Access to Health-Care

In the remote tropical forest in the Northern Congo, access to primary health care is a privilege many do not enjoy. Every day children are still dying because of malaria, pneumonia or diarrhoea, diseases that can be easily treated. Mbendjele, also known as Pygmies, have been living in these forest as hunter gatherers for hundreds of years. Traditional healers have a huge knowledge about healing properties of the trees and plants. But times are changing, roads are built, new diseases emerge and spread. Traditional medicine alone does not suffice. Government expenditure on health care is less than one percent of the national budget, mostly going to hospitals in bigger cities.

Frequently, health centers are built by logging companies, nature conservation programs or religious organisations. Congolaise Industrielle du Bois (CIB), a FSC certified logging company built a 40-bed hospital in Pokola, in the center of the region where project Bwanga operates. But Pokola is far away for most Mbendjele who still live as hunter gatherers in the forest. It can easily take several days to reach the hospital or a basic health care center, on foot or by hitching a ride on a passing truck. If people reach a health care facility at all, it is often in an advanced stage of disease; a simple malaria becoming life threatening anaemia, a simple diarrhoea a severe hypovolemic shock. Often making it impossible for the nurses or doctor to cure the patient. Project Bwanga does not aim to solve these problems by building hospitals or roads but by making sure the medicine goes where the people are. This we do by training traditional healers to give modern medicine alongside their own treatments to enable them to give access to effective health care.

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Three years ago over 25 Mbendjele children from the same community died because of diarrhoea, not being able to reach the hospital in time. These children died during the fishing season, when they were living near forest streams to catch fish. Without good hygiene standards the water became contaminated with faecal bacteria. A simple oral rehydration solution would have made a big difference to the children’s recovery. In almost all the villages in the forest, simple medicines like oral rehydration solutions, painkillers or antibiotics are not available.

Access to health care and education are often given as reasons to force people to sedentarise. History, however, has shown that the enforced sedentarisation of nomadic peoples has serious consequences on their state of health. High population densities facilitate the spread of communicable diseases. Previously isolated communities coming into contact with high population densities may die from diseases to which they have had no chance to build up immunity.

Access to health care is difficult for the Mbendjele living in the forest for multiple reasons. Geographical distance: It can take easily several days to reach a basic health care center, often only reachable on foot occasionally by hitching a ride on a passing truck. This is one of the reasons why people often reach the health care facility in an advanced stage of disease, often making it impossible for the nurses or doctor to cure the patient. Sometimes, colourful medicines claiming to cure many ills are sold by travelling traders. But these traders are usually neither medically trained nor do they know much about the drugs they are selling. These drugs are often powerful and can be dangerous if taken wrongly. Also there are a lot of counterfeit drugs, containing no active substance or different active substances then mentioned on the box. This creates perverse situations where people and children take expensive drugs that, instead of curing, may seriously harm them.

Discrimination also plays an important role in making the Mbendjele’s access to modern health care dificult. The dominant farming populations liken the Mbendjele’s mobile hunting and gathering lifestyle to that of animals. Mbendjele are frequently insulted by being called ‘animals’ (nyama) or ‘chimpanzees’ (sumbu). Like racist attitudes held by some white people against people of colour, some local people say the Mbendjele do not merit the same kind of help or treatments as other sedentary people do. Deep-seated prejudices may be hard to dissolve despite efforts to do so. Issues such as discrimination must be taken in to account when planning health, education and other services for marginalised minority groups.


 

Present Situation of Hunter-Gatherers

Commercial logging and mining, conservation projects and government policies all put increasing pressure on today’s hunter-gatherers to sedentarise. This not only threatens their physical and cultural survival, it also adds to the numbers of rural poor and the diseases accompanying poverty.

For the Mbendjele in and around Pokola, Fondation Frederic Assistance Bambendjele (www.ffab.org) will pay much of their hospital costs when treated in the local logging company’s hospital (Clinique médicale de Pokola de Congolaise Industrielle du Bois).

