Peace and palliative care in the DRC

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Sitting in the gardens of Hospice Africa Uganda, Dr Pili Pili relaxes under the shade of a thatched shelter. Even when relaxed, he sits with a straight back and looks sharp and alert. He holds himself in a way that suggests he is ready to meet and greet.

When asked about the on-going conflict and how it has affected health provision across the DRC though, a new side of Dr Paul Pili Pili opens up.

“The saddest story of DRC is that we are facing now 20 years of war. The war has caused many problems. The women are raped and this causes more HIV. Also, people couldn’t sleep in their own houses; in fact the entire economic network was broken….This war broke the health system, completely, nothing left.”

Paul stops for a second and looks up. One hand falls to his side and the other pinches the bridge of his nose as his eyes glance across the neatly kept garden in which he is now sat.

Recent news reports suggest Paul’s home town, Goma, has seen another upsurge in violence that threatens to break the fragile months of recent peace. Even sitting in the safety of a hospice garden in Kampala it was clear that the war still invoked strong feelings in him. He continued:

“The population has suffered too much. Most of the army comes from the country where HIV prevalence is too high. As you know, women and young girls, they….”

Again he pauses as he looks for the right words to describe a war zone that saw an estimated 48 girls and women being raped every hour. This is something that most people would struggle to do in their first language; Paul however is looking for these words in his third language, English. He continues though, saying:

“The soldiers they come and take by force and they give them HIV. Then it is bad, these same girls cannot get drugs and so they suffer a lot. They come to the hospital in very bad situations.”

Indeed, it is thought that as little as 30% of rape victims in the DRC underwent prophylactic treatment against HIV and that 34 million people are living with HIV in the DRC.

For Paul, these hard truths are much more than just statistics. Growing up in Goma, Paul knows all too well what impact war can have on a community. When he was growing up his school was used as a refugee camp in 1994 for fleeing Rwandans before full-scale civil war broke out and his home town became a base for the rebel movement.

Living in Goma at this time meant that it became harder and harder for Paul to carry on his medical studies. He needed to leave. What finally convinced Paul to leave his town though was his mother:

“My mother would [always be in] fear as they [the rebels and the government army] looked for young men. One day she said to me, ‘OK Paul, tomorrow you will travel and go to Kinshasa.’ At this time, it was impossible to take a plane; the country was divided in half with the government in Kinshasa and the rebels in Goma. So I had to find another way.”

Paul then explains how he travelled overland through Rwanda and Uganda on his way to Nairobi where he then flew to Kinshasa. Paul mentions details of the internal conflicts occurring in Uganda and Rwanda in passing as if they are small details to the DRC’s much bigger story.

When asked if he worries about his mother and his friends, who still live in Goma, he responds with open and honest concern:

“I worry about this situation with the rebels. Always wondering, why [do they] cause these problems for farmers who just want to work the fields, for people who just want to live in their houses. But people have to suffer the war every day. There is no peace.”

Despite these clear concerns, Paul remains optimistic about the future. He talks at length about the rebuilding of the country and his faith in the political leadership to bring about the stability the country so desperately needs.

With the mention of the President or “Mr Kabilia” as Paul refers to him, Paul resorts back to his official capacity and starts to talk more about the implementation of palliative care policy – something which is imperative in a country that has been so brutalised by war and ravaged by disease.

It is clear that in his official capacity, as Chief Officer of Quality Assurance in Primary Care within the Ministry of Health in the DRC, Paul is fully informed of the scale of the challenge that sits ahead of the DRC.

“The first challenge is of course money. But it is not only that, [we] also lack of information. What is palliative care? The first challenge is to give information to the health professional and policy maker and tell them about the population that face these diseases and needs palliative care to improve their lives.”

For some, these challenges might seem insurmountable. Paul though is still optimistic about the government’s ability to deliver:

“Palliative care started late in the DRC but has since moved very fast. You see, we have a health minister who is strongly involved in palliative care. We started in 2012 by showing him a holistic approach and the minister saw how important this was and that it needed to be implemented into our health system. The minister then sent six people to attend to this francophone course.”

He refers to the second ever ‘Palliative Care Francophone Initiators Course’, that Hospice Africa Uganda is hosting. The course is a chance for healthcare professionals from across francophone Africa to come together to learn about palliative care by learning but also by sharing knowledge.   

Paul is hopeful about the role regional cooperation can play in the DRC’s development of a functioning universally accessible healthcare system. Talking of the course he says:

“We have learnt from Niger, from Ivory Coast and everyone. The experience of each country is different but we face many of the same challenges.”

Almost without realising, Paul slips back into official talk about ‘roadmaps’ and ‘policy development’. All crucial but also clearly not where Paul’s passion rests. When asked though why he thinks palliative care is important, his raison d’être for being a doctor comes through:

“When I was growing up, my mother used to introduce me by saying, ‘this is my doctor’. Every day she would say: ‘When I become old, this is my son, this is my doctor who will look after me.’ This idea stuck in my mind.”

With a small smile on his face, Paul looks up and says, “DRC is a big country with a big health care problem. [The country has over] 100 million people. This is why these training courses are so important.”

Paul is fully aware of the challenges the country faces. But, despite the war, the lack of infrastructure or support, Paul remains positive about the future for the DRC and is convinced that soon, everyone will be able to access affordable palliative care and live in stability and peace.

With the interview over, Paul starts to walk away. After a few strides though he turns and as an afterthought says: “We cannot afford to get it wrong” before turning on his heel and striding off back into the buildings at Hospice Africa Uganda. 

This article was first published on the Africa edition of ehospice

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