Congo Kinshasa: Little Justine's malnutrition battles

The letter was written on a page torn from an exercise book. The paper was folded in two and fastened with a single staple.

“Boboto Medical Centre, Basankusu Diocese.

Dear Monsieur Francis,

We have a child here in our care. She was sent from a medical centre in a nearby village, with severe malnutrition. We’ve treated her as best we can, but she really need to have good food if she’s to continue to improve. Please send the following: Special milk powder F-75 (5 tins), rice, corn, sugar, vegetable oil, peanuts, beans, and dried fish.”

It’s not that we wanted to refuse them these essential foods, but our experience had taught us to be cautious. If we’d sent the things they’d requested, it would be the start of a slippery slope. A few of the staff at the medical centre would take a few cups of each thing, to use at home. We can sympathise with these little “borrowings” – perhaps their own children could do with a bit more nutritious food. What we suspect is that next time – and there would be a next time – they would ask for more foodstuffs, and take even more of it home. A slippery slope – and it would leave our children short. I wrote a reply.

“I was very pleased with your letter describing your patient and the care you are providing for her. Unfortunately, it’s against our policy to sent food to other institutions. We would, however, be very happy for you to transfer the child to our care.”

The little girl was Justine, a pale, frail looking 6-year-old. She’d arrived from a village, somewhere on the road to Bokakata, 20 km away. She was painfully thin. A lot of her initial swelling had gone down because of her treatment at Boboto Medical Centre, but she was very pale – and her skin was peeling as if she’d been burnt.

 Justine just after arriving at my house

Judith smiled. “She just needs the right food – in a couple of weeks we see a big change in her,” she said.

A couple of weeks went by. Justine was usually lying down next to her mother on a raffia mat, which was on top of her bamboo bed. Judith called me across to where they were so that I could give my opinion. We couldn’t see any change. She just lay there, listless. She started to develop pressure sores where her bony knees, and her hips, lay against her bed.8

“You need to change her position frequently,” I told her mother. “Change the position she lies in every half an hour. Raise her knees and where ever else she has a pressure sore from the bed, by making a cushion from clothes on either side of the wound. Dress the wounds with palm oil – we’ll give you some chloramphenicol to mix with it to avoid any infection.”

Justine’s mother and grandmother did a really good job. They made little cushioning pads to raise the affected parts of her body away from the bed, they changed her position frequently and they painted her wounds with shop-bought palm oil mixed with chloramphenicol powder. (We crushed tablets to make the powder.)

Another week passed, and we still couldn’t see any improvement. Her skin got worse and she couldn’t resist scratching. She scratched her face and removed a lot of skin. She was a mess. Her shoulder blade stuck out like an axe.

Justine's condition deteriorated 

“What more can we do, Francis?” implored Judith. Justine had had all the usual tests and treatments. She’d taken tablets for worms; she’d been checked for malaria. Perhaps we’d assumed too much about her treatment at the Boboto Centre. “Let’s take him to our hospital, next-door,” I said. 

“But she’s already been to Boboto – what more can they do?” said Judith, obviously worried. 

“The doctor knows his job,” I said. “It’s very easily something we’ve missed.” It crossed my mind that Justine could have an underlying condition – leukaemia for example – and not all of such conditions could be diagnosed here. If they could be, perhaps they couldn’t be treated.

I went with Judith to take Justine and her mother the short distance to the hospital. It didn’t take Dr. Eric very long to decide that her blood iron was low, and that a transfusion would help. 

I’m always reluctant when severely malnourished children are sent for injections, and transfusions. We had a little boy who had several intramuscular injections, at Basankusu’s general hospital. He developed huge wounds at the site of each injection and died, that night, of shock. So it’s easy to understand my apprehension. 

“Don’t worry,” Dr. Eric reassured me. “That’s only a problem with injections into the muscle. We’re not doing that. The blood transfusion will give her some appetite! She’ll start to eat with gusto! You’ll soon see a change in her.”

My experience of blood transfusions in Basankusu, has also left me wary of the eventual outcome. In the past we’ve had both adults and children who’ve improved tremendously after a transfusion, but then gone downhill again after two weeks. 

Justine’s mother agreed to the transfusion. She wouldn’t have been able to afford any treatment at all. The nurse sent someone to call one of his trusted donors. Even when they trust the donors, there’s still a risk that the blood could be harbouring some disease or other – but here in the Congo, everything is a risk.

Justine stayed in hospital for 5 days after her transfusion. They wanted to keep an eye on her. Her mother, who was pregnant and had another small child in tow, went home to their village. When Justine came back to us, she told us how nice it was to sleep on a foam mattress. She decided that the mattress had helped heal her pressure sores, which could be true, but it could also be the result of the transfusion. It’s true that she won’t return to one in her home village, but we decided to buy foam mattresses for all our in-patients.

