By Christie R. House*
Traveling to any of the three United Methodist clinics in the northern Kasai region of the Central Congo Episcopal Area that are part of the Abundant Health Initiative can be challenging. The lack of main roads into the area means international Methodist visitors fly into Kinshasa, the capital city of the Democratic Republic of the Congo. A regional flight can get them as far as Kananga. Then, they rely on the Central Congo missionary pilot, Jacques Umembudi, to take them farther. Diengenga, the largest of the clinics, is not on a Google map, but Captain Umembudi knows the way.
On the ground, Denise Mondji rides on the back of a motorbike, shuttling between the clinics as she oversees the progress of the Central Congo’s Maternal, Newborn and Child Health (MNCH) program. These days, she focuses on the very young, whose lives may end prematurely from severe malnutrition before they’ve even had a chance at life.
The population served by these three clinics – Diengenga, Dingele and Ongodu – is experiencing severe stress. Hunger in the DRC is increasing at an alarming rate. The World Food Programme reports that severe food insecurity afflicts 7.7 million in the DRC, which is an increase of 30 percent in the past year. Almost half of the severely food insecure people (3.2 million) live in the Kasai region. Humanitarian needs in the DRC doubled from 2017 to 2018. (https://www1.wfp.org/countries/democratic-republic-congo)
Global Ministries, through its Global Health unit, has partnered with the United Methodist Health Board of the Central Congo Episcopal Area to address the challenges faced by the clinics. In addition to addressing the deep effects of malnutrition, the board addresses facility rehabilitation and new construction; health infrastructure – such as sanitation, clean water and renewable energy sources – and sustainable ways of raising nutritional food in their communities. Diengenga and Dingele are now in the second phase of a Mother and Child Health Initiative made possible by a Global Ministries’ Global Health grant, and Ongodu has also started its journey to do a better job of meeting the needs of its catchment area.
The DRC has suffered through long-running civil conflicts. In the Kasai region, 1.7 million people fled their homes last year as fighting spilled over from conflicts in the eastern provinces, bringing the total number of internally displaced persons in the country to 4.5 million. Today, the DRC hosts more displaced people than any other African country. Displaced families have scarce resources to grow food, while their home fields remain uncultivated.
The Central Congo Health Board, which oversees 39 health facilities in the episcopal area, has partnered with Global Health to address challenges in each of the three clinics in the Diengenga area. Kathy Griffith, Global Health’s MNCH program manager, visited the area a few years ago. The roof had blown off the facility at Diengenga, water had to be transported in, electricity was unreliable, and the latrines were in an unhealthy state, shared by men and women. In Phase 1 of this multiyear grant, Diengenga received a new MNCH building, separated from the primary care facility. “When mothers and newborns are with general patients needing primary health care, their exposure is increased, and their privacy is reduced,” Griffith said.
Dingele is also building a separate MNCH facility and a Waiting Mothers’ Home. When the latter is finished, women from more remote villages can come to stay close to their due date, rather than traveling the difficult terrain while in labor.
Clean water is a major factor in preventing diarrhea and, therefore, malnutrition in young children. Today, Dingele has a deep well as part of the initiative. “The clinic has what it needs onsite and community members are also coming for clean water,” noted Griffith. “This is good to see.”
At Diengenga, the workers couldn’t locate a clear drilling path through the rock, but they didn’t give up. After four attempts, Diengenga also has a deep well. Both Dingele and Diengenga constructed new toilet facilities and hand-washing stations, another part of preventing malnutrition. All three clinics needed reliable electricity, which is not a given in remote areas, so Diengenga and Dingele installed solar panels in the first phase, and Ongodu is installing them in Phase 2 of the plan.
As the health board works on strengthening the capabilities of the clinics, step by step, Denise Mondji, as the program officer, concentrates on the people. She works with Community Health Workers (CHWs), medical personnel and patients to find, refer and treat babies and young children at risk from malnutrition.
‘On the ground’ means in the community
Mondji, known as “Madame Denise,” is a nurse and midwife with a master’s degree in public health and environmental science. She moved from Kinshasa to be close to her work in Diengenga, where she supervises services at MNCH project sites and in their catchment communities. She’s also a gardener. Madame Denise has worked with health workers to plant demonstration gardens on the grounds of the three clinics. This helps mothers and other patients understand that producing more nutritional foods for their families is within their reach. Harvests from the clinic gardens help to supplement the diets of the patients.
Many of the CHWs with whom Madame Denise interacts are United Methodists. They are not just “on the ground”; they also are in their village communities. Each connects with about 20 families in their vicinity – families they get to know and monitor for health needs, especially the needs of pregnant women and young children. Madame Denise went to the three catchment areas for these facilities to teach the health workers how to measure mid-upper arm circumference, a simple method recommended by the World Health Organization for diagnosing the severity of malnutrition in children. While visiting families, CHWs find children who show signs of malnutrition and refer them with their mothers to the MNCH facilities for treatment.
Mothers receive information about health, nutrition, the need for clean water and how the early treatment of the illness can prevent more serious malnutrition. The project protects children, in part, by empowering their mothers. Vaccinations are a priority because diseases like measles can wipe out a village’s children, especially if they are weak from malnutrition. Some of the underlying factors of malnutrition are easy to treat if people know what to do. Mild or moderate cases can be addressed before they become severe, keeping babies out of danger.
Children with severe malnutrition should stay in the clinics for 24-hour care, but only Diengenga is big enough for overnight inpatient care. While the DRC government would prefer that such cases are handled in larger inpatient wards, the area lacks larger accessible government facilities.
In Dingele and Ongodu, children diagnosed with malnutrition cannot stay overnight, so family members return with them every day. They are fed a porridge – a mixture of well-milled corn and soybeans, sugar, peanut butter and palm oil – ingredients available locally. Children are treated, monitored and sent home with food supplies. The CHWs follow up with the families.
CHWs come together to meet with Madame Denise in each facility once a month. They bring with them statistics and stories of the families they monitor. A dozen or so health workers collectively see hundreds of individuals throughout their communities.
CHWs, aware of new pregnancies in their communities, also refer mothers for regular prenatal care. Pregnant women receive information on subjects like nutrition, clean water, vaccinations and sanitation. With regular checkups, other conditions can be identified for treatment, such as HIV. Today, it is possible to prevent the transmission of the virus from mother to child if the condition is discovered early in pregnancy and treatment is available.
The clinics and health workers help families to understand the importance of bringing their newborns for well-baby checkups. Since the program implementation, the clinics have more than doubled the number of mothers coming in for prenatal care, deliveries in the facilities, and successful treatments for malnutrition. Baby by baby, more children are reached, more mothers are trained, and more families benefit from increasing their access to nutritional food, clean water and health care.
Unfortunately, the number of children who need the program has increased. The health board reports that last year’s crops in Dingele were partially destroyed by bad weather. Households struggled with how much to consume and how much to save to plant next year. In Ongodu, a cholera crisis left many children weak, increasing the cases of malnutrition.
Yet, the careful, step-by step phased improvements and lessons of the clinic projects may help in other areas. Madame Denise says the work with CHWs “has allowed us to be closer to the beneficiaries and to know their challenges. We also learned that with local foods and the resources we have, we can fight malnutrition.”
*Christie R. House is a senior editor and writer with Global Ministries.