Eight Minutes

Actress Sienna Miller traveled to Democratic Republic of the Congo in early 2009 to document the problem of rape, used there as a military weapon to terrorize the civilian population. The title of Miller's short documentary, "Eight Minutes" (click title or here to go to site), refers to the frequency with which a woman is raped in the Congo ... it happens every eight minutes.

The problem of peacekeeping in a country where there's no peace

The United Nations currently maintains a force of nearly 20,000 peacekeepers in the Democratic Republic of the Congo, comprising nearly 17,000 soldiers, 700 military observers and more than 1,000 police officers, as well as several thousand civilian personnel. The mission, known by its French acronym as MONUC, was deployed following a U.N. Security Council resolution in February 2000 to monitor the implementation and investigate violations of a ceasefire among the armies of Angola, the Democratic Republic of the Congo, Namibia, Rwanda, Uganda, Zambia, and Zimbabwe, as well as about 25 armed groups.

Since the deployment of an initial force numbering just over 5,000 soldiers, MONUC's mission has expanded to include support for the conduct of elections, protection of civilians and humanitarian aid workers, and disarmament and demobilization of armed groups operating within the D.R.C. And in the 19 years MONUC has been operating, 94 soldiers, 10 military observers, six policemen and 39 civilian staff members have been killed. During that same time, over five million civilians have died as a direct and indirect (disease and starvation) result of conflict in the Congo.

There are obvious problems with sending peacekeeping missions into countries that are not at peace. Although it is the U.N.'s largest peacekeeping operation, MONUC is pitifully undermanned in the context of the size of the D.R.C., the inaccessibility of much of its territory, and the continuing levels of military activity by both rebels and foreign governments.

Most critically, most U.N. peacekeepers, though fabulously paid by Congolese standards, would probably not consider themselves well paid enough to die for a country that is not theirs. And that, to my mind, is the problem with soldiering for hire, which is what U.N. peacekeepers do.

U.N. member states are paid for contributing peacekeepers, at a rate of around $1,000 a day per soldier. More for specialists, plus allowances for gears and weaponry. A nation, e.g. Fiji, Guatemala (the soldiers in the photos above are part of a Guatemalan special forces unit) contributing 1,000 peacekeepers to MONUC receives $1 million a day in compensation. Not an insignificant sum for a small nation that isn't Monaco or Luxembourg.

Most nations add a bump to the soldiers' pay, but it's nowhere near the $1,000 a day being received from the U.N. So imagine you're getting an extra $200 a month to be a peacekeeper in the Congo. If you're a Pakistani enlisted man, that's not a small amount on top of your regular pay, but is it worth getting killed over? Definitely not, and as a result, how well you do your job depends on how seriously you take your responsibilities as a soldier and a United Nations peacekeeper.

Late last year, during a handover from Indian to Uruguayan forces in the North Kivu town of Kiwanja, near Rutshuru where I was not long ago, rebel forces attacked Kiwanja and Rutshuru, killing civilians and taking control of both towns while MONUC peacekeepers (who had armored vehicles) bunkered down in their base, at one point even coming under fire from Congolese army soldiers whom MONUC theoretically supports. The Indians defended their (in)actions by saying they were unaware of the attacks on civilians occurring just down the road from their base, but not helpfully from an intelligence gathering perspective, the English-speaking Indian forces had no translators on duty in French-speaking Congo.

This is not to cast aspersions on the abilities of Indian peacekeepers alone. There are plenty of other examples (Rwanda, Bosnia, Somalia, Haiti) of catastrophic U.N. peacekeeping failures, reinforcing the fundamental problem: that few people, even professional soldiers, are motivated by a few (and it really is just a few) extra dollars to die for someone else's country.

Essential Drugs

Doctors who work for MSF are pretty much guaranteed they will face pathologies they would not have had to deal with in their home countries, even if their home countries are developing nations with significant health care problems. MSF's mandate is (for the most part) emergency response, and doctors respond to outbreaks of cholera, malaria and meningitis, treat victims of armed conflict, and set up treatment programs for HIV/AIDS sufferers.

Even doctors who served their residencies in Detroit, and have therefore seen more than their share of gunshot victims, have probably not treated too many patients who had stepped on land mines. The same is true of African trypanosomiasis, also known as sleeping sickness. Not too many cases of that at Karolinska University Hospital in Stockholm, for example.

MSF frequently operates in countries and regions where the health care infrastructure has completely fallen apart – the Democratic Republic of the Congo is an excellent example – and in order to maximize the speed and efficiency with which newly arrived medical teams can start delivering care to patients, the organization has developed a number of specialized kits, each containing a wide range of supplies needed to treat a certain number of patients in a particular pathology. MSF has also published a number of guidelines and protocols that share information from doctors who may have been in similar circumstances.

