Sunday, August 29, 2010

A Little Realism

          Around 2 a.m. the next morning, while Dusan and I are talking about poverty and prostitution in one of the night-clubs, three UN soldiers are killed.  They are killed in the same region we just drove through, where the Mai-Mai boys were trying to be big men.  Dusan is supposed to make the same drive back North to Beni the next day, but when I go out for dinner I see him sitting in the restaurant, once again.
    -What happened?  I ask.  You are supposed to be on your way up to Beni.
    -The road is too dangerous now.  It was not very good that we drove it yesterday, either.  There is more insecurity and Mai-Mai and locals are getting angry with MONUSCO for not doing more to protect people.  They are demonstrating and may continue to do so.
          He looks really tired.  He's hunched over and paying more attention to the words on his IPhone than what he's saying to me.  And he's not smoking.
    -Are you still going to make your flight to Croatia?
    -Yes, yes, not any problem.  I am catching flight early tomorrow to Beni.
    -Okay, that's good.
          He pulls a cigarette out of the box in his pocket, I relax.  Everything is okay.
          Dusan leaves the next day, as planned, and I am left to figure out Goma and Bukavu on my own.  Goma is a city of lava rocks, Swahili and Non-Governmental Organizations.  It is teeming with Internationals.  The New York Times is here, Ben Affleck's Eastern Congo Initiative, HEAL Africa, Catholic Relief Services, UNICEF, UNHCR, Save the Children, World Health Organization, Merlin, TEARFund, War Child, Handicap International, Finn Church Aide, and the list goes on.  Ashley Judd is even here for something called PSI.  I hear she wears a lot of make-up and still looks exhausted.
          I have brief meetings with various people involved in each organization.  It's relatively easy to network, since most Non-Profit workers are glued to their computers in the coffee shop of my hotel from 9-5.  It's not a bad office; there is sunlight, tropical flowers, and birds chattering in the background throughout the day.  Everyone seems to be doing the same things, working on grants, sending statistic reports, preparing presentations, all within the general topics of water supply, IDPs , rape victims, etc.  It's hard to get details, but they seem to be doing, more or less, the same things COPERMA and I are trying to do, except everyone here has funding.
          While sitting in the hotel coffee shop, a surprisingly Westernized little place, I overhear one of the Eastern Congo Initiative employees talking to a Graduate student about the motherhood mortality rates in Congo.  The Graduate student pulls out her computer and flashes through a power point presentation on the subject, searching for statistics.
    -1,000/100,000 women die during childbirth each year in all of Congo, but it almost doubles to 1,879/100,000 per year  in North Kivu alone, says the student emphatically. She moves her entire body as she speaks.
          The girls are talking about a new Eastern Congo Initiative project called Save Motherhood, or something along those lines.  When I speak briefly with the ECI employee, I ask her what the main focuses are down here, what the primary problems are and what the permeating NGOs are trying to accomplish and how.
          She reiterates the conversation I overheard, that the most devastating problem is a lack of access to medical treatment during pregnancy and childbirth.  It's not a problem like sexual violence, that only affects some women, but a problem that affects every woman here, because every woman here becomes a mother if she lives long enough.  Fistulas are typically reported in the Western world as caused by violent rape, yet they are more commonly caused by complications during childbirth.
          An obstetric fistula is a hole in the vaginal wall.  After days of obstructed labor with no medical intervention, a baby will die in the birth canal.  The pressure of the baby's head against the soft tissues of the vaginal wall, with the pelvic bones on the other side, causes a lack of blood flow which leads to tissue death.  This results in the opening of a hole between the vagina and rectum (rectovaginal fistula) and/or the vagina and bladder (vesicovaginal fistula).  The connections between these structures lead to chronic incontinence, which can lead to other medical problems such as recurring infection, kidney disease and death.  Fistula can also cause extreme social consequences.  A woman may be rejected by her husband and society, as a result of chronically leaking fecal matter and/or urine.
          Traumatic fistula has the same consequences, but it is caused by violent trauma to the vaginal wall, such as multiple rapes by more than one individual, or rape committed with the use of foreign objects.  Traumatic fistula happens more commonly in Congo than anywhere else in the world, but does not occur nearly as often as obstetric fistula.  A woman from UNICEF tells me that traumatic fistula accounts for only about three percent of all fistulas in North and South Kivu.
          Many of the International organizations are focusing on the horrifyingly high maternal death rate.  When I explain the problem I have generally chosen to focus on, since there are so many here to care about, the girl from ECI scoffs at the words sexual violence.
    -That's going to dry up in three years, she says, with a bit of hostility in her voice.
          I know she means funding, sensationalism, media attention.  When the fad passes through and the Western world moves on to the next horror story, the NGOs will shrivel up and die, but the problems will remain.
    -Motherhood is a much more dire crisis, she says, with a strong patronizing ring to her words.
