Only in the Congo!

Warning: this post may just be an excuse for me to vent about all the uniquely Congolese, frustrating, odd, and wonderful things that have happened to me here!

“Only in the Congo.”

If you live in the Republic of Congo long enough, you will inevitably find yourself saying this in exasperation or in good humour, and sometimes both. My most recent utterance was that of exasperation, as I found out I would not be able to order a single lab test here for 4 days because it was the long weekend in spite of having 2 very ill patients!

The only explanation I have for this, is found in the Congolese word for tomorrow, lobe (pronounced low-bay or low-bee). This is a word they have for tomorrow, and yet I am told, it only means some time in the future! It could be a day, a few days, a week! Maybe this would be her response as to why we couldn’t get it done, we’ll do it lobe.

Their disconnect with time is not limited to the future. The past is often even murkier, which is a difficult thing when trying to ask someone about their medical history. Sometimes this gets to an extreme, like an Aka gentlemen who didn’t know how old he was! When I pressed the question, he got out an ID card issued by the government some years ago that had a generic birthday documented that would make him far too young. They explained they get these cards and he probably just told them he was born sometime in the 1970’s, so that’s what was documented!

I had this happen again during rounds on the pediatric ward. I came to a young boy, and all that was on his chart for his age was a question mark. He was the most malnourished patient I have seen here, and was tall enough to be around 2 years old. I could see each and every rib, and he was lying in his own feces. It was heart wrenching. His current guardian was an elderly relative, who explained that his parents lived in Brazzaville but had shipped him up here and she was the only one to take him in!

A reason for a lot of the kids being malnourished is not a lack of food, most families can get enough for their kids from the jungle and their gardens. The problem is more often that they only feed the kids when they cry. So if you get a really content newborn baby, a mother may only be feeding them every 4-5 hours! There is a real lack of understanding of basic nutrition.

This isn’t the only misunderstanding. I work at a mission hospital, which pays a salary only to the local workers. I think many would understand this concept back home, but here people just can’t understand it. I realized this one day when we were talking about a patient having to pay their bills and I asked if they thought I was getting paid to be here. Everyone on the unit thought I was being paid well to work here!

People have to walk long distances daily, so the back of our Land Rover is always full!

It is very bizarre to come across these ideas, yet I get it. Why wouldn’t you distrust authority here? Medicine here is plagued with fraud. I have heard everything from the counterfeit medications at the pharmacies to a person performing bogus xrays out of his mud hut. This ruse  turned out to be him flashing lights at the patient and then he would produce an xray film of the appropriate body part (most of the time) that he had stolen! Only in the Congo.

All these things really start to wear you down over time! It makes life for local people here incredibly complicated, unjust, and frustrating. So then, it makes a lot more sense when they approach life and work with an easygoing attitude. If you got frustrated every time you were slighted here, you would probably go mad!

There are also a lot of positive things that would happen only in the Congo. Like lounging after supper to the sound of distant drums that are so incredibly regular that it feels like the pulse of Africa. Or the singing that is done with the drums; it is so simple yet profoundly beautiful!

One of my favourite things is the ways they can say hello. In Lingala, you can say a simple “Mbote” for hello, or you often here “Mbote mingi!” This roughly translates to “hello very much”, or a respectful and exuberant hello! This would then be followed by shaking hands with their left hand clasped on their right forearm, a way of showing respect. Similarly, they will often wave with both hands and a slight bow to show respect. Steph and I are always greeted emphatically by kids as we ride through town on our bikes with hello’s, mbote’s and moondele (their word for white person)!  If you forget it is only because you are white, it almost feels like you are a celebrity.

The Aka people (pygmy) are also one of my favourite things you will only find here! They are so friendly but have gone through so much abuse at the hands of people (the Bantu) who treat them as sub-human. They took us on a jungle walk and showed us their medicinal plans, got a vine for us to swing on, built a shelter and fed us their edible fruits, including cocoa!

Steph with some of the Aka kids that came along for our jungle walk!

Lastly, the close community is palpable here. People often pay their hospital bills with their own type of insurance system. People ask others in their family and community for help and raise money for one another on an as needed basis! They are very caring and helpful in this way, and always willing to humour me with a conversation in broken French. Even with complete strangers, people will stop and chat for some time!

Only in the Congo could I find things so incredibly frustrating and beautiful at the same time!

A day in the life of an average hospital patient…in the Congo!

