A new emergency response in Bushagara

 As the fighting rages on, Medair has been asked by the health sector to provide health care in a newly set up camp, outside of Goma, for displaced persons (IDPs) from Rutshuru territory. These are families who have been living in more informal housing (like we have talked about in previous blogs) right along the main highway into town. Some are being moved into this camp, which has been set up with better shelters, more space and a safer environment. 

Needless to say, there was a lot that needed to be done in order for Medair to begin providing health care to these IDPs. Tents were provided by the World Health Organization. The ground had to be leveled in order to put them up. Drainage

had to be dug so that water didn't run through the two tents (it is raining every day here). Supplies (like chairs, desks, cabinets, office supplies and health supplies) had to be procured and delivered to the site. Staff needed to be allocated to this new site. Medicines from our stock, as well as from the medicines which just came into Congo from Nairobi (which you prayed for) are being used to stock this new health center. Oral Rehydration Solution (ORS) stations need to be set up here. And there needs to be awareness raising among the families being moved here so that they know the health facility exists, what services it will be offering and how they can benefit from those services. 

One of the prelimary tasks, which one might not think, about is the digging of a latrine. This is important for any health facility. But it is even more important for a facility which is targeting cholera prevention and treatment. The challenge in this location is that it was covered by lava from the Niyragongo volcano eruption in May 2021. So the digging of a latrine is really a challenge! On Friday this digging through lava rock was ongoing!

In our last blog we talked about the training of community health workers (CHWs) in Kibati for the cholera response. The training targetted 2 important pieces: cholera symptons, prevention and treatment at the cholera treatment center and how to run the SRO points.  Rutshuru is one of the agricultural centers for Eastern Congo. Residents had herds of cattle (which they had to leave). This is the territory from which Goma received much of its vegetable supply. The people are enterpreneurs, and very industrious. This article talks about the refugees making charcoal to sell in order to provide for their families - and the long term effect that could have on the area. 

During the training of the CHWs in Kibati, it suprised Christine to hear that they were serving a glass of milk during what we would generally call "tea break." Because these people had cows, they really prefer milk over tea and coffee. This is their preferred drink. So Medair provided milk for their, err,

A Medair ORS (SRO in French) station in Kibati 

"milk break"  (ask us sometime about production of gouda-like cheese in this area). IDPs are people like you and I, with their drink preferences, livelihoods that supported their families until they had to flee their homes (and those livelihoods) and hopes for the future - the difference is that many of these things have been put on hold by the fighting from which they now flee. 

For Christine, one of the tasks that occupied a lot of her time this past week was assuring the supplies needed for the ORS stations in Kibati for which the CHWs were trained to run. These stations will not only provide life-saving ORS to persons dehydrated by cholera, they serve as referral points to identify people needing to go to our Cholera Treatment Center (CTC). And CHWs continue with raising awareness of how people can prevent cholera. 

All these things are keeping us both busy! Thanks for walking alongside us as Medair walks alongside these people not only having to flee fighting, but also facing a cholera epidemic caused by the conditions in which they are living. We had hoped that the epidemic was subsiding earlier last week. But it is stubbornly persisting. 

Praise:

• For staff at all levels (at the bases and in the field) who largely gave up time off during the holidays and continue to work 6-7 days/week in order to care for IDPs
• Phil seems to have finally had healing from the sinus infection - and the asthma that it provoked is much better. We both walked to or from work a couple of times this past week - a good sign for him.
• Medicines and medical supplies were flown by helicopter this week to a health center in the IDP camp in Rhoo. Because of the fighting there is no way of reaching this area by road. This was a significant logistical challenge greatly aided by advocacy from the funder, ECHO. And these supplies will bring much needed relief to the IDPs there. 
• For the safety of staff working in the field, where security is uncertain and monitored constantly by Medair. 

Prayer:

• For the staff in Kibati treating cholera in the CTC and the team which will work in the community preventing cholera - for efficacy in their work and protection
• For ongoing wisdom for Christine as she provides leadership to the community engagement teams in all 3 locations - connecting well in communities is key to acceptance of Medair's presence as well as long term sustainability and ownership of this work
• Medair had a new project approved in the last couple of weeks which will see nutrition work extended to all health facilities in a couple of health zones. We will need to procure nutrition supplies urgently for this project - and the global supply chain for these supplies has been extremely contracted for the last year. We need a miracle!
• For a peace based on justice in Eastern Congo, and with its neighbors.
• For Medair to be able to respond safely to care for people who are suffering - particularly safety for our national staff who work in areas where the security situation can change rapidly

Straddling two different worlds - and trying to make sense of it

Happy New Year and Best Wishes - this greeting has been common as we returned to our work here in Goma on January 2.

