Conducting health training in a conflict zone

Conducting health training in a conflict zone


A CARE staffer on the front lines opens his diaries. Here, he explains how Nurse Miphie Laya* showed strength and perseverance during crisis.


The Democratic Republic of Congo (DRC) is one of the most challenging places to deliver aid and train local communities. Not just because of the brutal conflicts that have been ravaging for decades, with the last one erupting in the provinces of Kasai just last year. It is also a huge logistical undertaking to reach affected areas as the country that has a geographical size of Western Europe yet has very few paved roads. After several days of travelling, the CARE DRC team and I have finally arrived in Mbuji Mayi, where we will train local medical staff how to treat survivors of sexual violence. Unfortunately, rape and sexual abuse is an all too common reality for many women here in the Kasai Oriental province since the conflict started. Some weeks ago my CARE colleagues conducted a study assessing the situation in the Kasai Oriental province alone and all 889 participants said that they know someone who had experienced sexual violence or that they had witnessed sexual violence during this conflict.

At the health centre Mbuji Mayi town, we find a group of nurses and the doctor in charge waiting for us. The nurses have all travelled several hours by foot, bicycle and motorcycle from their outlying villages to meet us here. For the next six days Dr Martin, CARE’s Sexual Reproductive and Maternal Health specialist and his colleagues, a lawyer and a psychologist will be training them on the care for survivors of rape and sexual violence.  Despite the logistical difficulties for the nurses to get to the health centre, they are all keen and eager to learn. At the same time my colleague Rose, CARE’s Gender Expert is conducting a training for so-called community health Focal Points. As part of the overall health system in the DRC the community Focal Points are located throughout the country in the remotest villages and work mainly as volunteers, helping to point people in villages in the right direction when they need medical care. Their main task is to refer and encourage people to go to health centres. For this reason they are a critical part of the program we are putting in place. Survivors of rape may not even know they have the possibility to get treatment and care that may save their live and having someone in a village who can help them get to a health post is important. critical.

One area that comes out strongly during this training is the very predominant belief in the supernatural, or as locals refer to it in Congolese French “fetishes”. “Fetishes” can have a wide range of effects and touch across almost all daily activities. Many of these “fetishes” will involve a heavy penalty on the women of the family. For example, if the family is victim to “bad luck”, like a house fire, death of the father or husband, death of child, the women of the household will be held responsible and need to undergo cleansing rituals or in some extreme cases be put to death. These types of beliefs place women and girls in an incredibly vulnerable situation and facilitate an environment where sexual violence can be very prevalent.


The brave health workers of Kasai

During the training I listen to Rose talking to the participants who recall their experiences during the conflict and the violence that has affected them all. One person that stood out was Miphie Laya, the head nurse of the health centre in a small village near the town of Miabi. She remembers that in October last year she started hearing rumours of conflict with houses being burned to the ground in the surrounding villages. Then, one day in November, militant groups arrived at the health centre around 10am and fighting began. Many of the people in Miabi were scared and decided to flee into the bush. The militant groups threatened to burn the health centre but luckily they did not. For a week afterwards, no patients came to even though Miphie faithfully went to the health center each day.

Michpie recalls: “When the people fled to the bush they could not find anything to eat and suffered greatly. Several women which we at the health centre were serving with pre-natal care gave birth to babies in the bush with no medical care or assistance. At one point I had to hide myself, going back and forth between my house and the centre. Despite all this, I still kept coming to the centre to help patients who were there, even spending the nights there. This was a very difficult time and my family was about to flee, but in the end we never did, because I felt I had to stay here and take care of people.” It was only weeks later in January and February that people came back to the village including displaced people from other villages.

I am very impressed with all these accounts. Many of these brave colleagues are very poor and vulnerable but are all eager to learn and help their communities. This is something I have learned over years of working in emergencies: There is always hope even in the most desperate of situations that would seem unfathomable in more privileged societies.


Radio tunes help spread the message to survivors

David and I spend the next day in town, attending coordination meetings and working out ways to get crucial medical supplies into town. Once the trainings for the medical personnel are over, we plan to stock each health centre with the medicine and supplies necessary to provide post-rape care to survivors. Though medicine and supplies will save people’s lives, we are having trouble figuring out how to get them to Mbuji Mayi and we are counting on our partner organizations such as UNICEF and the UN Populations Fund (UNFPA) to help us, given they have a much stronger logistical capacity. These types of challenges are common for humanitarian aid workers. There are always a million administrative and logistical constraints to get past, especially in a country as vast and poor as the DRC.

Before we leave, we visit a local radio station in a nearby town, asking if they can help us send out radio broadcasts about sexual and gender based violence, so that women and girls learn where they can find help and support if they are affected. The chaps in the radio station are very friendly and quickly agree to work with us.

The CARE team and I are very happy that we started these activities and we believe we will have a concrete impact on the care and support that will be given to women and girls who experienced rape and sexual violence. But we know we still have a lot to do and there are so many more people and areas that need support. We don’t have nearly enough funding to help everyone and we are currently working only in about a third of the Kasai Oriental Province, while the conflict has affected five provinces. So our next stop will be to the capital city of Kinshasa, a sprawling urban jungle that has as many as 15 million people (although no one knows exactly), where we will meet with donors and UN agencies and to find funding for our activities. This is critical after spending so many weeks with our dedicated CARE team and with these courageous doctors and nurses. I can only hope that our call for funds will be successful so we can reach more women and girls in urgent need of health support.


*Name has been changed to protect privacy

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