Update: Reinou and Adam in the Congo
For more than two months views of verdant mountains cloaked in fog and clouds; women in brightly
colored garb either squatting by the rutted road selling bananas, avocados and homemade charcoal or
hauling large baskets of produce or firewood; and children in tattered clothes who approach and
whisper “bonjour muzungu” (good morning in French and white-man in Swahili) were part of our
morning walk to the hospital.
Photo: Chiels Liu
Certainly the press often reports on atrocities by armies and rebel groups: attacks and rapes and
killings; conflict minerals; malnutrition and extreme poverty - but for us, the town of Masisi, in the
eastern Congolese province of North Kivu, was relatively quiet. It was far from Heart of Darkness,
Joseph Conrad’s novel set in the Belgian Congo. Instead, Reinou and I concentrated on providing and
improving surgical and emergency obstetrical care for the local population.
Photo: Chiels Liu
From the middle of February until the end of April we were in the Democratic Republic of Congo (DRC),
the country once known as the Belgian Congo and for a brief time Zaire, as part of an ongoing
Médecins Sans Frontières (MSF) mission. (For those who may not be aware, MSF is the French name
for the group, Doctors Without Borders). An emergency mission began in 2007 during the height of
the conflict and now with improved security and relative stability has transitioned into a long-term
development program. MSF provides support to the Masisi General Referral Hospital, a 170 bed
facility; the local health center; several surrounding health-posts; and conducts mobile clinics; all with
the aim of improving the health of the local population.
Photo: Chiels Liu
As most of you know, I have been involved in this type of work for about 7 years; however, this was my
first mission with MSF. When Reinou and I planned a joint mission (she was there to assist with
obstetrical emergencies) we initially envisioned working in a hospital where we would do everything.
Much to our delight, the emphasis of this program was on training the local staff and improving their
capacity to provide care – something that is often more difficult, but which we felt very comfortable
providing – basically the Surgeons OverSeas (SOS) model.
Photo Chiels Liu
The hospital is relatively nice by African standards: 2 operating rooms, an emergency room, a dressing
room for minor wounds, and separate wards for pediatrics, internal medicine, surgery and
obstetrics/gynecology. A small 3 bed “intensive care unit,” is where we sent the sickest patients, but
with no ventilators and only limited specialty medications, the term “intensive” might be a bit grandiose.
The surgical ward consisted of 35 beds and Dr. Jean-Paul, the Congolese doctor assigned to surgery
really did a great job. My role was to assist him to independently perform emergency surgical
procedures often seen at a district hospital in Africa.
Photo: Nick Czernkovich
Luckily, the patients did a great job of complying. We had cases of perforations from duodenal ulcers
and typhoid; obstructions from tumors, intussusception, Ascaris (worms), incarcerated inguinal hernias
and a femoral Richter’s hernia; psoas abcesses and liver abscesses and a whole host of other
abscesses that needed drainage. We had our share of trauma, although not as much as I would have
hoped for (but I guess that’s better for the population so I won’t complain). A few of the highlights
included: one patient with a high velocity gunshot wound through his stomach and large intestine, one
with facial lacerations from a gorilla attack, another with a machete to the abdomen, and I was able to
repair the tendons of a guy who walked 15 hours after having his forearm almost fully severed with a
machete - through both bones - luckily he was able to leave the hospital moving all of his fingers. We
also treated numerous children who were shot, burned or had tumors. We casted some broken bones
and put other patients in traction; and one day we had 11 gunshot wound victims, many of whom
needed treatment in the operating room.
Photo: Nick Czernkovich
Reinou was kept busy working the Dr. Janine, the Congolese doctor responsible for obstetrics and
gynecology. Together they dealt with difficult deliveries, resuscitated sick newborns and provided
gynecologic consultations in the 50 bed maternity ward. As giving birth to many children (often 10 or
more) was as popular as in Niger, she saw similar complications including: obstructed labor, ruptured
uteruses, pre-eclampsia and a number of stillborn fetuses. Luckily no mothers died, in part due to a
maternity waiting home where high risk women in their last month of pregnancy could stay until they
delivered. The local doctors are very capable of independently performing caesarean sections and so
she only had to help out occasionally; and therefore we could mostly sleep through the nights.
Photo: Nick Czernkovich
As in most African hospitals, despite the severe limitations, the staff was wonderful and very capable of
providing quality care. MSF has done an excellent job of proving material and salary support to the
hospital and without such additions care would be much worse. As always it was amazing to realize
what you don’t need to be able to still provide safe and appropriate care. We did not have x-rays and
often there was no blood for transfusions, but there was an ultrasound machine and Reinou was able
to image some abdominal tumors in addition to scanning pregnant women.
Photo: Chiels Liu
As for our living conditions, they were very basic but relatively comfortable; though austere might be a
better term. There was warm water for bucket showers and a squat outhouse isn’t so bad once you get
used to it. There was a cook who is fairly accomplished with western dishes so we didn’t lack in that
respect. There are no mosquitoes being at an elevation of 3500 ft (1200 m) and the weather was
comfortable with occasional tropical downpours, and not too hot. The MSF team was relatively large,
averaging 15 expats including logisticians, administrators, doctors, nurses, a midwife and a pharmacist.
Photo: Chiels Liu
Reinou and I hope that all of you are well and as we will be back in Amersfoort, NL in May invite those
of you who might want to visit. As for the next adventure, Reinou will be working in a real Intensive Care
Unit in the Netherlands for 4 months starting in mid-May and for me, who knows.
