Kokolopori – Democratic Republic of Congo (DRC)

IF is supporting a health initiative in Kokolopori, a remote northwest region of the Congo, located on the Maringa River, a southern tributary of the mighty Congo River. Kokolopori comprises 32 villages along a 70km ‘road’ with a population of approximately 8,000 people who belong to a single tribal group, the Mongandu. The Mongandu have a traditional form of government based upon tribal chiefs. Reports from elders at Kokolopori support the view that there has been a significant decline in population over the last 10 years caused by deaths from the two Civil Wars, disease and massive internal immigration.

There are two distinguishing features of Kokolopori. First, it is not easily accessible. It takes at least a week to get there from Kinshasa, DRC’s capital, motoring along in a pirogue (three hollowed out logs lashed together) for an average of 22 hours a day. The second feature is that it is located in the middle of primary and secondary forests of breathtaking beauty and richness. The forests are home to that wondrous ape, the Bonobo, a highly endangered species. There is much folklore about the Bonobo among the Mangondu people and it is bad luck to hunt them. Nevertheless, the Bonobo habitat is threatened both because their forests are being cut down and they are hunted for bush-meat.

Congo’s plight

Since independence from Belgium in 1960, Congo, like many countries in Africa, has struggled to overcome poverty, years of conflict and extremely limited health and education infrastructure. With the first democratic elections having taken place in July 2006, there has been some optimism that key services will start being provided. However, as with most post conflict, or transitional countries it can take decades to recover from such a devastating history. The current infant mortality rate in Congo is estimated between 113/103 per 1,000 live births for males and females respectively. In rural areas this figure is always substantially higher, and in Kokolopori the rate has reached 127 per 1,000 live births. Only 3.7% of the population has access to generic medicines in the district and 46.7% access to clean and potable water.

A characteristic of the most recent conflict (beginning in 1996 and ending in 2002) was that many women in Kokolopori were subject to various forms of sexual violence, abuse and torture. Soldiers used rape as a strategy to humiliate the population. As a consequence, there is a marked increase in the rate of sexually transmitted diseases, prostitution of girls and a rise in the number of children born with no declared paternity. These girl-mothers suffer stigmatization by their peers and youth of the villages and are often unable to provide for their children.

As noted, child mortality is high and this is not just due to the lack of health care and chronic poverty; the forest marshes around Kokolopori, for example, are a refuge for malaria transmitting mosquitoes. Of the one million or more deaths from malaria that occur worldwide each year, around 90% occur in Africa, mostly in young children. In the Congo almost 26% of deaths in children under five are caused by malaria, which can easily be reduced through the use of insecticide treated mosquito nets. Unfortunately, these nets can be expensive for families at risk of malaria, who are among the poorest in the world.

The war also disturbed the population dynamics, provoking displacement of people already living under severe stress and consequently increasing their vulnerability to preventable diseases and health problems such as respiratory infections and diarrhea. Again, in the Congo, 11% of child deaths under five are caused by diarrhea – which can be easily treated with simple ORS (oral rehydration solution), basically, a mix of salt and sugar.

Health issues in Kokolopori

The main diseases and illnesses people suffer from in Kokolopori include: malaria; gastrointestinal parasitic infections and severe diarrhea; obstetric and perinatal problems; tuberculosis, fungal skin infections & scabies; infectious diseases such as chickenpox; malnutrition; trauma from falls and machete wounds; and chronic musculoskeletal disorders of the neck and spine suffered, in particular, by women from carrying overly heavy loads to and from the river and cassava fields. Traditional medicine is practiced among the Mongandu people, particularly by the ‘wise women’.  This traditional medicine mainly involves the use of various leaves for different diseases.

The water in Kokolopori is contaminated and difficult to obtain in certain villages - as they are not located near a stream (due to the malarial bearing mosquitoes). Furthermore, public sanitation is a big problem. Most houses have a toilet, but there is no system or practice of washing hands after people go to the toilet.  Food preparation is often undertaken without washing hands. Children go bare foot everywhere in the dirt which increases the risk of hookworm and other infectious diseases. There is no tradition of dental hygiene. 

There are no registered or unregistered medical practitioners in Kokolopori although there are some ‘auxiliary nurses’, who have had four years secondary school. The nurses walk to and from Djolu once a year to get some medicine and consult with the doctor from Djolu. The Djolu doctor is also supposed to come to Kokolopori once a year, but it appears he comes only to check medical records (whose existence is questionable) and vaccination cards.

In short, there is a chronic need for basic medical services, along with sanitation and hygiene improvement. The government does not provide these at any level. No international aid reaches this area except from the Bonobo Conservation Initiative (BCI).

Bonobo Conservation Initiative (BCI)

IF’s link to the community is through the Bonobo Community Initiative (BCI), an international Not for Profit organisation, initially established to protect the Bonobo. Through their work, they have recognised one of the key components of such protection is the livelihood and well being of the local community, not least because alternative income generating activities must be found to the lucrative bush meat industry, which the Bonobo.

BCI considers that improved access to health care is the most urgent need of the local population. The nearest professional health care available is in Djolu, which is a full day’s journey by vehicle from Kokolopori. As such, BCI has been working with its local partner. Vie Sauvage, to build and equip a dispensary and a basic medical clinic, known as the “Bonobo Health Clinic” in Kokolopori. Kokolopori villagers have already donated significant time and labour to begin constructing five buildings to house the clinic, Yet, further support is required for capacity building and supplies.

