Entry 6 - Day Trip to Goma, DRC

King Leopold of Belgium, an insane man who never should have been free in a society much less allowed to “rule” one, kept this unimaginably fertile area, DRC, (equal in size to everything east of the Mississippi) for his personal exploitation and whim. During his lust for its minerals, gems, trees basically everything, he had 10,000,000 people murdered. What an achievement, in one short life time! When men would not work franticly enough to suit Leopold the Lunatic’s ever expanding need for Africa’s natural resources, he would have families kidnapped and tortured as incentive for the men to run deeper into the forests and bring out her treasures faster. The country was raped and pillaged, ancient cultures and social systems were decimated, and the people were utterly lost. They were ill prepared for self rule, their own historical ways and any self efficacy they had was dismantled, and the ways of the west were out of reach. In 1960 as self rule began, there were only 17 college graduates in this vast country. At present, in a nation of 2.34 million sq kilometers, there are a mere 2,794 sq km (roughly 1600 miles) of paved roads. I am lurching spastically along a typically rutted and pot holed road right now, oy vey! Papa Jack describes the roads as ravines. Destroyed by the Belgians then kept down by their first native ruler in the 20th century, Mobutu Sese Seko, who has the notorious distinction of a type of rule being named after him, kleptocracy, the Democratic Republic of the Congo, formerly known as Zaire and a lot of other things, has not known peace and stability since before the blood sucking Europeans arrived. This country, the 3 largest in Africa and heaving with a massive population growing at catastrophic rate, is chaos.

Right now, after having taken an hour to pass through a simple looking border, which involved Papa Jack reaching into this pocket for a steady presentation of $20 bills (we joked he should be used to it as the parent of a teenage daughter), we’ve been stopped by “police” in uniform with heavy weaponry. No traffic violations, just a simple and typical moment of attempted extortion. James our driver spoke Ngali and said we didn’t have any money. I am surprised the police believed him; I have binoculars around my neck and am working on this computer. (Binocs were a fantasy, there is no wildlife here compared to Rwanda; the habitat has been destroyed.)

I am here to visit our clinics that specialize in family planning, maternal and child health, and the treatment and prevention of malaria. (We also do safe water and HIV prevention in this area of the DRC). I also hope to visit with women who are rape victims. Rape is an epidemic here. It is an emergency. It is everywhere, on a massive scale. It is not altogether unreported in the western media, but it is grossly underreported. An ancient and common tool of warfare, this area’s female population has been hostage to gender based violence for decades. Passing into the DRC...Oh my God.

What a shocking difference a few feet makes. On the Rwandan side of the crossing, the roads are tidy, neat, maintained. The earth is red and the wind blowing through the trees, the lapping of the shores of Lake Kivu, is serene. There is a sense of orderliness and even within the clear poverty; I feel the purposeful attempt at self improvement, through agriculture and the tiny, colorful flower gardens.

After passing a few ramshackle villas at the border, Goma opens up as a relentless, vast dusty slum. There is rubble, garbage, filth, people covered in muck and grime, buildings that are nothing more than lean-to shanties. The earth is grey, drab, choking with dust, visibility limited by dust the result of lava flow from a nearby volcano. In our clinic, the back wall is thin - made of mismatched boards roughly nailed together. The padlock surely indicates someone’s sense of humor. The director of the clinic does a good job of keeping the space tidy, but it’s hard. Even here where women gather for family planning and maternal/child health information, to give birth and for gynecological care, there are patches of rubbish.

I sat with the director and we talked shop. He has a routine of in-home visits to generate interest in family planning (birth control, birth spacing, pre and post natal care). He has office hours around these topics Mon-Sat, which are painted in a sweet shade of blue paint on a rough white stucco wall. He reports that 20-25 new women present each month to access services. Though this number sounds small, he says it represents significant cultural change; men want their women to produce as many babies as possible. Women are for breeding. For them to begin seeking to regulate their fertility is big news. In terms of options, injectable birth control is most in demand. There is a misconception that IUD’s make one sick, so he is dealing with that, one woman at a time. The Pills, he said, are terrible, as compliance is very erratic and the water with which they take it infested with parasites, fecal matter, etc. The babies he delivers are often premature and the infant mortality is of the highest in the world. He treats women who are victims of sexual violence daily. Children are common, little girls 4, 6 years old - normal, every day occurrences, including gang rape. They suffer traumatic fistula rupture and more. They become HIV+. They become outcasts.