Justine with her mother at the hospital

Justine’s grandmother was becoming more impatient with her stay at my house. She wanted to return to their village. Around this time, we were arranging to travel to Kinshasa. There’d been a national lockdown on all domestic travel, because of Coronavirus, and so this would be my first chance to travel since my arrival, this year, in February. Justine’s grandmother decided, without foundation, that they wouldn’t be fed properly if Judith went to Kinshasa, and so she’d rather return to their village. 

I discussed the situation with Judith.

“Yes,” she agreed, “we could send them with food for a few weeks, but I doubt that they’d give it to Justine alone. They’d feed the whole extended family with it – and perhaps sell some of it. Justine wouldn’t make much more progress.” 

Justine after leaving hospital.
Her shoulder-blade still as sharp as an axe. 

I shared my worries about how the good effects of a blood transfusion might wear off after a couple of weeks, and that they should stay with us for another couple of weeks. “If not another month!” added Judith. 

A photo of Justine taken a few days
before she was taken home
to her village

After some discussion the grandmother reluctantly agreed to stay a few more weeks. We flew to Kinshasa and Justine was transferred to our main centre, on the other side of town. A week later, unable to settle at the main centre, they moved back to the accommodation at my house. We were happy that the spent a further 3 weeks to help Justine put on more weight. All her bedsores had healed, her colour had returned and she looked altogether better.

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So here we are in Kinshasa – still working hard, buying up provisions and equipment for the centre in Basankusu.

One day, Judith’s phone rang. It was Justine. Even though her village is 20 km from Basankusu, they have a clear view of our phone mast, and can make phone calls. Judith was over the moon to hear how well she sounded.

What's the difference: Francis Hannaway’s Centre for Malnutrition, Mary’s Meals and Aid Organisations?

Some people say, “Francis, why don’t you contact Mary’s Meals? They’re probably in Congo by now and they do the same as you.”

Francis Hannaway at his Malnutrition Centre
in Basankusu, Congo

Six years ago, when I was about to set off for my old stomping ground of the Congo, one of my past students, Jean René Lingofe, told me about his life as a teenager at secondary school. He lived in a village 80 km from Basankusu, with his younger brothers, so they stayed with an uncle near the school, returning on foot to their village at the weekend. His uncle often had little to give them and so they often went hungry. Studying was difficult on an empty stomach.

The logo for Mary's Meals
- our work is different 

One of the staple foods in the Congo is called fufu. It’s basically, flour of some sort, usually cassava flour mixed with cornflour, boiled up like ground rice, or semolina, without the milk and sugar. It accompanies whatever else you have and is usually dipped into sauce, or gravy, for flavour.

“If you want to help the local population, Francis,” Jean René implored, “please, just set up a kitchen to give school kids some fufu every day. We suffered so much, trying to study and then having to walk home hungry each weekend.”

Fufu - a filling and starchy favourite
in the Congo

I seriously considered it. There would be a huge group of hungry teenagers. Then there would be the people who cooked the food – perhaps they would take some home. People who already sold doughnut balls, peanuts, fried sweet potato and so on would see their businesses go down. The people cooking it would take half of it to send to their families at home – I would be feeding half of Basankusu.

Mary’s Meals is a fantastic organisation. They aim to give children one substantial meal a day at their school. They train local people to cook the meals, and build, or adapt an existing building, to serve as a kitchen. Children learn better when they’ve been fed. Simple.

Are they in the Congo? No.

Will they be in the future? They tend to be in English speaking countries, Congo prefers French. Perhaps I should talk to them.

However – that’s not what my centre for malnutrition does. 

Up to 75 children are treated at
Francis Hannaway's Centre
at any one time

The children we help are severely malnourished, and many in danger of death. Indeed, since we began, around 100 children have come to us too late, or had serious underlying conditions, and died. There is a difference with the children benefiting from Mary’s Meals. Our children are not hungry schoolchildren needing to eat before studying. They are usually from families who don’t have the means to send their children even for free primary education. Other children with moderate malnutrition are already on the slippery slope to severe disability and possible death – our job is to prevent further decline and to educate their parents to vary their diet and to make feeding their children a priority. Malnutrition can be seen in several ways; it isn’t just about not having enough to eat. Children can eat until they are full and still be malnourished. Malnutrition happens when they eat energy-poor and protein-poor foods. The child doesn’t thrive without protein, vitamins, minerals and energy giving foods like fats and carbohydrates. 

Some children have suffered neglect in some form or another. Family breakup is common. A child is left in the care of others – others who actually don’t care. Sadly, some very small children are left at home, without a thing to eat, from early morning until the evening while their parents go to their forest garden, or go hunting. That’s neglect.

Little Mboyo was so thin,
we named him "Skeleton" 

However, the classic case of malnutrition, in our experience, is of a child who has lived a fairly poor existence and then become ill. Perhaps his mother has become pregnant again, or given birth to a second child. Whatever the situation, the child loses weight drastically and struggles to put it back on with the poor diet that is available. Often the supplement of breast milk is no longer available.

Illnesses can include, malaria, intestinal parasites (worms), low blood iron due to poor diet, childhood immunisable illnesses such as measles, mumps, rubella, TB and general infections. Measles for example begins with a fever, small sores appear in the mouth, the child feels lousy and to top it all gets chronic diarrhoea. All these things prevent the child from eating.

