This fall, Paul Carlson Partnership launches a new initiative to bring electricity and running water to medical clinics in Congo.A Congolese male nursing student sits in a chair with a birthing simulator called “MamaNatalie” strapped to his abdomen. A fellow student at the Karawa Nursing School is practicing how to deliver a baby. It is her first delivery of any kind—real or simulated—and she struggles with her technique but gets important feedback. When she is done, other students awaiting their turn applaud.
The scene illustrates one of several new medical initiatives being undertaken by the Paul Carlson Partnership (PCP). Such initiatives are vital in the Democratic Republic of the Congo, which is regularly rated as one of the poorest, if not the poorest, countries in the world. It was ranked 177 out of 178 countries as the worst place to be a mother in the 2014 State of the World’s Mothers Report by international relief agency Save the Children. One in thirty women die in childbirth, and one in five children never reach their fifth birthday – deaths that could be prevented with better access to adequate medical facilities and treatment.
From its inception, Paul Carlson Partnership has sought to assist medical professionals in the Congo. The Équateur Province, where the Congo Covenant Church (CEUM) operates its medical system of 108 clinics and five hospitals in cooperation with PCP, is located in the northwest region of the country and is home to 1.6 million people. Équateur is the country’s poorest region, and the five hospitals serve 800,000 of those residents. Each hospital is staffed with one doctor, and one nurse is assigned to each clinic.
Soon after Paul Carlson’s death in 1964 (see page 9 for a brief profile of his life and work), a foundation in his name was formed. Its work focused on a hospital at Imeloko (Loko), which had been built in 1959 by the Belgian government but never occupied. Mobutu Sese Seko, president of Congo, agreed to transfer ownership of the hospital to the foundation.
Eventually the work at Loko expanded to include fifteen satellite clinics in nearby villages and development work in nutrition. By 1990, the work of Paul Carlson Medical Program (PCMP), as the foundation was now called, had become part of the ministries of the Covenant. The medical work of the CEUM was going well with five hospitals, including the one at Loko, and scores of clinics.
Karawa Hospital, the only hospital for hundreds of miles, was considered among the finest in the country. Medical trainees traveled there to do their residencies. It had running water and continuous electricity thanks to power supplied by the Zulu hydroelectric dam that became operational in the eighties. The continued development of health care in the area looked promising.
Ever since Congo gained its independence from Belgium in 1960, the country has experienced significant turmoil. Missionaries were forced to evacuate in 1960, 1964, 1991, and 1997. In the recent civil war that ravaged the country, CEUM structures and institutions were repeatedly looted. Congolese doctors and nurses continued to serve despite few resources and untold hardships.
The Covenant Church here in North America and the CEUM have remained determined to see the work of God continue. In 2004, PCMP was relaunched as Paul Carlson Partnership to give support to health and education initiatives and to address poverty in Congo. Much of the restorative work to the medical system has been focused on Karawa. Repairs to a waterwheel that was destroyed in one of the conflicts have provided water access at the hospital. Recent improvements at the hospital have included the installation of solar panels, purchased through PCP, which provide regular electricity, enabling doctors to perform operations and making possible the refrigeration of vital medicines. But more solar panels are still needed at the hospital, as well as at the clinics, Meritt Lohr Sawyer, executive director of PCP, says.
Helping Babies Breathe and Helping Mothers Survive initiatives introduced by PCP in 2012 and 2014, respectively, are designed to help reduce mortality rates from treatable diseases and conditions. The American Academy of Pediatrics developed the Helping Babies Breathe curriculum, and Laerdal Global Health developed the Helping Mothers Survive program. The initiatives focus on training trainers, who then share their learning with others throughout the region. Training equipment such as MamaNatalie is essential as are medications such as misoprostyl, which is used to prevent postpartum hemorrhaging, a major cause of maternal mortality.
“The uptake on Helping Mothers Survive has been tremendous,” says Eric Gunnoe, president of the PCP Medical Ambassadors, who has led teams to teach both courses. “The Karawa Hospital, where we taught the course, had integrated the training into their practice before we even left to return to the United States. Two days after the training, medical personnel saved the life of a woman who delivered by cesarean section. Had it not been for the training and new medication, she would have died.”
A neonatologist from the University of North Carolina who does research in Équateur Province visited the region this past spring, and Gunnoe described his reaction, saying, “The one predictable bright spot in each of the tiny clinics that he visited was the space devoted to newborn resuscitation. The nurses in the clinics were proud to demonstrate their new equipment and skills. One woman told the researcher she had saved eight newborns during the year since she had been trained.”
Yet the clinics remain rudimentary at best, lacking both electricity and running water. Most have little or no access to medicines. So earlier this year PCP kicked off the Congo Clinic Initiative in cooperation with CEUM to coincide with the fiftieth anniversary of Carlson’s death. His widow, Lois, says, “I am thrilled by what they are doing. They are doing more than Paul ever dreamed.”
Through the clinic initiative, churches, groups, or families partner with a CEUM clinic. The cost of supporting each clinic is $50,000 over the course of five years. In the first year solar panels (which cost $5,000) are installed to provide electricity. The next year they will purchase equipment that requires electricity. The succeeding years will focus on developing water projects. Each year, half of the funds will support the specific project for that year, and the rest will help pay for medicines, salaries, and other operational costs.
Sawyer says that many people in Équateur Province die because they lack access to basic medical services, noting that one out of five children die by the age of five, generally from easily treated or preventable diseases. In many ways, the clinics function as triage centers. “It’s best to think of them as the frontline of evaluation,” she explains. But when the nurse who staffs the clinic determines that a patient must be treated at a hospital, getting the person there may be all but impossible. “Even bike ambulances can’t get to some of these places,” Sawyer says. “Our passion is to deliver services right in the heart of the village.”
