Despite Dangers, Medical Clinics Act as Last Resort

KIRUMBA, DEMOCRATIC REPUBLIC OF CONGO — When Kanyere Vihamba felt something moving inside her belly, she consulted an herbalist who told her she was suffering from intestinal worms and prescribed a mixture of herbs.

Seeking medical help from professional doctors isn’t something she’d normally consider. But after taking the mixture of herbs, the pain became so extreme she could barely sit.

“I had no choice but to go” to a private hospital, says the farmer from Kirumba, a village north of Goma in eastern DRC. “I was afraid that I might die.”

The doctor discovered an ovarian cyst, already in its advanced stage. Before this, Vihamba had never heard of such a thing as an ovarian cyst. To remove it required surgery.

Vihamba’s case is common in rural DRC where, due to lack of access to health care and an over-reliance on traditional medicine, many aren’t accustomed to medical checkups. When women experience symptoms such as abdominal pain, many seek help from traditional healers or self-medicate with herbs. In some cases, by the time they seek medical help, their conditions are dangerously advanced.

Health officials warn that if the community isn’t convinced to seek professional health care as a first recourse, women in rural DRC risk losing their lives.

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Women are seeking medical help so late after developing fibroids and ovarian cysts — which account for most surgeries among females in the region — because of a lack of awareness about reproductive health that persists, says Dr. Demetrio Tembo Kipisa, medical director at Reference Health Center of the Baptist Community in Central Africa, in Kirumba.

The country’s health care system has had its share of challenges, which have contributed to poor reproductive health. Decades of violence that spilled over from neighboring countries —and still continues in the eastern parts of DRC — have destroyed health care infrastructure and displaced many people, making it even more difficult for them to access health care services.

Rural DRC has been particularly affected. Just 1 out of 4 households in rural areas live within 1 kilometer (about 0.6 mile) of a public hospital, according to 2015 data from the country’s National Institute of Statistics. More than half the country’s population — about 54% — live in rural settings, according to the World Bank.

But access to hospitals isn’t the only reason women aren’t seeking professional medical help. Many people in rural communities are accustomed to traditional medicine, which plays an important role in DRC’s national health care system.

A national program to regulate use of traditional medicine has existed in the country since 2001. But integration of traditional medical practitioners into the national health care system has faltered due to mistrust shared between traditional medical practitioners and modern medical professionals, as well as the lack of structure that characterizes the traditional profession and the unlicensed, and sometimes fraudulent practitioners who set up shop.

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Despite the risks, when rural residents fall sick, traditional medicine often remains the first treatment option. Sometimes, it’s the only one of which they are aware.

Edwige Katungu Pahali, a high school student, says she didn’t know she needed to go to a hospital when she experienced abdominal pain. “I had never been informed about it,” she says.

Only when the pain persisted did she go for a medical checkup, where she was diagnosed with an ovarian cyst and received treatment.

Chriso Kasereka tells a similar story. When his wife complained of pain, he thought she was suffering from appendicitis. He gave her fruits from the “muranda” — a plant used locally to treat appendicitis — hoping it would ease her pain.

But after several days in which his wife was unable to sit down because of the pain, Kasereka took her to the Reference Health Center of the Baptist Community in Central Africa.

“She had surgery after an ultrasound scan confirmed the presence of an ovarian cyst,” he says.

The surgery cost him 178,000 Congolese francs (about $89), a high amount in a country where 73% of the population lives on less than $1.90 a day, according to World Bank estimates from 2018.

There should be a campaign to raise awareness, says Kipisa, the health center medical director. “People have to be made aware that prevention is better than cure,” he says. “This means raising general awareness on this matter to ensure the population understands.”

While surgeries are mostly successful, Kipisa warns that if left untreated, women could develop conditions such as infertility, bleeding, removal of the uterus and preterm births, among other complications.

Dr. Eugène Nzanzu Salita, health minister for North Kivu province, where Kirumba is located, says the government educates the population on health issues and discourages self-medication. He didn’t provide specific information on these efforts.

Kavugho Kinyambumbu, a community health care worker at Centre de Santé Bulinda, a health center in Kirumba, says she and her colleagues also have been encouraging people to seek professional medical help. They have employed various methods, including visiting homes and using megaphones to make announcements in the village.

Despite these efforts, Kinyambumbu remains pessimistic. She sees little change in behavior. Some community members wait until they are too sick or close to dying before being brought to the hospital, she says.

But for Vihamba, the decision to finally seek care at a hospital changed her thinking.

“I’ve learned,” she says, “that it’s best to go for a medical checkup before receiving any treatment.”