Superb Congo Photos by Dominic Nahr

A friend sent me a link to a showcase of absolutely superb Congo photographs by a young snapper named Dominic Nahr. I'd seen a few of these shots before, but not most of them.

The slideshow is here: http://lens.blogs.nytimes.com/2009/09/01/showcase-43/ and Nahr's own website (links to stories bottom right) is here: http://dominicnahr.com/.

He says, on the New York Times Lens blog linked above, "Congo is a place where you need long-term projects," he said. "I’d love to work on different narratives, to get at the subtlety beyond just refugees and the war. Many stories stereotype Africa, but there’s so much more there."

Patch

When's the last time you patched a car tire? I'm willing to bet you've never patched a car tire. Neither have I. A couple of weeks ago I brought my car in to AUTOBACS and paid the guys there to install a couple of new tires on the front end of my Mitsubishi, and there was no discussion of patches or retreads. [I know, I know, and I never thought I'd be driving a Mitsubishi either, but when the truck division had that our-tires-fall-off-and-kill-primary-school-students-but-we'd-rather-cover-it-up-than-issue-a-recall scandal, I got a good deal. A very good deal. And of course, the car division is not the truck division.]

Things are a bit different in the Congo. In the above photographs you can see one of the drivers or mechanics (I'm not sure which category this guy falls into, but I suspect there's quite a lot of overlap) patching a tire (if you've ever patched a bicycle tire, you know how to do it). In the other photo, you can see a load of tires ready to be loaded onto an MSF plane headed for Kisangani and Goma.

If you need it, bring it with you. If it breaks fix it. And fix it again, and again, and again, until it can't be fixed no more (at which point, if it's a tire, it can be turned into sandals, or some other useful item).

Photographs of the Congo by Finbarr O'Reilly

Photojournalist Finbarr O'Reilly spent two years in the Democratic Republic of Congo and Rwanda from 2002-2004, and recently returned to update his coverage of the ongoing conflict there. He wrote something about his recent trip here: http://blogs.reuters.com/mediafile/category/africa-blog/; there's an audio slideshow here: http://www.reuterspix.com/congo/; and I've posted a few of his shots above. His website is here: http://www.finbarroreilly.com

The Risky Business of Making Babies

There’s no shortage of work in the Democratic Republic of Congo for pediatricians. The median age of the country’s 65 million population is around 16, and the population growth rate is 3.22% (population growth in Japan, Italy, Germany and Russia is negative; population growth in Liberia is 4.5%, Ireland 1.77%, India 1.46% and the United States 0.97%).

The DRC’s myriad health problems, however, mean life is especially tough (and risky) for the country’s children. While the infant mortality rate in the United States is 6.9 deaths per 1,000 live births (and the U.S. ranks an unimpressive 29th in infant mortality statistics; Singapore ranks first at 2.0; Hong Kong next at 2.5 and Japan third at 2.8), in the DRC 88.62 children of every 1,000 live births die before reaching their first birthdays.

In addition, about 510 women die per 100,000 births, and since the average Congolese woman gives birth to more than six children, baby making is risky business.

The children, if they survive their first year, can look forward to the very good possibility that at some point in the near future they’ll need medical attention for cholera, malaria, meningitis, tuberculosis or that old Congolese standby, malnutrition.

I shot these photos in the MSF hospital in Bunia, in Ituri province, accompanying Dr. Dede Sapo Mudinga on his rounds. Bunia is quiet now, but has seen more than its share of killing during the past 10 years, and is now the base of operations for a significant United Nations peacekeeping force.

How Would You Spend $8 Billion?

I've written previously about malnutrition [http://notes-from-the-congo.blogspot.com/2009/08/let-them-eat-cake.html], but decided to revisit the subject after feeling a bit hungry before lunchtime.

Hunger and malnutrition are not the same thing, of course. Hunger is what I felt before eating a big bowl of cold soba for lunch, and the word can also be applied to describe people who consume fewer than 2,100 calories a day; malnutrition is not merely the consumption of too little food. It is a pathology caused principally by a lack of essential nutrients.