IF’s Commitment Agreement

In 2006, IF made an in-principle decision to provide health support to Kokolopori, subject to an on-the-ground assessment by IF representative, Phil Strickland, who made the (self-funded) trip in December 2006-January 2007 with a representative of BCI, Dr Luke Bennett. On the basis of Phil’s report, IF finalised a 3 year Commitment Agreement with the international and national representatives of BCI in May 2007 to provide financial and some technical support in the following areas:

** Malaria prevention - the main focus of IF’s support - which includes:

• Procurement and distribution of insecticide treated nets (ITNs) initially to pregnant women and children under five.

• Education strategies on malaria prevention which will be delivered in parallel with ITN distribution. This is because cost is not the only barrier to the effective use of mosquito nets. Often people, who are unfamiliar with the nets or are not in the habit of using them, need to be convinced of their usefulness and persuaded to re-treat the nets with insecticide on a regular basis.

• A health promotion campaign on hygiene and sanitation.

** Provision of pharmaceutical items which offers immediate and visible support to the population and some tangible response to community expectations. The simplest and safest initial gains are being made through the provision of: Anthelmintics (anti parasite medication), simple analgesia, oral rehydration salts and ante/perinatal vitamins, and treatment for malaria on the basis of reasonable clinical suspicion.

** Salary support for qualified nurses who implement the education campaigns and provide basic clinical care.

In July 2007, Kokolopori received the first tranche of funds sent by IF (AUD$8,600) in the form of 400 insecticide treated nets (ITNs), basic medicines and medical equipment, and nurses’ salaries for 6 months. IF received independent confirmation of the delivery of these items and its appropriate distribution. In January 2008, IF’s second tranche was sent to BCI and arrived in February 2008. Given the substantial difficulties confronted by porters carrying the ITNs and medicines for distribution (e.g. collapsed bridges and subsequent detours), budgeted into this second tranche of funding was a small per diem for porters and money to purchase bicycles to facilitate nurses travelling to all the villages.

The local team

The Bonobo Health Clinic (as it is called) is administered by the following people (“the team”):

• Bienvenu Mupenda, an employee of BCI, is the overall coordinator, purchaser of ITNs and equipment, and gives detailed bi-annual reports to IF of what has been achieved/delivered;

• Albert Lokasola is a senior and respected man in Kokolopori and heads the local Not for Profit organisation, Vie Sauvage. He co-ordinates the project from the Kokolopori end, organises the distribution of the nets and other medication throughout the 35 villages and manages the nurses. He also provides independent reports to IF.

• Albert Alukana and Edouard Limboto are the senior nurses. They live in Kokolopori and are responsible for conducting a population census, assessing the incidence of malaria before the inception of the project, treating patients, distributing the medication, educating the villagers about the use of ITNs, disease prevention issues and sanitation and hygiene.

• Antoine Salimwa and Bienvenue Estimo are the junior nurses and their job is to assist the senior nurses.

The enormous efforts the team and the people of Kokolopori have undertaken to ensure the success of the project are inspirational.

Phil is also looking into the environmental component of BCI’s mission that IF may assist with. This entails supporting the provision of wages and equipment for local trackers, which not only helps to directly deter and expel bush meat hunters in the Kokolopori forests, but also creates a tangible nexus between Bonobo conservation and the Kokolopori community welfare. Those from the Kokolopori village who work on Bonobo patrols or as trackers hold positions of esteem in a community where there is little or no employment. The salaries they take home to their families have a flow-on effect through the village in that the Bonobo’s survival and the community’s economic wellbeing are interdependent.

Partnerships

An exciting spin-off from the project is that the City of Falls Church in the United States has raised funds to pay for the salary of a doctor and will concentrate on pre- and post natal health and care. The doctor has already been recruited and his work will build on the program supported by IF. We have been coordinating with Falls Church to avoid duplication in our efforts. To achieve this type of leverage in such a short period of time has been a very positive (and unexpected) outcome of the project.

Another working partnership has been developed between IF and Professor Ellen Kraly from Colgate University, USA to identify and investigate positive case studies of small public health interventions in the Congo. Colgate University is one of the top liberal arts Universities in the US, and Professor Kraly, a friend of Sally Stevenson, is heading up the research on health care delivery and malaria prevention and treatment in remote regions of the Congo. This research will be of great benefit to our project as there is very little publicly available information on positive public health programs (and their conditions of success) in remote regions of Africa.

Why support a project in such a distant and remote location?

On first appearances, the Congo is an unlikely choice for Indigo Foundation, since it is far from our ‘normal’ geographical area. However, we made an in principle three year commitment to this project because: (i) it meets most IF criteria; (i) we like to support and build projects where we have personal connections; and (iii) there is also a strong need for assistance in Kokolopori, the community is marginalised, there is demonstrated community commitment, and IF’s contribution has the potential to make a significant impact. The success of the project depends largely upon the relationships IF has with the local Congolese people who will implement the project. The Congolese that Phil met at BCI and Vie Sauvage in particular – Bienvenu Mupenda and Albert Lokosola – impressed him as competent and genuinely committed to the well-being of the community.

We anticipate that 2008 will be a year of consolidation for this project and we look forward to the challenges and rewards of such an undertaking. 

If you would like more information please contact the project manager Philip Strickland at p.strickland@mauricebyers.com or indigo.foundation@bigpond.com