My last blog was about a day in my life as a doctor in the Congo. And don’t get me wrong, it is a pretty complicated job. Yet, it is nothing compared to the life of an average Congolese patient! I have talked with many patients and nurses, and collected some stories. Some are bizarre, some are funny, and some are extremely sad. So here we go…

Where to even begin?! Probably the hardest thing I see coming from a country with universal health care coverage is when patients struggle with payment for our services. The first one that comes to mind is a 9 month old was sitting in triage with his mother. He had fevers, diarrhea, and was severely malnourished. For context, the normal weight for a 9 month old is 9kg and the lowest percentile for weight is 7kg. This child was literally off the charts at only 4.5kg! In addition to being severely underweight, he probably had malaria and needed some lab tests and treatment. We explained to the mom that at this hospital we treat malnutrition for free, they just have to pay a basic admission fee (something like 10000cfa, or $18). Unfortunately, the mom was unable to pay for anything and requested that we just give her the medicine so she can leave! It was heartbreaking!

If you decide to get a full admission to hospital, the next step is paying for everything ahead of time. You buy your medicines from the pharmacy, and bring them to the nurse. What if our pharmacy doesn’t happen to have it? Well, you go walking in to town to find it at another local pharmacy. These are often tiny and very untrustworthy.

The tiniest little pharmacy!

So you’ve got your medicines, now you have to supply a “guarde de malade”, which roughly translates to the guardian of the sick. A family member must accompany any person who is in hospital to make them meals, change their sheets, buy their medicines, give them baths, pay for their medicines etc. I can only imagine how ecstatic nurses back home would be if they found out that the patient’s family would be the ones dis-impacting the bowel, or ushering them to the commode!

If you are really sick you will be spending a night or two in the salle d’urgence (emergency room) or the sale d’observation (observation room; this is the closest we get to an ICU, but make no mistake, we have nothing special except for an oxygen concentrator). Typically, to make it here you will have malaria that has gone to your brain or malaria that has made you ridiculously anemic.  If you are anemic and need a transfusion, we can do those here (unlike the other hospital in town). The catch is that you have to get 2 of your family members to donate blood to replenish our little blood bank!

Also, just about every patient that walks through the doors will be dehydrated by a liter or two, constipated, and if you are a kid you will have worms. Literally almost every patient has these, and it really complicates the medical treatment! I had a little 4 year old girl come in who had been poisoned by a neighbour, and had a kidney injury as result! We were trying to collect her urine but each day we came she only had a small cup half full to show us. So we finally asked how much she was drinking, and it had to have been less than 300 ml per day! We gave her the task of drinking 1-1.5 liters, and she couldn’t believe we wanted her to drink that much. The main problem is that there is no running water for the city or power most of the time, so almost every has to haul water from a cistern!

Maternity cases are their own special thing. Women here generally freak out if it is their first child and we often hear them yelling in the suite d’accouchement, the maternity building. I know this is coming from a male and I will never know what they are truly going through, but women go crazy here compared to Canada. I had a patient literally roll out of bed and start writhing on the floor with her IV arm dangling above her in the middle of labour, and those floors are not clean! The nurses here have seen so many dramatic labouring patients that they have a hard time telling if there is actually something wrong!

Another fun thing is the buildings here all have these shutter type windows that never fully close. The family’s of the ladies in labour find this out quickly. So imagine you’re in the middle of labour and having a confidential conversation with your doctor when your mother-in-law starts chiming in through the window! Next, if you are an Aka pygmy or just anxious to have your baby, you may just decide to take a traditional medicine to help kick in labour or make it faster.  In Canada someone would usually take something like cod liver oil that works worse than it tastes. But in the middle of a rain forest in the Congo, people have found some absurdly potent medicinal plants that act way too well! I frequently have someone in labour who shouldn’t be but is having huge and painful contractions because they have taken some of these plants! It sounds funny at first but is actually quite dangerous and often end in C-sections.

A usual patient in the medical ward has no choice but to be quite social because it consists of 5 stretchers (iron bed frames) laid out with old mosquito nets dangling over head. No walls. No privacy. Your business is everyone’s business. This is so typical for the Congo that people are completely unfazed. I mean, the usual home has around 10 people living in about 300-500 square feet of space! So when I am explaining a diagnosis to someone during rounds, I often see many more attentive faces hanging on each word. They also aren’t afraid at all to chime in with their thoughts for other patients as well. More than once a spirited debate has broken out during rounds with all the members of the ward!

The one and only time Steph joined me on rounds, haha. A whole crowd of opinions!

