I hate the border crossing from Rwanda into Goma at Gisenyi. It frays nerves and sullies sunny dispositions in a heartbeat. Male street thugs prowl past luggage, waiting for that instant of inattention. Professional beggars steal into your personal space while the truly hungry are too afraid to ask for a franc or two, and the secret police pour over passports and personal possessions with imperious disregard for common courtesy.
Journalist Helen Thomas and a medical doctor from the States were joining me for a meeting with a midwife group from Goma, and we were waiting for my Congolese friend Omer to meet us with the required invitation from APROSAF (Action Pour la PROmotion de la Sage - Femme). I had not seen Omer in two years and cannot adequately express the relief I felt when I saw his round face and perpetual smile.
(See this photoessay below by Georgianne Nienaber)
A Swahili welcome in song from the APROSAF midwives and mothers said it all. “Welcome and we wish you a long life.” Australian journalist Helen Thomas and I looked at each other in disbelief …our voices are very small in comparison to world media, and these women were looking to us to tell the world about their experiences, trials, and challenges. The Acronym “APROSAF” in French says: Action pour la Promotion de la Sage Femme.” This can be translated in English as “Action for the promotion of the midwife.” These women had never before met a western journalist.
This is the water supply in a church-sponsored IDP camp in Goma. This is a relatively good situation for the displaced. Imagine delivering babies while hiding in the bush, surrounded by renegade militia. Imagine finding a brutalized rape victim there, and finding her vagina filled with super glue. Your only option is to carry the woman on your back, and then she dies along the way from the brutalities of her rape. Your goal? To get her to this church camp.
The APROSAF midwives work for free. They actually pay to receive training and risk their own lives in the course of their work. These are some of the proudest, bravest women in the world. APROSAF has been training and taking care of midwives since 2001. APROSAF has trained 102 midwives in the provincial health districts of Goma and Karisimbi. The goal is to train an additional 100.
APROSAF was founded in 2001 and Kalivanda Josephine (pictured here with Australian broadcast journalist Helen Thomas) is one of the founding midwives. She has been a witness to war and brutality for all of her 86 years. Kalivanda told us that when she was a child there were hardly any white men. With the coming of “the whites,” the worse the wars became. “There are so many wars, what do you want me to say?”
Doctor Kahavi Chrisogone is the APROSAF coordinator. Dr. Chrisogone has a regular practice at Heal Africa (The former DOCS Hospital) in Goma. We spent three days with him and he never lost this serious demeanor. How could he? The statistics he knows off the top of his head are heart-breaking. There are 83.11 deaths per 1,000 live births. Since the outbreak of fighting in August 1998, 5.4 million people have died. Although only 19 percent of the population consists of children, children and infants account for 47 percent of the deaths in DR Congo.
This is the midwife “textbook.” Unless you have visited this part of the world, you cannot begin to understand the lack of basic educational supplies. Bookstores are virtually unheard of. A book like this is a prize and a valuable teaching tool. A maternity study carried out in Goma and in villages around Goma showed that 70% to 80% of delivery cases are performed in health centers and 20% to 30% of cases at home in Goma. In villages around Goma, 70% to 80% of delivery cases are performed at home and only 20% to 30% are performed at medical centers.
It was also shown that cases of home delivery expose the pregnant woman and the infant to serious risks. Facing this situation, the Goma health authorities felt that it was necessary to find an adequate solution to this “alarming situation.” It is in this context that APROSAF received a mandate to organize the training of traditional midwives and to assure the supervision of their activities in order to limit risks during deliveries. Basic needs are obvious. Training also allows the midwives to learn about the importance of good nutrition for a pregnant woman and infant, hygiene, family planning, prevention of HIV/AIDS, and finally, rape counseling.
“There are so many mothers and babies dying because of this war. But we have hope.” “The problems that we are facing…we have to walk very far and we are exposed to rape and shootings. If we could even have a way to reach the rural areas, then this would be very good. We women, we suffer a lot. Please help us.” Desperate situations requiring transport can be arranged though a motorcycle “ambulance.” The techniques and knowledge acquired by this traditional midwife has allowed her to be recognized as a community leader.
“The rape victim that the rapists closed with super-glue...she died. The other, we tried to carry her to safety on our backs, but she also died. There is so much shouting and shooting and running in the war…we have to run for our lives.” “I have a simple request. Can you help us sensitize the world about the conditions in the IDP camps? I thank you for that.”
The view from a bed in a local clinic in Goma.