As I've written elsewhere, children (especially under two years old) are the most easily affected by inadequate diets, and when children suffer from acute malnutrition, their immune systems are so impaired that the risks of mortality are greatly increased. Malnutrition is identified in three ways: by weight for height, by measurement of mid-upper arm circumference, or by the presence of edema (bloated feet and/or face).

The fourth and fifth photographs above show feeding schedules for malnourished children. MSF provides patients with a ready-to-use food (RUF) called Plumpy Nut (third photo), the amount of which is prescribed according to the child's weight. The advantages of Plumpy Nut and other RUFs are that they deliver a lot of calories in a small package, contain the full range of nutrients needed by growing children, and come in individual packages, making them easy for children to consume (and making it easier to ensure that the malnourished children – rather than other family members – are the ones consuming them).

The World Health Organization estimates there are 178 million malnourished children around the world. In a 2006 publication, "Ending Child Hunger and Malnutrition Initiative", the World Food Program and UNICEF estimated the cost of effectively addressing malnutrition at $80/family, or $8 billion for 100 million families. On June 16, 2009, the U.S. House of Representatives approved the expenditure of $7.65 billion to respond to the swine flu pandemic, which to date has killed fewer than 3,000 people worldwide.

Fufu ... Tastes Like Nothing, But Fills You Up!

Cassava, also known as manioc, is a staple of Congolese (and other African) cuisine and is the major source of calories for more than 250 million Africans. Cassava is hardy, and relatively easy to grow, but unfortunately has the lowest protein-to-energy ratio of any staple crop. A typical diet based on cassava provides less than 30 percent of the minimum daily requirement for protein and only 10-20 percent of the required amounts of iron, zinc, vitamin A, and vitamin E. Moreover, because it carries low levels of a naturally occurring cyanide, cassava can be toxic if is not prepared properly. [http://www.grandchallenges.org/ImproveNutrition/Challenges/NutrientRichPlants/Pages/Cassava.aspx]

In the Congo, cassava root is used to make fufu, which is a thick paste (with a breadlike consistency) usually made by boiling the roots in water and pounding with a mortar and pestle until the desired consistency is reached. Fufu will typically be eaten as a carbohydrate-rich stomach filler accompanied by some sort of sauce or stew. Economic circumstances dictate the ingredients in (or availability at all of) the sauce. [I ate my first fufu in Boston in 1985, learning Swahili (now mostly forgotten) from a Congolese lady named Mama Vumbi Kalonji. Our class was held at midday, and Mama Vumbi would often bring a Congolese lunch she had cooked. Including fufu.]

In the first photograph above, you can see cassava root drying outside a couple of huts near Nyanzale. In the second photograph, a woman is pounding cassava root into flour. I took at a turn at the mortar and pestle, but unfortunately don't have a photo of myself doing so. She (and everyone else nearby) liked it. We wazungu aren't as useless as we look!

Home, Sweet Home

Before I came to the Democratic Republic of Congo, a refugee camp, in my mind's eye, comprised orderly rows of blue United Nations-supplied tents, perhaps even including an Internet cafe tent, and Silvio Berlusconi wandering around in expensive loafers, an expensive sweater draped over his shoulders and a fake look of concern pasted onto his face.

The Congolese reality is somewhat different. "Camp" simply means "place where people have started to live together, for (often illusory) security and because aid (food/medical) distribution more easily finds large groups of refugees".

Refugees/IDPs build their own huts, from sticks and grass and mud, and hope that aid organizations will eventually build toilets and water sanitation facilities (and distribute food). The plastic sheeting that covers some huts is (as far as I heard and could see) no longer distributed by the U.N. (perhaps this distribution is done only during "emergencies" ... not sure) – those who have plastic sheeting were given it years ago, or bought it from others.

The huts are tiny, only a few square meters (in which it is impossible to stand upright), sometimes divided into two sections, one for "living" (cooking/eating) and one for sleeping. Families of up to half a dozen (and sometimes more) adults and children live in these huts, and when you look inside, you can understand why the MSF medical teams encounter so many burn victims; cooking is done inside the huts as well, either over a small open stove (rocks on which a pot can be rested over charcoal) or a small oven (sculpted from mud).

