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The view from here
DRC to Dar: one physician’s journey to emergency medicine Mundenga Mutendi Muller Dr Mundenga Mutendi Muller is a young doctor from Kindu province in the Democratic Republic of Congo (DRC), currently training in the Emergency Medcine Residency at Muhimbili National Hospital in Dar es Salaam, Tanzania. He was interviewed in Dar es Salaam by Ellen Weber, Editor, and the interview was edited by Teri Reynolds, Associate Editor, EMJ. I was born in 1977 in Kindu, a province in the DRC, near Goma and Bukavu province. I did my primary school and secondary school in Bukavu. After that I Dr Muller (M) went back in Kindu, my province, and I graduated medicine there in 2007. Then I went in the district to work for about two years. We were three doctors. One, the senior, was ill-- he was very good, older than us and experienced, and he could teach us, but he was ill. The other doctor was a generalist. I was a bit more skilled than him. So we were working there, practising. EMJ: So you were the middle, There was someone more senior and someone more junior than you. M: I was the middle. But the person who could help us, the senior, was ill, so he couldn’t do some operations or round with us to see patients. So I was there to co-ordinate things. I was like a chief of staff, the chief of staff. EMJ: This was a district hospital? M: Yes, that was Kalima. Kalima is a big city—I can say a centre—and it was a big society in former times, many minerals there. And it’s a big hospital, and in the past, many white doctors from different countries were working there. Later the situation was not good, and they went back home. So I was working there. EMJ: What kind of patients did you see? M: In our country we have a problem with specialists. We don’t have many specialists. So when you are working at a district hospital you are doing surgeries, internal medicine, paediatrics, and so forth. That is the way they do it in my country. So I would do some surgeries, see patients in paediatrics, in gynaecology. Correspondence to Teri Reynolds, Department of Emergency Medicine, University of California, San Francisco, 94143 CA, USA; [email protected] Muller MM. Emerg Med J August 2014 Vol 31 No 8
And we know with such things you can’t perform very well. We needed someone to help us, as we were junior then—but he was ill. EMJ: At that point, had you done any other training beyond medical school? M: Yes, I did an internship, and then almost six months in a big centre in Bukavu. In Bukavu, I learnt a lot—some surgeries, paediatrics, orthopaedics, and internal medicine. After that I was working at the district hospital. When I had been working in the district hospital for two years, some doctors from HEAL Africa Hospital in Goma were coming into the districts to do some surgeries and to teach the young doctors. I met one gynaecologist, and he was impressed with my work, but I told him that I had a problem because I had no one to teach me here, and it was very difficult for me. I told him I would like to keep going with training, to learn more. This was in April, and he told me that HEAL Africa was a big centre—the first hospital in Goma province—and that in November there would be a test to select some doctors to train, and he said “if you are selected it would be good for you.” And I promised him that I would do my best to be in Goma in November so that I could do that test. And in November I went there, but it wasn’t easy, because I had to leave my province to go there by plane, by flight, and I didn’t have the means for that. They were paying me very little money, and I couldn’t do anything. We were working for—I think it was 61 dollars per month. So I used my salary, and I was obliged to sell my TV and other things I had so that I could get the plane ticket. So I sold them and I went to do the test. We were twelve, and the they took four of us. And at HEAL Africa I did six months in orthopaedics, six months in general surgery, six months in obstetrics and gynaecology, and almost one year in the emergency unit. EMJ: A year. M: Yes. But at HEAL Africa there were some visiting emergency specialists, Dr Margaret and Dr Teri, and they helped us very much. They came to teach emergency ultrasound for trauma and regional nerve blocks. We were almost five doctors, some orthopaedic officers and a nurse in the course. After training I was very, very