This child survived...so far. If he beats the odds, he faces a gauntlet of disease. Needs go far beyond the birth process and APROSAF midwives are trained in HIV counseling. They need a clinical center. It is the dream of the women we met to have a center where the midwives will counsel women victims of rape and people living with HIV/AIDS. They will emphasize voluntary testing and the need for immunization against basic childhood diseases.
Journalists are not supposed to get involved in the story. What do you do when the women weave a basket for you? Do you throw the rules out the window? “We wove this basket in such a way that it is like cooking a traditional meal with flour and water. When mixed together you cannot separate them. They become one and like that we wish our friendship on this day will make us like one. Please help us.”
After Omer smoothed the way through the border crossing, we piled into a small car and made our way through the mean lava streets of Goma to our hotel. It all looked familiar--nothing had changed in the two years since my last visit except for the increased MONUC (UN mission to DR Congo) visibility in the center of town.
It is a peculiar characteristic of Congolese society that people don't offer a request in a straightforward manner. Suggestions are made, and it is up to the listener to be sensitive to the fact that an offhand remark might actually be an important request. One of the young men helping us to get settled into our rooms mentioned to me that the volunteer APROSAF midwife group was having a meeting that afternoon. I asked Omer about it and he positively beamed, excited that we would consider attending. The doctor with us had brought medicines and supplies, so it seemed to us as good a time as any to deliver them, although we were all exhausted from work and travel.
After bouncing over streets filled with lava rock, we pulled into a school's parking area. Schools in this part of the world consist of a row of classroom doors facing a central area. Think of it as resembling an old-fashioned motel. What happened next was extraordinary and certainly an unforgettable experience for eyes and ears.
A whoop sounding for all the world like the battle cry of Native Americans in a B western, was followed by applause and a whirl of color as thirty to forty Congolese women, all singing
and shouting in Swahili, poured through the door to one of the classrooms and surrounded us. Hands touching and hands holding reached for us. Eyes dancing with light and genuine welcome embraced us. These were the midwives. These were the brave women--the guardians of what remains of civilized society in Congo.
The midwives had been waiting hours for our arrival.
After the days we spent dodging drunken, angry men and opportunistic border guards, this was relief. This was healing. This also represented a personal sacrifice on the part of the midwives, some of who had hiked for miles to visit the American women writers and the male doctor who offered hope that they could find the tools they need to do their work.
Their work is simple and it is profound. The APROSAF midwives risk their own lives to bring new life into the world. An advisor to the Red Cross told us about them. Their lives are spent in service to the ancient rhythms of creation-- assisting the newborn and mothers. 45,000 people a month are dying from war-related caused in Congo, yet life refuses to capitulate to the war, and the midwives hold firmly to a banner of promise and hope. But they have nothing to work with. Their needs are simple by American standards of health care. Some textbooks, basic medical kits, which include surgical gloves, and a small clinic building for transfer cases and HIV counseling.
The classroom was arranged so that the visitors faced the midwives, our backs to the black slate board. The wooden benches and desks were tiny, with barely enough room for a notebook. Strong serious faces, some young, some older-- faces filled with expectation and wrapped in hats and scarves riotous with the colors of Africa watched as we fiddled with cameras and recorders. We were there to learn and it occurred to me that the classroom should have been arranged differently, with the visitors in the desks made for the students.
Doctor Kahavi Chrisogone, the APROSAF coordinator began the presentation Dr. Chrisogone has a regular practice at Heal Africa (The former DOCS Hospital) in Goma. In a quiet voice, Doctor Chrisogone outlined the pilot maternity project while Omer translated. The midwives need a small maternity center in Goma where they can bring pregnant women and rape cases in need of emergency care. All too often the pregnant woman and the rape victims are one and the same.
The midwives also risk rape and shootings to reach the women who need them.
Goma health authorities are supportive, feeling it necessary to find an adequate solution to risks faced by the newborn and mothers in the extreme wartime conditions of Nord Kivu Province.
Doctor Chrisogone completed his presentation, and what happened next was powerful and riveting. In response to a question from Thomas and myself: "What do the midwives want to say?" there was perhaps a minute of uncomfortable silence. Then, one after the other, in strong sure voices and demeanor, the midwives approached the head of the classroom and spoke to us through Omer.
There was no laughter this time. No smiling. Faces remained strong, but eyes welled up as the tales mounted and mounted until he listener felt that there was no way the stories could get worse, but they did. You could hear the murmurs of discontent while your head felt like it might explode from information that assaulted rational thought.
The dream of the midwives is simple by American standards. A ten-bed clinic with the supplies and capacity to deliver seven to ten babies a day. The pricetag? $112,000--the cost of ten good quality AK-47 assault rifles.
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