For Congolese Women, A Lifesaver

By Lane Hartill

NYAMIBUNGU, Democratic Republic of the Congo — Dr. Freddy Mubuto, the head doctor at a rural hospital here, will never forget the day when he didn't leave the operating room.

He had hardly finished the sutures on the first woman when a knock came at the door.

"Hurry up," they pleaded. "We have an emergency."

The second woman was in labor and had been forced to stay in the village and push for hours. Now she had a ruptured uterus. It was serious. It couldn't wait.

So he quickly finished stitching up the woman on the operating table. As she slid off, the next woman was carried in.

"I didn't know which way to turn," Mubuto says.

That day, Mobutu was in the operating room for eight straight hours — three patients in a row.

For two years, he was the only doctor in at Nyamibungu Mother and Child Hospital. And for two years, all the emergencies fell to him. Nurses woke him at night to perform cesarean sections on teenage girls with slender pelvises. He spent hours questioning patients in Swahili, trying to divine tropical disease from vague explanations. But the rape cases were the worst; the violent ones. He was the last chance many women's reproductive systems had. He knew he couldn't let these women down.

Welcome to the life of a Congolese doctor at ground zero in South Kivu province. With a rural health care system rotting from years of war, Congo's rural doctors are on the front lines of a humanitarian calamity. According to the International Rescue Committee, 45,000 Congolese die every month, most of them not from the conflict, but from treatable diseases. While Nyamibungu now has two full-time doctors serving a health zone of more than 100,000 people, Mubuto's job highlights the challenges in Congo's rural health care system.

Unspeakable Horror

Mubuto's hospital is just a few miles from the jungle where fighters are holed up — the same fighters who are raping the women in surrounding villages.

Residents say that in nearby villages, militia men emerge from the forest on market days. They mingle with the villagers, buying and selling goods. During the night, though, they're not nearly as serene. Mobutu received 136 rape cases last year. But many of those came to him when it was too late.

A veil of suspicion still hangs over Western medicine here. Women prefer to go to feticheurs, traditional doctors, to treat rape-related injuries. Older women in the village often force raped women to go to the feticheurs, who accept goats rather than cash as payment.

Mubuto says they prescribe a toxic mash of leaves to be stuffed into the birth canal. This inevitably causes infection, and often necrosis of internal organs. Women will then go to a pharmacist who, having little or no medical training, will prescribe pills that only exacerbate the problem.

When the infection has spread, says Mubuto, that's when they come to him.

The stories roll out of him like a list of medical-school trauma cases. During a recent operation, he found leaves floating in a woman's abdominal cavity, which had caused the intestines to putrefy. Another case involved a teenage girl in labor. Her pelvic girdle was too narrow for her to deliver, but her family made her give birth in the village. The labor had caused her uterus to rupture.

Mubuto says some men believe that if their wife has a C-section, it's a sign of weakness, that they aren't strong enough to have a vaginal birth.

Despite these grisly cases, day after day, Mubuto calmly puts the torn bodies of Congo's women back together again. But the severity of the cases and the horrific stories that accompany them have taken a toll on him.

Training to Save Lives

When he first arrived at Nyamibungu, he had no training in gynecology and was unable to help many women. He referred them to Panzi Hospital in Bukavu, 135 miles away. Most of them were forced to walk. Those who were severely ill were carried, through miles of mud, on stretchers atop the shoulders of fellow villagers.

"When [the women] explain to you what they have … often it's a third-degree prolapsed uterus — and I find myself telling them, 'I can't help you.' And you see that the woman doesn't have the means [to travel to the main city for treatment]," he says. "First of all it affects me because I feel incapable of helping this woman. It stresses me out. Psychologically, this troubles me."

But last fall, thanks to a Catholic Relief Services program, Mubuto and other rural doctors in South Kivu trained under the province's top gynecologist, Dr. Denis Mukwege, at Panzi Hospital, which handles eastern Congo's most complicated gynecology cases. During the training, they learned how to repair fistulas, tears in the vaginal wall. Fistulas often result in incontinence. Mubuto is now able to repair simple fistulas and ruptured uteruses, and perform hysterectomies. Complicated cases still have to be referred to Panzi.

What's more difficult, says Mubuto, is the fact that he is often pressed into the role of a counselor.

"There isn't anyone trained in counseling in our hospital," he says. "We have to do it. We have to explain and comfort them and help them psychologically. We tell them that they are still women; that their future is still in front of them if they stay strong."

Aristide Munyakazi, who runs the hospital's laboratory, says villages ostracize women who have been raped, which make it harder for them to earn income. This means they can't afford needed follow-up hospital visits.

"Men here see a woman who has been raped as a woman who is dirty. It's a woman who is no longer useful to stay with," says Munyakazi. "A woman is only for that man. Once a woman has been raped, they think she is a victim of HIV AIDS and she has to be driven away."

Rape has now filtered down to the general population. That morning, two girls, ages 9 and 12, visited Mubuto in his office. They wore dingy dresses, flip-flops, and stone-sober expressions. In voices barely above a whisper, they described what happened to them. A few days before, they attended a village festival. Teenage boys, whom they knew, joked that they wanted to take them as "their wives." The girls refused. On their way home, the boys ambushed then on the trail and took them to a school where they raped them.

Finding the Courage

Another doctor who had done the initial examination said it was difficult to convince the girls that he was trying to help them, that he wasn't going to hurt them.

After the girls tested negative for HIV, Mubuto asked their father who would pay for the consultation. He said the rapists would; the matter would be settled in the village. The boys would not be shunned by village members, but the girls, once they are old enough to marry, will have problems finding husbands. Almost no Congolese man will marry a woman who has been raped.

Treating rape cases and other ailments is challenging in a hospital without running water or electricity. The generator is turned on when the ultrasound machine is needed and during surgeries. Munyakazi told me privately that sometimes Mubuto uses his own money to pay for blood testing kits, which cost about $100 for 100 tests. Several tests are required for each blood donor. With 65 percent of patients needing blood transfusions, finding blood donors and a place to store the blood is a constant concern. As a result, they have no blood bank. Since there is no refrigerator at the hospital, the doctors have to store medicine in the propane-fueled fridge in their house.

While the conditions are difficult, CRS is working to improve them. CRS has helped support the purchase of generators, motorcycles and medicine. It has also paid for repairs and infrastructure improvement to many remote hospitals.

The other worry: patients who bolt. Mubuto says some patients sneak off during the middle of the night to avoid paying. Some, for example, can't afford the $8 birthing costs. Since Mubuto doesn't receive a salary from the state, he relies on patients paying. Another lady who received treatment and is better now goes into town during the day to earn money, but returns at night to sleep at the hospital. "She's using it like a hotel," says Mobutu.

By the end of the day, Mubuto is still going strong. His last stop: the maternity ward.

A middle-aged woman, in the throes of labor, has a problem Mubuto has seen more than once. "She says she was paralyzed by a sorcerer and doesn't have the force to push." Her right arm is crooked and lax, along with her right leg. Mubuto uses a fetal stethoscope to listen to the baby's heartbeat, then takes the clock off the wall and times the contractions. "Have courage," he tells her as she stifles her moans. "It's going to be all right."

Lane Hartill is the West Africa regional information officer for Catholic Relief Services. He has visited CRS programs in Democratic Republic of the Congo, Burkina Faso, Ghana, Liberia, Nigeria and Sierra Leone. Lane is based in Dakar, Senegal.