At the end of last year, in the poorest, most densely-populated slum in Goma, the provincial capital of east DRC, seven men and women sat, lay or mingled around a small room in Kahembe Health Centre.
Between them they owed US$500 for medical treatment. They were not imprisoned, as such, because there were neither bars on the window nor lock on the door, but they had been told they could not leave until they had settled their debt.
“Here, we treat people first and ask questions later,” said Dr Josias Songya, the director of the health centre, which serves a community of more than 100,000.
The number of people seeking treatment has doubled since the war intensified at the end of October 2008.
Unable to pay
With little support from the government, the centre is funded by the consultation fees paid by patients and the sale of medications. The last official delivery of medicines to the pharmacy was last July so World Vision has been providing essential supplies to help keep the pharmacy in stock.
“What will happen to these people?” I asked Josias, very aware that I stood in a community where professional men and women, such as teachers, earn an appalling $30 per month.
“They will run way,” he said under his breath, with a small, knowing smile.
“Our accountant has a long list of people who have not paid. Forty per cent of patients cannot and do not pay,” he said.
Free care provided
I went back to Kahembe this week. Since January, World Vision has been covering the running costs of the centre, allowing Josias and his colleagues to provide free care to anyone who walks through the gate.
The walls are still crumbling and patients still wait out in the open on simple plank benches. Now, though, three times as many people are receiving care from doctors and more than four times as many are seeing nurses – for free.
I speak to a woman, Maria, whose five-month-old son is suffering from severe tonsillitis. She tells me how she cannot afford to feed her children properly, let alone the normal consultation fees and medication costs when they get sick.
We chat for a while and I discover she has a three-year-old daughter who has infected burns after falling into a pot of boiling water last October.
“Where is she?” I ask. “Why is she not here?”
Maria explains she had brought her son for treatment and felt she could not bring two children for free treatment.
“Of course you can,” I say. “You must.”
"Doctor, look at me"
Two days later I meet Maria at the centre and her young daughter Justine is with her. Justine finds it very difficult to walk unaided, since her wounds have damaged the muscles in her hip.
“Doctor, I cannot stand up, look at me,” the young girl says as she clutches on to her mother’s skirt.
In a poor slum like this one, the health centre is often the last place people come when they need medical treatment. They will try everything – the local pharmacy, witchdoctor, prayer groups – before they are forced to pay for the care they need.
When Justine fell into the boiling water almost five months ago, her mother went to get milk to cool the wounds. When that failed, she tried local herbal medicines, then any medication she could afford from the local pharmacy.
Now Justine will spend as long as she needs at the centre, receiving antiseptic gel, water and food to help her infected burns heal. She will sleep in a clean bed to make sure there is no further danger of infection.
“In two weeks time her wounds will be better and she will be walking unaided again,” the nurse tells me.
Seeing Justine’s eyes well up from pain but knowing she will soon be better, I left Kahembe happy in the knowledge that debt or detention would not be an issue for Marie and her daughter.
Anna Ridout works for World Vision in eastern Democratic Republic of Congo (DRC)