Democratic Republic of Congo, Day 4

This was our last morning in Muanda, which was a good thing. I was getting a bit tired of that place (which is probably going to make it hard to go back in June…). I did finally get to go running, though; the Defense Intelligence Agency (DIA) major went running yesterday morning, so I asked him if I could go running with him today. We did about 3 miles in 30 minutes, which wasn’t bad, considering the heat, humidity, and poor conditions of the road. I’m excited about getting to go running along the Congo River in Kinshasa tomorrow morning (even though it’ll be early).

The main road in Muanda and where we went running

The flight from Muanda to Kinshasa is the same plane that does the reverse trip (makes sense), which means it doesn’t leave until the afternoon, after the plane gets into Muanda and the crew gets a couple of hours to rest. So we spent the time in the morning hanging out the lobby of the hotel, with its spotty air conditioning, planning the details of the MEDRETE in June. It’s going to be four physicians—me, two adult infectious disease physicians, and one pediatrics infectious disease physician—as well as a laboratory tech who knows blood safety, and three support/security personnel from USARAF. In addition, we’ll also have five Congalese translators, because the doctors at Kitona don’t speak much (if any) English, and the American doctors probably (in my case, definitely) don’t speak much French. The Embassy has already identified two of those translators; I hope they find another three by June and that they know medical speak well enough to translate it.

In all, the mission will be 11 days, but with travel time to and from Muanda, there will only be eight days on the ground, seven of which are working days (they only have one doctor on call on Sundays and don’t see any new patients). On those days, we’ll have physicians paired up (one Congalese, one American) seeing patients as the Congalese normally do in the mornings. Then, in the afternoons, we’ll be having “summit meetings”, which will be discussions about programs that the DRC Ministry of Defense and Ministry of Health has for HIV, malaria, and TB, as well as the American doctors explaining our programs for these (well, for the ones we have programs for) and going over WHO guidelines for diagnosis and treatment. I think the lab tech will just be doing similar things with the lab personnel, in terms of teaching and learning (learning how to read malaria slides, teaching about blood safety, etc).

Finally, noon rolled around and we piled in the rental cars and headed for the Muande airport, where we again loaded a tiny little plane that stopped at the same places as on the way there before depositing us in Kinshasa. The embassy cars met us there and loaded us up to the Fleuve hotel, where we got reliable air conditioning, hot showers, and good food we didn’t have to wait three hours for. It was nice.

The Congo, from the air

Back at Ndolo airport, after spending two hours on the hottest plane in existance

The view from my 17th floor room at the Fleuve

Democratic Republic of Congo, Day 3

Today I actually got to sleep in until I woke up on my own, which is always a nice experience. Granted, I woke up on my own around 6am when breakfast wouldn’t be served until 7:30, but beggars can’t be choosers.

Because nobody had done a recon of Muanda, the town that we’re in, nor had I heard from anyone how safe it is/isn’t, I didn’t plan on going for a run in the morning (and it’s never a really good idea for a white woman to be running through the streets of Africa by herself), which was too bad, because one of the majors ended up going for run at 6, right around the time that I was awake anyway. Oh, well. We’re already planning on going running together tomorrow.

After breakfast, the day started by driving to Kitona Base. Our first meeting was with the deputy base commander and commander of the infantry, a brigadier general (one star). He claimed to already know what we were going to be doing for the mission, but then when we brought up medical stuff, he seemed surprised and said that that was out of his lane. He proceeded to take us to the infantry school and give us a presentation there, which we calmly listened to before insisting that we go to the hospital so we can actually do what we had planned on doing.

Shiny new infantry school buildings, courtesy of EUSEC (EU military, kinda)

The hospital commander, a colonel (not sure if that’s equivalent to our colonel or lieutenant colonel; he didn’t give a card), briefly explained his hospital to us: the Hospital Militaire de Reference de Kitona is a referral hospital, a tertiary care facility for the Kitona region (the DRC equivalent of, say, Brooke Army Medical Center in Texas—not the national-level military hospital, but the largest one in the area). Unlike our military hospitals, though, the population seen by the hospital in Kitona is about 40% military and 60% military, which is pretty normal for DRC. There are four military physicians, each of which is a general practitioner, who sees patients in all four departments of the hospital—medicine, pediatrics, OB/GYN, and surgery. On Mondays, Wednesdays, Thursdays, and Saturdays, the physicians see consultations, which means two of the physicians see outpatients and two manage the wards. On Tuesdays and Fridays, two will do surgeries and the other two manage the wards. On Sundays there is one physician on call. For each patient who comes in (about 50-60/day), they will be seen by the registrar, then triaged by a nurse before being seen by the consulting physician. It actually seems to be a pretty efficient system that is working well for them.