interested in emergency medicine and ultrasound. And after maybe a few months I got the chance to attend the African Federation for Emergency Medicine conference. There again I met Dr Margaret and Dr Teri, and we practised—I learnt more. I came back and it was very good to be doing nerve blocks at HEAL as there was usually no other pain medicine. And I remember during the war last year, M23 War, we did many. On all the patients we could do FAST, and go quickly to theatre. I had learnt to do surgeries—I could do the operations. EMJ: So you would do the FAST and then you’d do the operation. M: Yes. So after some time, I said I would like to continue to become, amongst other things, an emergency medicine specialist. And Dr Margaret and Dr Teri helped me. Every time they were in the Congo we were together at my hospital, working together. I learnt much, and they supported me so much. That’s why I said I would like to be an emergency doctor. In our country we don’t have emergency doctors. I don’t know one. And during my work with them, I discovered that many patients died because of their initial care—in my country many people died at the hospital because of the lack of the initial care. People have an emergency, but no one to acknowledge and to lead their case. So that is a big challenge at my hospital. It is a big centre for trauma, and in our country it’s a big challenge because we don’t have emergency doctors, so I applied for residency here in Tanzania. I thought to apply in Ethiopia, Morocco, South Africa and here, but I think here was the best after South Africa. So I applied here and I was selected. I began to learn and to work. My English is poor, but I am studying at the British Council here. I hope I will improve very fast. EMJ: Do you have a family? M: Yes, I have two children, a daughter and a boy. EMJ: How old? M: My first one is four years old. But they are still in my country, in Bukavu. I didn’t want to leave them in Goma, because in Goma, very often there is war. So they are in Bukavu. But I hope one day they will come. EMJ: So you’re here by yourself? Without your wife and children. M: By myself, yes. EMJ: Was it a difficult decision to come without them? M: Yes, because my parents are not in Goma. It wasn’t easy for me to leave my wife and my kids who are still very 611
Downloaded from http://emj.bmj.com/ on June 28, 2015 - Published by group.bmj.com
The view from here young, so I hope one day they will come. The problem is the ticket because to leave there to come here, the ticket—another problem is to rent a house here. Maybe, what else, their resident permit costs, and living costs here. I think it will not be easy to bring them, yes. EMJ: Will you be able to go back and visit? M: Maybe during the holidays if I can get a ticket. EMJ: Can you tell me a little bit about what it was like working in the Congo during the war? M: During the war, the M23, yes, we received many patients, and I have some photos I can show you. So trauma, gunshots, yes. Before it was the Congolese Army, a government army, and after that when the M23 took the city we were treating them. We couldn’t do anything. EMJ: Right. M: So it was really very organised because we made a good team composed by an orthopaedist, a gynaecologist, a surgeon and myself working in the emergency unit. And we had some orthopaedic officers. So in my hospital we have three operating rooms— one for orthopaedics, one for gynaecology, and one for general surgery. And so during the war, I had my room—I was doing my operations in my room, the surgeon in his room, and the orthopaedist in the third, and we could save all cases. EMJ: Was there difficulty with supplies during that time? M: In my country it is very difficult to get some supplies. But I think many organisations did something. They did something. I can’t know what all, but they did something to help people. EMJ: And how about you personally during that time? Were you in danger? Were you at risk of being shot or hurt? M: Yes, because we were—I remember I did two days without seeing my family, staying at the hospital, and my family were there, but only to communicate: “Are you OK? Are you safe?” Yes, there was shooting everywhere, yes. It was really risky. EMJ: Yes, and you carried on. M: Yes. EMJ: Were you scared? M: Yes. But we were working at the hospital. We couldn’t leave the hospital like that.