A child with severe acute malnutrition (SAM) will start to use the protein of his muscles for energy. Fluids will build up because of the imbalance of proteins and salts. The classic big belly, thin arms and legs image is created. Feet swell until they are so painful they look like they could burst. Damaged skin is stretched and starts to peel – it looks like the child’s been scalded. Even though this is not a burn, the effects are the same – blood fluid (plasma) is lost through the damaged skin and pressure sores develop easily because of tissue damage. Internal organs, such as kidneys, can be damaged. 

Little Mboyo - before and after

Treatment is a delicate process. It’s a combination of medical intervention and an easily absorbable diet, high in energy and high in protein. Education of the caregivers comes later – the first thing is to save the child’s life. That’s what we do.

“But, Francis,” you might ask, “isn’t that what Doctors Without Borders, the Red Cross, Cafod, Save the Children, Unicef and all the rest do?”

Yes, they do. The difference is that they respond to a specific crisis, spend several weeks and then move on to somewhere else. Our work is long-term. 

Doctors Without Borders recently came to Basankusu in response to the measles epidemic, which killed about 7,000 nationally. The materials that were left behind were never used after the aid organisation left. Instead, it was sold by local health professionals to the only organisation in Basankusu that treats malnourished children – and I know this, because it was my organisation that bought the special milk powder which had been denied to us earlier.

Children become irritable and often bad-tempered when they're severely malnourished. When the start to laugh and play, we know they're on the mend 

“But, Francis,” others might say, “surely you would make a change in society by holding training sessions for the general population. They would pass on the knowledge and malnutrition would come to an end.”

If only this were true.

My experience is that the people who would attend training sessions are the people who already know how to look after children’s wellbeing. It would be like preaching to the converted. I set up a community vegetable garden in a village upriver from Basankusu, with the help of the Catholic Mothers League. They did a great job planting beans to help poor families. Unfortunately, most of the money I sent for the project was spent on so called training – in which each attendee receives transport costs (it’s a village, they all walked), and their dinner. The danger is that people attend for the free meal and then don’t do anything with the training. It’s a national problem. The people who would benefit from any training don’t ever turn up.

Similarly, I’m often criticised for feeding the children with food that they wouldn’t normally eat. “They’ll go back to their villages and won’t be able to find these things,” they say. We use milk with sugar and vegetable oil in the initial stages of treatment. However, our porridge made from soya, peanuts and maize would be easy to make in the village. The traditional foods (actually introduced from Central America) are the things that made them malnourished in the first place. In the 28 years I’ve been associated with the Congo, I’ve seen changes in people’s diets. Bread is a much bigger part of the diet than it ever was, and beans are so easy to grow – and extremely nutritious!

Francis Hannaway's group is registered as the Association of Rural Women - Against Malnutrition

So, getting back to the original idea: Mary’s Meals is a fantastic organisation which helps children to stay in school.

Aid organisations do a great job in emergency situations.

Send a donation today to help Francis Hannaway with his work. 
Click/tap the link above

My malnutrition centre does an amazing job, using local volunteers and mostly local produce. We’ve successfully treated over 3,000 children. We save children’s lives and hope that later on they would benefit from a school feeding programme, like Mary’s Meals

In an ideal world, every neighbour would look over their fence and help the family next door. Because of general poverty, this rarely happens, especially if you’re not in the same family. 

Running a supplementary feeding programme is a very expensive enterprise – we can only do it with your help. Yes, your help. If we had more funds we would extend it further. Nobody takes a salary; we don’t even have a car. Send what you can today – save a child’s life. Thank you.

Congo Kinshasa: Covid-19 restrictions end - allowing a return to Kinshasa

As the leaves turn to reds and gold, and the sun starts to pass lower in the sky over Europe and North America, I find myself in hot and humid Kinshasa, Congo’s capital of 11 million people.

Since I last wrote, a lot of things have happened in Basankusu, where I run a centre for malnutrition. Basankusu is a small town of about 24,000 people, and sits on the Equator, in the rainforest.

Severely malourished children arrived
almost every day 

The Doctors Without Borders (MSF) team did indeed leave, as expected – and children with malnutrition started to return to us. The effect of their work, and perhaps the slightly earlier arrival of edible caterpillars, did seem to reduce the number of children arriving this year. Perhaps – this being the 6th year of my project, it has been the long term effect of my own project on the population generally. Yes, perhaps it’s time to congratulate ourselves for our ongoing successes.

The children that did arrive – mostly from outlying villages – were in a very poor state. They arrived with grandparents, parents and younger brothers and sisters. We accommodated them at my house. We built a single roomed house for them and a thatched shelter next to it as a kitchen. Three died during the first night after their arrival. A month later, 2 more children died – a week apart. They’d all arrived too late to be helped. 

