http://www.east4south.eu/index.php en boryana.dz@gmail.com Copyright 2012 2012-03-05T12:27:57+00:00 http://www.east4south.eu/index.php/site/carrying_the_burden_of_congo/ http://www.east4south.eu/index.php/site/carrying_the_burden_of_congo/#When:12:27:57Z {summary} It’s around 6 am. The sun is slowly lifting in the sky, a clear sign that Cesarine Maninga has to leave. With one skillful move she straps the 50-kilogram sack of charcoal to her back, tosses the rough rope around her head and hurries out the door of her small shack in Mushekere, a small village at least 15 kilometres from Bukavu, capital of the Congolese province of South Kivu. Cesarine is heading to the city to sell makala - dry charcoal that locals use for heating and cooking. She will walk the whole way, carrying the heavy load on her back. It’s excruciatingly painful work and she has to make the journey at least twice a week. “I don’t have a choice. I have to feed my family,” she says with a bitter acceptance in her voice. The huge sack of makala is three times her size. As she balances it on her back she looks much older than her 43 years.  Her husband can offer little help as he is unemployed and the burden of supporting her family of 11 children rests on her shoulders. Literally.  Cesarine is one of the thousands of Congolese women, whose job it is to carry heavy loads of goods. They are a common sight in the streets of Bukavu. But it is not the woman who captures one’s attention but rather the huge bundles that come in all sizes and colours.  In French they are known as les femmes transporteuses are; in Kiswahili they are called babeba mizigo.  The job is the same whatever language they speak: women carriers are human pack horses and the job title is as brutally blunt as the job itself.  Due to a number of economic, social and cultural reasons the transporting job, usually done by donkeys or trucks in other countries, in Bukavu is assigned to women.  They shuttle goods from the harbor to the market and they act as the home delivery service for well off market shoppers wanting their purchases taken home. They carry everything from cassava, a staple crop in Africa, sugar cane, flour to charcoal, sand and fire wood.  Each woman carries hundreds of kilograms of goods, sometimes even tons per week.  There are no meal breaks or Occupational Health and Safety considerations in this job, just more kilometres to walk.  At the same time these woman are paid as little as one to two dollars per day, barely enough to buy a measure of flour or rice.  No Place to Be a Woman Congo is almost the size of Western Europe. The UN estimates its population around 68 million people. Even though the country is rich with natural resources, most of the population lives in extreme poverty. For years the Democratic Republic of Congo was torn apart by war that claimed the lives of estimated four-five million people and left the country in ruins. Respect for the basic human rights of women rates little mention. Although the literacy rate is around 67 per cent of the adult population, many girls don’t go to school at all because their parents struggle to pay the school fees.  The incidence of gender violence is so high that Congo is considered the worst place to be a woman. According to a study published in the American Journal of Public Health last year, 48 Congolese women are raped every hour. For years different militia and rebel groups have used rape as a weapon of war, the cruelest way to destroy local communities.  But sexual abuse is not the only hardship Congolese women face. Poverty, unemployment and financial insecurity have doomed many women to live a life of everyday struggle for survival. Congolese women are often discriminated against and unequally represented in the political institutions. This is a patriarchal society and it is still a common perception that women’s main responsibility is to get married and have children. As unemployment has escalated, women are increasingly forced to offer their services to transport goods just to keep their families alive.  The number of women carriers drastically increased in the nineties when endless conflict, especially in the Eastern part of the country, resulted in a severe humanitarian crisis. Factories shut down and many people lost their jobs. Even now that the situation in the country is relatively stable, jobs remain scarce. Inhumane Job By 8 am Cesarine is only just approaching the outskirts of Bukavu. It’s a busy market day. Like an expert she weaves her way through the never-ending stream of motor bikes, cars and people flooding the streets in the morning. Barefoot, her feet are sinking in the thick mud covering the streets. Her slight frame bends over under the crushing weight of the makala. Although the sack is almost as big as she is, she moves as gracefully as a ballet dancer on her way to the city centre. But first impressions are deceptive.  Now women are speaking out against a practice they say is more than humiliating. According to them being forced to carrying sacks, bags or baskets that sometimes weigh up to a hundred kilograms is inhumane. “Women carrying goods is an unusual job. Unfortunately it has become a fashion in DRC, especially here in Bukavu,” says Solange Lwashiga, secretary of the South Kivu Congolese Women Caucus for Peace. “Women have replaced machines, women have replaced vehicles,” she adds.  Head of the Association of Women Carriers, Esperance Lubondo agrees. “This job is so dehumanizing that I decided to set up the Association so we can improve the condition these women are working in,” she notes.   “It’s like exploitation of women,’ says Stella Yanda who heads up a non-governmental gender organization called Initiatives Alpha.  