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Butoke’s Health Activities

Butoke has been striving to construct an integrated health program responding to the highest priorities. We have been doing this piece by piece, starting with nutrition, emergency care, and primary care.

Our work builds on that initiated in 2004 by Cécile de Sweemer, who was then working as a missionary with the Communauté Presbytérienne au Congo. Drawing upon her own funds and those of benefactors, Cécile and her associates helped people without means to secure emergency or primary care through the Good Shepherd Hospital and the Primary Health Care Centre in Tshikaji. She also took some handicapped people for operations and prostheses to Jukai.

Since Butoke began operations in Kananga in 2005, we have pursued these actions, focussing primarily on emergency care and dispensing simple primary care ourselves. Funding available for these various activities came to about $US 27,000 in 2004 and $US 10,000 in 2005. Because needs such as emergency care are acutely felt, these actions are very popular and well appreciated.

Many emergencies are turned away from hospitals for lack of ability to pay. Butoke provides an advocate who assists hospital patients get access to needed health care.


We are also seeking to develop a coherent approach, in collaboration with other partners in the region, that takes into account local problems and opportunities, and helps the most vulnerable groups to overcome the high levels of morbidity and mortality that they currently face. Our strategy is based on our analysis of the primary causes of illness and mortality in the region, with attention to those causes providing the greatest opportunities for improvement.

Most deaths in Western Kasai are due to malnutrition. WHO once estimated the share of deaths due to malnutrition at 75%, but the proportion may be even higher than that. In addition, malnutrition and the reduced level of immunity that accompanies it are responsible for chronic ill heath due to conditions such as osteomyelitis, atonic ulcers, and chronic anaemia. For this reason, Butoke’s principal efforts have been concentrated on food security and nutrition.

The conventional wisdom since the 1960s, based mostly on Western African and Indian epidemiological studies, is that the big killers are endemic diseases such as diarrhoea, pneumonia, malaria, and childhood diseases such as measles. However, the pattern in Western Kasai is different, in part because these are the diseases upon which local health services have focused their attention, with a relative degree of success. Our assessment is that childhood diseases, diarrhoea and pneumonia are not actually the most important causes of death in Western Kasai.

For this reason, and in order best to complement the work already being carried out by other organizations (for example UNICEF’s work on basic childhood vaccinations), we are focusing our attention on the following:

·             Malaria and the extreme anaemia that follows it

·             Meningitis, typhoid and hepatitis

·             HIV/Aids and tuberculosis

·             Diabetes

·             Mental health.

Health care facilities are sparse.  Church hospitals play a major role.



The Global Fund to Fight Aids, Tuberculosis and Malaria has popularized the concept that AIDS, TB, and Malaria are diseases of poverty. This is true. These diseases hit the poorest the hardest, and are the most difficult for the poor to combat. The same is true of typhoid and diarrhoea, of hepatitis and meningitis, and of almost all great killers.

In Western Kasai, we are still losing the battle with malaria, in all layers of society. Most of the deaths that we witness among people whose care we support are due to malaria and the extreme anaemia that follows it, especially in small children. To address this problem, we have prepared a three-year project to combat malaria and the anaemia that results from it. This project has been submitted to UNDP for funding from the Global Fund. The proposal emphasizes that the poorest should be given free access to prevention and free care. Too many people here cannot afford mosquito nets, or a simple course of treatment. We are hoping for a reply from UNDP by the end of February. The project covers seven health zones, and a population of over 900,000. Involvement in this project would provide an excellent opening for Butoke to launch a societal debate on rights to health care.

Butoke staff provide basic health care.


UNICEF sponsors normal childhood vaccinations, which are appreciated by most people but coverage is not as thorough as it should be. It is less than 80%, and, in many areas, less than 60%. The UNDP malaria program would put us in a position where we can educate people on the need to take advantage of the UNICEF vaccination program. However, we would need to go beyond that. Currently the second-level causes of death among children, adolescents and young adults are meningitis, typhoid and hepatitis. So far, except for emergency care, we have no systematic response to offer against these threats. We feel it is becoming imperative we provide leadership in initiating vaccinations and health education on meningitis, typhoid and hepatitis.

Because typhoid is water borne (as well as food borne), measures are required to improve access to potable water. The only practical means of achieving this within a reasonable time would be through household chlorination. A difficulty in achieving this is that there is fear of mass poisoning. However, Butoke’s Dr. de Sweemer has had experience organizing a campaign to chlorinate water supplies in equally poor, low technology regions of Laos, to combat a cholera epidemic. She has found that success hinges upon the establishment of a good rapport with the community, combined with efforts to extinguish suspicions of poisoning. Such efforts need to be accompanied with basic hygiene education. We have started exploring whether any of the foundations or the Centre for Disease Control in Atlanta can help.

TB and AIDS, individually or combined, are a third major cause of death requiring increased attention. We are already in the process of initiating a program for responsible sexuality, trying to further prevention of sexually transmitted diseases, as well as better spacing and planning of births. We are also about to conclude a partnership with AcsAmocongo (Action contre le SIDA pour un avenir meilleur des orphelins), which is developing an antiretroviral program in Kananga, with support from the Global Fund. Our role would be to serve as a referral centre that would identify people for voluntary testing prior to eventual treatment with antiretroviral agents. We would also help people to appreciate the importance of treatment before full-fledged disease breaks out. We would do this in conjunction with our agricultural activities and thus reach rural populations that AcsAmocongo could not easily cover. AcsAmocongo has good experience in Kinshasa but is new to Western Kasai.

TB programs exist in each of the major hospitals of Kananga, but there is a need for complementary support, such as feeding and transportation, as well as paying for access to the TB program, which is not entirely free. This is where Butoke has a role to play. We need to expand these actions to include active screening for TB, and to attack the question of access to food and simple life support for people suffering from TB. Research elsewhere (in India) has shown that provision of food for TB patients did not make any difference, but this was in a context where afflicted people were not left to starve to death, as is tragically the case here.

We have already helped numerous cases of diabetes type II and hypertension among people over 40. Most of these people were overweight, but many others were of almost normal weight but physically inactive and subsisting on a refined carbohydrate diet, especially intellectuals, civil servants and traders. We are approaching Help the Aged Canada to try to see whether they can assist us to provide affordable drugs in sufficient quantities as well as health education. Diabetes is not yet nearing epidemic proportions, but in the foreseeable future, if access to food improves, the disease could spread rapidly unless people change their dietary habits and the preference of all those who can afford it for physical inactivity. It would be good to start now educating the younger, still active, population.

We have so far dealt only occasionally with mental health cases (see story on the tarred woman), even though many street children and other people around us suffer from curable mental health cases or are simply social outcasts likely to become psychotic under the stress. Kananga needs a walk-in program of treatment and a Salvation-Army-style feeding program for such people. However, Butoke does not have the human and financial resources to deal with this fully at this time.

Among the most vulnerable populations are prisoners and the elderly (over 55 years), who suffer all the same problems as the general population, but in exaggerated forms due to lack of official or family support. We have launched some first initiatives to support these people with support of Presbyterian parishes in the US and also Help the Aged Canada, but they need to be reinforced.

Focusing on neglected social groups – whether they are mentally unstable, prisoners or just elderly – is important not just for the succour that is provided, but also for the implied message that all life has intrinsic value and that everyone has certain basic human rights. We hope that Butoke’s activities in the health sector, like our work in food security, will provide a measure of hope and resolve to solve problems and help to preach human rights through concrete actions.