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EMJ: So the working kept you calm. M: Yes, we were working, but we could not know what would happen for us and our families. EMJ: So you must have been very nervous while you were working? M: No. I’m happy with my job. I said to my family, to my wife, keep safe. She— I remember she had some food, for the kids, so she said no problem, yes, because I couldn’t do anything. And during the night the hospital could call me to go to do some more operations. EMJ: So you were staying at the hospital. M: At the hospital I did two days. After that I went back home. Next day, I went again at the hospital for the morning shift. But even if I wasn’t on night call, I could receive a call from the hospital in case of patients who needed surgery. And when the rebels left the city we continued to work, we were working and doing our jobs. EMJ: And you just did it. M: Yes, that’s work normally, but because we like our job. EMJ: You like your job. And you were willing to be there during the fighting—or did you have a choice of where you could be? M: The choice to do what? EMJ: To leave. But you stayed and worked there in the middle of this. M: Yes, at the hospital. We couldn’t leave the hospital while we were receiving many cases of gunshot trauma who needed surgery. EMJ: And you couldn’t leave Congo. M: To leave Congo, no. EMJ: Could you have left during that time? M: No. Some could go, but as a doctor I couldn’t. EMJ: You couldn’t because they wouldn’t let you? M: Yes, and in the emergency unit—I was responsible for the emergency unit, so— EMJ: So you were the captain. M: Yes, I couldn’t leave. I was the leader. EMJ: So is this now a better time than then? M: Since I left to study here, I don’t think so—Goma is not a good city. Many
wars, many traumas, yes. We were working during the night, the morning, during the day. Because of the war and the killing. That’s why I didn’t wish to leave my family there. My family is in another province, in Bukavu. EMJ: And what will you do when you’re done with the residency here? Will you go back to Congo? M: Yes, I will go to Congo because there is a high need for emergency doctors. I would like to teach. I wish to be in my hospital again to build a team for emergency care, and I can teach them how to do things, and how to teach other doctors. Yes, and I welcome other doctors, anyone who can help my country to improve emergency care. EMJ: Thank you for telling me this story. M: I don’t know if you have time but I can show you some photos. EMJ: I’d love to see your photos. Are you here next week? M: Tuesday I will be here again. At any time during my break time I can come, because nowadays we have class. More of the interview can be heard in a podcast which can be accessed here https:// soundcloud.com/bmjpodcasts/drc-to-darone-physicians-journey-to-emergencymedicine/s-5ck7t. Contributors This interview was edited by Dr Teri Reynolds and the questions were asked by Professor Ellen Weber. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
To cite Muller MM. Emerg Med J 2014;31:611–612. Accepted 19 May 2014 Emerg Med J 2014;31:611–612. doi:10.1136/emermed-2014-204019
The view from here is published quarterly. Please see our Instructions for Authors for guidelines: (http://emj.bmj.com/site/about/guidelines.xhtml# The%20View).
Muller MM. Emerg Med J August 2014 Vol 31 No 8
Downloaded from http://emj.bmj.com/ on June 28, 2015 - Published by group.bmj.com
DRC to Dar: one physician's journey to emergency medicine Mundenga Mutendi Muller Emerg Med J 2014 31: 611-612
doi: 10.1136/emermed-2014-204019 Updated information and services can be found at: http://emj.bmj.com/content/31/8/611
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
The view from here
DRC to Dar: one physician’s journey to emergency medicine Mundenga Mutendi Muller Dr Mundenga Mutendi Muller is a young doctor from Kindu province in the Democratic Republic of Congo (DRC), currently training in the Emergency Medcine Residency at Muhimbili National Hospital in Dar es Salaam, Tanzania. He was interviewed in Dar es Salaam by Ellen Weber, Editor, and the interview was edited by Teri Reynolds, Associate Editor, EMJ. I was born in 1977 in Kindu, a province in the DRC, near Goma and Bukavu province. I did my primary school and secondary school in Bukavu. After that I Dr Muller (M) went back in Kindu, my province, and I graduated medicine there in 2007. Then I went in the district to work for about two years. We were three doctors. One, the senior, was ill-- he was very good, older than us and experienced, and he could teach us, but he was ill. The other doctor was a generalist. I was a bit more skilled than him. So we were working there, practising. EMJ: So you were the middle, There was someone more senior and someone more junior than you. M: I was the middle. But the person who could help us, the senior, was ill, so he couldn’t do some operations or round with us to see patients. So I was there to co-ordinate things. I was like a chief of staff, the chief of staff. EMJ: This was a district hospital? M: Yes, that was Kalima. Kalima is a big city—I can say a centre—and it was a big society in former times, many minerals there. And it’s a big hospital, and in the past, many white doctors from different countries were working there. Later the situation was not good, and they went back home. So I was working there. EMJ: What kind of patients did you see? M: In our country we have a problem with specialists. We don’t have many specialists. So when you are working at a district hospital you are doing surgeries, internal medicine, paediatrics, and so forth. That is the way they do it in my country. So I would do some surgeries, see patients in paediatrics, in gynaecology. Correspondence to Teri Reynolds, Department of Emergency Medicine, University of California, San Francisco, 94143 CA, USA; [email protected] Muller MM. Emerg Med J August 2014 Vol 31 No 8