Best to all,
Reinou and Adam
For more than two months views of verdant mountains cloaked in fog and clouds; women in brightly
colored garb either squatting by the rutted road selling bananas, avocados and homemade charcoal or
hauling large baskets of produce or firewood; and children in tattered clothes who approach and
whisper “bonjour muzungu” (good morning in French and white-man in Swahili) were part of our
morning walk to the hospital.
Photo: Chiels Liu
Certainly the press often reports on atrocities by armies and rebel groups: attacks and rapes and
killings; conflict minerals; malnutrition and extreme poverty - but for us, the town of Masisi, in the
eastern Congolese province of North Kivu, was relatively quiet. It was far from Heart of Darkness,
Joseph Conrad’s novel set in the Belgian Congo. Instead, Reinou and I concentrated on providing and
improving surgical and emergency obstetrical care for the local population.
Photo: Chiels Liu
From the middle of February until the end of April we were in the Democratic Republic of Congo (DRC),
the country once known as the Belgian Congo and for a brief time Zaire, as part of an ongoing
Médecins Sans Frontières (MSF) mission. (For those who may not be aware, MSF is the French name
for the group, Doctors Without Borders). An emergency mission began in 2007 during the height of
the conflict and now with improved security and relative stability has transitioned into a long-term
development program. MSF provides support to the Masisi General Referral Hospital, a 170 bed
facility; the local health center; several surrounding health-posts; and conducts mobile clinics; all with
the aim of improving the health of the local population.
Photo: Chiels Liu
As most of you know, I have been involved in this type of work for about 7 years; however, this was my
first mission with MSF. When Reinou and I planned a joint mission (she was there to assist with
obstetrical emergencies) we initially envisioned working in a hospital where we would do everything.
Much to our delight, the emphasis of this program was on training the local staff and improving their
capacity to provide care – something that is often more difficult, but which we felt very comfortable
providing – basically the Surgeons OverSeas (SOS) model.
Photo Chiels Liu
The hospital is relatively nice by African standards: 2 operating rooms, an emergency room, a dressing
room for minor wounds, and separate wards for pediatrics, internal medicine, surgery and
obstetrics/gynecology. A small 3 bed “intensive care unit,” is where we sent the sickest patients, but
with no ventilators and only limited specialty medications, the term “intensive” might be a bit grandiose.
The surgical ward consisted of 35 beds and Dr. Jean-Paul, the Congolese doctor assigned to surgery
really did a great job. My role was to assist him to independently perform emergency surgical
procedures often seen at a district hospital in Africa.
Photo: Nick Czernkovich
Luckily, the patients did a great job of complying. We had cases of perforations from duodenal ulcers
and typhoid; obstructions from tumors, intussusception, Ascaris (worms), incarcerated inguinal hernias
and a femoral Richter’s hernia; psoas abcesses and liver abscesses and a whole host of other
abscesses that needed drainage. We had our share of trauma, although not as much as I would have
hoped for (but I guess that’s better for the population so I won’t complain). A few of the highlights
included: one patient with a high velocity gunshot wound through his stomach and large intestine, one
with facial lacerations from a gorilla attack, another with a machete to the abdomen, and I was able to
repair the tendons of a guy who walked 15 hours after having his forearm almost fully severed with a
machete - through both bones - luckily he was able to leave the hospital moving all of his fingers. We
also treated numerous children who were shot, burned or had tumors. We casted some broken bones
and put other patients in traction; and one day we had 11 gunshot wound victims, many of whom
needed treatment in the operating room.
Photo: Nick Czernkovich
Reinou was kept busy working the Dr. Janine, the Congolese doctor responsible for obstetrics and
gynecology. Together they dealt with difficult deliveries, resuscitated sick newborns and provided
gynecologic consultations in the 50 bed maternity ward. As giving birth to many children (often 10 or
more) was as popular as in Niger, she saw similar complications including: obstructed labor, ruptured
uteruses, pre-eclampsia and a number of stillborn fetuses. Luckily no mothers died, in part due to a
maternity waiting home where high risk women in their last month of pregnancy could stay until they
delivered. The local doctors are very capable of independently performing caesarean sections and so
she only had to help out occasionally; and therefore we could mostly sleep through the nights.
Photo: Nick Czernkovich
As in most African hospitals, despite the severe limitations, the staff was wonderful and very capable of
providing quality care. MSF has done an excellent job of proving material and salary support to the
hospital and without such additions care would be much worse. As always it was amazing to realize
what you don’t need to be able to still provide safe and appropriate care. We did not have x-rays and
often there was no blood for transfusions, but there was an ultrasound machine and Reinou was able
to image some abdominal tumors in addition to scanning pregnant women.
Photo: Chiels Liu
As for our living conditions, they were very basic but relatively comfortable; though austere might be a
better term. There was warm water for bucket showers and a squat outhouse isn’t so bad once you get
used to it. There was a cook who is fairly accomplished with western dishes so we didn’t lack in that
respect. There are no mosquitoes being at an elevation of 3500 ft (1200 m) and the weather was
comfortable with occasional tropical downpours, and not too hot. The MSF team was relatively large,
averaging 15 expats including logisticians, administrators, doctors, nurses, a midwife and a pharmacist.
Photo: Chiels Liu
Reinou and I hope that all of you are well and as we will be back in Amersfoort, NL in May invite those
of you who might want to visit. As for the next adventure, Reinou will be working in a real Intensive Care
Unit in the Netherlands for 4 months starting in mid-May and for me, who knows.
Best to all,
Reinou and Adam
| Congo, Democratic Republic of |
