SMNTY Classics: Sex and Gender Based Violence in the Democratic Republic of Congo

Coco Tang and Kimberly Spray of Global Outreach Doctors join the show to delve into their experience in the Democratic Republic of Congo to assess the fallout and possible sustainable, actionable items we can take to combat sex and gender based violence in that country in this classic episode.

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Episode Transcript

Speaker 1 (00:05):
Hey, this is Aye and Samantha and welcome to stuff
I Never told your protection of I Heart Radio. Today
we have an episode we wanted to rerun because we
recently talked about the d r C, the Democratic Republic

(00:25):
of Congo UM in in Activists around the World segment
and it made us remember a really good episode, fantastic
episode we did in the Before Times Before Times, Yes
UM about gender based violence and in that country, and
we had two interviews on there that were just fantastic,

(00:48):
and it was one of the last things we did
in the studio. But COVID was happening at that point
because we talked about it in there, UM, and we
also talked about um so off care and uh, we
should check we should check back in on them. I
would love to see see what they're doing now, where
they are now. But this was also a listener helped

(01:09):
us bring this all together. So we always love suggestions
like this about who we should be talking to, things
we should be talking about, So really appreciate it, UM,
and please enjoy this classic episode. Hey, this is Annie
and Samantha and welcome to stuff I'll never told your

(01:30):
production of I Heart Radio. So today's episode I'm very
excited to present to you and it's actually, um, it
was a listener that got in touch with us and

(01:51):
facilitate this whole thing. And we'll get more into that
and in a second, but we're going to be talking
about sex and gender based violence or STVV in a
Democratic Republic of CONGO or the DRC and trigger warning
for a discussion of sex and inner based violence, sexual
assault and suicidality. And um, this one is so valuable

(02:14):
and worth listening to. But though the topics that we
discuss with our guests in this one are are very intense. Um,
So just keep in mind your mental health when choosing
to listen or not listen, are what time, because you
know sometimes you're just not a good place right now,
which you might be later. I just want to put
that out there, and just to put it out there,

(02:36):
I guess are really optimistic, yes, in such dire circumstances,
it seems, and they had put a lot of positivity
and what they're talking about as well. So it is
it is heavy, but at the same time, it is
still hopeful, Yes, absolutely, and it is not all bad
at all. And so okay, this was a suggestion from

(02:57):
a listener named Rebecca, who volunteers with a nonprofit organization,
Global Outreach Doctors, and she said, I'm going to use
her words now. This organization quote deploys volunteer medical doctors
and nurses, at mental health professionals and midwives and integrative
health professionals like trauma trained acupuncturists to high need, low
resource global regions affected by natural disasters, refugee crises, war zones,

(03:21):
and famine, such as the Democratic Republic of Congo, Kenya, Ethiopia, Bangladesh, Iraq, Nepal, Lesbos,
and the Syrian border. She went on, the organization just
completed an assessment mission dealing with a gender based violence
in the Democratic Republic of Congo. The d r C
has been labeled by several organizations, including the UN as
quote one of the worst places in the world to

(03:42):
be a woman. During focus groups. In the assessment of
current medical capabilities in the eastern part of the country,
the go docs assessment team found that mental health care
for victims of sexual and gender based violence in the
DRC is severely lacking. According to the WHO as often,
there were only points zero eight psychiatrists and zero point
five psychiatric nurses per one hundred thousand people in the

(04:05):
d r C are less than sixty five psychiatrists and
four hundred five psychiatric nurses in a country of seventy
eight million people. So Rebecca put us in touch with
Cocotaine the go docs VP of Planning and Logistics, and
Kim Spray bs N r n c N, who are
both on the assessment team. Before we get into that,
we want to do a brief rundown of the situation. There.

(04:25):
Officially established as a Belgian colony in nineteen o eight,
what was then the Republic of Congo gained independence in
nineteen sixty. The region has since experienced political and social
unrest and instability, violence and periods of civil war, and
millions have been displaced. Rape and sexual violence are frequently
employed against women and violence as a method of control, intimidation,

(04:46):
and humiliation, so for most survivors, justice isn't really an option.
The perpetrators ranged from soldiers to teachers to neighbors, and
partly because of that, most women and girls don't report it.
Those that do might be cast out from their homes
and families. And on one day in noven between the
twelve hundreds were raped and schools are frequent targets. According