And we know with such things you can’t perform very well. We needed someone to help us, as we were junior then—but he was ill. EMJ: At that point, had you done any other training beyond medical school? M: Yes, I did an internship, and then almost six months in a big centre in Bukavu. In Bukavu, I learnt a lot—some surgeries, paediatrics, orthopaedics, and internal medicine. After that I was working at the district hospital. When I had been working in the district hospital for two years, some doctors from HEAL Africa Hospital in Goma were coming into the districts to do some surgeries and to teach the young doctors. I met one gynaecologist, and he was impressed with my work, but I told him that I had a problem because I had no one to teach me here, and it was very difficult for me. I told him I would like to keep going with training, to learn more. This was in April, and he told me that HEAL Africa was a big centre—the first hospital in Goma province—and that in November there would be a test to select some doctors to train, and he said “if you are selected it would be good for you.” And I promised him that I would do my best to be in Goma in November so that I could do that test. And in November I went there, but it wasn’t easy, because I had to leave my province to go there by plane, by flight, and I didn’t have the means for that. They were paying me very little money, and I couldn’t do anything. We were working for—I think it was 61 dollars per month. So I used my salary, and I was obliged to sell my TV and other things I had so that I could get the plane ticket. So I sold them and I went to do the test. We were twelve, and the they took four of us. And at HEAL Africa I did six months in orthopaedics, six months in general surgery, six months in obstetrics and gynaecology, and almost one year in the emergency unit. EMJ: A year. M: Yes. But at HEAL Africa there were some visiting emergency specialists, Dr Margaret and Dr Teri, and they helped us very much. They came to teach emergency ultrasound for trauma and regional nerve blocks. We were almost five doctors, some orthopaedic officers and a nurse in the course. After training I was very, very
interested in emergency medicine and ultrasound. And after maybe a few months I got the chance to attend the African Federation for Emergency Medicine conference. There again I met Dr Margaret and Dr Teri, and we practised—I learnt more. I came back and it was very good to be doing nerve blocks at HEAL as there was usually no other pain medicine. And I remember during the war last year, M23 War, we did many. On all the patients we could do FAST, and go quickly to theatre. I had learnt to do surgeries—I could do the operations. EMJ: So you would do the FAST and then you’d do the operation. M: Yes. So after some time, I said I would like to continue to become, amongst other things, an emergency medicine specialist. And Dr Margaret and Dr Teri helped me. Every time they were in the Congo we were together at my hospital, working together. I learnt much, and they supported me so much. That’s why I said I would like to be an emergency doctor. In our country we don’t have emergency doctors. I don’t know one. And during my work with them, I discovered that many patients died because of their initial care—in my country many people died at the hospital because of the lack of the initial care. People have an emergency, but no one to acknowledge and to lead their case. So that is a big challenge at my hospital. It is a big centre for trauma, and in our country it’s a big challenge because we don’t have emergency doctors, so I applied for residency here in Tanzania. I thought to apply in Ethiopia, Morocco, South Africa and here, but I think here was the best after South Africa. So I applied here and I was selected. I began to learn and to work. My English is poor, but I am studying at the British Council here. I hope I will improve very fast. EMJ: Do you have a family? M: Yes, I have two children, a daughter and a boy. EMJ: How old? M: My first one is four years old. But they are still in my country, in Bukavu. I didn’t want to leave them in Goma, because in Goma, very often there is war. So they are in Bukavu. But I hope one day they will come. EMJ: So you’re here by yourself? Without your wife and children. M: By myself, yes. EMJ: Was it a difficult decision to come without them? M: Yes, because my parents are not in Goma. It wasn’t easy for me to leave my wife and my kids who are still very 611
Downloaded from http://emj.bmj.com/ on June 28, 2015 - Published by group.bmj.com
The view from here young, so I hope one day they will come. The problem is the ticket because to leave there to come here, the ticket—another problem is to rent a house here. Maybe, what else, their resident permit costs, and living costs here. I think it will not be easy to bring them, yes. EMJ: Will you be able to go back and visit? M: Maybe during the holidays if I can get a ticket. EMJ: Can you tell me a little bit about what it was like working in the Congo during the war? M: During the war, the M23, yes, we received many patients, and I have some photos I can show you. So trauma, gunshots, yes. Before it was the Congolese Army, a government army, and after that when the M23 took the city we were treating them. We couldn’t do anything. EMJ: Right. M: So it was really very organised because we made a good team composed by an orthopaedist, a gynaecologist, a surgeon and myself working in the emergency unit. And we had some orthopaedic officers. So in my hospital we have three operating rooms— one for orthopaedics, one for gynaecology, and one for general surgery. And so during the war, I had my room—I was doing my operations in my room, the surgeon in his room, and the orthopaedist in the third, and we could save all cases. EMJ: Was there difficulty with supplies during that time? M: In my country it is very difficult to get some supplies. But I think many organisations did something. They did something. I can’t know what all, but they did something to help people. EMJ: And how about you personally during that time? Were you in danger? Were you at risk of being shot or hurt? M: Yes, because we were—I remember I did two days without seeing my family, staying at the hospital, and my family were there, but only to communicate: “Are you OK? Are you safe?” Yes, there was shooting everywhere, yes. It was really risky. EMJ: Yes, and you carried on. M: Yes. EMJ: Were you scared? M: Yes. But we were working at the hospital. We couldn’t leave the hospital like that.