She warns that women suffer double discrimination. ‘For the same amount of goods men are paid better than women. For example, men are paid double than women. Men get 1,000 Congolese franks [around $1] while women can barely make 500 [around $0.5 ]. At the same time men carry goods for a short distance while women carry goods for kilometers,” she says. Adding to their hardship, carrying jobs are not easy to come by.  At Beach Muhanzi, one of the biggest markets in Bukavu, women carriers are waiting idle for hours so they can get a job.  “We carry the sand from boats to the market, we carry around 50kg of sand every day,” says Jeanette Cibalonza who desperately hopes to find a client before nightfall.  “The money I earn is insufficient. I can only buy a plate of corn flour and vegetables with it. It’s a painful job and I have been doing it for 32 years,” complains another woman. Inevitably, carrying tons of goods for years has devastating repercussions on the bodies and health of women carriers. The result can go from muscle soreness and cramps to sharp back and neck pains to brain damage for those who have the loads secured on their foreheads. By the time Cesarine gets home she is completely exhausted.  She suffers severe headaches and backaches all the time. Once she even broke her arm while carrying her bundle. “I feel very bad when I carry my sack. Sometimes I carry this bag without eating anything and when I take it off I feel dizzy,” Cesarine admits. She shrugs her shoulders and adds: “I'm used to it and I cannot give it up”.  She lives together with her husband and children in a small shack in a village high in the mountains. As Cesarine is the only bread-winner, the family is struggling to make ends meet.  Little Hope for Better Future Gender experts urge the government to take some action and adopt proper regulations that can improve the working conditions for women carriers. While she acknowledges that the practice is here to stay for the time being, Solange Lwashiga and Stella Yanda want to see legislative change that would cap the weight of bundles allowed at 50 kilos.  “I don’t see this job disappearing any time soon, unless we have women in decision-making levels who would change the current situation,” says Lwashiga who blames the combination of extreme poverty and the fact that politician ruling the country didn’t do much to improve the standard of living of Congolese people.  The Association of Women Carriers promotes a different approach. It offers women carriers who are members, micro-crediting between $50 to $100 so they can support themselves. Lwashiga suggests that women should be provided more opportunities to start their own business. “There are women in the DRC who are entrepreneurial. So if you give like $10 dollars to a Congolese woman, I tell you that in a month you’ll find $30,” she says proudly. For the time being Cesarine’s capacity to exercise her entrepreneurial spirit is limited to    wandering around Bukavu, her shoulders sunk under the burden of the sack, until she finds a buyer for the makala. If she fails to sell it, she has to carry the load of makala all the way back to her home.  Today Cesarine got lucky. She has found a customer who wanted the charcoal delivered to his home. She’s going to make around $3. But she has to wait to get paid for at least a couple of days. Until she gets all the money she can’t afford to buy a new load of makala.  Today the mother is returning to her village burdenless, but not careless. She knows there is precious little to eat at home and she has mouths to feed and dinner to prepare. The hardest part of her day is yet to come: creating something out of nothing.  2012-03-05T12:27:57+00:00 http://www.east4south.eu/index.php/site/a_train_with_a_human_touch/ http://www.east4south.eu/index.php/site/a_train_with_a_human_touch/#When:12:47:28Z {summary} A train with a human touch Coming out of the Phelopepa train with such enthusiasm, Thandeka Makalima, a 72 year old retired teacher exclaimed ‘’I have never received such tender care from a doctor in all my life’’. I had a thorough check up with special and individual attention. These youngsters are so good. Do you know she spent more than an hour and half just on me’’ Referring to a final year optometry student from Medunsa University, who was working on the train as part of an internship requirement. ‘’Can you believe that I only paid R30 for the service? Have you any idea how much the doctors in the city charge you for less than ten minutes in their consulting rooms? I have had to pay close to R2000 for the glasses I used to have, and where do they think I get the money from when I am just a pensioner’’ The affordable prices are as a result of Transnet Foundation providing the train with an estimated R30 million each year according to Dr Lynette Coetzee, an economist who is also the senior portfolio manager of the Phelopepa Health train. 