From the end of May until the end of May, we treated around 30 children at my house (Centre 2). At the main centre food was provided for between 20 and 40 children 3 days each week, by the volunteers. Overall, around 150 children have received treatment since I arrived back in February. Mama Solange arrived with her baby and toddler, herself suffering from severe malnutrition. Everyone at the main centre got better and was eventually able to go home.

We’d applied for special milk (F-75 and F-100) from the Doctors Without Borders group and been refused. After their departure, we found that the health services hadn’t distributed or used the milk, they were waiting for their chance to sell it to the only effective treatment facility for malnutrition for hundreds of miles – namely to my centre. We bought it for the same price we would pay for ordinary milk powder. It has extra vitamins and minerals, and so on, to help children with swollen bellies (oedema). They should have given it to us for free – but they took the opportunity to make a couple of hundred dollars and share it out amongst their colleagues.

F-75 milk

And so our work continued – with the help of the good people of Hull, York, Middlesbrough and the whole diocese.

Because of Covid-19, my return flight of 8 July was cancelled. I’d intended to fly back to Kinshasa at the end of May, but all internal and international flights were forbidden. The government announced that all visas would still be valid, until restrictions were lifted. The local immigration police had other ideas and insisted on hassling me, obliging me to pay them money for a useless document, 2 days after my visa had expired. 

The government lifted general restrictions 3 August – so we were all hopeful that I would get on a flight. Then we heard it was with the exception of churches, as well as domestic and international flights. Flights would start 15 August. The work at both of my centres would continue in the capable hands of our 12 volunteers, led by Judith’s younger sister, Laetitia.

The promise of a commercial flight fell through after I’d bought my ticket (I got a refund!), but eventually I got a seat on the little plane that brings the teachers’ wages each month for the diocesan Caritas association.

It was a circuitous route – dropping bales of cash at several rainforest locations. A flight which would normally take just over 2 hours, lasted 7 hours; nevertheless, I eventually arrived at Kinshasa’s tiny city centre aérogare, of N’dolo.

Francis onboard the small Caritas plane

A plate of chips was the first thing on my mind! In fact, potatoes of any description would be welcome after 7 months without them.

Finally a plate of chips! 

After that, I would have to consider renewing my visa. They’ve made it easy for foreigners to renew their visas for a further 3 months – at a price, of course. Then I should make arrangements for a long-term visa. Should I travel back to England? Lockdown doesn’t seem to be completely over yet – so perhaps I should take a breather in bustling Kinshasa and decide what to do later.

Francis Hannaway in Kinshasa

Sunday Mass at St Pius X Church, Kinshasa. This is the Gloria (Kembo!)

Basankusu: the vanishing cat!

 

So, last night I coaxed my cat, Panda, outside. Too much moving around at night, jumping on the table and knocking things over. A cat should be on the prowl at night, looking for mice - and not peeing where she shouldn't.  

It's not the first time she's been outside for the night - but the frequency of her nights outside has certainly reduced lately.

This morning, no Panda.

We didn't think much about it. She's normally my lunchtime alarm clock - but today she didn't arrive.

Panda - my black and white cat

"Why did you put her outside?" asked Judith. "They kill cats at night - and eat them!"

We each went about our business as torrential rain fell.

A bit later, Judith said, "We'll get a new cat when we return from Kinshasa." We were both preoccupied with the situation.

I went through all the scenarios in my head - she's always here at midday, so, it doesn't bode well. Perhaps she's ill, perhaps she's found food elsewhere... she was just next to me yesterday, purring and wrapping her tail around my leg. What a shame if she's dead.

At the house, which is our 2nd centre, we're getting a new fence. Stout posts with thin sticks horizontally packed together will give us more privacy. We've also moved the gate across to the other side. The old fence had verical sticks and the dogs and cat knew where they could get in and out. Perhaps she'd got out through an unfinished bit and, when she'd returned, got confused by the new fence - and so wandered off to meet a stranger's machete. 

At around 3:30 pm, through the clattering noise of the rain on the roof, we heard the noise of cheering - 

"Francis, come quick! Francis come quick! Panda is here!"

They'd found her outside, near the next house. 

She was a bit bedraggled from the rain - but glad to be home. I gave her a small piece of fish, left over from lunch. She seemed suspicious of it and hesitated before taking a nibble. She didn't seem particulary hungry - so perhaps there's more to the story.

In the meantime, we're very glad to have Panda back.

Congo Kinshasa: A trip to Bokakata and meeting Mama Momba

“It’ll be a good distraction for you, Francis. You need a little change of scene and it’ll be fun,” Judith reassured me. Within a couple of days we were climbing onto motorbikes for a ride through the forest.

Bokakata, 70 km from Basankusu, was a loose community of small but quite separate settlements, which were ravaged by elephants in the 1970s. During that time, most people had moved towards the river. Judith’s dad returned to the original Bokakata and built a house there. Originally a simple structure, he built it up over time with fired bricks. He established a primary school, with himself as the head teacher. He planted crops and became self-sufficient. Although he later became head teacher, and then schools inspector, in Basankusu, he’s always kept one foot in his village.