The hospital on Kitona Base

The majority of the patients are there for infectious diseases—malaria, TB, HIV, diarrheal diseases, etc. This is actually exactly what we’re looking for, for our Medical Readiness Training Exercise  (MEDRETE) in June. The goal of the MEDRETE is to train U.S. military physicians in tropical diseases and public health, while doing good things that will (with any luck) have a lasting impact in Africa. We still have some discussing to do, as far as how many physicians we can bring on this mission, but I think it’s going to be a go. Which means I’ll be back in the DRC, at Kitona Base, in June. 

Democratic Republic of Congo, Day 2

Today started way, way too early, with my alarm going off at 4:30 so I could get ready and check out of the room a little after 5, because at 6, an embassy car came to pick us up to take us to Ndojo airport, the domestic airport in Kinshasa. We were going to Muanda to evaluate the hospital at Kitona Base.

Our chariot awaits

Not unexpectedly (as I have spent some time in the developing world), the plane that was headed toward Muanda took off late. We thought we were leaving at 9; it was closer to 10. It was a situation pretty similar to what I experienced in Papua New Guinea: one small plane (maybe 18 seats?) that made a few stops before it got to where I wanted to get off. DRC was pretty, from the air. Because there’s so little development, everything is all green and full of rainforests, without even roads to interfere with the landscape once you got away from the cities.

The view from above

It was around noon when we landed, and then we had to go through some rigamarole with the passports (why they were checking passports on a domestic flight is beyond me) and luggage, but finally we were able to step out of the grass hut that makes up the airport and into the air conditioned rental cars (complete with drivers) to take us to the hotel. Because the entire city of Muanda is lacking any real-sized hotels, our group is split up between two hotels. I think I’m in the nicer one, but that’s not saying much.

By the time we sat down for lunch (at the hotel’s restaurant), we had already missed our scheduled meeting with the commander of Kitona Base, which was pretty much all we had scheduled for the day. So instead of doing anything meaningful, we did “familiarization activities”, which consisted of scoping out restaurant where we could eat, seeing the beach (since Muanda is on the tiny stretch of Atlantic coastline that DRC has), and traveling the road from Muanda to Kitona Base. It’s a very, very bad road (“unimproved” was how I was told to describe it), and the mission planner is definitely not excited about the idea of a MEDRETE team driving that twice a day for two weeks. More if they don’t have food available on base. It was bad enough that the car I was in got a flat, which always makes for some entertaining pictures.

Fixing the flat

So that was today. Not much meaningful happened, unfortunately. Tomorrow we’re supposed to meet with the deputy base commander (word is the base commander is in the east of the country somewhere) and then visit the hospital to see if there is anything worthwhile there. Pretty much, unless they have really cool diseases and a staff that is really interested in learning about public healthy, we’re probably going to recommend that the MEDRETE not happen. Because it’s really not worth $150,000+ of the taxpayers’ dollars to go on a mission where nobody learned anything and the local Ministry of Defense couldn’t care less.

Democratic Republic of Congo, Day 1

I'm a few days late in posting, but rest assured, I did write this post on the day it should have been published (which in this case was Monday, March 11). Here it is:

After a long day of traveling yesterday, we arrived in Kinshasa around 10 pm local time. By the time we got to the hotel (which is very nice, by the way), it was almost midnight, and I went to bed right away. Because I was tired from a very long day of traveling.

My room in the Flueve Hotel

Today started by formally signing into the embassy and receiving the RSO (Regional Security Office) brief. Since it is the Democratic Republic of Congo and there are a number of security concerns, we listened carefully for anything of note. Before the mission, we received a warning of anticipated protests at the return of the defeated presidential candidate (who declares that he was actually the winner and has a following that does the same), but that didn’t happen. What we did note was that police officers are known to be corrupt, believed to be due to low pay and low training, and are to be avoided at all costs, as all they usually want from westerners is bribe money. We also learned that photography was illegal until recently, and still is in and around government facilities, and is still frowned upon, so if I don’t give very good pictures from this trip, that’s why.