75% of the funds are from Transnet while the remaining 25% is provided for by the partners and the sponsors of the initiative. Talking to Mama Thandeka from Ermelo, a province in Mpumalanga where the health train was recently stationed. It was clear how overwhelmed she was by the respect and the dignity she says she was treated with by the student doctors. She kept on repeating that these kids have “Ubuntu” which is a South African term used for treating and dealing well with humanity. ‘’They are so kind, I felt totally loved and cared for’’ She went on further to explain as to how rare that is in most health centers she normally goes to. She was so grateful for the work that is done by the doctors. She was so happy to have been saved from taking a trip to an expensive optometrist in Johannesburg. The optometry coach, headed by Dr Terrence Giles has 2 qualified optometrists and houses about 12 final year optometry students in each station. Typically 130 patients are seen in each day over a period of one or two weeks, depending on the duration on that particular station. This coach has proven to be especially popular with the senior citizens, who usually have serious problems with their eye sights. Speaking to the Psychology clinic manager Lynette Flusk, it was so clear as to how much emphasis was placed on treating the patients with dignity. Almost all the Phelopepa clinic managers repeated that the most important thing was treating people well. Lynette the Psychology clinic manager emphasized that despite the importance the physical help provided by the clinicians in the train, the human element which showed care and compassion was most vital. She further went on to explain that if the train could be loaded with the state of the arts equipment whilst it had staff that did not care for the people, the project would be a failure. People want to know that you care and understand their situation, without being patronizing, she said. The Phelopepa Health Train is an initiative of Transnet, which is a freight rail company. Transnet Foundation is the Corporate Social Investment (CSI) branch of Transnet and the Phelophepa Health Care which falls under the Health Portfolio with Transnet Foundation. From the growing success of the project the Phelophepa Health Care Train has now become the flagship of Transnet’s CSI. It has 18 carriages, comprising of the Dental, Optometry, Pharmacy, Health and Psychology clinics, a Dining Car, Kitchen, Accommodation Coaches and Storage coaches. Servicing mostly South Africa’s rural poor, it operates for nine months around the country in all provinces excluding Gauteng. In 2008 the train won a prestigious UN award in the category of “Improving the Delivery of Services’’ The success of the project has now lead to a decision of investing R82 million to build a second train which will be called the Phelopepa II, it is expected to start operating in 2012.   By: Zintle Tyuku 2011-03-09T12:47:28+00:00 http://www.east4south.eu/index.php/site/my_favorite_links/ http://www.east4south.eu/index.php/site/my_favorite_links/#When:09:27:29Z {summary} 2010-11-01T09:27:29+00:00 http://www.east4south.eu/index.php/site/dr._david_namwandi_vs_education/ http://www.east4south.eu/index.php/site/dr._david_namwandi_vs_education/#When:09:05:46Z {summary} 2010-11-01T09:05:46+00:00 http://www.east4south.eu/index.php/site/the_world_lets_9_million_children_die_every_year/ http://www.east4south.eu/index.php/site/the_world_lets_9_million_children_die_every_year/#When:11:29:34Z {summary} text by Magdalena Vaculciakova, photo of Juan Garay, Health team coordinator for European Commission, by Georges Drouet www.rozvojovka.cz “There is almost no progress on maternal health in sub-Saharan Africa, reflecting the very weak health systems. Still today at least half of all deliveries are at home with no support from health workers, often with high risk of complications,“ Juan Garay, Health team coordinator for European Commission, says. Reducing child mortality and the maternal mortality ratio seem to be MDGs that probably won’t be achieved. There are 27 countries with no improvement as for reducing child mortality and the majority of them is in sub-Saharan Africa. What is the main problem causing child mortality in Africa? Compared with other regions, the main attributable risk of ill child health and premature mortality in Africa is poor sanitation (leading to diarrhoea as the main killer), poor housing (for instance in-door smoke from solid fuels, causing respiratory infections), endemic tropical diseases (malaria and intestinal parasites-cause of high rates of anaemia- mainly) and low access to health services. Other also contribute, such as malnutrition and low access to safe drinking water; but these risks are even higher in South Asia yet the under five mortality rates are much lower. Where should we start in with solving the problem? The main approach should be through strong health systems which are multisectorial (promoting healthy environments) and provide universal access to basic health care. This requires more political commitment from countries in allocating public domestic resources to health and more international support targeting better countries in greatest need and providing more aligned and predictable support to health. How can maternal care be improved in Africa? Again, and even more clearly than child health, it requires good health systems but also respect to gender equality. You worked as a clinician in some of the african countries. If talking about gender equality, how did you find the role of an african man when his wife and child are ill, facing the death? Men are ususally detached from reproductive health issues, pregnancy and delivery, and often from child care; but there are many exceptions, the bridge in this gap is education... How do Africans see foreign doctors? With some sense of magic, view of power, gratitude, but always distant in understanding... Is it difficult to follow up communities? No, it just requires genuine sensitivity. What did you personaly do to follow up the communities when treating mothers with their children? For instance, I did the exercise of "community health diagnosis" : a 2-3 month intense exerercise of visiting villages, homes, schools, community meetings, walking between viallages, getting information through team work, discussing together...It is all in a book I wrote which I