Reporter: Henry Burnand

Contact at destination: Dr JP Ilunga. Email: He’s an anaesthetist and organizes all the medical students – very approachable

Year of visit: 2006

Country: Democratic Republic of Congo

Institution: Kinshasa General Hospital, Kinshasa, Democratic Republic of Congo

Departments: Emergency Surgery, Orthopaedics, A&E

Work / Study undertaken

Emergency Surgery: 7am ward round in salle d’urgences On calls and clerking emergency admissions Attended theatre two mornings a week with quite a few emergency operations (numerous obstructions, trauma, appendisectomies, acute peritonitis), followed ward rounds, clerked new referrals – overnight on calls are very demanding and the medical students take a lot of responsibility for patient care throughout the night. You get a lot of patient management experience. Orthopaedics: it was interesting to see some slightly older surgical techniques for fixed flexion deformities and fracture management. The wards were a great place to practise histories.

A&E: This was a good spot to be based since my main aim was to improve my history taking skills and basic examination. Many interesting cases such as gastroshisis, gunshot wounds, multiple victim RTAs, machete attacks, a gangrenous foot.

Polio: in addition, I spent a weekend at a project funded by expatriates in which children who are still getting polio and are unable to walk are managed by an orthopaedic team and rehabilitated whereby the older children looking after the younger ones. It is an amazing project and the stories of the children are incredible. Definitely worth going – it’s good to see something positive.

Description of the service and department

It is a public hospital with 2000 beds and all the major specialties. There is very little state funding and patients end up footing the bill for all their treatment. This can be very frustrating for all concerned but the hands of the medical staff are tied by inadequate funds.

Operations are frequently delayed for several hours and patients can spend up to a week in A&E as relatives struggle to put together what little they have to afford an operation or even a simple investigation.

The medical students work in the same role as house officers in the UK and I was impressed by their depth of knowledge and experience. Many have been at medical school for over 7 years since political instability has interfered with their studies and end of year progression. They and the doctors and other staff were very welcoming, helpful and keen to show me interesting cases.

Description of the destination

The hospital is in the centre of Kinshasa, which is a bustling African capital with high levels of poverty and unemployment but has its own identity through good music and dance. There are a lot of international NGOs (aid agencies) and journalists who have a “European” style existence in relatively expensive bars and restaurants.

Were the local people friendly? Did you feel safe and if not why not?

In general the Congolese are friendly people and a greeting and some basic phrases in Lingala (the native language) will bring broad smiles to people you meet.

There was a certain amount of tension during the time I was there due to the presidential elections taking place. Demonstrations are possible and sometimes start seemingly spontaneously, this is generally due to unemployment and local advice on where not to go is highly recommended.

There is quite a lot of begging and streetchildren have worked out ingenious ways of pickpocketing – so it’s advisable to be on your guard and not take valuables with you when out and about.

What did you do in your spare time? Is there anything that you would particularly recommend others to do?

At weekends, you can hire a small speedboat and head out into the massive Congo river and have a barbecue, swim, play about on the sand dunes.

The night life is fantastic and going out with the medical students is great fun – and their dancing is incredible. Outside of Kinshasa is a national park where the Bonabo monkeys live, they are supposed to the genetically closest animal to humans and a trip out there is well worth a visit.

What time of the year were you there? What was the climate like? July – August – the dry season – hot in the day and cool at night. The rainy season (rest of the year) is very hot and humid.

What was your accommodation like? I actually stayed with a contact in an international NGO which worked out very well. There are places run by missionaries which give affordable board and lodging for journalists and people traveling through.

Was it provided? No

If not who arranged it? I did, through a contact who no longer lives there but Dr Ilunga should be able to make contact with suitable accommodation opportunities.

How much did it cost? Nothing. The accommodation mentioned earlier is about $15-20/night but could do a discount for longer stays.

Did you enjoy your visit? Yes, it was an incredible experience and I managed to speak lots of medical and non-medical French which has given me a great deal of confidence to go again. The ongoing contact with the medical students via email is a happy reminder of the times we had and I hope to continue the contact for many years – comparing notes along the way.

Did you find the visit useful medically? – in what way? The exposure to medicine in central Africa was exceptionally valuable and I learnt many useful lessons. It is difficult to force yourself to stick to the routine of history and examination but everyone was very patient and happy to talk to me, patients and medical personnel alike.

Has it improved your French? Yes, and it has fuelled a desire to go on the next possible occasion. It was great fun speaking French again – it takes a while to get used to the African twang and the odd word of Lingala thrown in but I definitely felt myself improving.

How has it increased your knowledge of French culture? Belgian – from a colonial perspective – a good book to read is Michela Wrong’s In the Footsteps of Mr Kurtz which explains all the important parts of the DRC’s history.

If you went back would you do anything differently? I would like to think that I would concentrate on more than the history and examination side of things – and be more involved with management.

How did you get there? Air France – quite expensive flights – book early – about £700.

What was the approximate total cost? £1500

Is there any other information that you think may be useful?

There’s a consulate in north London where a visa costs £40. You need a yellow fever vaccination form. One month’s tuition costs $100 – paid by all medical students, Congolese and otherwise.

There aren’t that many travel guides and travel outside of Kinshasa is relatively difficult and not tourist friendly. It is worth going for the experience of a major African capital and medicine being practised at the limits of human experience.

Useful things to take:

2 sets of scrubs (tops and bottom)

2 white coats

1 stethoscope (basic – you don’t want to be the only person in the hospital with a Littman and not know how to use it)

bottles of alcogel

a pair of glasses or protective eyewear for theatre (I used a pair of clear glasses)

1 x AFMS handbook!!

1 x French dictionary

1 pair of theatre shoes

loads of gloves

mobile phone PAYG that is unlocked so you can buy a congolese sim card – essential.

mossie repellant (for the nights on-call)

digital camera (if poss)

business cards(!!) – to avoid writing out your email address every five minutes

lots of patience