Lubutu/Kinshasa - In the fourth pavilion of Lubutu's General Reference Hospital, the maternity staff are run off their feet. Amidst crying babies, Barbara, a Belgian midwife working for Médecins Sans Frontières (MSF), is doing her round of the 26 beds in the maternity ward. All are occupied.

Just a few steps away her colleague Ruslan, a Ukrainian surgeon, goes into the operating theatre with a young patient in need of emergency surgery. Meanwhile the Congolese doctor Fabien is checking a woman in the outpatient department. She is diagnosed with malaria.

Since MSF started working in the Lubutu hospital, just over two months ago, the number of patients has been increasing steadily. The hospital was almost completely run down when, on November 28, MSF stepped in and took charge of the 104-beds facility, introducing free health care for the patients. The hospital is located in a highly isolated part of Maniema Province, in the east of the Democratic Republic of the Congo (DRC).

"In January, we provided 2,753 consultations, mainly for respiratory tract infections, sexually transmitted infections, worms and malaria," said Freya Raddi, the MSF coordinator in Lubutu. "Our medical team performed 51 surgical interventions and did 71 deliveries. The ante-natal consultations and family planning were impressively successful, with 228 and 41 women seen respectively."

Referral system

An earlier epidemiological survey carried out by MSF had revealed alarming rates of mortality and very poor levels of access to health care in five regions of DRC. The health zone with the worst indicators was Lubutu, where the survey found an overall mortality rate of 3.4 deaths per 10,000 people per day. This figure indicates a catastrophic health crisisThe crude mortality rate (CMR) for a stable population in developing countries is estimated at around 0.5/10.000/day (for industrialized countries, this rate is around 0.3). A CMR of more than 1/10,000/day indicates a state of emergency. A humanitarian catastrophe is deemed to be reached when the rate exceeds 2/10,000/day.Yet, two out of three inhabitants of the Lubutu health zone reported they had no access to health care whatsoever. Most of the time, the financial contribution - even when a very low ammount - requested of patients is an insurmountable barrier.

An earlier epidemiological survey carried out by MSF had revealed alarming rates of mortality and very poor levels of access to health care in five regions of DRC. The health zone with the worst indicators was Lubutu, where the survey found an overall mortality rate of 3.4 deaths per 10,000 people per day. This figure indicates a catastrophic health crisis.

In view of these findings, MSF decided to try and reduce the mortality rate in Lubutu, by offering free access to care to an estimated population of 120,000.

"Though this is an isolated area, this health zone is at the intersection of two major geographical axes, between Kisangani to the west and Walikale to the east, and between Bafwasende to the north and Kindu to the south," explained Freya. "In order to reach as many people as possible, we will refer patients from the primary health centres on the axes up to the Lubutu hospital."

It is crucial to guarantee free care also in the outlying primary health centres, most of which are supported by another organisation. MSF will train staff from these centres how to  identify the patients who need to be referred, and install the communications equipment needed for organising referrals. Already the first patients who needed hospitalisation have arrived in Lubutu.

A logistical challenge

The MSF team has 186 staff and all but 16 of them are Congolese. The Lubutu hospital now looks like a hive of activity where people with a range of profiles work alongside each other: doctors, nurses, an anaesthetist, a surgeon, midwifes, but also logisticians, builders, water and sanitation experts, carpenters and plumbers. The high number of medical activities would have been impossible without the considerable work done by the MSF logistics team to prepare the facility.

"Completely taking over a reference hospital is big logistical challenge," explained Alexis Moens, MSF's head of logistics in Lubutu. "But a project like this one is really rewarding for logisticians, as our work here has an immediate impact on the medical activities. It is a hard job though. The more successful we are, the more patients will show up at the hospital. We constantly have to sort out supply difficulties, make sure we have sufficient storage capacity, and manage and train a high number of colleagues."

The hospital today shows the hallmarks of a major metamorphosis. There are still the clear signs of a nearly abandoned structure but also of the future reference hospital that will function in accordance to MSF's standards for quality. Large parts of the hospital have had a big make-over. Today, the main wards are functioning, access to drinking water and electricity is now ensured, and the outpatient department is in full swing.

These are important steps that will enable MSF to have a real impact on mortality, and alleviate the suffering of the population in a region of Congo that is dramatically neglected.

MSF has worked in the DRC since 1981. Today, up to 2,500 Congolese staff work alongside over 200 international staff to bring medical assistance to the Congolese population, with 26 projects across the country.