Judith Bondjembo overtaking 
me on a motorbike

The roads in the Congo are in a poor condition. Made from earth, they are badly eroded in many places. Our drivers, however, had a death wish and transported us, with all the spine breaking shocks imaginable until – fortunately – my bike got a puncture. We spent a good hour, if not two, repairing the puncture in a small village along the way. The glue they used was from a rubber creeper – the type that the infamous first rubber industry collected rubber from, in Congo’s early colonial days. Once the puncture had been repaired, we set off at a more comfortable speed. We passed Bokakata’s Catholic church and convent. The Daughters of Jesus had finally withdrawn from their convent here and have since been replaced by the local Theresian Sisters. The grass in the mission compound stood chest high – during the coronavirus confinement there were no schoolchildren to wield the machetes that slash the grass.

Half an hour later, we started to pass little houses made from mud and sticks. People ran out and waved their arms to greet us as we passed. Eventually, we came to the single road which makes up the village. We dismounted in front of Judith’s dad’s house. Children emerged to give a well rehearsed welcome in parroted French. Women from the neighbouring houses lay down pieces of brightly coloured cloth, the ones they use as wrap-around skirts, to make a welcoming carpet for us. The children arrived again to repeat their performance and to present a bunch of plastic flowers in an ancient looking aluminium vase.

We’d sent a bottle of the finest Indian whisky ahead of us with our provisions and this was opened to begin the festivities of welcoming us. Just about everybody from the tiny community took their place along the perimeter of the enclosure, while a young man passed along the ranks selling tots of foul-smelling moonshine gin and single cigarettes. We were invited to the house, where a meal had been prepared for us in what was to be my bedroom. I sat on the edge of my bed while balancing my plate on a wooden straight-backed chair. Once I’d finished eating, the party continued. A children’s choir sang and danced for us – a wise man from the village stood like a town crier, regaling how the village had been founded by a white man, in 1930, and that one day a white man would return to establish development projects (did he mean me?)

Francis perched on the 
edge of his bed to eat

As the evening wore on, I decided that the moonshine gin wasn’t as foul-smelling as I’d first thought and so I tried a little – and then a little more.

The first day ended and we went to sleep.

For the few days we spent there, Judith was in her element. She would often leave me for a few hours to sit among her family and chat to them in Lomongo, the tribal language, which is as clear to me as Chinese. It’s a running saga; everybody agrees that she should invite me to sit with her wherever she is and that she should speak Lingala. I’m fluent in Lingala. She says she will and starts off in Lingala, only to change back to Lomongo after a few sentences.

Fortunately, I had brought my trusty Kindle e-reader. I plunged back into My Family and Other Animals – The Corfu Trilogy, by Gerald Durrel and left Judith to chat with her relatives. 

The visit was very pleasant; it was relaxing. We’d left the very capable volunteers back in Basankusu to keep the malnutrition centre running and it felt good to leave our worries behind. Throughout each day, various visitors arrived – mostly Judith’s relatives, quite a few of them asking if we could help them in some way. 

We had three little trips out. One day, we followed the road to the left – we called in at each house, mostly spread out some distance from the next. A small cluster of houses was further away, on the other side of a thirty minute walk along a well-kept forest path. Everybody welcomed us warmly. We collected eggs, pineapples and sugarcane, as gifts, along the way. 

The following day we took the road to the right – the distance wasn’t as great, but we were received just as warmly at each house.

Francis Hannaway and Judith Bondjembo were welcomed everywhere in Bokakata

Meeting people in their homes

Judith’s dad, Jef, had the only fired-brick house in the village. There was a small medical centre in the grounds. Next door was the primary school that he’d founded. We set out one morning to visit his huge forest garden behind the house. To the uninitiated, it appeared as rough forested land with a lot of felled trees. We climbed over the trees to see the whole extent of it. He wanted to make an appeal for a petrol-driven chainsaw. Until now, each tree had to be cut down with a machete, then cut and removed by manpower alone. A powered saw would make things a lot easier. I filmed an interview with him on my phone.

The day before we returned to Basankusu, Judith received a visitor. A young, quite thin woman, called Momba, crouched in front of Judith’s chair telling her, in a quiet voice, of her problems. As she turned towards me, I noticed a huge mass on the side of her jaw and neck. “Francis,” whispered Judith. “What do you think it could be? Cancer?”

It certainly could have been cancer. We’d often talked about our work and how we should concentrate only on malnutrition and not get drawn into other activities, no matter how deserving. We’d been stung a few times, most recently with an old friend’s brother, who’d suffered crush injuries when a house collapsed on him. He’d been bedridden for almost 3 years when they finally decided to amputate his leg. We were asked for some help towards the costs, by the relative who was looking after him. The money was never passed on to the hospital. We said we’d pay for the medicines post-op – it couldn’t be that much. Later, without asking us, they did another operation on his hand because of pressure sores. To cut a long story short, he died. Badly managed pressure sores finished him off – and not the amputation as we thought at the time. We ended up being embarrassed with a bill for $400, and had no option but to pay it. 