The main drawback of this set up is with sensitive diagnoses, particularly HIV/AIDS. This is a diagnosis you will never here anyone say out loud in the hospital. Instead we use code word because there is a huge stigma surrounding HIV here. It is so bad that I have literally heard these words from a 24-year-old woman refusing an HIV test, “if I was HIV positive I would hang myself.” A 30-year-old woman I treated faced the same decision. Her husband was abusive and she had just had a miscarriage and was quite sick. She was losing consciousness so was transferred from the other hospital to ours for treatment (this happens not infrequently). She had a bad cough, was thin, and looking so ill we decided to order an HIV test. For 3 days in a row she agreed to the test during rounds but would later back out. Finally, we walked her to the test with her approval. It came back positive. Her husband promptly left and her father in law was one of the only one’s who stuck around to be here guarde de malade and to pay her bills! She came extremely close to dying, and I don’t think she could have waited another day to start the anti-HIV treatment.

One of my favourite patients I have is a 75 year old man who greets me emphatically every morning with a hoarse “Mbote Docteur!” and both hands waving! This acts to somewhat counteract the smell of incontinence emanating from his hospital bed, a hospital bed that has no shiny layer of vinyl but some sort of porous canvas to protect it from the ‘rains’. He has a chronic ulcer on his leg and has been in hospital for months, but you wouldn’t know it. His attitude in spite of all this is remarkable! He always has a smile on his face.

Some patients travel from a long distance to stay here. We were driving with a local missionary about 8km out of town and an Aka pygmy family flagged us down. Their daughter had just had a seizure from malaria!

This was the Aka village we stopped at!
The view from inside the hut. The little girl had just a seizure from cerebral malaria. The mother has her head covered because she had a severe bacterial eye infection! They are sitting on their bed (note that their bed is just wood planks with a mosquito net overtop!).


There are many more stories to tell like these so stay tuned! Let me know what you think in the comments, and I hope you enjoyed the read.

A day in the life of a doctor…in the Congo.

Impfondo, where my wife and I are working at the Pioneer Christian Hospital, is ever so slightly above the equator. This means there is consistently 12 hrs of daylight, rising and setting around 6 am/pm. They have a rainy and dry season, and currently it is the dry season. This means an average high of 33oC, and with humidity it feels more like 40oC!

So we wake up with the sun around 6am, turn on our propane stove to boil some hot water for coffee and porridge. The stove is only for us, the cooks that make us our lunch everyday use an outdoor kitchen and cook over a fire or charcoal. A sign above our stove reads, “Please conserve propane because when you run out we may not be able to get more.” We take this verrrrry seriously; no stove means no coffee! They only have instant coffee here, but being the addicts we are, we brought 3 bags of coffee for ourselves (plus one more that I surprised Steph with)! It usually gets down to around 20oC at night.

Chapel is at 7 am every morning for the staff of the hospital. It is often in French or Lingala, and our translator comes most days and helps interpret for us. There is usually a rousing song with lots of clapping and someone gets up to play the super tall drum at the front. Otherwise, it is all a capella. Next is a slow journey to the staff room, this is caused by the heat. People are rarely in a hurry to get anywhere! There we get morning report and the other doctor or I do some teaching. The room gets stiflingly hot by the end, and more than a few people have fallen asleep.


The hospital has about 30-40 staff, 60 patient beds, and is arranged as a group of 12 buildings connected by sidewalks. We walk in the hot sun to see any patients in E.R., a small building with 6 beds packed closely together. It rarely has more than 1-2 patients in it. We pass by the nursing consultation office, who sees and initiates treatment for patients without any physicians orders, usually based on protocols put in place by Dr. Harvey (the visionary, manager, chief medical officer). It is not uncommon to see a kid having a seizure, and a nurse casually walking around going through the usual treatments (cerebral malaria is very common here). They don’t usually even consult us for these cases!

Our little miracle baby! Lived in spite of a uterine rupture!

We move on next to maternity, which frequently houses very complicated or premature infants. Next is the medical wards, a small building each for men, women and pediatrics. Each have about 7 beds. They have 2 isolation rooms in each as well. As I walk in I say “ Mbote nobino!” (hello all), and almost always get quite an enthusiastic and surprised response back! The nurse tells all the family members to leave. Family is always around because they have make meals for them at the communal shelters, wash their clothes and buy their medicines. We work through each patient, and I review the chart that is a grand total of 3 pages! I think of our bloated charts back in Canada which have 50-100 pages, and at times I would wager up to 500 for the long stays. There is something to the efficiency!

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A 31 week preterm baby we are caring for. It was delivered as a twin in the middle of the jungle, the umbilical cord was cut with a machete! They love to bundle up their kids even in 30 degree heat!