Just as important, she emphasizes, “it’s about preventative care. It’s setting up a public-health system.” As part of that design, the clinics will become more involved in providing community-health education. “Healthcare is not just about treating diseases. It’s about preventing them.” Along those lines, Covenant missionary Marta Klein has overseen fledgling nutrition programs that are showing initial signs of success.
Congo Clinic Initiative partners will receive a devotional from a Congolese leader, a photo of the clinic they are sponsoring, and quarterly updates. Sawyer says that the more sponsors know about the people of Congo, the more they’ll realize how much they have to learn from the Congolese. “I hope the clinic initiative will encourage people to ask about this part of the kingdom of God,” she adds.
One of the things people in the developed world can learn from the Congolese, Sawyer says, is the way the Africans seek to integrate every aspect of their personal and communal lives with their faith. “In that, they have us beat hands down!” She notes, “When I was there, I’d wake up at five in the morning, and the community already was up singing hymns.”
Sustainable changes to the healthcare system won’t be possible without developing the local economies. To that end, PCP helps provide resources to build Congolese businesses through its Farmers to Market program, which develops a chain of farmers, transporters, and markets that enable farmers to grow and sell more crops at better prices. The program, which was launched under the guidance of previous PCP director Byron Miller in cooperation with CEUM, impacts more than 2,200 farmers and their families in the Loko and Bumba areas of Équateur Province—reaching as many as 10,000 people in all.
One of those people is Eliwo Lambert, who made about $50 a year, depending on the harvest and what he was able to trade for other essentials. As Texa Dembele Menda, the country manager for Farmers to Market, tells it, that income was not enough to pay for school and hospital fees for Eliwo’s family, which left them exceptionally vulnerable to disease and unable to improve their situation. When they received a Farmers to Market microfinance loan, Eliwo was able to purchase a bike to help him transport goods from farmers to wholesalers. As a result, his income increased twelvefold to $600 a year. Now he can pay for school and medical care for his family.
Sawyer notes that Richard Lingili, a physician and the director of the CEUM medical system, has been working with PCP to revive a business that makes orthopedics for people at the hospital. The business is unique in that it employs workers who cannot speak or hear. The program is in the 2015 PCP budget, but, Sawyer says, “We want to make sure there is a good business model there. Much of the funding will go into training.”
PCP also helps local business owners, such as one woman who developed a business sewing mattresses for one of the hospitals. Previously, PCP paid for and shipped mattresses from the States to Congo. That is changing. “Why would we send them mattresses when they can be made locally?” Sawyer asks. “This way we can give people new business opportunities.” She notes that the locally made mattresses last longer because people take better care of them since they are personally invested in their durability.
Helping local businesses also helps the medical system, Sawyer says. As people grow their incomes, they can afford to pay for medical care. The number of people seeking medical assistance has been growing since the Congolese government started subsidizing some healthcare costs in the past year. Those subsidies don’t cover the full cost of providing treatment, however, and many people aren’t able to make up the difference, which adds to the financial burden on the hospitals, Sawyer says.
Formidable cultural challenges also must be addressed. It will require a “huge paradigm shift,” Sawyer says. Due to the scarcity of food, goods, and services, the culture in Congo has necessarily been oriented toward taking care of immediate needs rather than planning for long-term success.
On the medical side, supplies intended for one program have sometimes been shifted to others when emergencies arise. And lack of access to local medical treatment—often patients must walk at least nine miles to the nearest medical facility—has rendered preventative healthcare difficult to provide.
“It’s very hard to talk about preventative healthcare in Congo,” says Wayne Carlson, Paul Carlson’s son and, like his father, a physician. “That is why PCP’s approach is a long-term solution with a long-term commitment.”
Starting businesses has also been challenging in an area that has relied on bartering. “Dealing in cash and developing savings are unfamiliar practices,” says Sawyer, as is the concept of making and repaying loans. “So is putting together business plans. These are new concepts.”
Still, positive signs are increasing. Outside organizations are teaming up with PCP on many projects that include completely repairing the Zulu dam, which was destroyed in the war, and running miles of transmission lines to the hospital. The government is interested in helping improve the system, Sawyer says. And CEUM leadership has a fresh determination to see the medical system succeed.
PCP recently hired a director of economic development who has extensive experience in Africa. An expanded Medical Ambassadors program is attracting new expertise from Covenanters with healthcare backgrounds to help plan and implement a variety of initiatives.
One of those ambassadors is Julie Malyon, a nurse and director of a free medical clinic in Red Wing, Minnesota, who joined the program after traveling to Congo. She says she was devastated by conditions she saw there. She hopes that other medical personnel will consider becoming ambassadors. “The need in Congo is on such a different level. If you get involved in a focus group, you could change the life of a whole people,” she says, noting that being a medical ambassador with PCP does not require traveling to the country.
Malyon was inspired by the people she met when she helped teach the Helping Mothers Survive course. “I was amazed at the resourcefulness of the medical providers,” she says. “Just think about refrigeration—there are so many kids coming in with malaria, and we’re doing a lot of blood transfusions, but how are you going to do transfusions when there’s no refrigeration for a blood bank? You take the blood out of one person, you test it, and you immediately put it in another person. They make a lot of things work.”
CEUM President Mboka said earlier this year while visiting the United States, “We have a true wealth in our people, people who have been well-trained—our doctors and nurses—people who are being trained to become future doctors and nurses. It is true that they sense God is calling them to do that as part of their life of faith. They see as a priority that people live healthy lives, so that is a blessing we have in our church.”