So, Momba probably had cancer. She’d no doubt spend a lot of time in hospital at our expense, they’d prescribe all sorts of cures, and even attempt an operation on the lump – and eventually she would die. Perhaps we should politely decline to help her; she would die in her village and we would be able to use our money to help malnourished children. Hmmmm … a difficult decision. 

Judith and I sat looking at each other. “Well,” I ventured, “if we make it clear that we’ll pay for a visit to the doctor and he can give a diagnosis, but we won’t promise anything else. We’ll have to be clear.” Judith agreed.

The next day, we climbed back aboard the motorbikes for the homeward journey. This time, the drivers didn’t need to be restrained. The speed they covered the hard dirt tracks, flying recklessly around blind corners – meant that I spent more time in the air than in my seat. Nobody could enjoy such an experience – but they did it to show their expertise. In any other country they’d be arrested. But eventually, we arrived back in Basankusu.

The following day, Mama Momba arrived by riverboat, together with her baby boy and 8 year-old daughter. She slept that night at my house and the next day I took her to the Catholic hospital next door. 

Mama Mômba on her arrival
in Basankusu

Dr Eric, recently arrived from Mbandaka, was all smiles. “No, Francis, don’t worry. Cancer is quite different. It’s probably an infected tooth. She said she’s suffered with it for almost a year, so it’s quite possible there’s been a blockage which has caused the swelling over time. However,” he paused, looking more serious, “it could be TB - I think I can see ganglions in the swelling.” 

Help Francis with his work
Send a donation today. 

“Oh, yes,” I exclaimed, “we’ve had cases of that at the centre before. Scrofula.” 

“Yes,” Dr Eric agreed, “Scrofula – that’s another name for it! Don’t worry, Francis, we will give an eight week course of a combination of antibiotics designed just for TB. Then she should be fine.”

What a relief. After a couple of days sleeping in the hospital, we installed Momba in our house – she very soon found her feet, cooking and cleaning and slowly growing in confidence.

Over the next two weeks, the swelling, although it didn’t disappear completely, reduced considerably. She started to put on weight. Then, one day, we saw her doing a little dance. “I’m getting better! I’m getting better!” she sang – and danced again!

One day I was at Fr. Christiantus’ house. I told him the story of Mama Momba. “Do you remember that I invited you to go to Djombo with me at that time – but you chose to go to Bokakata instead?”

“Yes,” I replied, “Momba was very lucky that we happened to be there at the time. If I’d gone to Djombo she would have missed her chance and probably died from her illness.”

“Luck has little to do with it,” Fr. Christiantus smiled with a knowing look. “I think you were sent.”

Francis Hannaway: what I do

Hello

My name’s Francis Hannaway.

I'm from Middlesbrough, in England.

Cette page en français

I live and work in the Congo. The Democratic Republic of Congo, to give it its full name, is a massive country right in the middle of Africa. It’s covered in lush rainforest. And I can pick avocados, bananas and pineapples from my garden to have for breakfast.

Francis and Judith Hannaway 

But how did I end up here? And what do I do?

I’ll start my story with my dad. He was a welder at Smith’s Dock shipyard, in Middlesbrough. When he was 29 he worked his way across Canada. Later, after he'd married my mother and had children – he took us half way around the world to Australia, where we lived for almost 3 years. I’d like to think that my sense of adventure comes from him.

The nuns at the convent school in Australia told us stories about explorers: Scott of the Antarctic, Magellan, and Captain Cook, of course. But it was David Livingstone who caught my interest. David Livingstone wasn’t just an adventuring explorer, looking for the source of the Nile, he was also a missionary. I decided that that was the life for me. 

We returned to Middlesbrough when I was 10. I grew up and became a teacher in special education. I was also involved in the Catholic Handicapped Fellowship, running a weekly youth club one evening and playgroups on Saturday mornings; we took our members away for holidays in the summer. It took up a lot of my time. I got a mortgage and moved into my own home, I had a car, a motorbike, a job, a social life, money in my pocket – yet it all seemed a bit too easy. I needed something a bit more challenging – I wanted an adventure.

So, I thought about my childhood dream of going to Africa. I realised of course that the whole world had already been explored – but I was sure there were things I could do to help people living in difficult circumstances. I applied to VSO, Voluntary Service Overseas. It’s a government sponsored organisation which sends people to developing countries for 2 years. I went for an interview in Glasgow. They rejected me. 

I didn’t know what to do next. I was back to square one. I suppose I could have just gone to Africa – Kenya I would probably have chosen – just to see what it was like. Then I saw an advert in a Catholic newspaper. Mill Hill Missionaries, England and Wales own Catholic Missionary society were recruiting lay people to do 3 years to support their work in developing countries. When I wrote and told them that I didn’t really know what I could do to help them, a very nice letter came back from Fr Mark Connelly saying that when he first went to Pakistan he had no idea what he could do either but had spent the last 10 years there building communities among oppressed minorities.