hope I can soon re-edit and translate. Another very important experience I believe all doctors should do, is to share a day's work with a mother in rureal Africa (the work in the house, the fields, the firewood, fetching water, cooking, washing, cleaning, resting...) : "empathy" is the key to real understanding... Can you mention any specific feature of african communities that surprised you? Fertility values, value given to elders, importance of spirtual believes, endurance to pain... How do mothers in Africa cope with their children‘s deaths? As everywhere in the world, with the deepest of sorrows. They adapt and have more children, but the impact in their lives is as profound as in any culture. What is your personal experience with child deaths? I experienced as a doctor the first child death out of poverty and lack of any means for treatment, when I first worked in Sierra Leone. It is the worst experience I believe one can witness in life and makes you question the global system, the distribution of resources, the lack of justice while one billion lives in abundance and obesity and one billion goes to bed hungry every day; while one billion people enjoy public health services with resources of over 2000 EUR per person, and the bottom billion barely had 20 EUR and has very low access to basic, often vital health care. The world literally lets 9 million children die every year : it would require adequate allocations from national budgets to health (around 15%) and additional 13 billion EUR from international aid, this is 1% of the money spent in 2009 in rescuing banks from their crisis due to greed, or 1% of the world's annual military spending. And it would be through comprehensive health services also covering maternal health and preventing half a million maternal deaths, and also over 20 million or premature deaths of adults. Do you think that the way the development aid concerning health care is delivered and implemented is efficient? Not in a very efficient way. It is not enough, not aligned with country plans and priorities, not predictable. We should change our way of working with countries. Stop deciding what is best for them from Brussels, Geneva, Washington or New York; and work in mutual trust, with good assessments, participation, dialogue, in the countries, involving the communities, and building social services accessible to all, especially to the poor. Is the health care situation in Africa more about resources and money or about people and their priorities? It is more about predictable resources, institutions being responsible for guaranteeing the right to health and communities demanding it. International support has often not respected the central role of the public service. Would you say improving health care is one of the most priorities of African countries and their governments? I would say with all evidence that it should be the first priority. Can you recall any of the stories you have seen or experienced when working in Africa? I always remember this story : In my first work as a rural doctor in Africa, I diagnosed and treated an elderly patient (as many other hundreds every month..) of tuberculosis. The patient (as most in the rural district I was working in) was very poor and had reached the hospital after one whole day walking some 30 kms, barefoot. One week after discharging him from hospital when he was slightly better, he returned walking the long distance, he came during our rest day on Sunday, to offer me in sign of gratitude, a plastic bag with bananas. I was very grateful, knowing the extreme poverty he lived in , and what this, on top of the long walk, meant to him and his family.. Two weeks later, he came again all the way. He asked me if I liked the bananas. I thanked him again but wondered if he had walked all the way just to ask me...I did not know very well what he really wanted. He was shy to tell...Finally he told me : could he have his plastic bag (old and simple, the ones we constantly throw in our society..) back...I always remember the look in his eyes when I see so much greed around... What mostly surprised you when working with Africans and treating with them? That deep inside, when we feel the fragility of life, we are all the same... 2010-08-25T11:29:34+00:00 http://www.east4south.eu/index.php/site/a_virtua/ http://www.east4south.eu/index.php/site/a_virtua/#When:09:18:52Z {summary} Bonjour! I'm sending you a big package of digital greetings from European metropolis which is currently soaking in vibrant African spirit. We are diving into the depths of development aids, building theoretical frames for intercultural reporting and above all, enjoying in colourful company of African and east European participants. The weather is awfully cold but the atmosphere keeps us warm! Greetings through the wires, Pina p.s. I couldn't find any beautiful postcard around. I'll make sure the one from Kenya looks prettier! 2010-05-14T09:18:52+00:00 http://www.east4south.eu/index.php/site/development_keep_or_kick_africas_time_is_now/ http://www.east4south.eu/index.php/site/development_keep_or_kick_africas_time_is_now/#When:09:56:51Z {summary}   It is time for Africans to assume full control over their economic and political destiny. Africans should grasp the many means and opportunities available to them for improving the quality of life," argues Dambisa Moyo (left) an international economist who writes on the macroeconomy and global affairs. She is the author of critically acclaimed New York Times Bestseller Dead Aid: Why Aid is Not Working and How there is a Better Way for Africa, which details the inefficacy of development aid for poor countries.   MORE 2010-05-12T09:56:51+00:00