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The health sector in the Democratic Republic of Congo (DRC), like other sectors, is in a deplorable state. This is stated by a former doctor-director of the Kinshasa General Reference Hospital (formerly Mama-yemo), in this case Dr. Jules Miatudila Malonga, a retired expert from the World Bank who gives an update on the health sector of the DRC before offering a shock therapy to save the sector.

Dr. Jules Miatudila Malonga with legendary broadcaster Mr. Shaka Ssali on his show “Straight Talk Africa”

Q1. You are a former doctor-director of the General Reference Hospital of Kinshasa (ex-Mama Yemo). What is your reading of the health sector in the DRC?

The health sector in the DRC, like its other sectors, is in a deplorable state. It is enough to realize it to consult the data which are published by various institutions and even by the Congolese Government. For example, the life expectancy at birth is less than 55 years in our country against 80 for the Japanese and 87 for the Japanese; maternal mortality remains appallingly high in the DRC, even exceeding the African average of 510 maternal deaths per 100,000 live births; in each group of 1,000 Congolese children under 60 months, more than 100 deaths are recorded each year, compared to 8 in the USA and 6 in Cuba.

Between 1967 and 1975, certainly at the time when I appeared in the staff of this jewel that was Mama Yemo Hospital, the entire DRC – understood as State, Companies and Households – had internal financial resources that could allow it to address these sectoral challenges. Since then, a constellation of endogenous and exogenous factors have come to put an end to this period of fat cows.

Q2. How can the DRC deserve such a fate when several scholars say the DRC was the birthplace of the Health Districts’ mobile teams strategy and other basic concepts of primary health care?

It is a fact that the DRC is the cradle of the two strategies you are referring to, the one concerning the mobile teams and the one creating the Health Districts. Because of its relevance, the Health District concept, which was initiated in Kisantu by the Leuven University Medical Foundation in Congo (FOMULAC), will be adopted in 1978 by the global community and integrated into the Alma Ata Declaration.

another creation of the DRC. It was in 1937 that the Belgian Congo became the first country to launch the training program for Indigenous Medical Assistants (AMI).

The first AMI school opened its doors in Leopoldville (Kinshasa) in 1936 – in the current Pavilion 26 of the General Hospital of Kinshasa – and the second, in FOMULAC-Kisantu in 1937. The candidates had to carry a diploma four-year post-primary studies and pass the admission test. The AMI training consisted of four years of theoretical study followed by a two-year practical internship in accredited hospitals. At the end of their training, the AMIs were able to perform complex medical procedures, such as caesareans, appendectomies, hernioraphy and other surgical procedures. Unfortunately, they were regarded as mere “auxiliaries of the colonial administration” and they could not, under any circumstances, sign a paper: in the absence of the white doctor – who was still a white man – another White assured him interim, even less educated. In 1959, the Belgian Congo had 136 AMIs. On January 1, 1959, all these native auxiliaries were eventually promoted to the rank of sub-status agent of the African Administration. The list of promoted includes Alexis Balimaka, Georges Bazunga, Paul Bolya, Pierre Disu and Etienne Ngandu.

The training of the category of Medical Assistants was unfortunately abolished in the DRC in 1961 on the recommendation of WHO.

As ironic and paradoxical as it may seem, this training has, since 1960, experienced a great expansion outside the DRC. At present, Medical Assistants are trained and participate meaningfully in the delivery of care in several countries, including the USA (since 1961), China (since 1965), Canada (since 1984), India ( since 1992), Australia (since 2011), the United Kingdom, New Zealand, Holland, Israel, Saudi Arabia, and Malaysia. It’s not too late to do it right. The DRC should, in my opinion, resume and diversify the training of Medical Assistants or Technicians.

Q4. The Ebola outbreak has just been mastered after causing a lot of deaths. What steps need to be taken to preserve human lives in the years to come?

On July 23, 2018, the DRC announced the end of its ninth Ebola outbreak, which caused some 30 deaths. To prevent deaths from Ebola Virus Disease (EVD) in the coming years, two sets of actions will need to be expanded and strengthened.

The first group should focus on the prevention of the emergence of new cases and the second on the prevention of death of individuals infected with the Ebola virus. Good implementation of information and communication activities, increased national capacity for rapid diagnosis of EVD, including the distribution of rapid diagnostic tests (RDTs) of the EVD, as well as the vaccination of at-risk populations can help prevent the emergence of new cases. Regarding the second goal – reducing the risk of death in people infected with the Ebola virus – we will need to equip our country with the capacity to rapidly provide the areas affected by Ebola serum, specific antivirals and other required products. for the curative treatment of EVD.

While EVD does and will speak for itself, it is not among the top 20 causes of death or disease in the DRC.

All nine epidemics of EVD, which were recorded in the country between 1976 and 2017 (ie a period of forty-one years), caused less than 1000 deaths (more exactly 818) against more than 150 000 by year for malaria. Besides the latter condition, which is responsible for more than 75% of our deaths, the other diseases that dominate our epidemiological profile include chronic malnutrition, high blood pressure, diabetes, diarrhoea diseases, acute respiratory infections, tuberculosis and HIV infection.

Therefore, if we really want to preserve a large number of human lives in the years to come, we must, as soon as possible, strengthen the fight – by curative, but especially preventive actions – against the main causes of death and death. of death in our country without ever losing sight of it: we will die mainly because of ignorance and behaviour resulting from this ignorance.

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