Fro

A Rwandan
medical facilitator
working for the
American Jewish
Joint Distribution
Committee in the
Rwandan refugee
camps near
Goma, Zaire,
feeds a baby in
the infant feeding
,program started
by the JDC.

Ellen Neiman, a nurse
practitioner working for
the American Jewish
Joint Distribution
Committee's relief
effort in the Rwandan
refugee camps in
Goma, Zaire, examines
a child.

adapted easily and hit the
ground running," he said.
"They are the only African
health professionals working
in any of the camps.
"We learned from our expe-
rience in Ethiopia to use home
facilitators as well as an infant
feeding program; it really made
a difference," he said, removing
an IV from a patient in the day
hospital . He sent her home.
In addition to the African
team dispatched by the JDC, a
team of doctors, nurses, para-
medics, nurse practitioners and
epidemiologists were sent to
Goma to deal with the prob-
lems of the epidemics of vari-
ous diseases. Recognizing that it was mostly the stronger of the sick
that were able to reach the clinics for medical care, they started an
aggressive program to help those that needed medical care the most.
"We followed a classic model of public health outreach and re-
cruited Rwandans to visit each family," said Dr. Michael Harbut
of Detroit, one of the medical coordinators.
The home facilitators are trained to recognize diseases and send
for stretcher bearers to take the infrim to the clinics or hospitals. In
order to create an order in the madness, people are sent out to paint
large numbers on the side of each hut. Each family receives a hasti-
ly photocopied health card to help identify the residents and new
families moving in are made aware of the services available to them.
The organization also serves to control the drugs dispensed. Often,
a person being treated with five days' worth of antibiotics will give

or sell the extra pills after a few days if he
sees the situation clearing up — but too soon
before the ailment has been treated prop-
erly. So, each person must return to the clin-
ic to receive his morning dose with the
evening dose broken in two to make it more
difficult to sell.
The JDC/IRC team understood that med-
ical care was not sufficient to halt the spread
of disease as long as unsanitary conditions existed in the camp.Ex-
perts from the United States were studying ways of dealing with
the problems of latrines. The volcanic rock that Kibumba was hasti-
ly founded on was too hard to be able to dig proper latrines. The
group came up with a design for a wooden platform that fitted over
natural holes and crevices found throughout the camp. The sani-
tation team immediately arranged for carpenters to build thousands
of platforms and quickly installed them throughout the area. Next,
they started a program of spraying disinfectant to control the vast
amount of flies that carry diseases from the latrines and from the
corpses left in the crevices of the volcanic rock.
With cholera under control, attention was soon diverted to shigel-
la dysentery, malaria, measles, mumps, worms, and half a dozen
other diseases, and to feeding the malnourished babies. Assefa Shu-
mie, a nurse from Ethiopia, started a feeding program for mal-
nourished infants.
"We have 137 children in our feeding program. Most of the infants
are brought here because they don't have mothers. They are brought
by family or neighbors who could otherwise be out looking for food
or fuel to cook with," he said.
Besides receiving formula to strengthen the children, adults are
given soap and taught about hygiene and diet to ensure the health
and growth of the children. The infants are checked for other un-
derlying medical problems that might exist. They are referred to the
clinic for treatment, if needed.
"This child is severely malnourished. Look at the thin neck and
the skin, but he will survive," Mr. Shumie said as he placed the tiny
infant into the cradle that hangs from the scale attached to the tent.
When the Israeli Defense Force medical unit left at the beginning
of September, its X-ray machine was purchased by the IRC. It has
been set up now in what will be a 100-bed hospital. The X-ray ma-
chine is one of two in a 500-mile radius.