Katanga infirmary – A clinic in the midst of a slum

In the south of Lomé on the coast, right next to the large industrial harbour, lies the district Katanga – a slum. Illegally built huts, cobbled together from whatever people can find when they have nothing, for the most part corrugated iron and wood. There is no electricity, at least not legally. Not many water pipes, even fewer drains. Nevertheless, many people live here in confined spaces and in appalling conditions. Illnesses which had long since been eradicated re-emerge regularly in this slum, most recently multiple cases of cholera. People who live here often die of it.
Most of the slum’s inhabitants come from Togo and the neighbouring states Ghana, Benin, Burkina Faso or Nigeria. Many are fishermen who, having struggled to survive in their own countries, have ended up in search of a better life in the Katanga slum.
Here, in the middle of this desolate and forgotten area, stands a single stone house, the Katanga Infirmary. Until recently it was run to the best of his ability by Damien Nofondi, a trained doctor. Unfortunately, the infirmary lacks just about everything. Even the most basic things you would expect to find at a medical facility are not to be found here. Most illnesses are caused by the adverse living conditions: germ-laden drinking water from wells, no sewage or waste disposal, inadequate and insufficient food. In emergencies medical care is inadequate due to bottlenecks in provision of medicines and equipment. A vicious circle!
The head of the Infirmary, Damien Nofondi, is calm and relaxed as he greets us in front of the building. Standing as it does in the midst of all the totally rudimentary sheds in the slum, the rundown stone building looks almost classy. Damien wears a white doctor’s coat displaying the wording “University Hospital Ulm” emblazoned across the chest. He tells us that this came from a donation he received years ago. Since then, it has been his daily workwear. We get a tour through the different treatment rooms and have to try not to show our reactions. The most normal room is the office, which also has to serve as a storeroom for a variety of things. The medication storeroom is the smallest – very dark and not much bigger than a broom cupboard. Only after getting used to the darkness can we see open shelving with sixteen square compartments. Theoretically enough space for the bare necessities. In four of the compartments a few packs of medication can be seen. They are old and crushed. Apart from a malaria drug we can’t see anything basic. Even as non-physicians we can tell that this equipment isn’t going to be much use in an emergency! Basic bandages are not the only items which are out of stock!
The treatment rooms reveal themselves to be in even worse condition. Beds – like props from a movie from two centuries ago – torn curtains and tattered mattresses. The delivery room for births has a white-paved stone table in the middle. As young fathers ourselves we can’t imagine how a woman could give birth in here. We hear with horror that the infirmary does not always have running water and often has to work with water brought in in buckets. We don’t dare to ask where the water comes from. In the corner just such a bucket serves as a waste-water bucket – in it a used urine bowl covered in flies.
Damien does what he can. He tells us in a calm voice how difficult it is for him to get medication. Because the infirmary is so badly equipped, many sick slum dwellers do not even consider coming to it. Common gastrointestinal infections if left untreated, and in combination with the contaminated water, can often be severe or even fatal. Only a fraction of the births take place in the infirmary, as many residents prefer home births. Even today, child and maternal mortality rates are high by nationwide standards. Despite the poor equipment Damien can still draw on medical expertise from his team of nurses. But residents simply seem to have a lack of confidence in the infirmary. The inhabitants are often illiterate or did not go to school at all. The children grow up without a school system in the tough everyday life of the slums. It will take a lengthy education campaign to build confidence in the infirmary and in Damien Nofondi.
After our first visit in April 2018 we compiled a list based on Damien’s most urgent wishes: Clean water, sufficient medication for basic care, bandages and sterile equipment.
We also quickly realised that only a relationship of trust between the slum inhabitants and the infirmary can lead to long-term success. The focus has to be on women in particular – it is them who take care of the children and their well-being. And so too contact with the next generation is being made at birth. Our idea is to build trust by giving gifts to pregnant women who attend a pre-natal check-up in the infirmary during pregnancy and who go on to give birth there. We want to provide baby clothes, sleepsuits, pyjamas, hats, trousers and shirts. Furthermore, we have established initial contacts with “Doctors Without Borders” in order to organise vaccination campaigns against Child Polio which is still very common in Katanga (see project Skateboard-Ball).

One year later (2019)

One year later, with the first presents in our luggage, we visit Damien again in Katanga. We want to discuss with him what the next steps should be, and get something of an idea as to whether we can take on the whole infirmary as a project. This, in turn, would involve the necessary renovation work. We were also considering bringing in the temporary support of a (french speaking) doctor from Germany.
But when we arrive things are not at all as we had expected. First, we are taken to the “village elders” where we are made aware that we now have to request a permit to film the infirmary. Of course we had told Damien that we were coming and made clear that we only wanted to film the infirmary, but not everyone seems very happy to see us. We try to explain that we have brought donations intended for the residents of the district. We do our best to calm down the situation which had deteriorated in the meantime. We put our cameras back in our backpacks and try to take the angry men to look at the bags containing the donations. Now things get even stranger. For some reason that even now we still don’t understand, the military police have turned up. Apparently they had noticed our presence in the slum and that this was causing some uproar. The mood is now tense. Any confidence that had been established is gone. And as if that were not enough, now two men appear and identify themselves as the heads of the clan. We seem to need their permission to interview Damien. We obtain permission after some discussion, but the two men actually sit in our immediate vicinity during the entire interview to listen to every word that Damien is saying. We also sense some reluctance on the part of the hitherto friendly and very open infirmary manager. Although this had been agreed with Damien previously, we are not even allowed to hand over the donations intended for the women who give birth in the infirmary, and designed to build confidence. By this time we are supposed to distribute these to the now enraged crowd. We explain that it is mostly baby clothes and fortunately can hold back a few bags. Given the situation we do not want to be perceived as white benefactors and therefore ask the two clan leaders to distribute the clothes themselves in order to calm down the situation. We ask them to explain to the residents that any woman who comes to the infirmary in the future to have an illness treated or to give birth would receive further supportive gifts. Due to the chaotic distribution of the donations by the two men standing in the entrance of the infirmary our instructions are in vain. Somewhat desperately we try to calm the crowd but our efforts go unnoticed. We eventually have to leave through the back door to get to the van.

What have we learned from this?

What have we learned from this? A lot. First of all, there always had been a suspicion that there must have been many reasons for the poor overall condition of the infirmary. Especially if Damien, despite his efforts, had been fighting a losing battle for so long. We later learn from Damien that although he is responsible for managing the infirmary, the building belongs to the government and the clan leaders always have the final say. Who pays for the drugs, who pays Damien, who receives the proceeds of sales, are all questions that now unfortunately provide plenty of room for speculation. Proper co-ordination, which is what we had hoped for from this second visit, was not to be.
Further research revealed that other relief organisations had been active in Katanga and, more specifically, working with the infirmary. None of them are still there. Unfortunately, this doesn’t constitute sufficient basis for collaboration based on trust.
Therefore, with heavy hearts, we have decided to suspend work with this project for the time being. A few weeks ago, we received the news that Damien Nofondi is no longer acting as head of the Katanga infirmary.