|
|
-
The day before yesterday, I received an email from my colleague and President of the Great Lakes Restoration Foundation, www.glrbtp.org - Dr. Matthias Cinyabuguma. Dr. Matthias had emailed to tell me my friend, brother and colleague, Dr. Eric Mpanano Ntwali had been attacked by unidentified soldiers and shot in the head at the hospital in Kabera, South Kivu, DRC. Dr. Eric is completing his residency and working in rural hospitals providing care to the very poor who have such limited access to care. Thankfully, Dr. Eric survived the attack and is home in Bukavu, DRC with family recovering. His colleague, Dr. Pascal was shot in the chest and is in serious condition in the General Hospital in Bukavu. Dr. Eric and his family work tirelessly to improve the health and economic resources of the Congolese people - they sacrifice daily to help others in their community. They are my family as well. They care for me, collaborate with me, educate me, understand me, and are always there for me. As Dr. Eric and his family are always working to improve their country, DRC. I am focused on taking this opportunity to advocate for greater support for peace and to support Dr. Eric and his plan to get back to the work of being a doctor and caring for his community. The soldiers stole his laptop computer, his medical equipment, including his stethoscope, resource books, etc. I encourage individuals who are able to go to www,glrbtp.org and make a donation to Dr. Eric as well as Dr. Pascal. The donation will be used for purchasing needed equipment to help Dr. Eric and Dr. Pascal get back to work - for their own healing and for the healing of their community and country.
|
-
Yesterday, I received an email in response to my blogs about my experience in collaborating with Congolese NGOs and individuals working to address the many health, justice, and economic issues in Eastern DRC. The author described him/herself as "having spent the last 20 years working for a wide variety of these organizations in 30+ countries, mostly in Africa but some in Asia and Latin America" initially caught me off-guard with its challenging (that is putting it nicely) tone with negative assumptions. Luckily, I am in Gerome, Turkey and was able to take a lovely walk in the gorge with plenty of time to get my thoughts together and think how to best respond. So, I decided to blog.
After reading the perspective of the author of the email, I am even more certain in our approach of supporting the Congolese to develop and implement solutions to the multiple and complex health, justice, and economic issues in the region. Specifically, let me take one example from the email. In one entry in my blog, I noted a concern about the number of 4X4s driving around with flags of their organizations, creating traffic jams, while many parts of Goma (a major city) after several years still does not have potable water, electricity, education, health care, etc. The response by the emailer to my comment was: "although you probably do see the expats in the 4x4s who are going to yet another meeting with the local government or donor agency or whatever, in order to try to make things work. Or maybe they are on their way to blow off steam in a bar with a 14 year old prostitute--this is also a part of the humanitarian scene."
A "part of the humanitarian scene"? I think this statement provides ample support to my Congolese colleagues assertion that "humanitarian aid is commerce." I can't imagine defining rape (sex with 14 year old prostitute) as "blowing off steam." In a country ravaged by war, like DRC, often the only people in the area with money are the aid workers and peacekeepers and in many cases, this is taken advantage of. Let's explore the impact of "blowing off steam" on the community in which these humanitarians are working. I am providing below an excerpt from testimony of Anneke Van Woudenberg before the US House Committee on International Relations, Subcommittee on Africa, Global Health Rights and International Operations, March 2004.
MONUC’s (UN Peacekeeping Force in DRC) credibility has been undermined by the exploitative and abusive behavior of some of its own staff. Investigations carried out by Human Rights Watch found that MONUC personnel have been involved in a pattern of sexual exploitation of Congolese women and girls. We interviewed girls, some as young as 13-years old, who had been raped by MONUC soldiers. We also spoke to girls aged between 12 and 15 who engaged in what is commonly called “survival sex”—sexual relations they entered into in order to get some food, money or protection. These relations are frequently exploitative and are particularly easy to establish in environments of conflict and massive displacement where women and girls have limited options. The U.N. response to allegations of sexual abuses by its staff in Congo was slow. The U.N. had earlier taken steps to establish a code of conduct prohibiting such actions and stressing there would be “zero-tolerance” for sexual abuse and exploitation. Despite these clear rules, not enough was done to stop the practice. Between September 2001 and January 2004, only sixteen cases of alleged exploitation or abuse were investigated by MONUC’s security branch. Some of those accused were rotated out at the end of their tour of duty with no further consequences. Further in-depth investigations were finally carried out in 2004 which concluded that sexual exploitation was a much wider problem.
