In Kasaï-oriental, free care for the most vulnerable is essential

In the paediatric emergency unit, Dr Masengo is talking to a patient’s mother. ‘He’s my first and only child’, says Noëlla, nineteen years old, sitting on a wooden bench near a child’s hospital bed surrounded by bars. The hospital cot is covered with a blue blanket, which is shaken by a child trembling at regular intervals. At just one year and seven months old, Mbiya is suffering from meningitis and tuberculosis, which have led to a state of severe acute malnutrition. Today, during a visit from Dr Prudence Masengo and her paediatrics interns in the therapeutic nutritional unit in Bonzola Hospital, the little boy started having a seizure.

‘At the beginning, he just had a fever, but he’s got worse, so I’ve brought him here to the hospital. I found out he had these diseases, and as he’d stopped eating, he had become malnourished’, Noëlla explains. The child’s father, who left two years ago when she was still pregnant, continues to call her regularly. ‘He didn’t have the money for the dowry. He said he was going to look for some, but he still doesn’t have enough for a wedding, and his family doesn’t want to help him’. Without a job, Noëlla lives with her mother, alongside her four younger siblings and her son. Myiba’s grandmother sells second-hand clothing, but Noëlla hopes to open a small shop of her own, so that she can look after her son herself.

In Bonzola Hospital, malnourished children are treated on three wards. The emergency unit deals with children with extremely severe medical complications, like Mbiya. The acute phase ward is for children who have not yet got their appetite back and are treated with therapeutic milk, so that they can recover their basic metabolism and move on to the transition ward. There, relieved-looking mothers watch their children switch from therapeutic milk to a ready-to-eat paste of therapeutic foods as they wait for them to get better enough to be discharged from hospital and continue their treatment in an outpatients centre.

In total, there are fifty-three beds distributed across the wards, and around twenty malnourished children with severe complications, such as Mbiya, are hospitalised there every month. The children’s carers receive free meals. Every young patient has their own story. For Dr Prudence Masengo, the main cause of malnutrition is poverty due to the collapse of MIBA, but another cause is the lack of time left between pregnancies. Having children close together increases the risk of malnutrition for the older child, who is often weaned abruptly when the mother falls pregnant again. To raise awareness among mothers and enable them to make their own health choices, family planning is part of the sexual and reproductive health activities carried out by Action contre la Faim in local medical centres, like the Jérémy Centre, led by Madeleine Ntumba.

Ensuring a sense of agency when it comes to pregnancy

In the half-light of the post-natal ward in the Jérémy Medical Centre, Madeleine Ntumba, the centre manager, takes care of three young mothers lying on beds covered with mosquito nets. Soubila and Kauawanga were born this morning, and the exhaustion marking all four women’s faces is balanced out by joy and relief that everything went well. Mutuba made his appearance yesterday. Swaddled in a blanket, he is held tight by Mélanie. He smiles in response to his mother’s smile, though he cannot see it. 

In the medical centres supported by Action contre la Faim in the Nzaba and Bonzola health zones in Mbuji-Mayi, birth assistance, pre- and post-natal consultations, and family planning are all free. These free services reduce the risks posed to these mothers and their children in a context of serious poverty. ‘The population is impoverished’, Madeleine explains. Before, the women really had nothing, and they sometimes gave birth in the community, and babies died. With support from ACF, we get to help a lot more people’. In parallel, medical professionals raise awareness of the importance of spacing out pregnancies, so that children and mothers are given the best chance of staying healthy and avoiding malnutrition.

Mélanie has followed all the pregnancy advice she has been given and has attended pre-natal consultations. There are two years between her older children, and they were both breastfed until they were six months old, as recommended by the WHO. Family planning reduces maternal death and infant mortality rates. ‘The medical centres were built for us. If I give birth at home, there are a lot of risks, for me and my child. There is a risk of catching diseases, of suffering a post-partum haemorrhage’. She took the advice on spacing out pregnancies: ‘I was told that if I leave plenty of time between children, my child is more likely to reach a good weight and be healthy, and that will save him from a lot of illnesses’.

With a metal tray of various objects on her lap, Madeleine sits on the edge of Mélanie and Mutuba’s bed. She describes all the contraceptive methods available to the new mother. Implant, injection, intrauterine device, so-called natural methods such as a necklace of colour-coded beads for tracking your cycle: the health centre manager presents the advantages of each type and how they work.

Mélanie chooses the implant. She considers herself lucky, because she has a shop and her husband is a teacher. The spouses have open conversations in the home, and her family planning choices are respected. Madeleine recognises that this is not the case everywhere, and that there is still much to do in terms of raising awareness of family planning and free access to care in communities.