Not a pair of Ferragamo loafers in sight ...

Food distribution at IDP Camp in Nyanzale

In the North Kivu town of Nyanzale I stumbled across a food distribution operation being run by French NGO Premiere Urgence. The food is provided twice a month by the United Nations World Food Program and consists of (third photo) 30kg of corn flour, 9kg of beans, 2.25l of vegetable oil (no balsamic vinegar, surprisingly!) and 375g of salt.

The flour is delivered in a single (heavy) sack that the distributor slices open to prevent its resale. The vegetable oil comes in a 5-liter jug that must be shared between two families, and again to ensure it is not resold, the distributor pokes his thumb through the foil cap before handing it over. The women – some of them quite elderly – must struggle back to their huts with the enormous, unsealed sacks, and of course they must try to find other food than these very basic staples.

I talked with the president (first photo) of the administrative committee of the camp, Bahati Mahombi, who said the camp consists of 28 blocks of 50 families, with families on average comprising 5-6 members. As in other camps, there is no education for the children, and as elsewhere, the camp is frequently attacked by raiders looking to either intimidate or rob.

Internally Displaced Persons

Before I arrived in the Congo I knew only one word for people who have been forced from their homes and are living in camps: refugees. I have since learned there's another word, or rather, group of words: internally displaced persons (IDPs). IDPs are "refugees" who have been forced from their homes by conflict or violence within their own countries. In the mid-1990s, most of the "refugees" in the Congo were Rwandan Hutus who had fled their country in fear of Tutsi reprisals for the Hutu-led genocide. In July of 1994, nearly one million Rwandans took refuge in Goma, where subsequently outbreaks of cholera and dysentery claimed thousands of lives. Over the past 10 years hundreds of thousands of Rwandans have been repatriated, but continued conflict (involving forces from both within and outside D.R. Congo) means there are still enormous numbers of displaced people, many of whom have been forced from their homes multiple times.

I visited a number of IDP camps in the Congo, but near the North Kivu town of Nyanzale I visited four in one day. I traveled with an MSF epidemiologist named Nicodeme, who makes the rounds of the camps around Nyanzale to register the IDP population with the aim of preventing and limiting outbreaks of contagious disease (MSF also provides health services and maternity care). In a day I visited four camps in which more than 20,000 people live in huts they have built themselves from sticks, grass and mud. A number of NGOs provide services to the camps including water sanitation, latrine and shower construction, food distribution and medical services.

In each camp, I first met the elders, to explain my visit and to learn something of the problems facing the residents of each place. In general, the problems are the same: the violence continues, in the form of rapes and robberies, there is not enough water, and there is no one providing educational services to the children. "This generation is lost," said the president of one camp to me. The president of another camp (pictured), Pascal Barimuchabo, told me he had been displaced four times. He had come to the camp where I met him, in Kikuku, in January of 2007 with his wife and four children. His fifth child was born in the Kikuku camp and is now two years old. Pascal and his family live in a hut they have built that is around three square meters in size, divided into two "rooms". His last words to me were, "Pray for us."

Security Situation Prompts Partial Withdrawal of Gety Team

In Gety, militia units have recently entered the town on two occasions, looting some houses, and forcing the MSF team to suspend visits and support to health centers outside the town. A reduced team is still working at Gety’s hospital. The safety of the medical and support team is of paramount concern, but of course the real victims are the local citizens whose access to medical treatment has been reduced. Above are some photographs of the Gety area and team.

The long and dusty road ...

I was lucky, or unlucky, depending on your perspective, to travel to the Democratic Republic of Congo during the dry season, which is pretty dry. The wet season, I understand, is very wet.

The one downside of the dry season is dust. Road dust. In a country where there are reportedly only several hundred kilometers of roads that remain paved, there's a lot of dust. [The "good" news is that there are very few vehicles kicking the dust into the air.] Dust in your clothes, dust in your bags, dust in your hair (if you have any).

On the recommendation of an old hand, I wore a bandanna over my face during one especially dusty leg. I half hoped we'd run into a rebel ambush, so I could pretend to be a bandit: "No, YOU drop the gun!"