Life and death in Congo

A Masters student conquers broken-down motorbikes, rioting mobs and snakes to report on the devastating health effects of civil war in the Democratic Republic of Congo.

In a scene with all the hallmarks of a classic Indiana Jones movie, Dr Ben Coghlan stands in oppressive humidity, knee deep in mud and water, holding up a motorbike with a flat tyre a in the snake-infested, Congo jungle.

But unlike a movie set, there is no luxury trailer for him to retire to after a long days’ work — only hope for hospitality from local villagers enduring the violenceof a rarely acknowledged conflict. And there were no feted walks down the red carpet at the conclusion of his work — only a desire to shatter the indifference of the international community to the war in Congo.

Dr Coghlan, a student of the Masters of Applied Epidemiology program at ANU, spent a dramatic 10 weeks in the Democratic Republic of Congo — Africa’s third largest country — as the lead epidemiologist on a study of mortality in the troubled nation between April and July last year.

He helped survey 120,000 Congolese as part of one of the largest mortality surveys of its type undertaken in the world and certainly the largest ever conducted in the Congo.

His report, written with five colleagues who travelled with him as part of the International Rescue Committee (IRC) project, made headlines around the world when released by the New York based agency in December 2004. The results make sobering reading.

Almost four million people died in the six years since civil war flared in Congo in 1998, and over 30,000 Congolese continue to die every month. That makes it the deadliest conflict since World War II.

While in Congo, Dr Coghlan trained local aid workers in epidemiological survey techniques and accompanied these workers on trips to villages around the country to speak direct to householders. The local team members also acted as guides, interpreters and sometime saviours.

“A permanent member of our team was also a mechanic, because it was very likely our motorbikes would break down or there would be an accident. I stitched up one of the guys after a branch sticking out onto the path ripped through his foot as we rode the bike,” Dr Coghlan, who has a medical degree, says.

“We travelled mostly by old Russian planes to regional centres and then we’d take motorbikes along little potholed goat tracks, up steep rocky hills, through dense jungle and over rudimentary river bridges to villages. It could take us two to four days just to reach a village.”

In one memorable trip, Dr Coghlan and his team packed a long boat with 800 litres of fuel in 44-gallon drums, three motorbikes and floated 200 kilometres down the massive Congo River for two days to fi nd a village which took another day and a half to find on land.

“In each village we’d ask families about deaths in their household. In one, 10 deaths were reported during the previous 14 months. They all seemed to have died from the same illness: fever and cough. Only five out of 15 family members remained,” Dr Coghlan says.

Violent deaths from the war constituted only about two per cent of all recorded deaths, and were mainly confined to the volatile eastern areas of Congo where ongoing conflict persists between rebel forces and government troops. Instead, they found that the major killers of civilians were the indirect consequences of the conflict.

“This could be aid not reaching civilians in war zones because it’s too dangerous to go there; medical supplies and health services slowing to a trickle for similar reasons; or the houses of civilians burned and looted.

“These cause displacement and families hide from the military in the forests where they lack food and sanitation and are exposed to disease. Malaria, cholera, diarrhoea, malnutrition all become more prevalent.”

The survey also found that infectious diseases, like measles, are on the increase in Congo, although less than one per cent of deaths were attributed to HIV/AIDS.

“That has got to be wrong,” Dr Coghlan says. “We think the figure is so low because many people are dispersed throughout the country and access to healthcare is so scarce that people wouldn’t know if they had HIV. They may also choose not to report it. However, many people did tell us of family members dying of tuberculosis, which could be a HIV/AIDS related condition.”

But the importance of the survey goes beyond just indicating the type of medical aid that is required.

Linking up

By showing a link between high levels of insecurity and high mortality rates, it suggests that military and political measures are at least as important to saving lives in the Congo as providing food and medicines.

As well, the survey methods could be applied to accurately gather health information in other areas of conflict, including other parts of Africa.

This is not the first time that Dr Coghlan has worked in devastated communities. He has previously spent six months in Sudan doing humanitarian work, spent time working in Australian Indigenous communities and travelled to Sri Lanka following the 2004 Boxing Day tsunami.

He completed medical training at Melbourne University, and worked in St Vincent’s Hospital, Melbourne. He then completed a Masters in Public Health in Townsville before taking up the Masters in Applied Epidemiology at the National Centre for Epidemiology and Population Health.

As part of the fieldwork for that program, he has been placed with the Macfarlane Burnet Institute in Melbourne and was recruited from there by the IRC to go to Congo.

His initial trepidation at being sent to such an unstable country turned to fear in two lifethreatening situations, when he was cornered by rioting crowds in a movie-like scene.

He first escaped from a mob that attacked and destroyed the IRC office in Kisangani by rushing to an evacuation fl ight back to the capital, Kinshasa — only to then find himself trapped in the IRC head office while police engaged protesters in heavy gunfights just outside their door. He escaped through back streets, many blocked by burning tyres and filled with mobs targeting westerners.

“It was scary, of course,” he says, “but that was the only really violent incident I encountered in the whole time. It’s not really anything compared to what the people of Congo go through every week.”