The book pictured above is a manual intended for use in the field by physicians, pharmacists, nurses and other health care workers involved in the prescription, dispensation and management of medicines. This particular volume looked as though it had been well used.

Other volumes published by MSF boast intriguing titles such as "Obstetrics in Remote Situations", "Management of Epidemic Meningoccocal Meningitis", "Blood Transfusions in Remote Areas", "Refugee Health in Emergency Situations" and "Rapid Health Assessment of Refugee or Displaced Populations".

Those titles are far more straightforward, I think, than "Essential Drugs", which has possibly been purchased by mistake by more than a few substance-impaired undergraduate university students.

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".

"I could never do that."

How often have you heard people say, or said yourself, "Oh, I could never do that."

In the course of showing my photos of the Congo to friends, I've heard more than one person say those words, or words like them. My friends seem to think they could never survive being shot in the leg, or that they could never build and live in their own grass and reed hut, or collect water and food every day in order to prepare that day's meals.

My friends are wrong, of course. Hundreds of millions of people do those things every day, because if you have no choice ... you have no choice.

Are we in the developed world "soft"? Yes, most of us are. We worry about trivia, because we have nothing worse to worry about. We convince ourselves we can't do things, because, if the going gets too tough we can always climb back into our BMWs and Audis, turn up the heater (and CD player), pick up a coffee at Starbucks, and have a hot shower when we get home, before deciding between ordering Chinese or pizza for dinner.

When you have no choice, things are simpler. If you have to collect 20 liters of water per day per person in your family, you know you need to wake up early and get moving with that 5-liter jug. If your child is sick and the nearest health clinic or hospital is 20 kilometers away, and there are no buses or other transport, you know you need to start walking.

If you had to run out of your house right now because drugged and drunken gunmen were attacking your community, indiscriminately spraying automatic weapons fire, and you had to hide in the woods for three days without food, returning to find that your home had been burned to the ground and you'd been left with nothing but the clothes on your back, could you handle that? You probably could.

Wanted: _____ologists

Dr. Richard is a 38-year-old anaesthesiologist working at Rutshuru Hospital in North Kivu province, and he's the only anaesthesiologist on staff. The hospital's surgeons perform 10-20 operations a day, around the clock, and Dr. Richard is stretched.

He has three nurses working under him who have anaesthesiological training, but Dr. Richard, who is Congolese and was trained at the University of Kinshasa Medical School, bears responsibility for their work, and more often than not, he attends in person.

A shortage of doctors in the Democratic Republic of the Congo, combined with an overall very basic level of medical care, means the vast majority of the country's medical school graduates (not a huge number anyway) go straight into general practice rather than undertaking a specialist residency.

The money is better in general practice (though by the standards of almost every other country on earth it's not good), so why spend an extra few years learning to be a gynecologist or endocrinologist or otolaryngologist? Or anaesthesiologist?

Perhaps in order to work overseas, for a lot more money, in a country where you're unlikely to be shot and killed because you have a job and perhaps own a bicycle and are therefore "rich"? No one would blame you.

The D.R.C.'s "medical brain drain" is, like so many of the country's other problems, rooted in the decade of war that has thus far cost 5.5 million lives, and prevents Congolese from establishing a society in which they can live without fear and work toward realizing their dreams.

No one can blame those who have the opportunity for choosing to seek a better future overseas, but equally, few can be unimpressed by those like Dr. Richard who choose to stay, to work for little pay and often at great personal risk to reclaim their countries from the depths of anarchy and despair.

Not Architecture for a Rainy Day

I've always liked rain, in part for the cozy feeling I get when I'm inside, warm and dry, looking out at it. And when it rained yesterday here in Japan, I had occasion to think about people whose homes aren't quite so warm and dry in wet weather.

I visited the Congo during the dry season, but having lived in and traveled around tropical and semitropical Asia for 20 years, I can easily imagine how wet the rainy season is. The rainy season will see the dusty unpaved roads (and nearly all the roads in the country are unpaved) turn into impassable rivers of mud, which will connect seamlessly to the dirt floors of refugee/IDP (internally displaced people) huts (the roofs of which are made of those not-very-waterproof building materials, leaves and tree bark).

Above are some photographs of the huts refugees and IDPs construct for themselves, and a shot of a mother and child who invited me and my MSF nurse/guide Didier (whose shoulder is visible in the shot) into their tiny hut. Their hut was partitioned into two spaces: one for living/cooking, and one for cooking. The entire hut was the size of the passenger cabin of a compact car.