The Congolese may not know which humanitarian or peacekeeping group each individual works for, but they do know and see the exploitation of their community by some members of these groups. There are consequences to these actions "blowing off steam" and rarely is it a negative consequence for the humanitarian or peacekeeper.
|
-
I have been reviewing the interviews and data from our work in Bukavu and Goma, DRC. As I have been thinking about next steps for collaborations with Congolese partners – I started to think about Major Honoriene, she is the policewoman in charge of the Child Protection Unit in Bukavu, DRC. The unit (which is Major Honoriene) was formed in 1996 as a response to the impact of the war on child health and rights. As the rapes against women and girls continue the mission of the unit is to arrest the perpetrators of violence, assist victims through referral to health care, documentation of violence, and referral and follow-up with criminal justice system.
Major Honoriene is committed to her work, she has been featured in Lisa Jackson’s documentary, The Greatest Silence, and testified to the Congolese parliament on December 11, 2008 about rape in Eastern DRC and the need for policy and financial support. Even with her exposure internationally and plea for support to her own leaders and international NGOs, she still has no means of transportation to reach women who have been raped, or to help them get to the health care center. Raped women often need to provide the money to pay for the paper for the Major to take the rape report. Major Honoriene calls for the ambulance at Panzi Hospital to take the victim, but the ambulance rarely comes. Major Honoriene – has no recorder or even a camera to take pictures of the injuries for the legal case. The raped women have to pay for their health care ($25), their transportation to the police, health care center or lawyer, and then they need to pay the lawyer to take the case. When there is no functioning government in the area – there is no financial support for victims of crimes. The majority of women give up, they just do not have the resources to pursue the perpetrators.
Major Honoriene makes $25 a month as a Major in the Police. She has taken two raped women and their children into her home and paid for the children’s schools because their young mothers had no support. I asked her why with all the publicity and all the NGOs working in Bukavu, she had not received any of the resources she has asked for to do her job – her only comment – the money rarely flows to those who need it.
I asked Major Honoriene what she would do if she had funds, she laid out her plan:
1. Develop a system of communication and transportation for victims from villages to needed support systems (police, health care, legal) 2. Develop a system of communication and collaboration between all the needed support system (health care, police, legal, family) 3. Obtain appropriate tools for documentation of the rape (recorders, paper, pens, cameras) 4. Computer to develop database to track cases and write reports and proposals for funding 5. Support economic reintegration of rape survivors into their family and villages (microfinance)
We could easily support this work – here at the School of Nursing, we have Sexual Assault Nurse Examiners that could work closely with Major Honoriene to implement the health care and legal documentation component of the project. For not a lot of money, we could train the nurses in the villages and nurse and physicians at the local reference hospitals to complete the physical exam, provide post-exposure prophylaxis (PEP) and document the case. Certainly, I can provide a tape recorder, paper, pen, and camera to help the Major do her work. Even a computer – not that hard. We can also connect this work to our Pigs for Peace program – helping women rebuild their economic resource through animal husbandry. The only difficult and big expense – transportation – the Major needs a 4X4 to get out to the villages to the victims – what about one 4X4 that Major Honoriene can share with Rama Levina Foundation – the Foundation needs transportation (they rent a 4X4 now)to go out to the villages to provide health care for rape survivors. Collaboration and sharing resources is critical to the success and sustainability of this work – so, if we could get $100,000 of Secretary Clinton’s 17 million pledged – I bet the Rama Levinia Foundation and Major Honoriene would be able to demonstrate impact in one year –rape survivors getting access to appropriate and timely health care, rape case being documented and brought forward to justice and rape survivors having access to economic empowerment through Pigs for Peace – that would be real impact.
