday 23 January

Our work week was not quite over yet – Drs. Delphin, Pierre and Benza needed to do an ultrasound demonstration in our livingroom in the morning. It was very interesting for everyone. After that we said goodbye to Dr. Benza and we were finally on our own again! It felt good.

Wow… reading over it all again I realize this was an exceptionally busy and stressful week. A couple of things made it harder: the money situation, John’s cold, and our inability to plan for Dr. Benza’s unexpected presence. I am very thankful for Maman Regine’s help during the week, for Suzanne’s support, and for this day off to recover and process. I think we’re ready to go back to the office tomorrow. It’s 10 pm now – good night!