          I understand where she's coming from, but I don't appreciate her demeaning the survivors of sexual violence, because they permeate North Kivu even more than Internationals permeate Goma.  Everyone here has had to choose a focus, two if they have strong funding; nobody can choose everything.  If you can't feed a hundred people, then just feed one, as Mother Theresa said.
          I say, you can't compare suffering.  It all has meaning, it all has weight.  The hierarchy is necessary, so create yours but respect the structure that others choose.  It's all arbitrarily based, anyway.
          The other meetings I have are similar.  Different focuses, different thoughts, same professionalism and strange hostility.  Almost everyone seems tired and closed off.  One of my meetings, however is with a woman working for HEAL Africa named Ann, and she is refreshingly friendly.  HEAL Africa is a Congolese based organization run by a man named Dr. Luisi.  I meet with Ann at Dr. Luisi's house, where he rents rooms to many people who work for the organization.  It is a sprawling estate, perched on Lake Kivu.  There are beautiful gardens that end abruptly in the lake.  I feel like I'm standing on a cliff, and I want to jump off.
    -I used to swim in the water, says Ann, watching me stare at the Lake.  But a lot of people started getting schistosomiasis and gerhardia.
          I decide to stay on the cliff.  I ask her about what HEAL Africa does and how they do it.  She responds with kindness and patience.  I relax and let my hackles come down.
    -Dr. Luisi is really wonderful, she says.  He is married to a woman from England, but he is Congolese.  There is a HEAL Africa hospital here but we also have projects in the rural areas.  The hospital treats all patients, but its primary focus is on fistula repair.
          She explains that HEAL Africa hospital is the center of the organization, but their efforts are expanding to include Gender Based Violence, development and support for survivors of sexual violence, community education to prevent sexual violence, and more.  It sounds to me like a wonderful organization, and Ann's openness and the lack of bitterness in her voice makes me like the organization even more.  I've seen their vans driving around in Lubero, but I explain to Ann that I haven't actually seen them do anything tangible.  She's a bit surprised at this, but not very.  Lubero has only recently come out of a very violent conflict, and in Congo it takes a long time to get anything to grow again after soldiers have burned the land.
          Before I left Musienene, I told Frere Maurice that I wasn't going to speak about Jesus once during my vacation.  And yet, my conversation with Catholic Relief Services turns out to be one of the most engaging.
          Janine has been in Congo for only two months, but she has been working with CRS for much longer.  I explain my situation, she explains the projects they are working on.  The projects involve a spectrum from helping people gain access to clean water to educating people in rural areas about HIV/AIDS.  They have many projects, mainly because they have a lot of funding.
    -The thing about working for the Catholic Church, she says, is that we have an opportunity to do more than all of these organizations.  And you'll see that as soon as the money in Goma leaves, the funding for aid, these organizations will all be gone in a day.  But Catholic Relief Services has been here since the 1960s, and when governmental funding dries up, we will still be here.
    -You're kind of like your own International governement, I say, and we both chuckle.
    -Not exactly, we won't still be here just because of funding.  We'll be here because we don't follow money, we follow the need.  But it is good to have support in order to help in the long-term.
          Janine and I are sitting in a small cantine drinking Coca-Colas.  Goma is much more humid than what I'm used to in the mountains; the shade of the cantine is more refreshing than the soda.
    -I'm curious what you think about a dilemma I've been having, I say.  But I don't want to be offensive or disrespectful in anyway.
          She stays relaxed and waits for me to continue.  She's been working in a religious-political atmosphere for a while, so she doesn't seem worried about what I might say.
    -I was raised a Catholic, I continue, but no longer consider myself to be of the Catholic faith.
          I need to preface my question so she understand the foundation it grows from.
    -In the rural areas, there are many girls and women who have been raped.  With COPERMA, we are trying to train accompanateurs--sort of like basic counselors--in order to give people who feel the need, someone to speak to who will support them and also maintain confidentiality.
          She's nodding encouragingly.
    -One consideration, was training the priests to be "listeners," because they are already involved in the communities, and can almost definitely be counted on for confidentiality.  My problem is, that many of these girls who have been raped, were able to take the morning after pill, which is against Church policy.  I'm worried that if a girl speaks to a Priest about her experience, he will tell her that she has sinned, which might increase her feelings of self-guilt and in general can compound the negative emotional consequences of an already horrifying experience.  Additionally, many of the girls are living in extreme poverty and they will sometimes resort to prostitution.  I don't think this is a good thing for them to be doing, but I think it's a problem that is inevitable in the face of such extreme poverty.  Thus, if we can't stop them from doing it at this point, we need to help them.  So, again, I don't want these girls talking to Priests who will tell them that condoms and contraception are also a sin.  The girls will still prostitute because they need to feed themselves and their children, but without condoms they could get a host of infections including HIV/AIDS, and they will definitely get pregnant again, which will simply make their living situation even worse.  If they live through it.
