Three weeks after my return from Kongolo, I wanted to share with you some videos on YouTube to give you a very concrete idea of the difficulties that may be encountered in the data collection in the bush (and I admit that it ‘is a bit for me Ithat I do it because I’m already nostalgic 🙂 and impatient to come back in mission).
The purpose of our mission was to analyze the situation on maternal and child health in the area of health of Kongolo to develop targeted and appropriate measures to local conditions and to perform further analysis at 6 and 12 months to measure the progresses achieved .
The health mapping of DRC is quite complex because of the sheer size of the country. Briefly DRC is administratively divided into 11 provinces including that of Katanga where I am based in Lubumbashi and where went in mission. The provinces are further divided into several zonal health (67 zones just for the Katanga!) which are subdivided into several health areas (between 20 and 30 health areas by zonal health which means more than 1000 areas for the province of Katanga). These zonal health are supervised by a central office (called BCZS) which is responsible for centralizing data about health state population and to forward these data every month for the national health information system (like the French national hospital database system … but much more complex to implement and you’ll understand why …)
To give you an idea of the challenge of the country size, Katanga itself represents 497,000 km2 while France is 640 000 … By overlaying the map of DRC on Europe, we cover France, Italy, Switzerland, Benelux, Poland, Germany Austria, Czech Republic, Slovenia, Croatia, Hungary.
Two months after my arrival in DRC, I still have difficulties to realize the size of this country! DRC is really like many countries in one country with high ethnic and geographic diversity.
So a large country and therefore distances are very challenging. I’ll will give you to much details of my very long trip to join my colleagues from Kongolo to Kalemie … 12 hours to make 500 km at an average of 40km / hour up to 70 km / hour when the track was good (:-)). And we were lucky we did it during the dry season but in the rainy season, you take the risk of spending the night in the bush if you cannot get out and that your vehicle breaks down … I admire our drivers who know every place of the bush!
Unfortunately I did not have the chance to capture our passage mountainous area because I was so focused on trying to remain on my seat and afraid of having my head down and feet up in the air …:-) (filming in these conditions is no mean feat)!
At Kongolo, we have dispatched the team (coaches, supervisors and investigators) among several areas. Even the dispatch was very challenging because means of travel available were very constrained.
I went through the area of Katea which is located at more than 100 km from the BCZS of Kongolo and we slept several nights in a convent. Living conditions are harsh but in fact we did not think about this as we were so focused on our objectives. And to be honest it’s almost indecent to think about living conditions when you look at the hard life of people living in the bush.
I did not have the opportunity to explore other areas because it is not possible to do this in only one week but other team member that even within one zone health, you can have very different context from one area to another !
In the bush I realized that bikes were very precious for people as it is their only means of transportation. You see a lot of people along the tracks that carry incredible amounts of goods on these bikes! When you are lucky, you can buy a motorcycle. But getting a car is just unthinkable. The bike here is a matter of survival. Pregnant women who have childbirth complications may come to deliver in health centers on a bike ! even if the process of labor has already started …
Hard to imagine what it’s like to practice the nursing profession in the bush … it makes think about issues of medical density in French rural areas differently isn’t it ?
The less accessible village that we visited is Mukumu. Only bikes and motorcycles have access to this village. When we entered in the village, some children were scared because they had never crossed vehicle in their life.
We were able to make the trip in one day as we had a car but just try to imagine what could be doing 100 km of rural roads under the blazing sun, dust and bushfire with a bike ! Bushfire irritates your respiratory tract and is source of conjunctivitis especially in the dry season …
Conditions of data collection are definitely not obvious at all. Under these conditions, it would be better avoid missing data … I thought to myself that internet would be easier but it is an equation without solution because: 1) internet means computer (and to equip health areas with a computer is not a priority face with the necessity to deliver drugs and other essential inputs), 2) computer says energy (fuel for generators or solar energy whose access is problematic in the bush) and then even if we have solved the first equation, the problem is that the telephone network does not cover certain health areas … and this is definitely something on which local communities cannot have actions … and even if there is a network, did already not try to send a database using via 2G mobile internet 🙂
Very excited to keep you posted my next two missions. The first one will be at Mbuji-Mayi in September in order to test a tool for monitoring the Expanded Immunization Program on which I’m working hardly for 3 weeks with my colleagues and to train their users. The second one will be in October to help to set up a vaccination campaign. Great upcoming things to share ….:-)). Take care.