A Fragile State

Last week, anti-government protests swept across the Democratic Republic of Congo, killing more than 44 people and widening the cracks of the country’s fragile political stability. With the flagrant abuse of human rights, President Joseph Kabila is trying to stay on past his elected term, and in a country that has never experienced a peaceful transition of power, things don’t yet look set to change.

For my six-month practicum I am living and working in Goma, a sprawling city sandwiched between an active volcano and the shores of Lake Kivu in the eastern DRC. With local non-profit Rebuild Hope for Africa and Population and Family Health professor Les Roberts, I am conducting a study measuring mortality in the displaced population. Though I have worked in sub-Saharan Africa before, this is the first time I have come to a city like this, born out of the world’s most brutal human suffering, and a country so precariously on the cusp of falling apart.

It is at times like these that the protective veil of wealth and whiteness thins and I am soberly confronted with the reality of people’s lives here. I know that danger and fear sit not far beneath the surface of existence in the DRC. But it is only now, as we sit on the balcony of the office where I am working in Goma, contemplating the months ahead, that I can see it in the eyes and hear it in the voices of those I am working with, tinged with the weariness of history repeating itself.

Whilst at once tying our fortunes together, these events also underline our separation. I have the contacts and material resources to leave. I exist in a world that cares about my fate, my skin color and citizenship holding me above others. I chafe at the irony of my colleagues asking me about my safety, while knowing they themselves have no way out.

As a student in global health, the increasingly uncertain situation here raises difficult questions. What is my role? What is the role of the global health community more broadly? By being here we are part of this, but is simply being here enough? What difference can we hope to make in a problem so dauntingly multifaceted, so grand in scale?

In Goma, the international aid and security presence looms large. UN tanks full of gun-toating, blue-helmeted men and white land cruisers emblazoned with the logos of international NGOs choke the streets of centre ville. Most aid agencies are founded on the principle of neutrality, because taking no side and playing by the government rulebook preserved their ability to act safely and fairly, and reach the greatest number of people. But as recent events in Syria and Afghanistan show, where humanitarian actors have been deliberately targeted in illegal acts of war, we find ourselves in a lethally one-sided agreement.

With impartiality no longer the shield behind which we can safely give aid, I find it difficult to condone having no opinion, not engaging in the issues that create the need for our work, not using our voice at all. The world is all too ready to swallow more clichés and accept the deaths of distant others. Not being tied to a political agenda, perhaps our role is to capitalize on our privileged status and break the silences that kill so many.

However, we cannot expect, and nor would it be desirable, for autonomous aid organizations to risk their mandates by wading into political debate. Rather, it is the collective effort of the global health profession that makes us powerful. There is a decades-old industry of humanitarian assistance in this city and one that I think has made a profound difference to many people. From those at the small Congolese NGO that I am working for, to the big names of the aid world, there are an awful lot of people here, each achieving small victories in a vast machine trying to alter the narrative of this country.

While it can be hard to see how my presence amounts to more than a learning opportunity and stripes on my lapels, a career of many small actions alongside so many colleagues in similar pursuits could amount to something profound.  

The tension of global health is feeling the need to act whilst knowing that quick fixes won’t do the job. In medicine you can take direct action to help those in front of you, though you are merely patching up recurring wounds. Yet the starkness and immediacy of the needs of the population also make the delayed impact of public health and research seem insufficient. As one of the community monitors in our study asked, “How can I expect to ask questions to these people every month, without giving anything in return?”

As the disturbingly familiar scenario starts to unfold here in the DRC, the questions I have posed remain only partially answered. But I’m beginning to wonder if perhaps this is how it should be in this field.

If you turn up at a hotel bar on the right night of the week, you will find ex-pats of all stripes exchanging stories over bottles of local beer. Beneath the bravado though, I think most are asking themselves why they are here and whether they are doing the right thing. I hope this uneasiness inherent in global health work spurs individuals and organizations to be vocal, and that the constant questioning signals our collective ambition to keep searching for better answers.

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Prudence Jarret is a medical doctor from London, UK, and a second year MPH student in the department of Epidemiology. She has conducted research and clinical work in Zimbabwe, Swaziland and Malawi, and aims to apply her combined clinical and public health training to future work in humanitarian assistance.

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