February 18, 2009

Goma report

In mid November 2008 I was copied on an email describing the need for orthopaedic surgery among many children identified by Disabled International. These children were living in displaced persons camps in eastern Congo in the vicinity of the city of Goma. The email also said that there were many residents in surgical training in the hospital there who were keen to receive teaching. I was already committed to participate in orthopaedic lectures at the Pan Africa Association of Christian Surgeons (PAACS) meeting in late January, so I volunteered to give the two proceeding weeks, January 7 to the 21, to Goma under Samaritan's Purse as a volunteer in mission, PC(USA).

The travel to Nairobi, where I spent the night in an apartment held by Samaritan's Purse, was a distance of 8,000 miles covered in 24 hours. The next 600-mile leg of my journey was covered by a flight of 70 minutes southwest to Kigali, the capital of Rwanda, then three hours in a pre-arranged taxi ride through the lush, mountainous Rwandan countryside to the border of the Democratic Republic of Congo.

The gathering darkness was symbolic of the state this country is in. There was a lot of fussing and clucking over my passport in spite of documents, clearances, and photos that had been prepared in advance. Fortunately, I was met at the border by representatives of the HEAL Africa Hospital. I paid the 25-dollar visa fee and thought it was done with, but a lower echelon official had climbed into our vehicle and we drove together to a more central office of Customs in Goma city. It was getting darker as we picked our way over a stone-strewn path and through the break in the walls of an earthen courtyard, then through another hole in crumbling concrete to get to a room with three or four officials in it.

Our driver had to furnish light from his cell phone for the very important, well-fed official in a white uniform, who slowly thumbed through my passport. Eventually, he gave me a paper saying that the man who had the official stamp had gone home for the night. Leaving my passport, which was picked up two days later, we made our way to the hospital’s guest hostel, Maji Matulivu ("Still Waters"), in time for supper.

Goma

This bustling, border city of 800,000 people has no more than two major paved streets, which are crowded with four-wheel drives and small motorcycles. Goma lies at an elevation of 5,000 feet in the shadow of three volcanic mountains. There is hardened lava and volcanic rocks spread all over the city and a remaining active volcano frequently fills the air with a fine ash. Many homes that which had had been two stories have only a remaining upper floor, with the lower floor inundated by an earlier flow of lava. The edge of the city forms the northwest shore of beautiful Lake Kivu, deceptive for its underlying deadly methane and carbon dioxide gases that erupt from its quarter-mile depth every thousand years or so. 

The Goma region has suffered successive disasters. In 1994 the genocide erupting in Rwanda caused refugees to flee over the Congolese border to safety. In 2002, Mt. Nyiracongo erupted, causing lava to flow through much of the city, destroying everything in its path. Now, for the last three years there has been a storm of fighting, looting, rape, and murder in the region. Two rebel groups and the undisciplined Congolese army roam as marauders. The only semblance of order is in the city proper, which enjoys the presence of U.N. Peacekeepers from India.

The hospital

HEAL Africa, an acronym for Health, Education, Action and Life, which exercises a holistic mission,  was begun by a Congolese surgeon, Dr. Jo Lusi, about 10 years ago. I first met Dr. Lusi ("Dr. Jo") when he was regional MAP director in Nairobi and was  interested in foot surgery at Kikuyu. He spoke of his dream to serve the needs of his home area of eastern Congo. Now, with amazing hard work and exercise of faith by him and his English wife Lyn, they have succeeded in establishing a multimillion dollar establishment. 

He had been appointed by the government as director for dealing with the hundreds of thousands of clubfoot patients among Congo's 60 million population. This is approached by the establishing of training programs for the corrective cast treatment of the deformity in infants. One of Dr. Lusi's goals is to establish HEAL Africa as an outstanding orthopaedic center. Each year he draws four young residents from the nearby university medical school into his program of  training Africans in a triad of general surgery, ob-gyn, and orthopedics. His goal is modest but practical: training these men without sending them outside the continent and then getting them into regional hospitals throughout the country.  At his suggestion, we are inviting Dr. Jo to come to our Kikuyu  Orthopaedic Rehab Centre in Kenya with three or so young orthopedic doctors and an orthopedic nurse for several weeks to see how a quality orthopedic center operates in this part of the world.

HEAL Africa consists of a number of programs that are an extension of the 150-bed hospital. There is HEAL Africa Arts, which is designed to meet the needs of many young women who have suffered rape and loss of home in the conflict. Most of these have been left incontinent of urine due to traumatic vaginal fistulas. These are surgically repaired and the women kept for several months for medical care, training in sewing and other skills, and taught how to operate an independent business. Their shattered lives find restoration through Christian nurturing.  

Stan Topple visits Magunga children in a refugee camp near Goma.

HEAL Africa also operates an orphanage of 154 war orphans under the care of its founder, Mama Jan, and her husband, who began with Rwandan children coming to their home out of the conflict more than 12 years ago. There is also a women's awareness ministry, bringing women into an understanding of their place in the family and society from a Christian prospective.