The first real meeting of the day was with the AFRICOM training advisor and the Deputy Chief of Mission, where we learned that the Ministry of Defense (MOD) is not organized well, but the medical corps is better than most departments within the MOD. The key issues all revolve around logistics, because things are too expensive, too difficult to get out of Kinshasa (due to lack of roads in most of the country), and hoarding is an issue.

Following the embassy, we headed out to the MOD, where we first met with COL Kambale, the Director of Military Cooperation. He didn’t have too much to offer. The second meeting was with COL Louis Kakudji Ilunga, MD, the Deputy Surgeon General. He identified four disease surveillance programs within the MOD: malaria, HIV, TB, and cardiovascular disease. I don’t know how robust these programs are (with the exception of the HIV program, which is funded, monitored, and run by US DoD programs), but if the MEDRETE happens, these will be the areas that we focus on. Pretty much, all I learned is that their disease surveillance is low, consisting of monthly reports of disease counts. This doesn’t really mean much, because I don’t think that they follow trends or even take into account denominator data of the overall population (troops, dependents, etc) who are at risk.

The final meeting of the day was with the medical director of Clinique Kinoise, the first public hospital in DRC, built after independence in 1966. It is currently in very poor shape, with a roof with structural problems, electricity that is unreliable, and no running water. It is a 300 bed facility with 4 ORs, but there are around 3 surgeries/week, approx. 10 inpatients currently, and an average of 15 patients seen in the outpatient clinics daily. The medical director does have grand plans for the hospital, all of which would require significant donor equipment and funds, and is unlikely to be maintainable without significant outside assistance. It is unlikely that we will use this at the clinical site for the MEDRETE, because there’s really not much to see or do, with such a low patient count.

Clinique Kinoise. Lovely, isn't it? Oh, and there's no elevator, in case you were wondering.

In all, pretty long and exhausting day, and I was glad to be able to get back to the hotel to go for a run (on the treadmill) and sit by the pool to work on my sunburn (because it would be embarrassing if I returned to Savannah without any color to me).

More Medic Training and Some Random Musings

I actually started to write this post on Friday, but then I realized that I didn't have everything I needed to write it. By that I mean the link to the article I wrote... Keep reading and that will make more sense.

Before I left for ACPM, we had Dr. Likita Aminu from the CDC come over to talk to the medics about hepatitis. Dr. Aminu is originally from Nigeria, and met LTC Gardner in December at an African culture event in Savannah. Because LTC Gardner can talk anyone into anything (he is, without exaggeration, the type who would be able to sell ice to Eskimos if he wanted), Dr. Aminu agreed to chat with the medics. Since he had done research on hepatitis in the Coastal Region of Georgia (where we live), and hepatitis is an issue in Africa, that's what he talked about.

And here's the link to the article I wrote about the training:

http://www.stewart.army.mil/homepage/news/news8.asp

Now onto my random musings. For the second half of last week, I was in a pretty annoyed mood. I think it started on Wednesday, when we had a Command and Staff meeting. Command and Staff is pretty awful to begin with--each of the staff sections talks about what's going on in that section. It's great if you really care about how many humvees are due to be serviced or whose evaluations are due. If you don't, it's about an hour and a half of torture. Well, because the conference room table is only so large, I don't have a seat at the table, but I do have a slide (as in, one PowerPoint slide) to brief, and that's the medical readiness of each of the companies. To make an already long story somewhat shorter, before the meeting started, I was trying to find the right chair to pull into the corner of the room, the entire time thinking, "I went to four years of medical school and three years of residency for this?" Yes, a bit egotistical, perhaps, but that is what I was thinking.

I think part of that was the fact that I was just at a conference, hanging out with the people I used to work with, which was a nice little reminder of how well I used to have it. In residency, my only obligations were to learn as much preventive medicine as possible (and stay up to date with all my Army required trainings, of course). Now, I see routine complaints (boring), track who is due for which vaccines or blood work (boring), and only rarely get to do anything preventive medicine or tropical medicine related (yay!).

I guess the point of that is, going to such conferences remind me that I do like the Army, but that I think I'll be happier if I leave FORSCOM and go back to MEDCOM, where doctors typically get to do what they're trained to do.

We'll see what happens.