|
-
We arrived in Kampala, Uganda after a brief flight from Kigali, Rwanda on Saturday. While there, I was able to meet with Dr. Sara Groves, a Hopkins School of Nursing faculty member. Sara is based in Uganda and is serving in the role of liaison between Hopkins and Makerere University for the Gates Learning Grant. As well as being the liaison for this multi-disciplinary (Hopkins schools of Medicine, Public Health, and Nursing) and multi-component project, Sara is working very closely with the faculty of the Makerere University Department of Nursing. In her role, she is providing mentorship and guidance to young and developing faculty in several areas. But let me give an example of one specific focus area developing research infrastructure and evidence-based programs. The faculty of the Department of Nursing identified an area of research interest and focus for their department--malnutrition in young children in rural villages. As well as identifying an important research area, the faculty identified a potential funding opportunity for their collaborative research. They invited Sara to meet with them to discuss the research opportunity. In her role, she creates the environment through encouragement and expertise for the faculty to openly discuss their research ideas, including research design, methods, analysis and dissemination of findings. She works with them to develop the timeline for submitting the proposal, the budget, and the resource support that is needed and that is already available. For example, she encouraged the faculty to consider leveraging existing resources to complete the research, such as undergraduate public health nursing students to assist in data collection and analysis in the rural areas where they are participating in clinical learning. It was exciting to sit with the Department of Nursing faculty and listen to their discussion on how to improve the health of Ugandan children and families, and the role of nursing research in developing evidence-based health programs. I think this example illustrates the importance of collaboration, mentorship and support for our nursing colleagues who are taking on challenging and complex health issues with great passion but with limited resources.
|
-
Yesterday with the Gorillas was incredible. We left at 5am with Henri, the Director of the Diane Fossey Gorilla Fund. The trip to the ranger station is about two hours on roads--well it is hard to explain roads, other than you must have a 4x4 as the roads are dirt paths with many holes and rocks. We arrived at the station and started off to the park entrance by foot. There were three of us with two guards and a guide. Although the park is open, the rangers are still very concerned with rebels and poachers. Over 100 Congolese rangers have died in the war trying to protect the gorillas. As we walked, the Volcana was in the distance with villagers out planting sweet potatoes, cabbage, corn, cassava and many other vegetables. The soil is very rich near the volcano. As I walk the children yell out "muzungu" -- white person! We reach the park entrance and the ranger pulls out his Garmin GPS for the coordinates -- they take the coordinates each half hour when they are tracking the gorillas. We were looking for the largest family, a group of 35 gorillas with 10 young gorillas. The treking begins and this was very demanding -- the guide led as he cut his way through the forest with a machete. We followed up the mountain, down the mountain and up again -- we trekked for two hours looking for the family. The gorillas average about 4km of travel each day. When I first saw the female gorilla, she was in a tree six feet away enjoying a lunch of leaves and vines -- it was spectacular. Then one of the curious babies came within two feet -- I was able to film her playing and trying to figure me out. We kept watch of the family for about an hour and moved with them. The silverback, the male in charge, ended our trekking when he charged us. I got it on film. He was basically telling us enough -- go away -- so, we did and the long march back to the ranger station began. I am leaving Eastern Congo in the morning -- the month went too fast -- will be taking a bus to Kigali then a flight to Uganda to work with colleages at Makerere University. I am very sad to leave -- the work has been difficult but my Congolese colleagues inspire me with their work and vision of peace.
|
-
Work in Goma is slow going. We have run into the multiple layers of UN
authorization. There is an extremely large UN peacekeeping force
(MONUC) in and around the city and a large population of
internally displaced persons (IDP) on the outskirts of the city. The
UNHCR is everywhere and with the UNHCR comes many other humanitarian
aid NGOs, like MercyCorps, UNICEF, International Rescue Committee and
many others from around the world. You can see why the locals called
it "commerce" rather than aid - the NGOs are driving around in 4x4
vehicles with flags - creating traffic jams - but the locals report
limited improvement in access to clean water, basic healthcare,
education, and education. Yesterday I had received permission from the Section Chief of UNICEF
to interview child soldiers who were being reintegrated into
communites. I managed this after explaining my research objectives in
French - no easy process for me. I provided a copy of questions for
review. All was well and I confirmed permission this morning and set
interview time for 2pm before heading out to site visit of Women to
Women International program for women living in the IDP camps. On
returning to the city to go to the interviews - I received a call from
the Director of Communications telling me that they had decided that
my interviews may not be possible. She said she would call back in 20
minutes with final decision from the Chief (who gave permission the
day before). Two hours later I received a call that although the Chief
had not confirmed, she did not think it was possible to conduct the
interviews - but would call back if anything changes--starting to feel
like I am getting the run around. The reason given for the change:
many donors are arriving to see UN programs and that the child
soliders will be closely monitored by donors so asking questions of
them at this time is not seen as a good idea by administration. I
think in short that Secretary Clinton arrives in Goma next week and they
want no issues--and having me ask questions of the child soliders in
the program may potentially raise important issues around the health
and social needs. I understand this concern on some levels but am also
concerned that there is tight control on access to any UN program
which can limit access to information that could ultimately be used to
improve program and outcomes. My Congolese colleagues were not surprised by the change in plans.