Singing carols around the family puzzle

In thinking about the last couple of months it feels like we are straddling two very different worlds.  We spent the month of December in the very different world of the US where together with extended family and friends we celebrated my dad's eternal homecoming, where various members of the family picked up COVID19, where we adjusted travel plans to Ohio to beat the snowstorm to enjoy immensely time with our kids and their significant others over Christmas and where generally we were able to 'let go' of the realities of life and work here in the DRC for a full month. It was healing despite Phil catching COVID19 as well.

IDPs chased from their homes by the fighting

When we left the DRC the 1st of December to fly to the US, Medair's team in Goma was gearing up to support the health centre of Kibati on the outskirts of Goma, an area which had received a massive influx of IDPs (internally displaced people) fleeing fighting from an armed group.Upon returning we learned that an outbreak of cholera was officially declared mid-December in the IDP camps around Kibati. Medair worked hard to set up a CTC (cholera treatment center) which has been operational since the end of December.  Integral to any cholera treatment response is prevention. As the person managing community engagement efforts, my teams' efforts are critical to prevention at the community level. In wanting to prevent any disease it's important to to look at motivations and barriers to doing things like handwashing with soap - which is key to preventing cholera transmission. This meant doing a quick evaluation, so on my first day back on Jan 3 I made a trip out to Kibati, to meet with leaders to set up the evaluation. I would have loved to have taken photos to document and share what I was seeing, but did not feel comfortable doing so. All along the road, from the outskirts of Goma to where we reached the health centre in Kibati, IDP informal shelters lined the road. This was a distance of several miles.

The CTC being constructed. 

Last Thursday I conducted a 1 day training for the team using a rapid assessement tool used to orient hygiene strategies in humanitarian emergencies. Friday the team went out and spent several hours listening to people's stories, video recording how people wash their hands and leading focus group discussions looking at people's perception of their risk to getting cholera, their motivations behind prevention and to understand who they listen to in their community and how they hear information. 

All this data was then inputed into a software program which gave recommendations for our prevention strategy. We know already that most people do not have easy access to a handwashing point (let alone water for other purposes), that "site chiefs" are important community leaders, that people really want to be good parents and make sure their children stay healthy, and that they had 'normal' lives back home in the communities from which they fled (had work of some sort of work, had homes, had roles in their community, had friends and family, had hopes for the future). 

The CTC during Christine's visit the day after our arrival

By midweek we hope to have started implementing our prevention strategy throughout the different IDP camps which will include working with community health workers to raise awareness about cholera, holding community meetings, setting up ORS points (oral rehydration solution which treats the dehydration from cholera which can kill people within 24 hours left untreated) and implementing the recommendations from our quick evaluation. 

Upon returning we also learned that the shipment of medicines that Phil has been working to get from Kenya finally arrived in Bunia - 3 containers of much needed medicines. 

And back in the US, snow continues to fall, at least in Minnesota. It is a bit discombobulating to straddle two such different worlds. Yet we know that wherever we are, people face challenges and have hopes for good lives. In this new year of 2023 - may the Lord grant you meaning and all good things. 

Praise:

• Most of the last prayer concerns have been answered! Medicines arrived, guidance on interventions to respond to, customs convention signed the day before medicines arrived at the border from Kenya.
• For wonderful family time in the US and a really special Memorial service for my dad

Prayer:

• For Phil, who is recovering from a sinus infection
• For the staff in Kibati treating cholera in the CTC and the team which will work in the community preventing cholera - for efficacy in their work and protection
• For wisdom for Christine as she provides leadership to the community engagement teams in all 3 locations - connecting well in communities is key to acceptance of Medair's presence as well as longterm sustainability and ownership
• For quick resolution to the last hurdle for the 3 containers of medicine - negotiations with the equivalent of the FDA over how many samples they need to take
• For a peace based on justice in Eastern Congo, and with its neighbors.
• For Medair to be able to respond safely to care for people who are suffering - particularly safety for our national staff who work in areas where the security situation can change rapidly