(05:09):
to Congolese women's groups, things like an ineffective justice system,
poor governance, and women's inferior social position all play into
the sexual violence in the d r C, and while
it is under reported, the numbers we do have are disturbing.
Recent obtained statistics revealed that about eleven cases of sexual
violence are documented each month in various health zones, which

(05:32):
amounts to an average of thirty six victims a day,
and the most affected population is comprised of girls aged
between ten to seventeen, although ten percent of the victims
are less than ten years old. Congolese women constitute the
DRC population. Their visibility and contribution to food security for
the survival and running of the Congolese society is undeniable

(05:52):
and internationally recognized. However, studies and recent investigations show that
the position of Congolese women in several dominions of national
life remains low in comparison with men. Access of women
to decision making tables, as well as to national economical
resources and production factors remains very limited. The situation has
deteriorated in latter years with the negative effects of wars

(06:13):
in repetition to the current persistent insecurity. In fact, sixty
one point two percent of Congolese women live underneath the
poverty threshold against fifty one point three percent of men,
while forty four percent of women cannot attain economical timeliness.
And Furthermore, in the d r C, the situation of
gender based violence, particularly domestic violence on women and young girls,

(06:34):
is very worrying. Collected national data on various forms of
violence against women demonstrates how it strongly correlates with the
under development in conflict battered DRC. Gender based violence, including
sexual violence, has reached epidemic levels. In alone, close to
twenty six thousand, eight hundred cases were registered, but many
more have not been reported for fear of retaliation, because

(06:56):
of the limited monitoring and reporting systems in place, which
don't cover all affected areas in the country, and because
of security and access constraints. Humanitarian partners have been advocating
for more funds to be able to provide survivors with
post rape kits within seventy two hours in safe spaces
where they can get dedicated psychosocial support. In the twenty
nineteen Humanitarian Response Plan requires one point seven billion dollars

(07:20):
to reach nine million people. Of those, five point seven
million people require protection services. To date, the appeal remains
only twelve percent funded. And we can't forget the consequences
beyond the trauma of rape, like dropping out of school, pregnancy,
forced marriage, s t I S. Things like that. And
just so you know, early marriage is a common practice
and an estimated seventy four percent of women between fifteen

(07:42):
and nineteen years of age are married, and mostly in
the rural area. The legal minimum age of marriage is
fifteen for women in eighteen for men, and because of this,
in the more rural areas, girls as young as thirteen
are forced into marriages in order to provide for their families.
So clearly this is something we should be talking about.
But it's one sing reading the statistics and it's another

(08:03):
thing being on the ground talking to those who are impacted.
We talked with two amazing women, Coco Tang and Camplice Spray. Seriously,
there are resumes outstanding, astounding about what they experienced when
they went on an assessment mission around sex and gender

(08:23):
based bilence in the DRC. And we're going to get
right into that, but first we're gonna take a quick
break for word from our sponsor and we're back. Thank

(08:43):
you sponsor. So let's let our guests introduce themselves. My
name is Coco. I'm a paramedic. I'm currently the operations
director for Global Outreach Doctors. UM. I also worked with
a few other different NGOs. I'm usually practice over so
I'm just getting out of my Afghanistan contract, kind of
my way to Norway before I go back to the US,

(09:07):
and then I'll throw the ball over to Kim. Hey. Yeah,
my name is Kim and I'm an emergency nurse by
training volunteer with Global Outreach Doctors and have a little
bit of experience working in West Africa as well. Yeah,
you both were kind enough to send along your resumes

(09:27):
and they were super impressed. They were very impressed. It
made me feel very very Um. I'm not accomplished or something.
I'm just gonna leave at that. Um. But how did
you How did you get into this line of work?
So I first became an emergency medical technician when I

(09:48):
was in undergrad UM partly because both my very Asian,
very Chinese parents are m d pH ds and wanted
me to be a doctor. So I had to have
some kind of exposure to medicine, but also because being
e m T paid better than other minimum wage college jobs.
So that's what I did. And then when I got
my born, I'm full Bright scholarship and fellowships to the

(10:09):
Middle East. I was living in Jordan and then I
was doing research on this Yeraron refugees and the ISIS issue.
So I was working in this year and refugee camps,
and then someone heard that I have medical skills, so
I was like, do you want to volunteer for the
border metavacs? And I was like sure, And that's how
I kind of got started. And then I walked out
of UM sort of that experience, realizing that there are
these huge international crises that I can be a part of.

