“It’s about transformative change, especially for women and children” in Democratic Republic of Congo.

Joint U-M–Congolese team is at work on a research and training center to shift focus from violence and conflict to hope and innovation.

“The eastern part of the Democratic Republic of Congo (DRC) has endured one of the most intractable scenarios of war and post-conflict violence; it is time to start focusing on long-term solutions and capacity building,” says University of Michigan School of Nursing (UMSN) Associate Professor Janis Miller, Ph.D., RN, APRN, FAAN. “There are a lot of people doing good work in the region, but humanitarian and non-governmental organizations are limited in their ability to evaluate what programs are and are not working. This lack of systematic evaluation hampers long-term planning, efficiency, coordination and progress.

“Our collaborative of U-M and Congolese investigators is to my knowledge the first in the region to really look at how establishing a center of excellence—and focusing on research and training—can help the Congolese people take ownership for improved long-term health care solutions, and for increasing sustainability and economic viability. That includes building human capital and developing skill sets.”

Augmenting earlier funding, a spring 2013 grant from U-M’s Global Challenges for a Third Century Program was awarded to Dr. Miller and U-M colleagues Paul Clyde (Ross School of Business) and Jane Hassinger (Institute for Research on Women and Gender); also on the team is Lisa Peters (School of Public Health alumna in Epidemiology). They will work closely with Congolese colleagues Professor Gustave Mushagalusa, Chancellor of Université Evangélique en Afrique (UEA), and Dr. Denis Mukwege, director of Panzi Hospital/Panzi Foundation DRC and well-known leader in the care of survivors of sexual violence and women suffering from severe gynecological conditions in DRC. Dr. Mukwege has won numerous humanitarian awards, including the 2010 U-M Raoul Wallenberg Medal, and has been nominated for the Nobel Peace Prize.

Projects and Programs

“We’ll be leading several pilot projects and training programs,” says Dr. Miller. “On the surface they may not appear connected to the war but they can be directly tracked to the traumatization of women and their families. For example, we’ll be investigating solutions for the many women who present to the hospital with seriously advanced cervical cancer when simple screening with vinegar could have detected early and treatable forms. Early treatment requires only inexpensive cryotherapy. However, the war has so seriously crumpled the infrastructure that CO2 canisters and appropriate adapters necessary for the cryotherapy machine are not available in DRC. They are available in surrounding countries, however, and working to procure supplies and implement screening and treatment could make a huge impact on the women in Eastern Congo.

“Why screen for early stage cancer if women are blocked from the treatment due to infrastructure collapse? We aim to document and resolve treatment barriers.”

Other projects include supporting a Congolese student’s thesis on malaria transmission through blood products, systematizing data forms and analysis for the large numbers of women presenting to the hospital with health concerns from either sexual violence or obstetric fistula, and setting up ethical reviews and technical assistance for projects conducted through UEA and Panzi.

“One of the training programs, with Jane Hassinger as the consultant lead, is about launching an advanced certification program through UEA for the nurses and social assistants who are so integral to providing mental health care at Panzi Hospital,” says Dr. Miller. “In the eastern part of DR Congo, almost no one has been untouched by trauma. Complex mental health issues such as post-traumatic stress disorder are difficult to manage or even really understand without advanced training. And, like anywhere else, there are people in DRC who are suffering from other mental health disorders such as bipolar, schizophrenia, depression, anxiety. Learning how to identify those individuals and select appropriate care, from village clinic to specialty hospital and transitioning back home, is of utmost importance.”

The other training program will support UEA and Panzi Hospital in offering certified training for surgeons (including those who come from abroad) to learn skillful repair of obstetric or trauma-related fistulas. Dr. Mukwege and his team of skilled obstetricians and gynecologists are arguably the most expert team in the world in repairing fistulas (tears in the tissue barrier, such as between the woman’s vagina and bladder or rectum).

“There is a misperception that in DRC fistula is strongly connected to rape,” says Dr. Miller. “Those very rare kinds of traumatic fistula do happen in conflict areas when soldiers have sometimes used awful things like sticks and guns or repeated gang rape, but the overwhelming majority of fistulas occur because women are having babies without access to medical care. This still tracks back to infrastructure collapse—traveling to a hospital from remote areas is close to impossible when in labor. The roads are indescribable.”

Looking Forward

Through development of a UEA/Panzi foundation research and training center, more sustainable partnerships between international and local researchers can occur. “It has to be economically viable,” says Dr. Miller. “We have to ensure that Congolese investigators, staff, and doctors are compensated for their work with international partners, something that has been a problem in the past.” Paul Clyde offers systems analysis and business expertise to make certain there is financial sustainability of the center, Dr. Miller explains.

“Research opportunity also provides skill-based learning opportunities. The dedicated staff and faculty at UEA and Panzi, along with local businesses such as banks, are seeking Congolese employees who understand spreadsheets and are adept at managing basic data reports. The training that the center will provide in its research and evaluation programs will build those skills.”

Planning is well under way, and the U-M team is scheduled for travel to DRC. “Panzi Foundation DRC and UEA have developed a partnership that represents an extended center of excellence in the middle of a post-conflict environment,” says Dr. Miller. “There are challenges but the intellectual capacity at their institutions is abundant and impressive. This work is not about humanitarianism. This is research and generating new knowledge to solve the world’s biggest problems. That’s what will bring transformative change, that’s what these grants are about.”

Photos courtesy of Lisa Peters. Story written by Jaime Meyers, UMSN Office of Marketing and Communications

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