612
EMJ: So the working kept you calm. M: Yes, we were working, but we could not know what would happen for us and our families. EMJ: So you must have been very nervous while you were working? M: No. I’m happy with my job. I said to my family, to my wife, keep safe. She— I remember she had some food, for the kids, so she said no problem, yes, because I couldn’t do anything. And during the night the hospital could call me to go to do some more operations. EMJ: So you were staying at the hospital. M: At the hospital I did two days. After that I went back home. Next day, I went again at the hospital for the morning shift. But even if I wasn’t on night call, I could receive a call from the hospital in case of patients who needed surgery. And when the rebels left the city we continued to work, we were working and doing our jobs. EMJ: And you just did it. M: Yes, that’s work normally, but because we like our job. EMJ: You like your job. And you were willing to be there during the fighting—or did you have a choice of where you could be? M: The choice to do what? EMJ: To leave. But you stayed and worked there in the middle of this. M: Yes, at the hospital. We couldn’t leave the hospital while we were receiving many cases of gunshot trauma who needed surgery. EMJ: And you couldn’t leave Congo. M: To leave Congo, no. EMJ: Could you have left during that time? M: No. Some could go, but as a doctor I couldn’t. EMJ: You couldn’t because they wouldn’t let you? M: Yes, and in the emergency unit—I was responsible for the emergency unit, so— EMJ: So you were the captain. M: Yes, I couldn’t leave. I was the leader. EMJ: So is this now a better time than then? M: Since I left to study here, I don’t think so—Goma is not a good city. Many
wars, many traumas, yes. We were working during the night, the morning, during the day. Because of the war and the killing. That’s why I didn’t wish to leave my family there. My family is in another province, in Bukavu. EMJ: And what will you do when you’re done with the residency here? Will you go back to Congo? M: Yes, I will go to Congo because there is a high need for emergency doctors. I would like to teach. I wish to be in my hospital again to build a team for emergency care, and I can teach them how to do things, and how to teach other doctors. Yes, and I welcome other doctors, anyone who can help my country to improve emergency care. EMJ: Thank you for telling me this story. M: I don’t know if you have time but I can show you some photos. EMJ: I’d love to see your photos. Are you here next week? M: Tuesday I will be here again. At any time during my break time I can come, because nowadays we have class. More of the interview can be heard in a podcast which can be accessed here https:// soundcloud.com/bmjpodcasts/drc-to-darone-physicians-journey-to-emergencymedicine/s-5ck7t. Contributors This interview was edited by Dr Teri Reynolds and the questions were asked by Professor Ellen Weber. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
To cite Muller MM. Emerg Med J 2014;31:611–612. Accepted 19 May 2014 Emerg Med J 2014;31:611–612. doi:10.1136/emermed-2014-204019
The view from here is published quarterly. Please see our Instructions for Authors for guidelines: (http://emj.bmj.com/site/about/guidelines.xhtml# The%20View).
Muller MM. Emerg Med J August 2014 Vol 31 No 8
Downloaded from http://emj.bmj.com/ on June 28, 2015 - Published by group.bmj.com
DRC to Dar: one physician's journey to emergency medicine Mundenga Mutendi Muller Emerg Med J 2014 31: 611-612
doi: 10.1136/emermed-2014-204019 Updated information and services can be found at: http://emj.bmj.com/content/31/8/611
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