(10:31):
And then that winter the typhoon Hyan hit the Philippines UM,
so then I immediately signed up to volunteer there. And
then as soon as I graduated, I went to Sierra
Leone UM at the height of the Bowla crisis to
do this community outreach thing, and then it just kind
of snowballed from there. I think can can attest to
this too, like once you kind of meet someone in
this weird little community. You get networked and sucked in

(10:54):
and then before you know it, all these organizations are
asking if you are available for this mission or just
some or availability for this other vision and stuff like that.
Very true, yep. UM. So for me in terms of
global health, UM, I actually was finishing my Bachelors of
Nursing UM and was working full time as an e

(11:15):
our nurse, which is three twelve hour shifts a week,
and finishing my BS and I felt all of a
sudden I had all this free time on my hands
and was kind of bored and UM. So it was
the beginning of the fourteen A bowler crisis. And I
put my appetition out the U S A I D
and I was accepted by an m g O UM
and signed on for six weeks and ended up staying

(11:36):
for two years in mist Africa. UM. And so that's
kind of how this whole thing has started for me. UM.
And now I'm getting multiple master's degrees in the field
UM helping to continue. That's awesome. And UM. One of
the reasons we brought you on today that we wanted
to hear from you, is I one of your coworkers.

(12:00):
I guess Rebecca reached out to me and said, you
should really be talking about sex and gender based violence
in the d r C, which is something that both
of you have experienced with have seen firsthand. Um, could
you give us sort of a for for listeners, maybe
a one on one of what's going on there? Yes,

(12:23):
but sort of before we jump into that, I think
it'll be good to preface this with, you know, like
for us, we were just kind of there for like
a two week thing, like, this isn't our reality, and
we're not you know, like the experts on it by
any means. They're certainly a lot more people who are
more qualified to speak about it than us. Um, So
we're just kind of coming at it with the perspective of,

(12:44):
you know, like a two week medical mission volunteer type
of point of view, if that makes any sense, Right,
That's why you were sent there, right, sort of a
mission to to understand the scope of the problem. Perhaps, Okay,
So and Kim obviously feel for to jump in whenever
you like. The original sort of idea for the mission, um,

(13:05):
Like when this idea with birth was that we would
go in for some kind of healthcare assessment and see
where the gaps are UM in sort of like the
healthcare infrastructure in health Hebrew, and this was something that
Go Duck has done in other countries, so like earlier
the year we did something similar for Ethiopia UM, but
our local partner that we were working with UM it's

(13:26):
called SUFFCO and it's this French acronym that I'm not
going to try to pronounce because I'll mess it up,
but it basically works with like these local girls and
women and empowering them giving up skills sort of like
navigating the social landscape of being a woman in DRC.
So we kind of approached it with maybe like focusing
on STDV, which is like sexual gender based violence, but

(13:49):
obviously we didn't really know what we would find until
we actually got on the ground and started doing our assessment.
Can't we have anything to add? Yeah, no, I was
just gonna go further from that, and then you know,
once we arrived on the ground and realized UM, there
are quite a lot of people, as Poco said, that
are much more experienced in this and actually doing a
lot of work in UM SGBV UM, which is a

(14:11):
sexual gender based violence area, including Dr Mucuig who's there
in um Mukabo, who's won the Nobel Prize and he's
there doing all the like physical problems. So, um, we
realized that the mental health issues related to both the
SGBV and the ongoing war in um the d r
C where how global outreach doctors could add some support

(14:35):
to the area. Yeah, So I think one of the
key issues that like became like immediately urgently apparent was
that there was kind of like no psychosocial support for
all of these like women or just victims of STVV
in general. And I mean, God knowes it doesn't have
to be female, but like I think the statistics are
right now something like point eight like psychologists for like

(14:58):
a hundred thousand people in Congo, And I think when
we were there, there was maybe like one psychologist that
was working in the entire South Keybrew area. So this
was like a completely kind of like foreign territory for
I think the healthcare providers there. Um. And even in
some of the interviews that we were doing, it's like,
you know, what are you doing after your assault to

(15:18):
kind of help you get over this? And a lot
of the answers we got were just, oh, you know,
maybe some support groups or sometimes I can talk to
my friends, but it was just like a complete lack
of this particular support, even so much so that the
providers realize that this was an issue. People would show
up to the hospitals and our clinics complaining of kind

(15:40):
of generalized body aches or just your attention was another
big one. Yeah, And really, if you dialed down, you
found out that there was some trauma. Whether it was
s GBV or related to the war, UM doesn't really matter.
It was just a trauma. And really the the underlying
problem was the mental health issues that nobody had been