Mill Hill Missionaries decided to send me to Pakistan. I’d been hankering after Africa – but Pakistan would be something else again. I left my job, sold my house, my car, my motorbike, whittled down my collection of photos and cassettes to the bare minimum and moved to Mill Hill in London. I waited for over a year for a visa which was eventually refused.

Back to square one again.

Now I did visit Pakistan – I did a tour of all the places Mill Hill Missionaries were working over a 6 week period on a tourist visa.

And when I returned to Mill Hill in London they asked me to go to a place called Zaire. At that time the Congo had changed its name to Zaire – but has since changed it back to Congo.  I had no idea where this Zaire place was and the young men studying to become priests in Mill Hill all told me it would be horrible because it’s so isolated, it’s not near anywhere and there are no real roads connecting places. Basankusu, the place the missionaries worked was right in the middle of the rainforest. No shops, no phones, no newspapers, no McDonalds … I thought WOW! That’s exactly what I’m looking for! It was 1992.

When I arrived, I was shocked by how broken down everything was, how dirty and unkempt everything was – but after a week, I got used to it. I spent two years there in a small village, teaching small groups of young men who wanted to become missionary priests. I learnt the local language, Lingala, made a lot of friends.

I returned to a teaching career in primary schools in Teesside, I visited Basankusu several times after my stint there and eventually did a couple of visits to Kinshasa to help an environmental group there. During one visit, in 2013, I went back up to Basankusu, and I stayed at the mission where there remained only one English priest, Fr John Kirwan, from Merseyside. He said, “Francis, you keep coming back for visits; why don’t you come and do another 3 years with us? We need someone to teach the students English and if you could look after the accounts for us that would be even better.”

So, I agreed and went back.

While I was getting ready to go, I read about the scourge of malnutrition in the Congo. 50% of infants don’t live past their 5th birthday – it’s incredible. Having such large families is part of the problem. Women give birth just about every year and then can’t feed their children. Poverty is the major cause of malnutrition – but there are other causes – a child could suffer from one of a number of tropical illnesses and then just not be able to put the weight back on afterwards. The staple food is cassava – it’s a root which is easy to grow. They make it into a starchy doughy lump and eat it with everything. It’s got plenty of carbohydrates but zero protein. So it’ll fill you up, but you won’t grow. You’ve got to eat meat of fish with it otherwise you’ll have serious problems.

So, I decided I would collect some money and see what I could do.

I started my teaching duties and started keeping accounts. And the mission cat gave birth to 3 lovely little kittens. We gave 2 away and the 3rd sort of became mine. He did well for a time and then one day he refused to eat. Each day that passed he got thinner. I tried to feed him but he kept his mouth firmly closed and refused everything I offered him. Eventually he died and I was quite down about it. How was I going to cope with malnourished children if I get upset about a cat dying? I’ll have to pull myself together.

So, I gave support to a group that was just starting in Basankusu, I gave them the money to buy food to feed malnourished children for 3 days of the week – so that it’s a supplementary feeding programme, the parents still have responsibility for the children on the other days. 

One of the volunteers, Judith Bondjembo, decided that some of the children, 2 or 3 children, were so severely malnourished that they needed support 7 days a week. So she fed them herself from her grandmother’s house, where she lived at the time. I said I would fund it.

After 9 months or so, we saw that the project was being mismanaged – the woman in charge was creaming off food for herself and her family. Judith suggested we rented a small house and set up a centre by ourselves. So we did. We were so pleased when all of the volunteers from the first project followed us. And that’s how we started.

After 4 years the Missionary Society moved its teaching facility to Kinshasa so now I’m independent of them. Judith and I are still running the centre, this is our 6th year. We’ve sort of become the Social Services of Basankusu. People stop us in the street to show us their children. 

Francis Hannaway
with Judith Bondjembo

So what’s a typical day like for me? It’s like this:

Up at 6 am, washed in water from the well.

Judith joins me at 7 am. We have breakfast together.

Often we have parents with malnourished children arriving from far away villages.

We take them to the small Catholic hospital which is next to my house. We get them registered, vital statistics are taken, address, name, age, weight, etc. Then we move on the laboratory to get other tests: blood iron, parasites (worms), malaria, and other illnesses are tested for. 

Some children need further treatment and are admitted to the hospital. Malnutrition comes in various forms and various degrees of severity. So, we group the children generally into severe and moderate cases. The parents are asked to present themselves with their children at our feeding centre which is on the other side of Basankusu. It’s just a small, single storey house. The cooking area is a thatched shelter outside the house. And the children sit on a tarpaulin to receive their food. We get water from our well for washing, cooking and drinking. 

Work at the feeding centre begins at 7 am. The majority of children are usually moderately malnourished. Volunteers take turns to attend, cooking meals for them on Monday, Wednesday and Saturday. At just after 7 am they will drink some milky tea with sugar, and eat bread. Between 9 and 10 they eat porridge. The porridge is made from ground maize, ground peanuts and soya-milk, with vegetable oil and sugar added. This ensures an easy to absorb source of protein and energy. Towards midday they have a meal of beans, in tomato sauce, rice, and fish. 