Project Bwanga works in an area where the FSC certified logging company CIB is active. The Forest Stewardship Council (FSC) is an international non-profit, multi-stakeholder organization established to promote responsible management of the world’s forests. This means for the Mbendjele they do have a voice in the process of wood being cut on their land. Social communicators of the company go out in the forest together with the Mbendjele to establish which trees can’t be cut because they have either a meaning for food supply (honey, caterpillars) or sacred rituals.

Although this makes the CIB run hospital far more accessible, many issues persist. A lack of knowledge about hospital procedures such as, registration, where to sit to wait to see the nurse, where to sit in the office, how to explain your disease to staff, all make a visit to the hospital a difficult task. And if someone is hospitalized, how to find food for them? Since most land around Pokola is owned by others, you can not just hunt or gather as in the forest. Also, discrimination by patients from sedentary ethnic groups still exists, this can make hospital stays for hunter-gatherer patients a difficult and stressful experience. It is unacceptable that people are discriminated against because they are thought to lead an 'outdated mode of life'.

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An essential part of good health is access to food. Mbendjele are hunter-gatherers, but their way of life is under great pressure because their land-rights are ignored. Agriculturists have sometimes moved into desirable established Mbendjele camps along rivers and claimed them for themselves. Hunting and gathering is not seen as a worthwhile use of land or acknowledged to give land rights. The territories of nomadic peoples are thus treated as unoccupied land. In Congo, government agencies, farmers, logging and mining companies all superimpose their claims to land over those of indigenous people such as the Mbendjele.

The situation in terms of hunting has changed dramatically since the introduction of armed ‘Eco-guards’. Commercial logging opens roads into the forest and makes it easier for commercial hunters and poachers to access formerly inaccessible parts of the forest. To confront this in the late 1990s, international conservationists and the Congolese Ministry of Water and Forests set up anti-poaching squads called Eco-guards to patrol forest areas and enforce hunting law. Certain animals are now protected from hunting (elephant, gorilla, chimpanzee, crocodile, buffalo, wild boar and certain large antelopes). While in theory a sensible protective measure, in practice some members of the local elite organise commercial poaching activity of protected species and use their power to protect themselves from prosecution. Thus it is very difficult for Eco-guards to control the most damaging activities, since they know that the patrons of hunting can punish them for doing so, or they are bribed.

Providing meat for the family is an Mbendjele hunter-gatherer man’s main contribution to the household. But the severe restrictions placed on hunting combined with fear of the eco-guards’ violent behaviour towards Mbendjele when encountered in the forest has lead to many Mbendjele fleeing the forest and being frighteded to go hunting. No longer able to fulfil their role as hunters and provide meat for the family, there is a loss of dignity and self-worth that has lead many into alcoholism, has resulted in the break-down of moral values, increasing disruptive behaviours and levels of violence previously unknown in Mbendjele society.

Examples of the same pattern can be found world-wide. It is astonishing how little is learnt from history. We repeat previous mistakes making other indigenous groups suffer similarly devastating consequences. Enforced sedentarisation, social integration programmes and attempts to assimilate indigenous peoples into dominant societies all contribute to the significant loss of human cultural diversity – a resource as important to humanity as biodiversity, in addition to the terrible consequences it has fro bringing misery, death and suffering to such peoples.

Hunter-gatherers have unique knowledge of the balance of the eco-system they live in. Forests showing signs of over-hunting for instance are called kwana ‘tired’ and are sealed from human activity so that they recover. Leaf signs are placed around such forest areas so that anyone passing by knows not to hunt there until the forest has recovered. In order to address climate change it becomes increasingly important to search more innovatively for solutions. The intimate knowledge of people who have lived for millennia in such eco-systems could be valuable in conservation projects working in the Congo. When people are forced to abandon their mode of living and be sedentarised to have access to health, education and other services, they not only abandon their previous mode of life but also lose the accumulated knowledge and skills that came with it, and humanity is that much poorer.


 

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