Health For All

As elders tell it, “The Problem of Lions” a parable told around campfires in rural central Congo defined the priorities of the health service of the Baptist Community of Congo (C.B.CO) since its beginning in 1912.  Their people faced great danger when working the fields, when drawing water at the spring, even asleep in thatch houses at night.  Hungry lions roamed, maimed, and killed.  What could they do?  They sought local wisdom, and wisdom from afar.  Someone suggested if they build a health center, they could at least care for the injured.  Hopeful, they built, equipped, and hired personnel.  They rejoiced when injured villagers got treated effectively for their wounds, but they still lived in fear.  Government authorities suggested erecting a fence around the village.  Energized, they accomplished this mission with diligence, but the next day, while fetching water, lions carried away three young children.  Later, their young people returned from school in the city for vacation.  Couldn’t they arm themselves and learn to kill the lions.  Though dubious as first, they armed and trained and the elders encouraged them.  They’d killed numerous lions by the time it came to return to school.  Most of the rest of the lions fled into the hills.  The village lived at peace again.

In 1912 missionary physician, Dr. William Leslie, steamed up the Congo, Kasai, and Kwilu Rivers in central (Belgian) Congo to land at Vanga, a site in a rural, but heavily populated region.  Garnering agreement and land from the chief and village elders, he established a mission center: a church, a school, and a hospital.  Thus began the medical work of the Baptist Community of Congo (C.B.CO). In 1926, missionary physician Dr. A.C. Osterholm joined him, constructing a basic hospital with 100 beds.  Dr. Osterholm, later joined by Paul Musiti, a Congolese graduate nurse, offered the only medical and surgical services in this vast area.  As the quality of care gained the confidence of the population, patients walked great distances to reach Vanga.

In 1960, as Congo gained independence from the Belgian colonial regime, political unrest broke out and foreigners, including missionaries, evacuated the country.  Then, in 1961, missionary physician Dr. Daniel Fountain and his nurse wife Miriam arrived at Vanga, to be welcomed by Paul Musiti and a few auxiliary nurses, as they’d kept the hospital open, and persevered in offering medical care to the population after the departure of Dr. Osterholm.  When he arrived, Dr. Fountain was the only doctor within 2500 square meters, serving a quarter of a million people in 330 villages, divided by 4 distinct languages, subsisting on shifting agricultural practices, and a high burden of undernutrition and preventable diseases, especially among women and children.

The Fountains quickly perceived that “health for all” required developing a health service that went beyond treating sick people and building fences, to “killing lions”.  Key priorities to effective health care for all - geographically, economically, and culturally - required a wholistic approach, involving communities, combining world views and cultural wisdom, and training health care professionals.

Under the Musiti/Fountain leadership, the Vanga Evangelical Hospital (HEV) became the foundation of the CBCO health services.  Church leadership and Congo’s ministry of health gave approval to open a nursing school at Vanga in 1962, the only one in the then Bandundu Province.  Training in primary care and community health, the first class of 20 mid-level practitioners, polished their skills on the hospital wards and in village communities during regular visits to learn about the “lions” the population feared and the weapons needed to overcome them: febrile illnesses, diarrhea, cough; dirty drinking water sources, food insecurity, maternal mortality, superstition and sorcery.  The first graduates worked in health centers built mostly of local materials by the population in collaboration with hospital, church, and local authorities in strategically chosen larger villages in the Vanga catchment area.  They provided primary care services, vaccinations, prenatal care and partnered with the community to protect water sources, improve sanitation, tackle malnutrition.  Missionary nurses and doctors joined the Vanga team through the 1960’s and 1970’s, and the hospital grew to a 450 bed rural tertiary care hospital, while providing regular oversight to the work done by community based primary care nurses in a growing network of rural health centers.