My experience

The first day after my arrival began with a clinic of over 20 children brought to the hospital by International Disabled and began with surgeries, which ran steadily until the afternoon of my departure on 20 January. Dr. Lusi saw to it that I had the full attention of the staff, always working with senior residents, most particularly, Dr. Medard who was very obliging and a good learner. All men were careful to commit each case in prayer. Dr. Simplice, who was spending his leave from orthopedic training in Kampala, Uganda, is also an ordained minister.

We had two rooms and two full teams of nurses and anesthetists to speed things along from one case to the next. Dr. Lusi assigned me a driver and vehicle to be called up on my cell phone at any time, a service that I had little need of. During the ten days of surgery we operated on thirty-five patients. Twenty-three of these were age 12 or less. Twenty of the cases were various degrees of clubfoot deformity and eight cases were polio deformity requiring contracture releases, tendon transfers, and triple arthrodesis. 

Other cases were valgus and varus correction procedures of the lower extremities, burn scar release and skin graft, fusion of an old, unreduced ankle fracture and a malunited tibia fracture. Unfortunately, one complication of infection has been reported since my departure. I was allowed to work on one national holiday, but Saturdays were devoted to major cleaning of the operating room. Samaritan’s Purse had given HEAL Africa’s cost of 50 operations on children, covering my work and that of Dr. Bob Greene, an orthopaedic surgeon who had come in November.

Lyn and "Dr. Jo" Lusi.

My second Saturday, following ward rounds, I joined another visitor, the Reverend David Cohen, an Anglican minister from Sydney, Australia, our chief orthopaedic nurse, Charlie, and a young Californian lady photographer in visiting one of the four displaced persons camps outside the city. Mugunga Camp was a collection of about 5,000 refugees who had been there for three years, having fled from the Masisi region 50 kilometers to the north. At least half of the group was made up of children, living an aimless existence without schools or other positive stimulus.

Each family unit lived in a shelter located about six feet from its neighbor, typically consisting of  a plastic or nylon tarp thrown over a skeleton of sticks with banana leaves augmenting the walls and roof. Occasional chickens or goats were drawn into their owner's shelter each night to avoid landing on a neighbor's dinner table. We sheltered from a sudden downpour in one of the few wooden structures. This was a single room with volcanic earth floor, smaller than our living-dining room in the United States. I was told that this afforded sleeping accommodation for five families each night. 

Other than a couple of cinemas that ran off generators, I was unable to identify any communal activity. There was said to be one Catholic church building. Samaritan's Purse was soon to build a four-room building for school and worship. Water taps and latrines were strategically located throughout the camp. To one side was a small wooden-framed building painted in white with a red cross on the side. This was the original structure build by the International Committee of the Red Cross dating back to 1994 when Rwandan refugees flooded in to escape the Hutu-Tutsi genocide. I asked a 12-year-old boy what he aspired to be and he immediately replied, "president."  Yes, of the nation. And if that didn't work out, did he have a second choice?  Yes, he would like to work for an NGO.

The hospital chapel services are held on two weekdays and each Sunday morning, always at 7:30a.m. The chapel is decorated as for a celebration African style, with multicolored drapery on the walls and Christmas lights wound around streamers hanging from the ceiling. The messages were usually delivered in French with a Swahali translator. Music is a big feature, with drum set and keyboard beefed up by amplifiers. Dancing figures and smiles are everywhere. The nurse in charge for the hospital was leading the service and she knew how to keep the program moving. 

There were several singing groups but the one that most caught my attention was a group of ten women who represented the Africa Arts program. Coming from rape, extreme terrors, traumatic vagino-vesicular fistulas, and often infected with HIV-AIDS, the joy and hope that shone on those faces that had suffered such a hellish past could only have come from heaven. One morning during the service there was a 17-year-old girl with sightless eyes who sang a solo. She was the daughter of a pastor who with his wife was killed by marauders. Lanette was then raped and had her eyes gouged out, leaving her infected with HIV. Following the song, Lanette gave a simple testimony, saying, "I can stand."  I was reminded of Paul's word in Ephesians, "…take unto you the whole armor of God that you may be able to withstand in the evil day, and having done all, to stand."

The two formal lectures that I gave were attended by up to 50 young doctors, nurses, and physical therapists. A stimulating question-and-answer session followed each presentation.

There were a number of surprises. I was living in a beautiful compound for hospital guests and the Lusis located on the shore of Lake Kivu, a 15-minute drive from the hospital. The food and services were more than satisfactory. Also, I found that I was surrounded by many international guests, some coming for a short stay and others for a few months. They had different agendas, ranging from Christian instruction on conflict and community building to supporting Congolese Christian ministries, and to inspecting/overseeing non-government programs. I was the only visitor performing a medical function.

Clean linens were running low and many of the younger children were crowded two to a bed, so it was time for me to go. I suspect the staffs as well as I myself were ready for a break when I departed from a morning of surgery to cross the border and catch my afternoon taxi ride to Rwanda's capital, Kigali. There I chanced upon a pavilion where a group of Rwandans were watching President Obama's inauguration live on television at 7:00 p.m. Worlds apart and yet one world!

The 2009 Mission Yearbook for Prayer & Study, p. 37