In addition to the hospital in the administrative area of Ococia (Uganda) we managed to successfully finish another project at the eve of the New Year: A hospital in the Democratic Republic of the Congo. It is located in the middle of South-Kivu, in the eastern part of the Congo, in an area that has experienced fights and clashes for years. Urgent medical support was necessary, especially to those living in the most affected areas close to the border with Rwanda. Therefore, in the summer of 2008 we took over the care of a 250 bed hospital in the Kamituga area, at that time in a poor structural state and with not nearly enough space to accommodate the high demand and number of patients. Additionally, no sustainable concept of covering costs of the institution was in place. Therefore our first task together with our local colleagues was to remodel the structure of all lines of work at the hospital.
Towards the financial independency
The majority of the changes were related to the administration of the hospital. Our biggest challenge therefore was to foster the financial independency of the establishment. The state has commonly no means to pay the salaries to the hospital staff. There is no health insurance, and most of the people are poor, meaning the costs have to be adequate. Within some years before our involvement, the hospital had gradually raised the prices to overcome the financial decline. As a result even less people could afford to receive any medical treatment. And the less patients arrived, the higher the costs became. Many people were left without any care at all.
Our team educated the local colleagues about the management of the hospital. Even though some persuasion was needed, after several months of work a new concept was created: the costs have been lowered to an affordable level, hence the amount of patient co-payments raised so considerably that the operating expenses of the establishment could be covered (the number of surgeries raise from 3 to 60-100 a month). The freshly opened delivery room is very well arranged, and the premises for expectant mothers are occupied at a sufficient capacity. On this basis the hospital can operate long-term also without our support.
The focus of our medical work lay within the training and further education of the staff: the Cap-Anamur team, including surgeons, paediatrics, gynaecologists, care personnel and midwives, were providing training to the local colleagues on the most effective treatment methods. The midwife Sabine Ndukwu has followed the development of the hospital for two years and supervised the handover of the project to the local colleagues: „It is of course always a bit sad, when a project is approaching its end. One should part from the friends and well accustomed colleagues. However it offers an opportunity to the local people to continue the work started together and to move on independently.“
Along with the further education of the staff, also the day-to-day operations have been restructured: at the entrance of the first building a new admission point of the patients together with an integrated consultation room, as well as an emergency room were arranged. Previously, in order to carry out primary examinations the emergency patients were brought to one of the units of the hospital. Together with competent local colleagues the pharmacy has been reorganised in a well-structured manner. Also the laboratory and the blood bank has been supplied with all the necessary equipment. Cap Anamur organised one last big medication and material supply delivery for the coming months, so that a slow transition towards self-dependency is ensured even after our departure.
„Through the collaboration of the nurses, carers, doctors, midwives and technicians from the Congo and Germany, a good medical care standard for the people in Kamituga has been achieved“, tells Sabine Ndukwu. „It was a very proficient and intense period for me, there were many obstacles to overcome, I was constantly struggling with bureaucracy, but I was also often moved and amazed by the many situations that could be dealt with quickly and easily without much effort. I have met many people, shared their uneasy fates that still move me very deeply. I would like to thank all my friends, colleagues, people in Kamituga and Bukavu and first and foremost and all the donators in Germany for the support and trust.“
Construction and renovation
We had to repair the roofs and the ceilings of all the buildings, partly rebuild, stabilise, patch and plaster the walls. The floors had to be remodelled, the windows and the doors – repaired and replaced. Over the last five and a half years we have been involved in the construction and repairs of the surgical room, the radiology, the outpatient’s department for the outpatient care, the pharmacy with laboratory and blood bank, the intensive care and maternity ward, as well as the paediatrics, former tuberculosis ward and administrative offices. For more than half of the time, supervision of the construction and repair works was carried out by the technician Michael Beirle. He was working for Cap Anamur in Kamituga for three years.
Another focus lay on arranging the sanitary facilities. „They are the foundation for good hygienic conditions,“ says Beirle, who took care of the water supply and built the showers and lavatories for the patients together with local colleagues. „We have built four complete units with septic tanks, three-chamber system and an absorbing well. In total there are currently 25 lavatories and 21 showers or washing areas on the compound. In addition, water tanks will be installed to collect and use rain water (three times 5.000 litres and two times 2.000 litres), as well as one 10.000 litre tank for the tap water to compensate water shortages.“
At the time of our arrival, the roads of the compound resembled a lunar landscape with a number of mounds and holes. It was impossible to move a wheelchair or to transport patients on a rolling bed. All the roads are now levelled and paved. The entire entrance area was also paved with natural stone, extracted from the local hills. Thus the whole hospital area remains cleaner. Previously, whenever it rained, the roads turned into muddy trails and the patients and staff dragged the mud into the wards. „In order to protect against the sun, we have planted some tree seedlings that will provide the necessary shade in the future. Additionally, the trees around the hospital serve as a good protection against the deterioration due to exposure,“ Beirle explains.