A DREAM delegation has visited Democratic Republic of Congo to check up on the progress of works at Mbandaka centre – scheduled to be opened shortly – as well as to sound out the possibility of expanding the presence of the programme to other areas of the country, especially in Kinshasa, the capital.
Unfortunately, up until mid-2004, Democratic Republic of Congo was the theatre of notorious armed conflict waged on a massive scale, which gradually saw the involvement of a large number of neighbouring countries.
The conflict was so long and complex that it earned the title, somewhat inappropriately, of “the first African world war”.
This conflict and the guerrilla warfare accompanying it, which dragged on until only a short while ago, coupled with a fairly unstable political situation, make it difficult to define the epidemiological situation in the country as regards HIV infection.
At the moment, there are no operational “sentry posts” for testing that are linked to international monitoring of the epidemic, and most of the data available about AIDS in Congo is based on HIV prevalence and mortality trends found in neighbouring countries.
This is really not adequate when one considers the enormity of the sprawling territory that is Democratic Republic of Congo, a country nearly as large as all of Western Europe.
UNAIDS data currently fixes the HIV prevalance rate for the adult population of DRC at around 3.2%. But there is a significant margin of error.
A number of factors need to be taken into account: for years the Congolese territory was traveled by military troops, rebels and displaced people; many women were sexually assaulted; the overall condition of the population is one of poverty; much of the social fabric has disintegrated to a worrying extent.
In reality, there are many signs that the AIDS epidemic is advancing in Democratic Republic of Congo.
The Congolese province of Equator (in the northeast of the country) is one of the areas where these signs appear most strongly.
It is an immense province, half the size of Germany, with rain forest and the Congo River offering symmetry and an undoubtedly fascinating landscape, consuming in its beauty.
However, due to the incredible difficulties imposed by the forest and the current lack of means of river transport – rendered unusable as a consequence of the war or due to lack of maintenance – the entire area is very hard to reach, and is practically isolated.
For all that, Mbandaka, the provincial capital, which overlooks the Congo River, situated exactly on the Equator (its name under Belgian colonial domination was Equateurville), is home to around 700,000 residents.
Once upon a time, the city was equipped with an important river port. But this has fallen into disuse, even if the river is often the only link between the city and Kinshasa, which is hundreds of kilometers further south, the only link with all that may reach the outside world.
In both the province and Mbandaka itself, one is immediately aware of the burden of isolation and its consequences. Malnutrition reaches unacceptable levels, especially among the Pygmy community. Schools and teachers are in short supply, and illiteracy levels are aggravated by the fact that everything is fee-paying. The same applies to health. There is no laboratory in all of Mbandaka and the Hopital Central is equipped with just one microscope for use in parasitological investigations.
It is precisely for these reasons, and to meet the enormous needs of its population and that of the surrounding region, that the city of Mbandaka was chosen as the first base for a DREAM centre in Democratic Republic of Congo, with a molecular biology laboratory attached.
This project was launched some time ago and has not yet been completed, even if the construction of the external structures has been finished. The works actually took much more time than initially envisaged.
The land on which the centre and the laboratory are being built was nothing more than a piece of forest land, which had to be cleared of trees and fenced in by a solid wall. Then we had to await the arrival of many materials from Kinshasa. The bricks were manufactured on site, but the cement had to be dispatched from the capital by boat, along the river, using means of transport that from time to time required up to 15 days. Moreover, there are no water or electricity supplies in Mbandaka. To provide for all these needs, cisterns and generators of high capacity had to be installed.
All in all, DREAM and the Daughters of Charity of Equator province have had to face a challenge that was by no means easy. The Daughters of Charity are the sisters who will take responsibility for the running of the new centre. One cannot yet say that everything is ready. A final effort is needed to equip the laboratory with the most fitting machines and supplies.
However, it is estimated that all the works will be completed by the coming June, not least thanks to the precious support extended by Cooperazione Italiana. The two technicians who will take care of the laboratory are already undergoing an internship for this purpose at the DREAM laboratory of Conakry.
The DREAM project in Mbandaka was born from a partnership agreement signed in Kinshasa in June 2005 with the Health Ministry. This agreement not only authorises in toto the diagnostic and therapeutic protocols of DREAM, it also identifies its centres as proper pilot projects, reference points for the Congolese national health services for the prevention and treatment of AIDS.
The agreement defines in practice a model of long-term intervention based on co-responsibility between the government, the Daughters of Charity, and the Community of Sant’Egidio, and may be considered as replicable in other contexts where the Daughters of Charity or other religious congregations are at work.
Everyone is awaiting the imminent opening of the DREAM centre of Mbandaka with eager anticipation, both in loco and in the capital. Political leaders, health officials, and Church authorities, are looking upon the project with the greatest favour, because it aims to take care of the most abandoned and inaccessible part of the country.
Once the new centre is operational, a place where everyone thought it was impossible to do anything will have one of the most advanced structures in all Democratic Republic of Congo.
In Mbandaka – and in all of Equator Province – no AIDS prevention and treatment programmes are in fact operated, not by the government or by other NGOs. Its geographical location and the difficult logistical conditions have discouraged everyone from undertaking any projects of this kind.
And yet the presence of a molecular biology laboratory in Mbandaka says so much, as does the fact that antiretroviral therapy will be guaranteed free-of-charge.
The DREAM delegation welcomed the opportunity provided by its visit to go to Bikoro (south of Mbandaka, in the interior) too, because the aim is to open in Bikoro a first satellite centre of the future setup for the treatment of AIDS.
The Daughters of Charity have always been present in Bikoro. They ran a hospital there even when the road linking it to Mbandaka was nearly non-existent and every time they needed to go there, they had to find a path that could be used through the forest, a journey which took up to 12 hours. Today, fortunately, the road may be travelled in a less problematic way and Mbandaka is only three hours away by car.
The second part of the DREAM mission concerned above all Kinshasa.
In its capacity as sponsor, Assicurazioni Generali has recently thrown itself passionately into the Congolese project, committing to support the opening of a second DREAM Centre in the country, this time in the capital. This centre will also be equipped with a laboratory, which may function as a model and pilot centre for the southern provinces.
Kinshasa is a chaotic capital, where people seek to get along amid many difficulties. The main hardships are economic: work available is casual labour and life is expensive, especially transport. The circa ten million residents of this metropolis sprawled along the Congo River live in immense stretches of small houses and shacks that have mushroomed in disorderly fashion. For the most part, they get about on foot, searching for ways to make ends meet. Many children may be met on the street, and many have not been registered at the Registry Office.
After some meetings of dialogue, the DREAM mission in Kinshasa managed to reach an accord with a religious congregation that seriously intends to take on the responsibility of managing the programme in the Congolese capital.
The diocesan Congregation of the Sisters of the Immaculate Conception took on the idea of setting up a centre in Kinshasa for the prevention and treatment of AIDS with great enthusiasm. Greater still was their enthusiasm about the plan to establish and activate a laboratory of excellence, offering services completely free-of-charge, and destined to become a point of reference for the immense southern hinterlands of the country. The religious sisters have already embarked on initial surveys to identify the land on which to build the centre and the laboratory.
The molecular biology laboratory of Kinshasa will play an extremely important role. It will receive blood samples taken from future DREAM satellite centres in Bandundu province (southeast of Kinshasa), which is another large area deprived of substantial health resources.
A privileged relationship will be activated with Kimbau Hospital in Kenge district, where Dr Chiara Castellani is at work. Dr Castellani is an Italian doctor who has lived and worked for many years in Democratic Republic of Congo, a person well known in Europe and Africa for her passionate and tireless activity.