Congo Violence Creates Medical Crisis

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Hundreds are dying daily in the embattled Democratic Republic of Congo. But most of the deaths aren't from bullets. Disease and malnutrition are taking a steady toll. After years of civil strife, the health care system in much of the Central African country has collapsed. In one town, the organization Doctors Without Borders is attempting to provide services to nearly 20,000 refugees.

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The ongoing conflict in the Democratic Republic of Congo is killing hundreds of people a day. Most of those deaths aren't from bullets. Most people are dying of disease and malnutrition. After years of war, the healthcare system in much of Congo has collapsed. Clashes between militias, rebels, and the army continue to drive farmers from their homes. In the town of Dubea, in the southeastern part of the country, Doctors Without Borders is attempting to provide medical care, shelter, and clean water to nearly 20,000 refugees, as NPR's Jason Beaubien reports.

JASON BEAUBIEN reporting:

When Dr. Hermietta Edenburg(ph) walked into the pediatric unit of the Doctors Without Borders hospital in Dubea on a recent Tuesday morning, the nurse handed her a small bundle wrapped in cloth. The nurse said it was a dead baby that had just arrived, but it wasn't dead, and Dr. Edenburg quickly started CPR on the tiny, emaciated body.

(Soundbite of foreign language spoken)

BEAUBIEN: Lusakabela Kaloy(ph) is another victim of a war that officially ended four years ago. She was born in November in the jungle. Her parents had fled their village to get away from fighting between the Congolese army and Mai Mai militias. Her mother, who claims to be 20, but looks to be about 14, said Lusakabela was born during a two-week trek to get to Dubea. Lusakabela is a month and a half old, but weighs just four and a half pounds. Her ribs protrude from her chest, and her tiny forearms are only about as thick as Dr. Edenburg's thumb.

Ms. KABEELA MATUMBA(ph)(Nurse, Doctors Without Borders Hospital, Dubea, Democratic Republic of Congo): (Foreign language spoken)

BEAUBIEN: Kabeela Matumba, a nurse in the hospital, said the baby is sick because people in this part of the Congo, who've been displaced repeatedly by the war, aren't able to eat properly. The Doctors Without Borders Hospital is a simple, red-brick building. There's no electricity or running water. After thousands of refugees descended on Dubea in November, this pediatric unit expanded from 10 beds to 20. The occupancy rate in December, however, was still 175%, with two children at times sharing one foam mattress. Within an hour, Lusakabela's heart is beating regularly again. She's breathing, and Dr. Edenburg has put her on a drip.

Dr. HERMIETTA EDENBURG (Physician, Doctors Without Borders Hospital, Dubea, Democratic Republic of Congo): The history is that there is diarrhea for a couple of days, so what happens is, in that she is severely dehydrated, and she came in in a really bad state with hardly no pulse or heart action anymore, because of the dehydration.

BEAUBIEN: This area of the Congo is one of the most remote parts of Africa. Roads haven't been repaired in decades. A deeply rutted dirt track connects Dubea to the regional capital, Lubumbashi. In the dry season, the trip by 4X4 takes three days. Now that the rains have set in, the 250 mile journey takes a week and a half. Dr. Edenburg says people in the region haven't had regular access to medical care, and thus, they often don't seek medical attention until it's too late.

(Soundbite of crowd)

Dr. EDENBURG: So, even simple, in our eyes, simple diseases like diarrhea which you can treat quite easily, or simple malaria, yet children can die of it because there is a lack of primary healthcare.

BEAUBIEN: An article published in the medical journal, The Lancet, in January, reported that almost 4,000,000 people died in the Congo since 1998 as a direct result of the conflict in the country. Most of those deaths were due to a lack of food and medical care. That staggering death toll continues to rise. Children who fled the fighting are dying now every month in Dubea from treatable conditions; some from malnutrition, some from diarrhea, some from malaria.

A group of Franciscan missionaries have run a small hospital in Dubea for decades. The Sisters, however, were the only healthcare provider for miles, and their resources were overstretched even before the population of Dubea swelled from 10,000 to 30,000 people as a result of the war. Doctors Without Borders originally came to Dubea to bolster the work of the nuns, but then they switched into emergency response mode as refugees started to inundate the town.

