Out of Africa

Kinshasa's general hospital has stood through revolution, civil war and civic breakdown. It is a touchstone of change in the Democratic Republic of Congo
April 22, 2006
Kinshasa's hospital
The general hospital in Kinshasa has been a touchstone of change in what is now the Democratic Republic of Congo. A colonial relic, its single-storey brick blocks, corrugated iron roofs, courtyards and covered walkways have somehow survived in the centre of town. During Belgian colonial times, the hospital was for blacks only. Then President Mobutu Sese Seko, who ruled from 1965 to 1997, renamed it after his mother, Mama Yemo. He had a bust of her erected by the entrance. But he clearly forgot his mother in later years. The hospital fell into ruin: the roofs leaked, the paint peeled, beds lost their mattresses and springs, and power and water supplies frequently failed. I will not describe what that did to the morgue in this climate.

The hospital became like a refugee village, packed with families encamped around sick relatives lying on the floor, cooking and washing on the steps outside. Some wards were so full you could see no floor at all. Like sick pilgrims at Lourdes hoping for a miracle, they waited patiently for a doctor or a nurse to do something.
In Mobutu's last years there were few miracles, but the hospital was redeemed by some dedicated staff. Unpaid for months, sometimes years, they eked out the scarce drugs and tried to keep death at bay. They treated patients on arrival but, in order to survive themselves, forcibly kept the convalescents at the hospital until the bill was paid. Some doctors, led by Jean Baptiste Sonji, formed a political cell to defy and subvert Mobutu's rule. They founded an English-speaking club called the Great Guys, which met on Sunday mornings in a school and, under the guise of practising English, discussed politics. Their day finally came in May 1997 when the rebels who had walked across Zaire (renamed DR Congo later that month) arrived at the edge of Kinshasa. Sonji played a crucial role in guiding them into the city and negotiating its peaceful surrender. He later became minister of health, but was a disaster. He also changed the name of the hospital, and the bust was removed, but it is still known as the Mama Yemo.

I recently visited the hospital again. Thanks to the World Bank, the walls have been given a lick of blue and white paint and some of the roofs repainted. Lightbulbs—a good test of an institution's functionality in Africa—are plentiful. But the flowerbeds in the courtyards are still rubbish dumps with grass growing waist-high among the broken beds, bandages and other material flung out of the wards and picked at by crows.

The most striking thing is that the place has very few patients. And those that come are very poor indeed. The crowded village has melted away. But lots of staff in new white coats hang about in groups with shiny stethoscopes around their necks.
In the emergency room, a man lies dead on a trolley, unkempt and shoeless. A very old woman lies dying on the floor with a rag over her. She looks as if she might be dying of starvation—a shocking sight in Africa where everyone talks about respect for the elderly.

"We are trying to find out if she has relatives," Kabamba Mbwebwe, head of the emergency unit, tells me. And if she hasn't? He shrugs. "If you cannot pay you do not get seen." On a bed with a drip in her arm is a well-dressed but very sick girl. Her anxious mother unpicks dreadlocks from her hair. Mbwebwe says that she has peritonitis and that they have sent for money. With luck they will be able to operate soon.

The doctor explains that the staff had a pay rise. He now gets $300 a month—it was $20 the last time I visited—and sometimes it is only two months late. He explains that the new hospital policy is to ask for payment up front—$10 for a consultation—except in emergencies. There are no drugs at the hospital so relatives have to chase around the city pharmacies to buy them. "Yes," he says, "people die here simply because they do not have money." Before I can question him further, Mbwebwe rushes off to operate. The money has arrived.

Digging deeper I find that the government has delivered only half the health budget this year and the hospital is starved of funds—hence the new policy. But the Congolese boss of an NGO tells me that the number of private hospitals in the city is soaring. Almost every doctor has shares in them, so they tell patients at the Mama Yemo that there are no drugs and then point out the private alternative. As usual, matters of social debate in the rest of the world are matters of life and death in Africa.

East African drought
From Resim in northern Kenya, the hot empty land of the Samburu stretches to the horizon: rock, thorn and mountain. But the local cattle-keeping families complain that too many people live there now. I can't see them, but they can spot a boma—grass huts and a thorn fence—five miles away. The population has indeed increased, but this land will not support any livelihood except wandering herds of cattle, camels and goats. Settled farming only works six or seven years out of ten, and climate change makes it harder. Some families have a city worker who sends money home. The amounts can keep people alive but cannot change their circumstances.

The Kenya government knew the drought was coming from early last year but did nothing. These tough nomads do not expect aid or compensation. They know how to cope with drought. Every few years they have to move their animals further to find grazing. But this year it is different. This drought is worse than anything they have known. Whole herds have died. Maybe a whole way of life is dying too.