They say this is how they are always treated by UN and partners. So when the going gets tough, the tough go mountain gorilla trekking
in Virunga National Park -- the park reopened in May after being closed
for several years from the war. We are going with my colleage Henri,
who is the Director of Diane Fossey Gorilla Fund. For more information
on their important conservation work, check out www.gorillas.com. Cheers, Nancy
|
-
From Goma today -- it is Sunday, so this afternoon we will take a few hours to go up to the mountains. Yesterday, we had the opportunity to visit a small Congolese orphanage and center for vulnerable children, called Flamme d'Amour (Flame of Love). There is a nun who opened this small Center as a result of the war. She originally had the Center in the rural area but was chased into the city because of the violence. The Center is the home to 27 children ranging from age of 6 months - 18 years. Some children have lost their parents in the war, some were born as the "products" of rape, then cast out of the family for being "cursed" or "witches." Other children -- their parents are just so poor -- are homeless and the children are sick with malutrition and other illnesses. Lastly, I met with 6 girls ranging in age from 3 years to 9 years - who were raped by soliders or rebels. There is a belief among some men, especially in the armed forces and rebal groups, that if you rape a child under 10 years of age, even 1 year old, you will be protected from HIV/AIDS. Several of these girls are then abonnanded by the family -- as they are now "cursed" or bring shame to the family. The children are now in school, eating 3 meals a day, and have a small bed to sleep in. They have a safe place to play and a few volunteers to care for them and love them. The nun in charge works with the families to reunited the child with a family member. She also helps to educate families about rape and the trauma care needed for the child -- she even pays for the medical care or seeks free care for the children who are raped at the Heal Africa program. She gets extremely limited support from the hundreds of international aid agencies in the area. When I ask why, the nun says the aid agencies want to take the children to the refugee camps rather than reunite them with their families. So, she continues to accept children into the Center and figures out ways to support the children--through donations, small commerce she has with food, and animal husbandry, etc. Her program costs about $600 month and includes food, school fees, and medical care. For example, a child can go to primary school for $12 a quarter in Congo. Can you imagine how much an international aid agency receives to care for 27 children a month? The nun refuses to send the children on to a refugee camp, and frankly, based on what I see, I completely understand her unwillingness to give the children over to the large aid agencies -- and refugee programs. They tend to become just another number in the camp, with very limited opportunities for future reintegration with family and community. I continue to be impressed with the efforts of Congolese groups to address their country's problems with limited resources and support. I continue to have limited faith in the ability of big international agencies to do more than create greater needs for the people.
|
-
Today, we are taking the ferry, Miss Rafiki, to Goma. The ferry takes about 6 hours and my first class ticket including a breakfast of eggs and coffee was $25. Goma was developed as a strategic city on Lake Kivu by the Belgiums in response to the German presence in the boarder town of Gisenyi, now in Rwanda. In 1977 a major volcanic eruption of Mount Nyiragongo destroyed the city and killed 2000 people. Mount Nyiragongo erupted again in 2002 -- the lava flow came right down the center of the city. The city has changed hands many times during the war, especially from 1998-2003. The rebel leader, Laurant Nkunda, has been a major source of terror in the area over the years. MONUC, the French term for the UN mission in DRC, has provided realitive stability in the city for the past few years -- with the airport open and people returning to more normal life. The town is also close to the Virunga volcanoes and the national park where many mountain gorillas are found. I was able to go to the park and see the mountain gorillas in 1991-- not sure I will have time on this trip as we only have 6 days for the research before I need to be in Uganda for our Gates project. Work will start tomorrow morning! More soon...