(Soundbite of baby crying)

BEAUBIEN: Because the government healthcare system collapsed years ago, most people haven't been vaccinated for anything. At Camp II, on the northern edge of Dubea, Jose Cramer(ph) is running a measles vaccination campaign. Measles is a real danger here, the Dutch nurse says.

Ms. JOSE CRAMER (Nurse, Dubea, Democratic Republic of Congo): Especially when it's as crowded in a refugee camp like this, then it spreads very easily, and it kills a lot of children, that's how, because they are already so vulnerable. So, that's why a measles campaign is one of the first things which is carried out in the refugee camps.

BEAUBIEN: Hundreds of thousands of people in this part of the Congo have been on the move since the fall of Mobutu Sese Seko in 1997. Some people in Dubea lived for several years in the bush before coming to the camps. Others say they moved in and out of their villages as soldiers from various armies and rebel groups swept through the region. And the conflict has left many people with almost nothing.

(Soundbite of crowd)

BEAUBIEN: In Camp III, Kazoos Umbalonpontinga(ph) fled into the bush with his wife and four children in November.

Mr. KAZOOS UMBALONPONTINGA (Refugee, Dubea, Democratic Republic of Congo): (Foreign language spoken)

BEAUBIEN: We had nowhere to take shelter from the rain, he says, and if the Mai Mai found us, they would kill us. He displayed the only things he still owns: an axe, a wire for trapping wild animals, a tattered green gym bag, a cooking pot, and a wicker basket. These are his sole possessions. Not only is there no government assistance here, there's also very little international aid flowing in. For several months, Doctors Without Borders was the only international agency trying to help the refugees in Dubea.

(Soundbite of foreign conversation)

BEAUBIEN: Back at the hospital, a white Toyota Land Cruiser that serves as the ambulance, has just arrived with what the Doctors Without Borders team fears is a case of cholera.

Unidentified Woman #1: Why don't we put the infusion in the (unintelligible)?

Unidentified Woman #2: Yeah, that's also fine.

Unidentified Woman #1: You have a cathoder and everything?

Unidentified Woman #2: No, no we have nothing.

BEAUBIEN: A woman in her late forties or early 50's is lying in shock on the floor in the back of the vehicle. So far, there have been no confirmed cases of cholera in the camps of Dubea, but there's an epidemic raging through a series of camps to the west of here. A cholera outbreak in the region in 2002 affected more than 10,000 people, and left hundreds dead.

(Soundbite of radio transmission)

BEAUBIEN: The staff carries the sick woman out of the ambulance, and puts her in an isolated room at the back of the hospital. Dr. Chris Lansen(ph) radios the base to ask about getting the ambulance disinfected.

(Soundbite of radio transmission)

Unidentified Man: Send it back to the base, and we clean it over.

Unidentified Woman: That's very nice. Thank you very much. Over and out.

BEAUBIEN: The doctors are worried that cholera could already be spreading through the camp. Dr. Lansen orders the woman who just arrived to be monitored closely. Walking back to the hospital, she says the patient has classic symptoms of cholera.

Dr. CHRIS LANSEN (Physician, Doctors Without Borders Hospital, Dubea, Democratic Republic of Congo): Of course, in a camp with almost 9,000 people and poor sanitation, we're very worried about that, because that could then spread out into an epidemic. But, yeah, up to now it's just an infection which we have to clarify as soon as possible.

BEAUBIEN: By the end of the day, it's clear that the woman does not have cholera, but the doctors say the threat of such an epidemic is real. Back at the pediatric unit, the tiny Lusakabela is still on a drip, but each day she is gaining more and more strength. The color has come back into her face, and her ribcage doesn't look quite as bony. Even if she emerges from the hospital, however, she'll come out into a country with an infant mortality rate that's 25 times greater than in the United States. Her chances of dying before her fifth birthday of disease or warfare or malnutrition are even far greater here than in most of the rest of Africa. Jason Beaubien, NPR News, Dubea, Congo.

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