Additionally, funds and missionary doctors mostly from Baptist churches in the US built a small network 50 – 150 bed hospital on other Baptist mission stations in western DRCongo (now Kwilu, Kwango, and Central Congo provinces).  Under the umbrella of C.B.CO, these hospitals provided curative medical/surgical services to the rural and poor population, while also working in conjunction with church, community, and political authorities to develop and staff rural health centers – often the only health services available to the populations they served.  As possible, Dr. Fountain visited to these distant hospitals, and some larger health centers, to consult patients triaged for complex problems and to do surgery.

In those post-independence years, in addition to hospitals established by the colonial regime mostly in the major cities of that time, these faith-based hospitals and health centers, protestant and catholic, provided access to health care for a significant percentage of Congo’s rural populations.  As Congo’s Ministry of Health developed a national health care policy, the impact and importance of the partnership and investments faith-based health services was eventually officially recognized in partnership agreements signed between the Ministry of Health and faith-based health services (catholic, protestant, Kimbanquist, Salvation Army), and have been instrumental through the years to the CBCO health services in facilitating legally recognized and (mostly) harmonious working relationships.

In 1978, unofficially, and almost by accident, the family medicine medical residency program started at the Vanga Evangelical Hospital.  The 1970’s saw a growing number of medical schools, government and private, in DRCongo.  On a visit to the CBCO hospital in Moanza served by a nurse with additional training at Vanga in basic surgical skills because there was no doctor, Dr. Fountain met Dr. Makwanga, fresh out of medical school, unknown to C.B.CO or to Moanza, recently assigned by the Ministry of Health.  Eager to begin his career, but with little practical training and no guidance on what he was to do, he wanted to leave.  Dr. Fountain, after discussion with Dr. Makwanga and church leaders, invited young Dr. Makwanga to Vanga for two years to perfect his skills.  This scenario repeated itself at the hospital at the CBCO mission in Boko (Kwango province).  Dr. Kwata, equally unequipped, was assigned by the Ministry of Health, to work there.  A “family medicine residency program” was born as Dr. Fountain and the other missionary staff doctors, focused on practical training for these young Congolese physicians.  Other protestant mission hospitals became aware of this need Congolese physicians began being assigned to these hospitals.  Catalyzed by Dr. Fountain, the Church of Christ of Congo, legal umbrella organization of protestant health services, organized consultations out of which a curriculum of medical/surgical practice for a two-year residency training program developed.  Dr’s Makwanga, Kwata went on to serve brilliant careers providing excellent medical/surgical care in CBCO mission hospitals.  This residency subsequently evolved into a four-year program, with oversight by faculty of medical school of the Protestant University of Congo

The Vanga Evangelical Hospital remains the primary teaching hospital of the CBCO health care services, which has grown from its beginnings of six faith based hospitals directed by missionary physicians and surrounding health centers on church properties in rural villages, to a network of 14 hospitals and surrounding health centers.  These hospitals are located in the Kwilu, Kwango, Kinshasa and Central Congo provinces: Vanga, Sala, Kikwit 3, Mulolo, Kipata Katika, Moanza, Kikongo, Bandunduville, Boko, Kintambo (Kinshasa), Sona Bata, Nselo, Nsona Mpangu, Kimpese.  In this network of the 14 hospitals in CBCO, six are directed by graduates of this residency program, and with the staff of the hospital they direct, are key actors in extending access to quality health care services in Congo, especially in rural areas where people still have very little access to care.

The role of the coordination team of this hospital network, a Congolese physician, a Congolese administrator, and a missionary physician assistant, is to accompany these institutions and their leadership in facing the numerous challenges of providing quality, holistic, care to an impoverished rural population, on a fee for service basis, against a back drop of subsistence agriculture, minimal infrastructure in terms of roads and transportation, poor governance, poor education, intense corruption and a gross national product is $1 USD/day.  For individual institutions, the greatest challenges include retention of quality health care providers, maintaining and expanding infrastructure, meeting needs for equipment, water, and electrical power, and nurturing harmonious partnerships with the communities whose lions include fear, poverty, and a predominating animistic world view.