|
-
|
Yesterday morning I joined my friends again for some basketball--I feel
much
better if I can get a little exercise it prepares me for the
work. After a
game or two, I took a break and sat down beside Ginny
and Ben -- we had lots
of children around us talking and laughing
(mostly at us). A young boy
approached--maybe 10 years old--it is
hard to determine age with
malnutrition. He demanded money and became
very angry and aggressive, he had
been drinking alcohol. He is street
child who likely either lost his parents
to war or was born from rape
-- often children who are "products" of rape are
considered cursed by
the family and sent away, so many end up living on
street.
As the young boy became more aggressive the other children
called
over the men playing basketball to assist. Our friends came over
to
try and calm the boy -- they soon realized he was very drunk and
would
not be calmed, so they asked him to leave the area -- he finally
did.
The men were clearly shaken with his behavior and we talked about
the
impact of war and the destabilization of families and community. The
men fear, as do many here in Congo, that the next generation is
at
terrible risk of living through many wars--as the youth only know war.
|
-
|
Well it is Saturday morning, in Congo Saturday morning is a work
day -- we
work until 1pm and then the weekend begins. The last three
days of work have
focused on interviews for my study on the factors
that influence the exile or
reintegration of women into family and
community after experiencing rape. We
have interviewed rape survivors
who have been exiled and reintegrated,
husbands who have exiled and
reintegrated wives after rape as well as
community leaders, doctors,
nurses, priest, community health workers,
lawyers, police, and rapist.
In DR Congo as in all the world, rape brings
great shame to woman and
family -- the Interhamwe (Hutu rebels who perpetrated
the genocide in
Rwanda) continue their genocide targeting Congolese women.
Simply,
and it is much more complicated, the rebels have
destabilized
families and communities through rape -- bringing great fear and
trauma
too all, so they are in complete control of communities in some
rural
areas.
There are amazing and strong Congolese doctors, nurses,
health workers
and advocates that are working with families and communities
for
reintegration of victims and educating women and men on health
and
trauma, as well as building skills in agriculture and
animal
husbandry to support economic well-being. It has been a pleasure
to
work with these men and women -- I am very fortunate.
|
-
Yesterday, was my day to tour our Pigs for Peace project in the villages surrounding Bukavu. We left early in the morning to reach the villages and have plenty of time to meet with women and families who have received the pigs - my research assistants - Dr.Octave - a physics and math teacher at a local high school and Dr. Maphie - a physician at the general hospital - will be conducting interviews in the Mashi language with the women as part of our evaluation of the program as I go out to tour the project. One challenge to the research is my lack of knowledge of the local language - the RAs translate the Mashi to French for me at the interview - they write the responses in French - I am recording the interview as well - then I have hired another Congolese teacher here to transcribe the interview to English - so I can review with Hopkins team to see if we need to do follow-up on questions - etc. I am lucky to have such good colleagues here because we are making it work well. Back to the pigs - we were welcomed to the villages of Ciriri at 8am with women dancing and singing - the team walked to the village followed by the singing and dancing of 30 women, children running along side and lots of greetings - we great in Swahili - Jambo- we all walked to the village meeting room for a formal welcome - which consists of introductions, more singing, and speeches from the village and program leaders. After - we are off to see the women who have received the project pigs and briefly talk with them about the project. As I am touring - Ben Brinton - Hopkins med student and research assistant will stay in village with Dr. Octave and Maphie to have more formal interviews with project participants. So - I am off up the mountains over the hills to meet women and their families - and by 1pm - I had managed to visit about 25 women. All the stories were impressive but some will stay with me forever - up a very steep hill - I met a 70 year old widower who used her money from selling piglets from her pig to build a house for herself and grandchildren - her children were too poor to support her so she was struggling to live - after selling her piglets - 7 from first pregnancy and 5 from second - she had enough to build the house, buy clothes for family and buy seeds for planting. More later time for work...
|
-
We just arrived back from a productive and busy day. Sunday morning is
when my colleage who directs Rama Levina Foundation plays basketball
with his Masters team - so I invited myself along to play- I was in
need of some serious exercise following a week on interviews with
victims and perpetrators of rape - and seeing the trauma of 15 years
of war. I think it is also important to try and make life as normal as
possible when working in a conflict zone. So we met at 9am and played
until 11am. I was so excited to play that I forgot Bukavu is almost a
mile above sea level - so the altitude hit hard at the beginning.