            I take a breath.
    -I'm curious about your opinion on that.
          She doesn't seem offended at all and jumps right in with a response.
    -It's definitely a difficult situation, she says.  My personal views aside, Catholic Relief Services is a Catholic organization, so we must follow Catholic law, that being Vatican law.  The Vatican does not condone use of condoms or contraception, so neither do we.  The morning after pill is considered abortion, so obviously that is also not something supported by the Church.
    -I don't know what your personal views are, but that would really frustrate me.  Considering, of course, my own views.
    -Well, look at it this way, she says leaning forward on the bench and resting her elbows on the table.  We have an opportunity to help people in so many different ways.  There are children who are dying of malnutrition, there is an extreme lack of clean water supply, there are people dying from treatable diseases.  In all of these areas, there is a drastic need, and there is a lot we can do to help.  There are organizations here that are not connected to any Church, that focus specifically on Gender Based Violence and Sexuality, for example.  So when we come across a situation that falls within those boundaries, we can call in other organizations and ask them to help in whatever way they see fit, with the expertise of their specialization.  We simply do not involve ourselves.  We don't even touch it.
          I like this perspective, something about it is calming.
    -It's kind of like the environmental organizations here, I say.  They don't help victims of violence or help internally displaced persons or refugees, because their specialty is in environmental protection, not sexual violence, etcetera.
    -Yeah, she says.  It's kind of like that.  We can't hand out condoms, and we can't tell people it's okay to take the morning after pill.  But we can still educate people on the effects of HIV/AIDS, or help them gain access to water pumps; things like that are also extremely important.
          She is, in a way, throwing my own thoughts about respecting the chosen hierarchies of others, right back in my face.
    -So, in terms of utilizing Priests as "listeners," what do you think?
    -I think you're right in believing it might not be the best idea.  Not only might it change the medical treatment or recovery of a survivor, but it would also be a conflict of interest for a Priest, in some ways.  It's a complicated situation, especially here, and it changes in every parish, every Catholic group, even every Bishop.
    -I know the Bishop here has said that it is okay to use condoms, even though that's not following with Vatican law, I interrupt.
    -Exactly.  He has also given his support to the morning after pill in instances of rape.  And in a sense he is taking a risk, because the Vatican can say that he is stepping too far outside of the bounds of our religious law, but he is also doing what he believes is the right thing to do considering the circumstances.
    -Interesting.  Do you go by what the Bishop says or what the Vatican says?
    -Vatican law is Catholic law, and we are a Catholic organization.  No matter what the Bishop says, he is making a personal choice within his region.  CRS is an arm of the entire Catholic Church, not just the Catholic Church in Congo.
          I didn't know that about the Bishop supporting the morning after pill, considered abortion from a Catholic perspective.  I'm starting to like this Bishop.  I heard that he was friends with the Chief of Lubero.  The Chief of Lubero happily accepted a bribe from the man who raped Kahambu, and let him off scott-free; I immediately jumped to conclusions and put the Bishop in my Cruel & Corrupt category.  I am hearing more and more, however, that he is a very good man.  Even Dusan thinks he's the tops.  I can even see the purpose of his relationship with the Lubero Chief.  After all, I make nice with soldiers almost every day.  I'm coming to terms with accepting the bad with the good.  Maybe it's letting go of idealism, or maybe it's just finding realism within it.  The most effective way of slowing down a train, is probably by getting the conductor to do it himself.  Even if speaking to him makes your stomach turn.
          Janine's lunch hour is up, so I thank her for her time and we head our separate ways.  I hope on a motor taxi and drive across the asphalt and lava rocks back to my hotel.  The Internationals are still stuck to their computers, and I join right in.  There was a mass rape in a village called Luvungi a few days ago.  I read articles about the tragedy as I eaves-drop on the New York Times reporter conducting his round-about interviews two tables down.


  1. What a complicated situation for the CRS lady (and you). Interesting stance she is taking though it seems hypocritical to abide by Vatican law only when you are facing a certain direction. But like you said; at some point you have to choose a focus. Reality steps in and Idealists suffer.

  2. Amy - I'm not sure if the Bishops of DRC have made an official statement on the use of the morning after pill in the case of rape. Most people do not realize this, but the United States Conference of Catholic Bishops actually ALLOWS the use of the morning after pill in the case of rape, as long as conception has not occurred. See paragraph 36 of Ethical Directives on Health Care:

    Blessings on the good work you are doing!

  3. Amy, I just began following your blog after I saw Nick Kristof's announcement of it. I work for a humanitarian organization that provides contraception and postabortion care to IDPs in South Kivu, so I am reading with great interest. I am also a writer/journalist. In this regard, I want to thank you for your honesty and your candid thoughts about how we prioritize suffering. As we travel around the world -- and through developing countries -- this is sure to touch each of our sensitivities.