When I asked about where this pervasive practice of rape comes from, and was it cultural, he said it was not cultural to begin with. He repeatedly said it is a weapon of war, and that there has been armed conflict for so long, it has become the cultural norm, the way political instability is their norm. Now, it is all that generations know.

I asked him whether he believes the Congo is fit to receive international aid; can donors trust the money gets to his clinic and others, will the products and services reach the people? He said if money can come to “la base,” (the base), then it will benefit the base. We discussed at length accountability and transparency, and some good movement on the government’s part in creating a Parliament and other bodies that will get the money to neediest quickest. They need the money as sorely as any where I ever visited. I am straining to convey the urgency of the need here.

The stench of Goma is putrid. There is no sanitation. The water is unsafe. The rooms of the next two clinics I visited were stuffed with people who were malarial; although children under 5 (undeveloped immune systems) and pregnant women (taxed immunity) are most at risk, here in Goma there were patients of all ages. They looked miserable, their bodies sagging, eyelids heavy, hopeless.

I sat on a few beds and chatted, making small talk about future prevention and in my own way hopefully introducing the possibility of each individual making a commitment to sleep under a “mousquitaire” when they go home. We also talked about the treatment, the artemisinin based meds that are working well. It was a visiting day, so most patients had family in, grandmothers, other children, and siblings. One had a transistor radio. One man was feeding his small son, an IV pick awkwardly taped to his hand, which it dwarfed. The boy was lethargic and mute, his nose ran. The man fed him black beans from a tin plate, around which gnats and flies flew. The man was a very hard person, as were the other men with whom I spoke. He raged at pregnant women to whom we give nets for no charge when they come to the clinic: Am I not a man? Should I not be given a net?

I asked him if nets were available in the private sector and he said yes, but that he has no money. I said, “Oh, come on, I bet you have a little money from time to time for a smoke!” “No!” he exclaimed. “Beer, what about a glass of beer?” Again, “No!” he declared. “Ah, you have so much virtue! Such a clean life! But….I bet from time to time you have a little money to spend on a woman!” The room erupted into delighted laughter. (It is very well documented, through micro financing organizations, that men in the developing world waste money at shocking rates, where as women save and invest every pittance.)

We debated the value of investing in prevention by spending .50 on a net. “Wouldn’t it be wise,” I said, trying again, “to spend a little money for a net, so as to save all it costs when you’re sick? When the children are sick?” I gestured to the tiny, stifling room, loaded with prone bodies. He had no response to that.

I don’t think he has anything against buying products. He had plenty, especially a high end mobile phone with incredible features and decent clothes. His grudge against buying a net is that some women get them for free.

A lovely little girl was eyeing me cautiously. She began to stare at me more openly, and I thought to take her picture and show her the image. Perhaps it would please her. Instead, the man leapt up in between my camera and the room, blocking me from not just his boy but everyone in the room. I explained what I had meant to do, and that it was a means of reaching out to a new friend, and he began to mock me. He got his phone out, scrolled through its zillion features, found the camera, and ran all over room as if taking my picture with it. I hammed it up, posing from each angle to which he darted. Everyone giggled.

It was time to go. I thanked everyone for the visit, wished them a good afternoon, a speedy recovery, and good health. I walked to the car wondering not if, but how many, has that man has raped.

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The people here are not just reserved in a cultural way, they are cautious in the way of the stunned, of those who have lived with trauma, brutality, and suffering. Of the hundred or so people I visited today, a few after a greeting became soft and warm, but most could merely give me superficial smiles that said, “Oh, hi, yeah, okay. Whatever, hi, bye.” The rest of their countenance and demeanor was occupied with living horror. They wanted to be nice and friendly what they offered was all they had to give, and except for the few with whom I visited at length, sharing their clinic bed, and it wasn’t much.

Everywhere the car lurched children with stunted growth stared. Once eye contact was made and a wave offered, their faces would joyously erupt into smiles. They wore tattered western clothes. I saw one little girl in a shaggy tutu.