The surgical wards (a building each for men, women and wound care) are much of the same. There is a lot of leprosy left in the Congo, and people that don’t seek treatment immediately end up with a lot of sores and amputations. There are always 4 or 5 patients with leprosy here. A diagnosis I would never see in Canada. If there is a visiting surgeon this ward can be more full, but still not as full as you would expect considering the need. The difficulty is with the payment. Surgeries are prohibitively expensive for most even though they are only around $100 USD.

Our rounds finished, we may have time to see some patients in clinic prior to lunch. This requires a translator because a lot of patients won’t speak or understand French well enough, and the more common language is Lingala. For clinic, there isn’t even an attempt at a daily schedule or appointments. People arrive whenever, and then wait to see a doctor in order of arrival. Their medical charts are little notebooks that they carry with them any time they need to be seen! They then place these in order of arrival in a little hanger near my door. People come in with anything and everything. I recently saw a man who had been shot a month ago in a hunting accident and had shrapnel still imbedded in his face and brain! We had two head x-rays to confirm and that was all!

Shrapnel visible on an x-ray. Unfortunately not much could be done for this gentlemen unless he flew to another country.

Lunch is served around noon, and is prepared by local Congolese women for us. They have been taught to cook foods that blend their traditional foods with food palatable for us. Compared to the average Congolese meal, we get different meat (they eat a lot of goat) and more vegetables. Some ingredients for our meals would be very costly for them, but again, very cheap for us. They do all the cooking and cleaning for this meal, which is very much appreciated because it takes them about 4 hours to do all of this! We simply wouldn’t have any time to make our own, plus, it is a means of supporting local workers.

I go back to clinic after this, and right now do not see many patients. They tell me that when a new doctor arrives, the people don’t come in as often because they don’t trust them yet! Clinical decision making is very, very difficult here. I have to ask what a person can afford and unless they are rich, only order the minimum of our basic tests. It is also quite difficult because we have a total of 32 different lab tests. I recall searching for a particular blood test in a hospital in Canada one day, and searching through hundreds of possible tests. To make it worse, we are running out of HIV tests and so they are only ordered for mothers and the very sick!

My day finishes whenever patients stop arriving or by 3:30pm, usually earlier. The heat is often thick at this point and I retreat to the house to rest and drink a whole lot of water. Any time patients come in or they need me they can call me or knock at my door (located within the hospital walls). Steph and I make supper or heat up leftovers, and then relax. We play games, read, go for a bike ride, go to the market or watch some of the movies or TV shows we downloaded before we came!

So that is a typical day for me here! These are usually interspersed with little trips to local villages as well!

We visited 5-6 local villages one day, saw 11 patients, and diagnosed a serious eye infection here!

We will be traveling to a remote hospital in the Congo!

Yes, we are frightened.

L’Hopital Evangelique le Pionnier (HELP) is located in Impfondo, The Republic of Congo, Africa.  It is a 60 bed facility that has been transformed from a Communist youth camp into a hospital, serving the neediest part of Africa in the Congo River Basin Rainforest.

“Pioneer Christian Hospital serves an estimated population of 300,000 people, including local residents, villagers, and vulnerable people groups including indigenous peoples, refugees, the poor, elderly, chronically ill, and AIDS orphans and widows.”

Personally, the medical aspect of this trip frightens me the most. Although there are many well trained staff that are there to help in any circumstance, I will still be the only physician at the hospital for around 1 month. Given a preponderance of tropical diseases in the Congo, a lot of the medicine will be new to my practice. Traveling to this area lends a high risk of acquiring a tropical disease like malaria, parasites etc, and also has a high incidence of HIV/AIDS.

I also haven’t mentioned it yet, but I have been there before! 11 years ago. At that time thoughts of medical school were but a dream! I helped as much as I could, painting a whole lot of buildings but also helping out in the operating room as first assistant because the surgeon there at the time found it useful to speak to me in English!

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Reading some xrays!
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A view of the hospital.
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Sarah Speer working with pygmy tribes.
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The hospital! (former Communist youth camp)
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Walking out after surgery! Note that there were no IV poles, do they have to be held up by hand!
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In between surgeries.

We do have some needs! We will be supporting ourselves financially, but medical supplies are always running short due to inadequate government resources.

  1. Compresses, gloves, IV tubing (not the ones used in machines), IV needles/catheters (the usual ones), sutures.
  2. They are always in need of common medications used everyday, like tylenol, advil, benadryl etc.

If you would like to help support this amazing hospital, here is the link to donate: