diary of an emerging social enterprise

We have arrived!!! Yes, that is right, we just got a letter from the IRS that let us know that OperationOF is now exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code.

We are now a registered charity in the United States! This means we can accept tax-deducable donations (as well as bequests, devises, transfers or gifts). So we now a place where you can donate!

But we aren’t only looking for money. We know people are short on cash in these trying times, but you can still help.  Check out the donate page to see how you can help on the cheap.

We had a great deal of interest in Shannon’s posting about Jessica, the young fistula survivor who escaped the LRA. This video is a montage of pictures, music and audio of Jessica speaking about her ordeal. She specifically discusses a conversation she had with her father after the LRA abducted her. The soliders brought Jessica home and the exchange she describes with her father is quite moving. You def want to see this video with the sound on.

Thanks to Lauren Bucherie for the fantastic music supervision.

As Seth sprinted off to the surgical ward to accompany Dr. John Kelly in a complex fistula surgery our first day, I wandered into the post-op recovery ward hoping to make some friends and listen to some of the women’s stories. People say that Ugandans speak English, but that really means a select few educated Ugandans speak English fluently. When speaking to people from villages, you have nothing if you cannot communicate in Lugandan, Bantu, or Runyankore. Needless to say, I had nothing.

I slowly walked through the ward feeling like a self-conscious spectacle as most of the women unabashedly and curiously stared at my every movement. Young white women are not the usual in the Kitovu fistula ward. Smiling and trying pathetically to communicate through hand gestures and facial expressions, I felt like I was going to be the day’s main attraction. After about 15 minutes of inadvertently amusing the nurses, Mama Winnie, the head nurse and a fistula survivor, led me to a young girl from the North of Uganda who sat quietly reading the Bible on her bed. Mama Winne told me that this young lady was a very special patient I would be able to speak with her. Her name is not Jessica, but that’s what I’ll call her in order to hide her identity and protect her from the danger she escaped.

In perfect English, Jessica introduced herself and invited me to sit with her and play cards. I was immediately stunned by her ability to express herself, her confidence and her unwavering faith in everything she said and did. We passed the morning chatting Jessica even taught me to wear an African headscarf (resulting in my immediate celebrity status in the fistula ward). Jessica was from a very small village, but spoke English as well or better than many of the educated professionals we encountered along the way. I wondered how this twenty year old woman full of poise, who in any other life would be experiencing her first years of college, ended up in rural Masaka for a fistula repair? I soon learned the heart breaking answer when Jessica and I went for a walk on the hospital grounds. We stopped on a grassy knoll and I listened to her unimaginably tragic story. Her words left me with a confusing mix of admiration of her strength and complete disgust at the depth of humanity’s sadism.

As she painted my nails, Jessica told me about her village in the North of Uganda and how it has frequently experienced the brutal aggression of the Lord’s Resistance Army or LRA. For those of you not familiar, the LRA is an extreme rebel group claiming to bring a theocratic government based on the Ten Commandments and the Bible to Uganda. In order to implement their vision, the LRA regularly resorts to a variety of human rights abuses including rape, abduction and maiming of civilians, especially children. The LRA is led by an especially brutal megalomaniac named Joseph Kony. When Kony’s influence with the population began to wane, he set about abducting children from villages and indoctrinating them through unspeakable violence into his inhumane regime Kony uses children in his war because they are easy to manipulate, intensely loyal and are emotionally immature. Young boys effortlessly carry small automatic weapons that create mass carnage and young girls are forced, in many cases, to be sex slaves.

At fourteen, Jessica returned to her village on holiday from the school she attended in the South and one night was abducted from her home by the LRA. She was brought to Kony, who gave her as a ‘wife’ to one of the Commanders of the Army. She spent the next four years living in the bush. As she lifted her long skirt to show me the scars from the bullet wounds she endured while fleeing from the fighting, Jessica told me there were many girls who lived such a life. Girls who are taken from their families and lives, forced to cook, clean, care for and sleep with strange men. Girls forced to forget those who love them, run for their lives when fighting started, feel the bullets intended for soldiers, live the war that stole their innocence… Jessica eventually became pregnant at 18 and went into labor in the bush. But something went very wrong, and her baby died after days as she laboured in the bush, trying to push it out of her small malnourished body. As Jessica describes it, she died and God brought her back to life. Only, the life she was brought back to left her with an extremely severe vaginal and rectal fistula. Kony allowed her to seek treatment in a neighboring country and she made a bold decision to take that opportunity to flee – a choice that often ends in a brutal death.

I do not really have the words to describe how I felt when I listened to her story. I do not believe a string of sentences exists that can convey the suffering in her eyes or on her sweet youthful face, neither of which we can actually show you for the sake of Jessica’s safety. Nor can I describe the depth of her Faith and her profound belief in God’s plan for her.

When you read these stories, or others like them in newspapers or magazines, its easy to imagine a far-off place that almost feels fictional. But, these tragedies are real. They destroy lives, they abhor our senses and ultimately, they inspire our action.

Determined. That is the best word to describe John Kelly. I know, I know. If you look at my blog postings, at least 40% of them include a reference to or direct praise of John Kelly. Sorry, I cant help it. This guy is superhuman and the closest thing to “hero” I have had the pleasure of personally witnessing.

When Shannon and I returned from checking out of the hotel and into the home of a Kitovu-trained doctor, John was still seated exactly where I left him…3 hours earlier. He never, ever, ever gives up. “No hope? ahhh, there’s always hope.” I can still hear his voice echo as he faces down what other doctors would call a lost cause. You see, some surgeons don’t want to stain their success rate with a failed attempt on a hopeless case. John doesn’t actually know what that phrase, “hopeless case” means – he just can’t comprehend the absence of possibility. Even in the most desperate cases, where a woman has lost most of her soft tissue and retains only tatters of her excretory system, John will step up and give it a try if he thinks he can help her live a better life. Maybe not a perfect life, but an improved existence – maybe even a tolerable one. It is in these catastrophic circumstances that Kelly morphs into determination personified – the best, the only chance at a livable life for women no one else will help. So was the case when I found John sitting sweaty and undeterred, with a lap full of surgical tools and a confident focus beneath his half-tied mask. “Almost done,” he smiled.

After he finished up, John invited me for a tea in the break room. We chatted a short catch up over the warm brew and I lost John as he noticed the next patient roll past the open door. “Make sure you get enough to eat,” he demanded as he rushed out the door waving, “those doughnuts are good.”

I completely understood – John was off to save another life and there was no time to spare.

To get an idea of how local people travel and to understand the challenges of moving long distances by road transport, Shannon and I take public transport everywhere we travel. While certainly not the most comfortable mode of travel, public buses are undoubtedly the most educational.

By arriving in Masaka, we have now covered the following distance.

Total Distance: 1,724 miles (2,775 kilometers)
Total Transit Time: 74 hours

The light blue color indicates a road we traveled down twice.

View Larger Map

• Kigali, Rwanda to Masaka, Uganda - 200 miles by bus - 8 hours
• Goma, DRC to Kigali, Rwanda - 80 miles by bus - 4 hours
• Kigali, Rwanda to Goma, DRC - 80 miles by bus - 4 hours
• Butare, Rwanda to Kigali, Rwanda - 57 miles by bus - 2 hours
• Kigali, Rwanda to Butare, Rwanda - 57 miles by bus - 2 hours
• Kampala, Uganda to Kigali, Rwanda - 275 miles by bus - 9 hours
• Nairobi, Kenya to Kampala, Uganda - 375 miles by bus - 14 hours
• Mombasa, Kenya to Nairobi, Kenya - 300 miles by rail - 14 hours
• Nairobi, Kenya to Mombasa, Kenya - 300 miles by rail - 17 hours

In the DRC, internet connectivity was rarely available and my Rwandan phone didn’t work. So when I learned that the doctor at our next destination had a last minute schedule change, we had a bit of a problem. Given the communications difficulty, we decided to head back to Kigali to get our feet under us again.

After reviewing the options, we decided to pull our trip forward and go to Masaka, Uganda, to visit Dr. Maura Lynch at Kitovu hospital. I first heard about Kitovu at the April meetings in Accra, where I met Dr. Maura and she told me about the wonderful work she and her team were doing in Uganda. Kitovu is Uganda’s leading fistula hospital and was right in the middle of one of its four annual treatment camps. We were very excited to visit, but when we called Dr. Maura to let her know about our schedule change, she was clearly very busy and less than enthusiastic about our revised agenda. Her style on the phone was far from the warm Maura Lynch that I met fourth months earlier in Ghana. I attributed her less-than-inviting-tone to Maura’s shear busyness and tried not to take it personally. Shannon and I boarded another bus back to Uganda where I told her all I knew about Kitovu and Dr. Maura Lynch over the roar of the African road.

For over 70 years, Sisters from the Medical Missionaries of Mary have been committed cost-effective healing and development in some of the most desperate parts of the developing world. In 1951, the Sisters came to Kitovu Hospital and have since grown the hospital to well over 200 beds with an outpatient clinic and community-based HIV program. Dr. Maura Lynch, an Irish surgeon and Sister, started the fistula program in 1990 and has since grown it from nothing into one of the leading fistula treatment centers in the world treating over 250 of the regions worst cases every year. The hospital built a dedicated fistula ward in 2005 and these facilities attract leading surgeons from around the world to come and operate and train. Dr. Maura used to do roughly 8 surgeries a month until she permanently lost sight in one eye in the middle of a VVF (fistula) surgery. Now she serves more of an administrative function, coordinating the expatriate surgeons who come to work at one of the four training and treatment camps. I hoped and expected this to be one of the most productive and important legs of our journey and I was really excited to be there during the camp.

When we finally arrived into the dusty roadside bus stop in Masaka, dusk was falling and we were immediately accosted by the bodaboda drivers trying to grab our bags and takeus for a ride on the back of their motorcycles. For safety purposes, I am completely opposed to riding on the back of motorcycles in Africa, especially when carrying a big bag (it totally throws off the balance). After several calls to Maura, we threatened to take a bodaboda and ultimately convinced her to send a hospital pick-up to rescue us from the dusty roadside. When we finally saw her, Maura was nice enough, but she had no place for us to stay and sent us to a hotel. We went to a local hotel and spent our Fourth of July eating samosas and wondering if this leg of the trip could possibly deliver on earlier hopes. To top it all off, the ATM wasn’t working and we were very quickly running out of cash. Life was not good on America’s birthday and I was real grumpy about it.

The next morning we hopped in an expensive taxi and road over to Kitovu’s hill not sure of what we would find. Neither Shannon nor I was feeling particularly good about how the morning would turn out, especially when Maura was no where to be found. As we walked into the compound, Shannon wanted to go back and try to get cash as it was a Saturday and our last hope till Monday. I convinced her to stay but she was not particularly happy about it and sort of went off in a different direction. I went to find John Kelly, the fistula legend and my good friend who I hoped would somehow give us out mojo back. After changing into scrubs, I wandered into the operating theatre where I immediately saw John Kelly and managed to catch his light-up-the-room smile with my camera. There was an hectic energy in the room, but amidst the excitement and my confusion, John greeted me warmly and I knew would be fine in Kitovu. Shortly thereafter, Maura tugged on my sleeve saying she had a place for us to stay and was sorry she didn’t have more time to welcome us, but that she was very glad we were here. Maura also said we needed to move right away in order to avoid excess hotel charges and my smile beamed as I went to find Shannon.

I caught up with Shannon in the courtyard of the ward and excitedly attempted to tell her about the turn around. Shannon beat me to it when she said, “You are not gonna believe the stories I am hearing here. This place is fantastic!” I silently nodded in agreement as we hustled off to check out.

Just to give some idea of how much we are moving around, and the means by which we are doing it, we are launching a little travel report called “On the Road.” You see, we want to get an idea of how local people travel and to understand the challenges of moving long distances by road transport. So Shannon and I take public transport everywhere we travel. While certainly not the most comfortable mode of travel, public buses are undoubtedly the most educational.

Every time we move, we will update a map and a summary count of distance and time. For the details, just look below the map.

Total Distance: 1,444 miles (2,323 kilometers)
Total Transit Time: 62 hours

The light blue color indicates a road we traveled down twice.

• Kigali, Rwanda to Goma, DRC - 80 miles by bus - 4 hours
• Butare, Rwanda to Kigali, Rwanda - 57 miles by bus - 2 hours
• Kigali, Rwanda to Butare, Rwanda - 57 miles by bus - 2 hours
• Kampala, Uganda to Kigali, Rwanda - 275 miles by bus - 9 hours
• Nairobi, Kenya to Kampala, Uganda - 375 miles by bus - 14 hours
• Mombasa, Kenya to Nairobi, Kenya - 300 miles by rail - 14 hours
• Nairobi, Kenya to Mombasa, Kenya - 300 miles by rail - 17 hours

At breakfast the next morning, Lyn and I chatted through some ideas regarding developing an expansion of her cleft palate program and preparing a grant application to The Smile Train to fund it. Lyn wanted me to get a deeper understanding of HEAL Africa’s outreach mechanism and arranged an agenda for the day.

I started out learning about the Safe Motherhood Program. This community-based prevention program very cleverly leverages local competency in order to make motherhood safer. The trick is that the HEAL Africa program embraces all elements of the service chain. Working in 82 health centers in 4 territories, HEAL Africa engages community leaders to gain support to start training – first, the health workers and then the traditional birth attendants (TBAs). Often, these TBAs are left out of planning and action because they are not qualified health workers, but the reality is that many rural women turn to these TBAs as their primary source of obstetric services. Finding a way to work with these TBAs is critical to reaching rural woman, yet paradoxically, it is an element often left out of public health systems planning. This exclusive structure pits health workers against TBAs and results in the two groups working against each other. But by training the TBAs with the health workers and creating inclusive structures, HEAL Africa facilitates a symbiotic relationship and a deeply-reaching referral mechanism.

After training people, HEAL Africa provides health workers with basic equipment including plastic tubs and mattresses and TBAs with kits containing buckets, lanterns and blankets. While these items cost very little, they make a remarkable impact on motivating the health providers (both trained and informal) and improving the safety of childbirth. HEAL Africa has also set up over 130 Solidarity Groups, essentially clustering over 4,000 women of motherhood age into income generating teams. In addition to producing profit that acts as a maternal health insurance fund, these groups also create an empowerment bond that has women looking out for each other amidst the calamity of war. Of all the projects these groups do, I thought making baby clothes was the coolest. In most parts of North Kivu, newborn babies are wrapped with dirty blankets or left uncovered all together. But the Solidarity Groups make baby clothes that HEAL Africa buys and offers free to any baby born at a participating health center. Women who would have had their babies in villages trek well out of their way to get this $1 perk and deliver their children in supervised environments that are safer for mother and baby alike. Now that is social innovation!

That afternoon we hopped in a jeep and headed out to a school partially funded by HEAL Africa. I tagged along on this visit, mostly just to see a bit of the area surrounding Goma. The school was situated a couple miles off the main road and directly adjacent to an enormous UN Refugee camp that had moved there about a year after the school had been built. As we slowly crept down the lava road that ran along the camp, I peered down the endless rows of rounded straw huts wrapped in white plastic tarps that almost looked like a neighborhood of igloos. The displaced people had lived in this “temporary camp” for several years and there was really no end in sight. I saw sad, empty faces, weighted down from the struggle for survival and the absence of hope. I couldn’t help thinking about how awful it would be to grow up in such a desperate environment. These unsettling thoughts stayed with me even after we arrived at the school, which provided quite a contrast in terms of possibility. As I watched the singing children play happily in their school yard, I couldn’t take my eyes off of the white plastic valley of hopelessness in the background.

We stayed at the school a couple hours and then headed back over to Grounds for Hope, the long term fistula care center we visited earlier in the week. In this day, I had already travelled from the excited lightness of the morning’s safe motherhood discussion to the dark heaviness of the refugee camp. I wasn’t talking much as we bounced down the dirt road in the HEAL Africa jeep, but I was thinking as I stared out the window. That’s when I saw him. We turned a corner and there stood a man on the side of the road. His wide eyes were completely focused on our jeep and his dusty hands cradled a Kalashnikov assault rifle. I don’t recall how the rest of the car reacted or if anyone even noticed, but this site took my breath away. Here stood a man in a sleeveless black t-shirt and tattered green shorts – not a soldier, but a farmer - too poor to buy shoes or a shovel, but armed with immediate and deadly force. Time seemed to abandon us as we passed this man, returning only as we turned the corner and escaped his gaze. This sight shook me up and I outwardly wondered why the gunman allowed us to pass. The other passengers told me that because HEAL Africa is a Congolese organization and so well respected in North Kivu, they had never had any incidents when traveling in marked vehicles. I began to understand why every HEAL Africa car had the logo hand painted on the doors and usually flew HEAL Africa flags out the window in addition. Even with the explanation, I still hoped we wouldn’t run into our machine gun-toting friend on the way home.

Luckily, we didn’t see anymore gunmen on the ride home, but instead we had the good fortune of some stunning views of the volcano. The events of the day dominated my thoughts. Seeing exactly how tough the outside environment was in a relatively safe area made HEAL Africa’s work even more impressive to me. I resolved to understand more about how they established such a presence amidst so much instability. Over dinner, I quizzed Lyn about their outreach process and discovered HEAL Africa’s outreach enabler: the Nehemiah Committees. Like other groups doing good work in the chaos of conflict, HEAL Africa is a faith-based organization. To build a network, HEAL Africa approaches community leaders, most of whom are religious leaders of various faiths, and invites them to a workshop to read the Book of Nehemiah, an account of the rebuilding of the wall of Jerusalem. Since its part of the Old Testament, all Abrahamic religions recognize the Book of Nehemiah and are willing to discuss it. This important detail enables HEAL Africa to engage both Muslims and Christians, alike. The reading workshop is intended to create a Kumbe Moment in which the community leaders commit to developing a cross-faith committee that works to protect the rights and interests of the society’s most vulnerable people. Through these committees, HEAL Africa is able to offer services to the most needy people in the most isolated places.

After a volatile day of intense emotions, I fell into bed feeling really good about our trip to the DRC. Though we would be leaving soon, the trip had been an incredible success. We learned volumes about holistic services and creative outreach mechanisms and we were even able to lend a hand with the Smile Train grant application. I fell asleep wondering what was next.

The short night had not only robbed me of slumber but it also nearly made me late. I scrambled to get dressed and missed breakfast in my rush to meet Dr. Jo Lusi, who I found waiting patiently in his jeep with the passenger door open. As I hopped into the jeep, Jo put a tape into the car stereo and immediately started singing along with music. In between his accompanying vocals, Jo explained the reasons why this Congolese singer was a legend and exactly why her voice was so magical. I remember the reasons, but have forgotten her name…

Lulled into an absolute state of relaxation by the melodic commute, I was not prepared to chase Jo as he burst from the almost-stopped car. But lucky for me, he spotted some clubfoot patients before Jo could get too far from me. Having spent considerable time the night before discussing this devastating and correctable condition, Jo was excited to show me and I was thrilled to learn more. The kids absolutely love Jo and as he knelt down to show me the cast of one boy, I noticed several others waiting their turn for even a small amount of Jo’s attention. He made an example of each of the children, showing me the nuances of exactly the same cast multiple times. Jo’s passion was evident and it was less for the cause than for the kids whose lives he was transforming. After he had attended to each of the boys in the yard, Jo rushed me onto a quickly-paced jaunt through a maze of wards.

As we bounded through the dizzying and emotional tour, I found myself overwhelmed by the sheer number and magnitude of sad stories in the ward. Everywhere we turned there were crowded wards full of kids waiting for surgery, all living with different debilitating and very visible ailments. There were several babies with clubfoot, and a few with hydrocephalus, a condition where the skull fills up with water and expands to an incredibly large size. There were also several kids with cleft palate, a condition that those of you who were part of Summit for Smiles know is very close to my heart. Other wards had direct victims of violence, from burns to gunshot wounds, but the saddest and most haunting patients were the survivors of sexual violence. Their wounds were much more than physical.

Every square foot of space in the hospital had a body awaiting medical attention. When I commented on the numbers of patients to Jo, he smiled and said, “You know, this is the second floor, right?” As my face contorted while I considered the logic for building a basement ward, Jo started laughing. It was only then I realized that he was referring to the hospital that stood on these same grounds before the volcanic eruption destroyed everything in 2002. As tough as things were here now, I imagined how awful it must have been for the citizens of this region when HEAL Africa’s buildings had been consumed by the lava only 6 years earlier.

It was when we were nearly running to get to another part of the complex that Jo abruptly stopped and turned to look me right in the eye. “Seth, I love your idea and I think you can really help, but if you really want to make a difference, you need a Kumbe Moment.” Hmmm, I could hardly disagree. So far, Jo had been nothing but insightful. I wondered what a “Kumbe Moment” was and where I could get one. Just as I drew the breath to ask, the smiling Jo launched into his colourful explanation. “A Kumbe Moment is a discovery – it’s when you realize something you didn’t know before and you say, ‘ahhhh, Kumbe! – I get it now.’” This is where I expected Jo to reveal the great flaw in the OperationOF strategy – the Achilles heal that would keep our burgeoning social movement from greatness. I began to consider the volumes of things I didn’t know, scouring the seemingly infinite list for the one detail that would sink us. Jo’s laugh brought me out of my trance, “Seth, the Kumbe Moment you need is with African doctors.” Completely enthralled, I nodded and breathlessly paused for the second half of the insight. “If you want African doctors to really work on something, you have to show them why it is worth their passion and focus. You need to inspire a Kumbe Moment where they deeply understand and connect to the cause. Otherwise they will simply take your money, say all the right things, and dance your dance until you leave.”

Completely shocked from the unrestricted candor and incredible insight, I was not only speechless, but I also must have had quite the look on my face. Jo looked at me with concern, patted me on the shoulder in an it’s-gonna-be-alright kind of way and said, “Check out Healing Arts and let’s catch up at dinner.” And with that Dr. Jo Lusi quickly floated away. I took a moment to catch my breath and absorb what Jo said and then wandered over to Healing Arts.

To say HEAL Africa has a holistic approach to healing is a bit of an understatement. Instead of simply merging the medical and psychological aspects of treatment HEAL Africa also includes the economic and emotional well-being of patients and their families as part of their strategy. An important component of this effort is Healing Arts, the textile business that allows patients to produce and sell anything from wristbands to dresses. A room full of classic-looking Singer sewing machines had a woman at every terminal, each crafting some ware with the beautiful and colorful fabrics native to this land. Even in front of the building, there were women hand-sewing simple fabric bracelets as their children played in the black gravel of open space. Melody was ever-present with these women and from a distance they sang beautifully simple songs as they stitched fabric in the sun. Only when they noticed me approaching did they grow quiet and shy. Determined to capture some of their lovely songs, I set up a mic and walked away. Only after several minutes of my absence did they resume their harmony. Here is a little clip of what I recorded, though it hardly does the original version justice.

Shannon and Jackie (a doctor we met in Rwanda who joined us in the DRC) were measured for some custom fitted clothes and when they were done, we all headed over to the little hospital school room. As mentioned, HEAL Africa goes to great lengths to fully engage as many people as possible while they are in Goma. This includes offering a young patients an opportunity for some lessons taught by a psychologist-in-training named Charles. Shannon mentioned a bit about this visit in her blog, so I will only say that we have posted a short slideshow in the pics section of the blog that includes some of the songs they sang for us.

When we finally returned to the paradise of Maji Matilivu (the guest house), we found Lyn Lusi clipping roses in her beautiful garden. After a short tour through the garden, I found a quiet place to ponder. I could not stop thinking about all I had seen during the day. I thought about all those patients waiting for a chance to heal and how limited general surgical capacity affected each of them by delaying their turn for treatment. I thought about how adding specific capacity for fistula could potentially benefit all patients, but wondered how I could help an organization already doing over 200 fistula surgeries per year and doing them well. Even though we had come here to learn, I really wanted to help, but I just could not figure out how.

I had my “Kumbe Moment” at dinner. Lyn was describing some of the difficulties of serving such a broad set of constituents over such a large and tumultuous area. She discussed how certain conditions get left out because of limited skill set or funding. In this discussion, she mentioned cleft palates as one such condition. I immediately lit up and nearly screamed, “ahhh Kumbe!” After the initial scare I gave the table, I went on to explain my epiphany. If we could get funding for cleft treatment, it would allow HEAL Africa to expand their organization and eventually serve more people, including women with fistula. I suggested we work on an aggressive growth strategy and prepare a grant application for funding from The Smile Train, who I met with last May in New York. Of course, this spurred an excited conversation that lasted far too late and kept my heart beating far too vigorously.

I climbed into bed through a cloud of thoughts, considering precisely how treating children with cleft palates could indirectly benefit women with fistula and knowing this would be another long night.

I’m not sure if it was the flashing Travel Advisory by the State Department or the stories of people being detained at the border, or maybe everything I had read about the Democratic Republic of the Congo (DRC) in the Spring semester as I had studied sexual violence in the Eastern region, but the air seemed to have a overt sense of explosion. The DRC has been embroiled in a horrible regional and civil war for the past decade that has cost the greatest number of lives since World War II. Currently a ‘ceasefire’ remains in place but as we quickly learned, words and signatures on an agreement are trivial in an environment where human life has little value.

Signs of the war were palpable as we toured the hospital grounds observing victims of gun shot wounds, burns, and rape. The fighting continues and the most horrific consequences fall on women. Rape has systematically been used as a weapon of war in the Eastern Congo in an effort to demoralize, deject and destroy communities. The violence has not subsided as over 2,000 women reported rape in North Kivu in the month of June alone (although the true figure is likely much higher as cultural stigma is assigned to the victims). Sexual violence continues on an unimaginable scale and women who survive such harrowing experiences can derive a traumatic fistula—a tear in the vagina from violent rape. Violent injuries like traumatic fistula are generally less common than obstetric fistula, which results from lack of access to maternal healthcare systems. In regions of war and instability, increased violence coincides with a complete break down of already dysfunctional systems and absolute catastrophe ensues.

My months of reading and research materialized as we walked through the doors of the female ward. An elderly woman shuffled around her bed, using the edge to support her frail body. When our eyes met, she stopped and I watched this poor woman hunched uncomfortably over her bed, every line in her deep brown skin and the faint light in her eyes conveyed a lifetime of hardship and tragedy. When Dr. Jo told us this eighty-four year-old woman had endured a violent rape only a few weeks earlier, my heart sank. I wondered how a human being could purposefully inflict so much pain and suffering on the life of another. This woman was waiting for a corrective surgery to repair the traumatic fistula that violent encounter left her. Despite appreciating the service HEAL Africa offered this woman, I felt heart broken that this grandmother in the twilight of her life should ever need such an intervention.

Some cases of fistula are not easily corrected and require multiple attempts at surgery. Around 10% can never be healed because so much tissue has been lost. HEAL Africa established a small commune of women with complicated or irreparable fistulas who live and work together several miles outside of Goma. The commune collectively produces soap and textiles to sell as well as raise rabbits for food and manages a large garden for vegetables. Some women have been there for weeks and others for years but they have all bonded like sisters and mothers, taking care of each other, giggling and gossiping. The community is called “Grounds for Hope” and the name lives up to the mood in this compound. Most of them are smiling and affectionate, which is encouraging to see when you consider the emotional trauma that lurks just below the surface.

While we were there a beautiful young woman was visiting Grounds for Hope. This young woman, lets call her “Rebecca,” had lived at the commune while she healed from her complicated fistula and wanted to come see her friends during her school break. Her story is disturbing. At 14, a rebel militia man courted her and when her family refused to give her hand in marriage, the militia responded by setting her home ablaze. She was not there, but several members of her family were trapped inside and burned. Rebecca continued to escape abduction until the rebels finally caught her and made this adolescent their slave in every sense of the word. By 17 she had survived rape, pregnancy, and a prolonged labor in the bush that left her with a fistula. Leaking urine, Rebecca had little worth to the militia and she escaped before they murdered her. She eventually found her remaining family and Heal Africa and returned to school – the only subject that really made her smile.

We had a chance to visit a school HEAL Africa created to accommodate young patients or the children of patients as they waited to recover. When we first walked in the small classroom, the scene in the class could have been a school house anywhere. The kids, obviously overjoyed to have visitors, sang welcoming songs and were eager to see where we came from on the map. After this very warm welcome, the teacher wanted to show us the affects war has on the children asking basic questions such as ‘what do you want to be when you grow up?’ The traumatic scars of the war emerged in their answers. One gregarious boy stood up and replied ‘NOT a soldier!’ as he recounted the night soldiers came into his home, beating his mother and stealing all of their belongings. In this brief encounter, we heard these children calmly recount unimaginable tragedies - for a child should see their father abducted or their sister raped and to recount it so unemotionally…its an unsettling experience.

Press reports and articles in magazines cannot fully capture the absolute chaos of the Congo. But in an environment where little provides hope, HEAL Africa is a wellspring sanctuary offering some note of redemption in such a destructive place.