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A balanced approach to provide complete solutions for poor people:
While PSI is working with its partners (USAID, UNICEF, Doctors without Borders, the CDC, WHO, Global Fund, UN, etc.) to protect and empower poor people’s health through medical services, education, and products, Women for Women International provides literacy, hygiene, nutritional, educational, and job skills. An NGO with programs in 8 war torn countries, they pair, for $324 a year, a woman who can afford it with a woman who cannot. Less than a dollar a day and the money does so much!

In the midst of this ragged and doomed place is a walled courtyard filled with grass that is actually green, a garden that is actually tended, a building that is clean and proud. There were enough chairs for 20 (!) people to sit, and some tidy (if out of place looking) furniture.

I was greeted with joyous clapping, singing, and ululating, the great African vocalization. I ran to the throng and threw myself at them, dancing and exclaiming my hello in their tribal style. After some time discovering each other in this way, I was introduced as someone who sponsors in W4W and who was there to hear their stories and to take them to America.

We sat for hours, each woman taking her turn to stand before her sisters and me, sharing her life story. They were each so incredibly beautiful! The eyes, the cheekbones, the lips! They wore traditional, colorful dress and I so want to learn to wrap a turban like that! They were all reached by a Women for Women recruiter about the same time and have been in the program one year.

This is what those 4? hours sounded like to me:

I am an orphan My husband was killed My 3 sons were killed I could not read I could not write I could not count I lived like an animal I have 13 children I have 10 children I am a widow I am a refugee I am an internally displaced person I fled with nothing, not even a cup I did not know how to feed myself I was half mad I was crazy I was a cadaver I was a corpse People in the street were afraid of me I begged I scavenged in the dump I treated my children like animals My husband went to other women My husband’s people pushed my from our home when he died I was run off the land I was cheated because I did not know how to sign my name My children died I have taken in orphans I knew nothing I was filthy I smelled bad I came to this area to escape violence I carried loads with my body to earn money for food I walked everywhere with my hoe to see if people needed my services if they did not I starved I had no where to go I was dead I had no idea how not to have more children I was in a constant panic I lived in terror I could not cope with stress I abused everyone around I was in a rage The psychological trauma was so great I was abandoned I neglected myself

And then, the transfiguration:

I am the happiest woman in the world - I am so blessed - I know my rights - Women have rights - I learned to read - I learned to write - I can asses the value of my small goods to ask a fair price for them - I received a small loan to buy fabric - I sew now to earn a decent living - I can calculate my profit so I can manage my finances - I save a bit and I use my capital to expand my business - I learned about nutrition - I know how to eat -Vegetables are important - I know where to get them - Look at me I am clean! - I use soap - I use lotion - My children eat 3 meals a day - My husband and I are partners now I have rights in the household I have a voice - I keep my pamphlet which describes my rights in my pocket, it is with me at all times - I was able to save enough to buy a small plot of land I have my own home I built my home - I am saving for my home I was able to get back two plots of my dead husband’s land and I sold them for a profit - My soul opened up - A new woman was born inside of me - I use the money W4W gave me to pay the fees for my daughter to go to school - In my culture no girl ever went to school but mine do now - The woman who recruited me would no recognize me today I thank God - I space my births by at least 3 years I am at peace I am empowered I live a respectable life I have dignity I have worth I harassed all the governors so much, they were sick of seeing me, they would not give me back my land, but eventually they did I joined another women’s rights group and they elected me their leader

Their stories are unbelievable, each woman a Congolese Lazarus, nothing short of an absolute and total miracle. As we listened, the group made clucking and groaning noises of recognition, and would burst into applause at a particularly heightened expression of empowerment. When the entire group finished, we talked in more detail about sexual exploitation, rape, HIV, malaria, and unsafe water. Each woman had personally had malaria, yet strangely, not a single one slept under a net last night. Half had babies die from it. Most “knew” (perhaps they spoke of themselves) someone who had been raped. A few knew her HIV status, and again, strangely, only one was using modern birth control.

