Voice from the field In South Kivu, in the eastern part of Democratic Republic of Congo (DRC), Médecins Sans Frontières (MSF) runs a hospital in the town of Baraka, along with three health centres. These facilities provide primary and specialized services, including nutrition, testing and treatment of HIV/AIDS and tuberculosis (TB), and reproductive health. In the spring of 2011, nurse Alice Echumbe was appointed to open and run an MSF family health centre called the Jamaa Letu. Here Echumbe talks about reaching out to women and traditional healers to explain the critical care the centre offers, including help for pregnant women as well as confidential support for survivors of sexual violence. I am the supervisor of the Jamaa Letu centre, which in Swahili means, ‘Our family.’ MSF opened this centre in May 2011 to offer additional community services, especially to pregnant women who need to be close to the hospital just before birth to avoid a long travel from their villages. The centre also welcomes patients who want a more private and confidential setting for their consultations in family planning, voluntary HIV/AIDS testing (especially for pregnant women), treatment of sexually transmitted diseases and treatment for survivors of sexual violence. These survivors are not only women, but men and even children, some of them less than five years old.

DRC © Claudia Blume/MSF
Supervisor and nurse Alice Echumbe, stands in front of the Jamaa Letu centre for family health in Baraka, South Kivu, DRC in November 2011.

I am a nurse by training and have worked for MSF since 2009, previously at MSF’s Baraka Hospital.  I have done outreach work with mobile health teams, travelling to remote villages to raise awareness about health issues such as cholera, malnutrition and TB. What our teams notice in the villages is that people often go to traditional healers when they are sick, for example if a child has malaria, one of the most common illnesses. But traditional medicine can sometimes lead to serious complications and with patients at risk of dying especially if they cannot get to a hospital in time. So we explain to the community and to traditional healers to recognize when it is necessary to seek help and send their patients to a health centre. We also try to convince pregnant women to go to the rural health centre or a hospital to give birth because those places have a skilled birth attendant, equipment and drugs. Another part of MSF’s outreach work is to organize consultations and treatment for survivors of sexual violence. At our mobile clinics, we often meet rape victims. The worst case was when we did a mobile clinic in June and there were more than 100 victims of sexual violence. Rapes often happen when people walk from their village to the market, or when they are on their way back. Armed men stop the villagers and separate them into groups – men, women, young girls. They steal their belongings and divide the women and girls between them “I like this one, you can have that one,” they often say.  Even the men and boys sometimes get raped. When we hear about acts of sexual violence we contact the community and let them know how important it is to get medical and psychosocial help. We tell them we offer the morning-after-pill, for example, treatment of sexually transmitted diseases, vaccination against hepatitis and referrals to counselling services. Many survivors come to the rural health centres to seek medical treatment and psychosocial support. Husbands in the Congo often leave their wives when they hear that they have been raped. For this reason, survivors of sexual violence are reluctant to reach out for help. To avoid stigmatization, women can go to an MSF-supported rural health clinic or hospital where they can talk to staff behind closed doors, without other people knowing why they have come. This is one of the reasons why MSF set up the Jamaa Letu centre, which offers more privacy for patients, away from the main hospital in Baraka. I cannot be too emotional when I talk to patients who have been raped, because when I am discouraged, they become discouraged too. But after I come back from a mobile clinic, at night, the stories I have heard during the day come back to haunt me. Sometimes I am scared, especially when I am travelling, but I try to remain strong. And when I arrive somewhere I simply get down to work. MSF has in the past sent psychologists from its office to support my colleagues and myself, and that has really helped me a lot. MSF field coordinator Ferry Schippers writes from the mountains of the Hauts Plateaux in the Congo. Read his blog here .