In the Democratic Republic of the Congo, a nation the size of France, the hospital in Goma is a beacon of medical excellence. Unlike most other Congo hospitals, it has an X-ray machine, anesthesia for surgery and drugs that haven’t yet expired. And yet Goma is chronically understaffed. Its one qualified pediatrician had not been there for six days. Even though Juma’s nurse, Alphonse Ndagije, had had to cut his training short “due to a lack of money,” he had no trouble getting a job there anyway. (His salary consists of breakfast, lunch and dinner in the hospital canteen.) The country’s medical system is unable to provide more than one qualified doctor per 120,000 people. “State structures exist only in name,” says James Bot, a humanitarian-affairs officer at Medecins sans Frontieres-Holland who recently conducted a study of health care in eastern Congo. “Surgery without anesthesia by unqualified people is very common, as is people with basic first-aid training making diagnoses.”
For most Congolese, the quality of health care is not uppermost in their minds. Three years of civil conflict have driven as many as 10 million into the bush, miles away from any medical facility. As a result, 3 million people die each year out of a population of 52 million, according to the International Relief Committee. One in two infants dies before its first birthday, the humanitarian agency says. In some provinces, three out of four children never reach the age of 2. “They die for no reason,” says Colleen Cowhick, who runs an MSF-Holland feeding center near Goma. “And it’s not just the children. It’s everybody, because there is nothing.”
