Tuesday, April 14, 2009

Panzi Hospital Caregivers

Psychosocial staff: (l. to r.) Joseph, Sarah, Roger (my translator), Ester, Lidia, Helen, Yvette, Cecile, Pascaline, Rosa (front)

During this visit to Bukavu, I am working at Panzi Hospital to help its psychosocial staff. From previous experience in DRC, I know that caregivers at Panzi suffer from both Burnout and Vicarious Trauma, because they deal with severely traumatized patients.

Women survivors wait to see caregivers.

Violent rape is considered the most difficult trauma for therapists to treat, especially for women caregivers. The patient's sense of vulnerability, as well as despair and helplessness, are often taken in by the caregiver and experienced as her own-- we call this process Vicarious Trauma.

Lidia talks with a patient.

In the US and Europe, therapists have learned that Burnout and Vicarious Trauma are inevitable consequences of treating severe trauma. Sexual, gender-based violence (SGBV), combined with loss of spouse, home and community, is considered by many to be the worst trauma in the world . . . so it is not 'if' Vicarious Trauma will happen to caregivers, but 'when'.

Dr. Victoria and Dr. Mukwege at Panzi Hospital

I met with Dr. Mukwege, Founder and Director of Panzi Hospital, who shares my concern about his staff, and agreed to present an 8-session workshop for the nine caregivers who make up the psychosocial staff at his hospital.

Panzi Hospital Psychologists: Cecile and Joseph

Two psychologists lead a team of seven Social Assistants, some nurses, all women. This small group is responsible for the psychological care of 300 patients on a daily basis. They work six days a week, with 2 days a year off for vacations. Imagine that.

Pascaline poses with women patients in front of the nurse's office.

Yet despite shouldering responsibility that is off the scale by western standards, these caregivers are holding their own, still warm and caring, all in good health. Yes, the signs of Vicarious Trauma are there, all manifesting mild-to-moderate symptomatology depending on the individual. Several are struggling with more serious symptoms of secondary trauma.

Cecile and Pascaline check patient's progress.

When I completed the training, I recommended that the Administration do two things to improve the general health and emotional well-being of the psychosocial staff: 1) encourage caregivers to take at least one weekend off per month, and 2) schedule a peer counseling group once a week where caregivers can debrief their difficult cases.


This training was a great way for me to give back what I’ve learned over the years. I was delighted that they received value and want to continue using the skills I taught them.

With love and gratitude,

Monday, April 13, 2009

What to do with an abundance of bags?

Nyassa shows Fatuma and Therese how to weave bags.

I've visited the women at Victoria Center several times a week now for a month. In that time, we've discussed a number of hot topics, such as birth control and emergency medical care (yes, they are getting both), microlending, and men. They elected two new members to their governing committee and rented the small room next door to use as a store for the children's clothes they make.

Rosette, Marceline and Silvie pose with their sewing machines at Victoria Center

All this has been made possible by contributions from generous friends and family. Thank you! I was also able to provide all 20 women with a $50 microloan-- not so much money, but enough to start a small business.

Fatuma and Alise work together sorting thread.

When I arrived, they presented me with a bag they'd woven from plastic thread, a brightly striped, handy carry-all that I've used every day since to lug all my stuff--cameras, shawl, water bottle, snacks, and writing tablet. It's come in handy.

The bag that started it all.

Thinking what great beach bags and shopping totes they would make, I told the women I would buy all the bags they could make in 10 days. Because hand-weaving these bags is a difficult, time-consuming job, I imagined they would make one or two each.

Nyassa weaves another bag (she wove six!).

Silly me! These women were on a mission! Working night and day they hand-wove a total of 75 bags! All sizes, colors, with different weaves, like a rainbow!

The women were very happy that I bought all their bags!

That says alot about how motivated they are and how hard they work when given the opportunity. I am impressed, not to mention the proud owner of 75 bags!

So the question now is, How do I get them home?

With love and gratitude,

Sunday, April 5, 2009


The Ruzzi River defines the border between DRC and Rwanda.

Last Saturday I visited Kamanyola, a sprawling country town that lies south of Bukavu on the Ruzzi River. The three-hour drive took us up and over several mountain ranges, the roads a combination of mud and boulders, then down into the rich delta farmland of Kamanyola.

Kamanyola and outlying fields.

