Augustin, Sign Maker

Sorting through some photographs the other day, I looked closely at these shots I took of department/ward signs in an MSF-run hospital in Bunia. On each of them you can see (click on the image to see in a larger size) the sign maker's signature, Augustin. [I've added another sign, by Pierrot the sign maker, which may or may not have been taken in the same hospital (I can't be bothered to figure it out from the shot timings).]

I love the purity of Augustin's marketing strategy, though I imagine that if he hired an agency they would recommend writing "Augustin" in the size he's written "Maternite".

Will Work for Food

There's not a lot of commerce in the Democratic Republic of the Congo, with the result that there's not a lot of work. The majority of people are subsistence farmers, and in many parts of the country war prevents them from doing much farming, which in turn means they struggle to find sustenance.

The main industries (they are interrelated) in the D.R.C. are mineral extraction, aid and war, and aid organizations that operate in the D.R.C. are a significant source of employment, especially outside of the country's few major cities. Every morning outside the gates of aid organizations that are actually doing work (there appear to be quite a few that simply exist in as a signboard and a caretaker, having run out of operating funds or capable managers), local men assemble, hoping to be selected to work on projects that can't be handled by the organization's full-time staff.

I shot the above photographs in Bunia, in Ituri province, at the end of a long day that looked as though it was a lot longer for the man in front of the lens. Still, he put food on the table for his family.

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.

Let them eat cake

I had some blood (quite a surprising amount, I thought) taken yesterday, and was reminded of many of the malnourished children I saw in various hospitals and clinics in the eastern Congo. As I've noted before, many of these kids have other (mostly related) health problems (including bad, bad burns), but I never saw a child cry except when a doctor tried to put a line into a vein. That's mostly psychological, I think (though it does smart a bit), but the real problem is that these kids' veins are incredibly hard to locate (I guess because of dehydration?). Which can mean multiple jabs, not easy when the kid is screaming and squirming ...

Not to diminish the seriousness of eating disorders, but I had to laugh the other day when I Googled 'malnutrition' and followed a link to a New York Times page on the subject that emphasized eating disorders as a primary cause. Perhaps among teenage girls living on Park Avenue and in Orange County, but not elsewhere. Malnutrition is estimated to directly cause 300,000 deaths worldwide each year among children five years and younger (and is a secondary cause of death for hundreds of thousands more). In 2001, it was a contributing or direct cause of death of 54 percent of children in developing countries. And the World Health Organization estimates that although by 2015 the prevalence of malnutrition will have decreased to 17.6 percent globally, it will nonetheless affect 113.4 million children below the age of five.

What's striking in the Congo (especially to me, with a medical knowledge base almost entirely accumulated by watching episodes of "House, M.D.") is the relative good health of the mothers bringing in malnourished children. That's because infants and young children are most vulnerable to the effects of malnutrition. The question that occurs to everyone who visits the Congo is why there is malnutrition at all. The country is so spectacularly fertile that more than a few people told me that a discarded beer can would quickly grow into a beer can tree. The problem is war. When people are afraid for their lives, they can't and don't cultivate the land. They hide in the bush, and eat what they can, when they can. The effects of these disruptions are usually not felt immediately, but the following season, or year, when crops that should have been cultivated are not available to be harvested. Other problems result when mothers stop breastfeeding too early (sometimes only two to three months after the child is born), give children food and drink that causes gastroenteritis, and rely solely on (nutrition-free) manioc flour rather than corn flour (distributed by aid groups, but often sold).

The ongoing fighting in the eastern Congo means that many children are treated for malnutrition and released, only to return some months later, when their health deteriorates again. The fundamental problems preventing parents from feeding their children have nothing at all to do with agriculture or the land.

Believe it or not, the child in the top photograph is three years old, and weighs seven kilograms.

Hotel Bunia

Had the chance to spend a couple of nights in the Hotel Bunia this week, in the town of Bunia (not recommended as a holiday spot) in Ituri province. The room was $35 a night, and the price included a mosquito net (with holes) over the bed. It did not include a flushing toilet, nor a door that latched properly. The restaurant, which I did not eat in, is supposed to serve decent Indian food (the owners are Indian), and there's a pool table in the outdoor bar/carpark. Given the thickness (thinness) of the walls, though, the good news is that the guest rooms are supposedly a weapons-free zone.

Water, water, every where; Nor any drop to drink

There's no shortage of water in the Democratic Republic of Congo, but for millions of people, there's none clean enough to drink, or to wash in. Among the most important health care services aid groups provide to rural villagers is water sanitation facilities.

I took the above photos in Soke, between Gety and Bunia in Ituri Province, where MSF personnel had constructed a water sanitation plant and piped clean water 800 meters uphill to the main part of the village.

MSF Water-and-Sanitation Engineer Barry Gutwein, who worked in Katanga Province in 2006, wrote in detail about his experiences delivering water to villagers there: http://doctorswithoutborders.org/news/article.cfm?id=1758&cat=voice-from%20the%20field