I was able during this round table dialogue to complement W4W’s extraordinary work by giving a reproductive health, safe water, and malaria lessons. For example, I explained that one can become pregnant 31 days of the month! Most said the only used birth control during the “dangerous” times….we talked about injectable birth control as long lasting and safe, but how they needed to use a condom each time to protect from HIV (all did have good perception of their HIV risk). We discussed the female condom as discreet option, though most said they could negotiate a condom with their husbands, as fine a tribute as possible to W4W. I told them about my recovery buddy, and asked if they would be willing to make a commitment with a friend to buy long lasting insecticide treated mosquito nets; they gave their word to one another and committed to following up….today!!!!! All raised their hands and said she would begin sleeping under a net immediately. “Imagine how you would feel,” I said, “If you had to write your sponsor that you had missed your W4W graduation with a case of malaria! You came here to learn how never to neglect yourself….so step up and protect yourself from malaria! (Congo’s children account for 1 in 20 malaria deaths world wide; these great women lose their productivity if they are sick with preventable diseases….)

That last paragraph is not meant in any way to suggest that W4W’s work is partial or incomplete. In fact, their work is extraordinary in the maximum. I was visiting with only 20 out of thousands of Congolese women they have reached, and this group is not finished yet with their “topics.” It just means that it takes all of us NGO’s working in partnership to provide a complete solution to an exceedingly complex and varied series of life challenging problems that confront the poor. We specialize in health: prevention, creating recognition of problems and treatment seeking behaviors, treatment, products, and services, and we’re damn good at it. W4W teaches traumatized, victimized, poor women to bathe, to learn to feed themselves, to read, count, write, parenting skills, social skills, money skills, a trade. Together we empower and protect the whole woman.

Back on that lush, soft grass, we danced, caroused, ululated, clapped, bumped, hugged, and smiled. At the very end, I lead a passionate salute to Zainab Salbi, founder of W4W: her name rang through the air in a series of joyful waves, sung by beautiful, clean, fresh smelling, literate, skilled, empowered standing tall Congolese women!!

And at PSI we’re already brainstorming about how to cooperate more, to hire their graduates as Peer Educators, to present reproductive health activities as new women come in, etc.

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For more on how W4W works, and to become a sponsor, see www.womenforwomen.org

There is a new looking compound set incongruously in Goma’s ruins. In Cambodia, such villas are built by pimps. I wondered what kind of people could afford such a palace in one of the poorest countries on Earth. I was grateful to learn it was, in fact, my next destination and was dressed with a Unicef badge. It is a medical clinic that specializes in genital reconstruction for raped women. Yeah. You read that right.

Women squat at the facility hoping for services someday (they are that busy). Some with whom I visited with have lived there for years. They were squatting in the courtyard, washing their clothes or the children. They were sitting blankly on beds. All looked unbelievably traumatized and dark. Most clutched babies and a few were pregnant by their rapists. One was disfigured from having been burnt, her otherwise night black skin raw and pink.

I wish I could tell you more about this clinic, but it was Sunday and given some confusion in the coordination of our day, the Director had left thinking we weren’t coming. I hope to learn more and when I do, I’ll share it with you.

A clutch of women in a door way, mute and scared, stared at me when I wished them a good afternoon and said good bye, and thanked them for letting me visit.

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Passing back into Rwanda was simple. No mysterious delays. No attempts at extortion or graft. On the DRC side a menacing figure approached the car, demanding our documents when he knew good and well they were already inside; one simply does not encounter such intimating acts in Rwanda. The breeze off the lake began to blow freshly again and the leaf cover from beautiful old trees provided shade. On a grassy lawn a wedding was in progress with a magnificent view of the mountains. At the hotel, I sat near hibiscus and plumbago to write this diary; my friend from the gift shop brought me ceremonial ankle bracelets with bells for traditional dancing.

Rwanda feels hopeful. The DRC does not. I dread spending the next week there, I cannot imagine why my friend Theresa took the post there (from Cameroon) and I thank God I was not born there. Our programs are fantastic, but they are a tiny help in the face of vast problems. In fact, we are about to run out of long lasting insecticide treated nets. Run out. As in, no more, finished, over, basta, done, forget about it.

Our staff has the will and ability to execute the mission with integrity. My host there is the first girl in her family to go to school and has worked in development her whole adult life. She has 4 children, 3 of school age. The work she does is incredible. She said her parents are so proud of her, as am I.

We need funding to hire more women like her, which has an awesome series of positive effects on her, her family, her society….and we need money for the supplies of birth control, nets, safe water solution, and HIV/AIDS testing and counseling.

When asked what the Congolese have to be proud of, the director of the maternal health clinic said, “We have so much potential.”