In the Les Collines de Selembao maternity clinic (in the south of Kinshasa) midwives accompany deliveries for a relatively cheap price. Nevertheless, five mothers and their babies spent Christmas Eve in the maternity clinic, because they were unable to pay. A situation which has been all too familiar for many Congolese families in recent years.
It is three o'clock in the afternoon, and the main streets and boulevards of Kinshasa are thronging. The Congolese capital is slowly getting into a festive mood following the unrest on December 19, 2016, when the second term of the current president expired. On the road between the city centre and the Université Pédagogique de Kinshasa (UPN), people are busily making the last of their purchases. Vehicles are laden with crates of lemonade, meat, vegetables, and all sorts of food for a wonderful Christmas Eve. At the bus station near the UPN, a few kilometres before the municipality of Selembao, traffic is completely gridlocked. Cars try to weave their way between a hearse and a truck which has been loaded in spectacular fashion.
After the Badiadingi market, the worst of the traffic has gone, and things start to move smoothly again. Cécile Edungu chose this spot between a busy highway and the tranquillity of the hills around Kinshasa to build the Les Collines de Selembao maternity clinic. 'I wanted to get away from the busy city centre, because I especially wanted to help the poorest people for whom there is no space in the Congolese capital', she explains. Cécile Edungu is a trained nurse and lives in Belgium. In 2011, she set up her project in the municipality of Mont Ngafula. In 2015, she rented a house in Selembao for her project, and established a maternity clinic there. She bought the land where the current maternity clinic is based in 2015. It opened its doors to the public in April 2015. Since the opening, two hundred babies have been born here, a fact of which the founder is very proud.
They take good care of us here and the nursing staff are friendly. It's just that we don't have any money to pay the bill. Our husbands are unemployed.
Low cost childbirth
'There were five deliveries this week', explains Dr. Tony Makiadi. 'All the mothers who are currently here gave birth between 22 and 24 December.' Five mothers lay in their beds on Christmas Eve. Some of them were breastfeeding, others were talking with each other and keeping a close eye on their babies. 'We accompany births here for a relatively cheap price', the doctor emphasises. A standard delivery in the other maternity clinics costs 35 dollars. In this maternity clinic with its low rates, most of the women are not in a festive mood. 'We are happy that we could give birth here. They take good care of us here and the nursing staff are friendly. It's just that we don't have any money to pay the bill. Our husbands are unemployed', explains one of the mothers. 'I delivered on 22 December and I am still here because l can't afford to pay the maternity clinic', another young mother in the room explains. For this young mother who delivered her second child, Christmas doesn't mean anything. 'How do you expect me to be in a festive mood when I'm sitting here, with my newborn in my arms and not knowing whether I will have any sugar in my tea to stimulate lactation.' Bijou has had four children, but the child in her arms is the only one which has survived, adds Dr. Tony. 'She came here to deliver. The deliveries went reasonably well each time, but all the children died shortly after birth. They were all suffering from anaemia. We hope that this child makes it.'
'It often happens that a mother and daughter from the same family give birth here in the same week', explains Dr. Tony with a certain incredulity in his voice.
According to this doctor, who has worked together with Cécile Edungu since the beginning, much more awareness still needs to be raised in the municipality of Selembao. 'Selembao has 12 districts, and the district of Mbala, where the maternity clinic is based, is one of the largest. Unemployment is very high here. You mostly find soldiers, police officers, security agents, bricklayers, plumbers and of course drivers of "taxi-motos" here. Average income per inhabitant ranges between 20,000 and 30,000 Congolese francs (20 to 30 euros) per month.' It is difficult to convince women to follow a family planning programme. Most families have a lot of children, and women don't want to know about contraception, even though they can receive free contraceptives. 'Some women have told us they have heard that contraception has repercussions for fertility, and others say that the contraceptives we provide are carcinogenic. It therefore takes a lot of effort to propose any form of contraceptive, even though they are free.'
What makes the situation worse is that the imported products are cheaper than the local products. And that has consequences for the health of the population of Selembao.
Malnourishment: an alarm signal
'You need to plan for every eventuality here', explains Violette Batekela, who takes care of the administration for the maternity clinic. 'Sometimes, the women who come to deliver have not had anything to eat. A lot of people suffer from anaemia in this district, and that is also why we would like to have a blood bank. We would then be able to solve a lot of problems related to blood transfusions.' 'One of the women in the theatre had difficulty pushing during the delivery. She was trembling all over her body', recalls Dr. Tony. 'I was very scared. When I asked her if she had eaten anything before coming here, she said that she hadn't'. The doctor at this maternity clinic also bemoans the altered eating habits of the population. According to Dr. Tony, the population of Selembao, and other municipalities in Kinshasa, prefer to eat meat and imported products instead of locally-grown vegetables. What makes the situation worse is that the imported products are cheaper than the local products. And that has consequences for the health of the population of Selembao. In addition to anaemia, malaria is also very common, observes Dr. Tony. In every five consultations, it is often the case that three cases of malaria are diagnosed, even among pregnant women.
As soon as we have strengthened the capacities of our Congolese partner, they need to be able to take over from us.
Lax government approach
In this maternity clinic, where one doctor, four nurses and one lab assistant work, it is not only deliveries that are accompanied. Dr. Tony performs other operations such as removing ovarian cysts, carrying out appendectomies, and even caesarian sections. Nonetheless, everything is rudimentary at Collines de Selembao. From the labour room to the reception and the delivery theatre, everything functions here with a minimal amount of resources. The clinic runs on solar power. 'We currently have 9 solar panels, but only 2 of them work at full capacity, until we can find the technical resources to activate the other 7', explains Batekela, who also bemoans the lax approach of the Congolese government. 'I have been to the provincial health ministry countless times. They have promised that we will receive government support. But up until now, that hasn't happened. That would make it a lot easier for us. We keep the clinic running solely out of love for our professions', she concludes.
Wallonie-Bruxelles International provides support
Les Collines de Selembao exists thanks to the dedication of its staff, but it also receives support from Wallonie-Bruxelles International (WBI), as Austin Emeka Dengba, assistant for cooperation and economic partnership, explains. 'The Collines de Selembao project was not set up by the WBI, but by Cecile Edungu', emphasises Dengba. 'Her project fits well with our priority areas of operation, such as support for young people, women and vulnerable people. Since 2013, we have funded the project within our programme for indirect bilateral cooperation. But you must remember that this cooperation is not permanent.' 'As soon as we have strengthened the capacities of our Congolese partner, they need to be able to take over from us. If we initiate a project, the government or health administration ultimately needs to carry on with it. Of course, it cannot be the case that we subsidise a project indefinitely', he concludes.
Unfortunately, a considerable amount of projects are far from completed by the time the cooperation ends. Many projects stall, and ultimately die a quiet death. Hopefully Les Collines de Selembao will remain operational, even after the support of the donors expires.