Children who are severely malnourished sleep at the centre with their parents. They are fed every single day until they can be classed as moderately malnourished. These children often have the classic signs of kwashiorkor: swollen bellies, faces and feet, pale peeling skin, fragile pale hair, lethargy, little interest in eating, often irritable – malnourished children are often in a bad mood – when they start laughing you know they’re getting better! They begin for the first two weeks with a diet of full-cream milk, from powder, with a little sugar and vegetable oil added, every four hours. After one week the swelling is reduced. Eventually, porridge is introduced and then solid food, such as rice and beans.

When Judith and I have finished processing children at the hospital, we take a taxi-bike each, over the rough dirt tracks, across town to the feeding centre. We manage the provision of food, maintenance of the building and grounds, planting of soya and leafy green vegetables, and follow the registration and progress of children on our books.

The first Saturday of each month we hold a meeting with all twelve volunteers. The volunteers get an allowance for expenses at this meeting. They each receive about £14, plus 5 cups of beans, 5 cups of rice, and 2 cups of salt. On special days, Christmas, International Women’s Day, church festivals, etc they often receive the same again. Usually, they will get a length of cloth to make their uniform from. The centre manager/storekeeper gets a bit more because she lives at the centre and is on call for severe cases. We also have a nurse who prescribes medicines and gives training to the parents. During the meeting, chaired by Judith, the volunteers discuss what went well and what could be improved. Associated activities, such as our gardens for peanuts, maize and beans, are discussed. Members who are late for work, or have caused any problem, can be penalised and privileges suspended. Those who have made an extra effort are applauded.

November to January is usually a quiet time at the centre. May to October is the busiest time, with as many as 75 children attending. The past year has been busier than ever because of a measles epidemic, 7,000 dead nationally.

At around 1 pm. Judith and I leave the volunteers to finish off. We return on foot. 

Sometimes we have children at the General Hospital, and might visit them. There are countless incidents of us having to track children down at home, but generally we get them to stay in one place. Similarly, we often have to diplomatically give advice to care staff and nurses in the hospitals because of the fragile nature of children with malnutrition.

After lunch – usually of fish, green vegetables, and rice or plantain bananas, I set about organising photos and videos to post on facebook. I also write an article each month for the Middlesbrough Catholic Voice. Through these efforts we try to raise enough money to continue.

During the afternoon we could sometimes get a visit from a disabled person in need of a wheelchair. During the past 5 years, I’ve provided 30 wheelchairs. Polio is the major cause of disability in Basankusu and Congo generally. A lot of disabled adults have no option to crawl around on the ground – in dry weather it’s difficult enough, but in wet weather the ground just turns to mud. Providing a wheelchair for someone completely revolutionises their life. If someone turns up, asking for a chair (or a bike as they like to call them here), I take some photos, or make a little video – and then make an appeal on facebook to raise the money. We build the chairs locally. They cost around £340 each to make.

During the evenings we usually make a tour of the Catholic hospital to visit any of our children who are there.

Other days I help at various places in the diocese with projects. One of the local brothers helps street children, or children who’ve become outcasts after being accused of witchcraft. I’ve made videos to appeal for their school fees. Recently I translated a project for a corn mill. Use of the mill would provide money for the boys’ support.

The local convent houses some very capable sisters. I’m presently supporting a project for deaf children. It involves the conversion of a building and equipping it as a workshop for sewing and carpentry.

At the moment there are restrictions because of Coronavirus, but nothing very strict. Kinshasa, the capital city is about 1,000 km from us. It’s sealed off for travel. But the virus hasn’t reached here yet. Basankusu has closed all the schools, churches and beer-gardens like the rest of the countries (but the bars are still open unofficially).

In the past, Judith and I would sometimes go for a glass of beer in one of three beer gardens in Basankusu – but we’ve had to put that on hold. Things have changed quite a lot since the 1990s when I was first here. Solar panels and satellite TV can only be afforded by a few – and similarly mobile phones are too expensive for most people – but all the same, quite a few people have them these days. I have a basic package for TV at £7/month. So I get the news in French and Judith gets her soap operas.

On days when we are not at the hospital or the feeding centre, we go to our vegetable garden in the forest. All the volunteers and their children join in. This year we have a hectare of land planted with peanuts. This brings the costs at the centre down by supplementing our stocks. Some of the peanuts can be sold and each volunteer gets a share of the rest as encouragement for their work. It’s about 4 miles from Basankusu.

I have a quite meagre existence, luxury items aren’t really available. We argue about whether a jar of chocolate spread is an extravagance of not. Fortunately, Judith is determined that I don’t let myself go and ensures I live without starving.

So, how do I fund it all?

I take photos and make 2 minute videos to put on facebook. People send small donations and St Gabriel’s Church in Middlesbrough collects money for me, and that’s how I get by. I need to generate around £3,000 each month to keep going. That covers food for the children, hospital costs and my daily living costs. It’d be great if people could have a look at my facebook page to see what I do and perhaps send a small donation themselves.

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