After the game, I had a focus group with the men on the basketball
team about violence and rape in DR Congo, the reasons, the impact on
women and families and what has to be done to stop the violence. After
the group, several men wanted to talk individually about their
understanding and experience. We set up several individual interviews.
We arrived next to my good friends house - Remy Matima - he directs a
microfinance program and we co- found our microfinance project Pigs
for Peace - an animal husbandry program for rural women and families
who have experienced rape - we have provided 85 families with pigs to
start breeding and raising for funds for food, medicine and school
fees. We have done all this with $4000 - imagine what we will be able
to do with more donations - a pig costs only $50. I will be working on
the evaluation of Pigs for Peace next week - more then. After a
wonderful meal with the whole family - Remy has 9 children. After
the mea, we had a meeting with the Supervisor of security for the UN
peacekeepers. I met him last Sunday and had a great conversation - he
called me to talk about our research and health care program - he is a
good advocate for our work. He also wanted to touch base on our
security as we had been in the rural areas - we made sure he knew we
were safe and planned daily to return to the city before night - and
we are very safe as I only do what my Congolese colleagues tell me is
safe and they know best. It was a great day but perhaps the best part - I had a full
conversation with a native French speaker - a Belgium woman here
working on justice issues- and she understood my African French - now
that is progress.
|
-
Hello from Bukavu DR Congo. Bukavu is a city in the South Kivu region in Eastern Congo. It is on the shore of Lake Kivu - one of the deepest lakes in the world. Bukavu was a city of 400,000 when I lived here in 1990 - now the population is around 1 million - as people from the rural villages flee to the city for safety during the 15 years of war. The research and work with my colleagues from Rama Levina Foundation is going well. I have hired two of their staff as research assistants and we work closely together in completing the interviews with victims of rape and the perpetrators of rape We communicate in French, but many of the interviews are conducted in the local languages Kiswahili and Mashi among others - I am learning a little of the language. My RA from US, Ginny Carter is helping me with KSwahili as she knows it from her studies in international affairs at UNC- Chapel Hill- as you imagine it is a great help. I also am working with Ben Brinton a medical student at Hopkins who brings great skills in working in Africa and a level of comfort and easy with people that is a joy to observe. Our Hopkins team has been working until late in the night - but last night we took a break and went to a nightclub with our Congolese colleagues and friends to enjoy and dance to Congolese music - which is known to be the best in Africa. It was a great evening with friends and reminds us that people try to make life normal even as war surrounds them. More later....off to work
|
-
Report from DR Congo Yesterday we spent the day working with the Doctors and Nurses of Rama Levina Foundation--a Congolese group of health care providers who run mobile clinics to rural villages to work with rape victims. Today, we will be going to the prison in Bukavu to interview the perpetrators of rape. This will begin my research on understanding the context of rape from multiple perspectives. Understanding from perspectives of the perpetrators--it is an important way to build programs for prevention. More soon...
|
-
Dr. Glass is traveling in central Africa and will be blogging periodically from Rwanda and the Democratic Republic of Congo.  I had the opportunity to visit the Kigali Genocide Memorial today. The memorial was opened in 2004, the 10th anniversary of the genocide. The memorial is at the site where 250,000 victims are buried. http://www.kigalimemorialcentre.org/old/index.html I am off to DR Congo in the morning. I will be taking a car to the border of Rwanda/DR Congo, to cross the border and arrive in the city of Bukavu, DR Congo. The trip should take about 5-6 hours over some rough roads, but beautiful terrain. Rwanda is often called the land of thousand hills "des Mille Collines." I have never driven this route, I usually take a small plane to the border city of Cyanangugu - but I’m feeling like an adventure. I will try to blog again on arrival in DR Congo.
|
|
|
|