Kamanyola lies on the west bank of the Ruzzi River, directly across the river from Rwanda. Because of its strategic location, Kamanyola has endured much conflict during the past 12 years, initially after the Rwandan genocide when the Interahamwe (Hutus) fled across the river and settled in the hills surrounding Kamanyola, then later when Tutsi forces under General Mutebishi invaded on the pretext of hunting them down. This area is rich in agricultural and mineral resources, which unfortunately makes it a target of military forces supported by the Rwandan government.

Kamanyola at dusk.

I am traveling again with Honorable David Mubalama, a Senator elected fby the Province of South Kivu, where Kamanyola is located. We are here, because it is said that atrocities against women are worse in Kamanyola than elsewhere in Congo, and they continue to occur daily. It is estimated that 60% of women in this area have been brutally gang raped, with cruelty greater than in other areas.

Dr. Amie stands in front of his hospital with patients and staff.

Our first stop is St. Norbert's, a small, general hospital supported solely by its founder and principal physician, Dr. Amie. The hospital serves the poor and is in need of many things, from medicines to an X-ray machine. So far it has been unable to attract grant money, yet it continues to survive by the will and hard work of its founder.

Women with newborns in maternity ward at St. Norbert's Hospital.

Our next stop is a women's collective with over 500 members: some survivors of sexual, gender-based violence (SGBV), others widows, and many "vulnerables", who are women with children and no means of support. Senator Mubalama is hoping I can generate microloans for these needy women.

Senator Mubalama explains that I have come from America to help Congolese women.

There are many pygmy women in this group, as they have been relocated to Kamanyola from the forest where they traditionally lived. Although they were the first indigenous people of Congo, pygmies now represent only 1% of the population and suffer from discrimination and starvation.

Pygmy women listen to the Senator.

The good news is that this women's collective makes beautiful, hand-made clay pots that are becoming popular in larger cities, such as Bukavu. They rent the meeting hall were we met, but they need a larger shop where the pots can be made and sold; their last workshop was destroyed by the rains.

Woman stands with a clay pot she made.

With love and gratitude,

Thursday, April 2, 2009

Panzi Hospital

Located in south Bukavu, Panzi Hospital provides treatment for survivors of sexual violence and surgical repair for women suffering from fistulas in the urogential tract.
The hospital was founded in 1997 by Dr. Denis Mukwege, a gynecologist who wanted to reduce infant and maternal mortality in the rural population. It now serves as a referral source for other health centers who seek expertise in repairing obstetric fistulas and the damage done to women survivors of sexual, gender-based violence (SGBV).

The hospital is quite pleasant. One-storey, brick buildings are lined with tropical plants and roses. Patients sits on low walls waiting their turn to see the doctor.

Although Panzi is a general hospital, it boasts a relatively new women’s compound, which has two wards, one each for pre-op and post-op patients, and two large surgeries dedicated to fistula repair. During my visit, three American surgeons sponsored by Harvard Medical School were in attendence at Panzi, sharing their expertise and learning more from the patient population.

Administration and doctors' offices occupy the front buildings, while the women's wings spread out toward the back, opening to a lovely grass area with a pond, eucalyptus forest, and palapas where the women gather during the day.
There is a luxuriant garden on the grounds. To the side of that lies an area where young children, too large to be carried and not old enough to attend school, spend the day playing. Beyond that is the new nursing school building, soon to be completed.

This is my second visit to Panzi. I came a year ago and toured the hospital, but everyone was inside that day and the women's area had not been completed. Now there are people everywhere, doctors and nurses in lab coats, country women wrapped in colorful cloth, small children clinging to their mothers, crippled men on crutches, and a few muzungus (white people) touring the hospital.

There are over 300 rape survivors and fistula repair patients being treated at Panzi on a daily basis.

During the day, aides provide life skills training and teach handicrafts. All the women survivors are concerned about their future: How will they survive when they leave the hospital? Where will they live? Will they be able to support their children? Many practice handicrafts, learning to knit, sew, weave baskets and rush mats, in the hopes that this will sustain them.

Up until now, my work with rape survivors has been with women several years out of hospital, who had been raped, treated and then released. Being at Panzi Hospital surrounded by so many raped and damaged women, most in pain, all ashamed and trying to make sense out of their shattered lives, is an astonishing, humbling experience.

I feel the full weight of the evil done to these innocent women. So much damage has been done for what? What could ever justify this cruelty, this suffering?

With love and gratitude,