(16:00):
addressing there at all. In any way. Um, they don't
have the medicines available, they have very limited UM support.
The women don't really feel like they can even discuss
it with each other very much. UM and certainly across
gender lines, there's really no discussion on this problem. Yeah.
When we were doing the research for this, they were

(16:23):
just so so so many stories, UM so many women
who were talking about it. And I do think that
it's something that UM, we don't think about a lot.
Is the mental trauma, like people who have experienced it do.
But if if you haven't, then it just doesn't occur
to people that this is a huge gap that that

(16:43):
would cause all these other things. And I think in
sort of that region in general, I mean, I think
people kind of treated as like a tired or talked
out topic almost. You know, like it's known that DRC
is like the rage capital of the world just because
of it's like violent in recent history. Um. But also
like this issue has been eclipsed by a lot of

(17:05):
other issues, you know, like the M twenty three rebellion
or like the recently Bowl of crisis, Like this has
sort of kind of become like a bad burner topic. Um.
And even when I was coming off of the mission
and reaching out to some of my journalist friends to
see if there might be potential interest um on writing
about kind of like what's going on with these women
sort of like how years, decades after these conflicts, like

(17:27):
there has been no respite for them, and the response
has been, you know, there there will be no interest
for such an article. It's like a talked out issue. UM.
I don't know, it's just like very sad that is
so disappointing that it's something can be talked out when
it's people's lives that we're talking and how they are
affected on a daily basis in such an awful dramatic

(17:48):
la that's really saddening. Yeah, and that does actually bring
me to your question. I was going to ask later,
but since it's a good segue, how what ways do
you think the media could improve when talking about this?
And um, what ways have they failed? Which might dovetail

(18:09):
into each other probably oh, um, like in Congo in
general or kind of like sexual violence as a broad
topic both honestly, um and cann't if you don't mine,
I'll start with sort of like a personal experience. So actually, um,

(18:30):
before this Congo mission, I was in Ethiopia on a
different mission, and I was actually sexually assaulted by Ethiopia
and local there um. And it's like still an ongoing
issue that I'm dealing with a lawyer in Ethiopia to
try and see this case through even though like no,
des might not be in Ethiopia, which is a complete nightmare.
And I had just like reaching out to some of

(18:51):
the local newspapers to see if there might be interest
in sort of like outing this guy that lives among
their midst and it is a well known sexual assaulter
and you know, like thief of like foreign tourists. Um,
I got like zero response. UM. And I think it's
just like it's not popular news or it's like talked

(19:12):
out news like I was saying before, like oh another
person got assaulted. What were they thinking? You know? Or
the other end of the spectrum is like who cares
about that? Like that's so like a non issue and
that I guess that's sort of like Ethiopian media. I
can't really make a broad comment about like US media
with writing a book about it or guess how much

(19:33):
time three can What thoughts do you have? I don't know.
I don't have really great thoughts on on that. UM
too much really, Um, it is a huge topic and there's, um,
you know, so many different parts of it right that
you know, people need to be feel free to address
their issues and recognize that there are issues. We also

(19:56):
need to recognize that it's a problem in the world. UM.
But UM, you know, our our DRC mission UM was
kind of more focusing on how can we get the
local providers to help recognize that this is a problem
and then treated as such. I do kind of just

(20:17):
want to add also, um, and this really hit hard
for me when I was asked this question so one
of the local women, I can't remember which one of
us did her interview, um, but she was asking like,
so are you she she you don't like recounted for us,
like her probably her worst moment in her life, like
talking about her sexual assault. I think she was getting
raped or something. Um. And then she was like, so

(20:38):
are you going to do something? Like are you going
to help me with it? And you know, we had
to give her a very painful answer of like no,
we're here for the assessment, Like all we can do
right now is collect your story. And it kind of
like reminds me of the times that, like I've worked
in other refugee camps or in like vulnerable populations where

(21:01):
my job wasn't not as a journalist, but even as
like a humanitarian worker, My job was to collect their
stories m or like turn them into data and numbers.
And you know, in the same vein that journalists just
turned them into like names and words on a page,
but for them that's like their lives, like they're telling
you their worst moments and then not knowing if they'll

(21:23):
ever kind of see any recourse from the information they
give you, and even if it does, you know it
could take years, months, what have you. And I just
think that's like a very painful thing for them, right, Yeah, absolutely,
And um, I know a lot of cases go unreported
because there is a fear of of retaliation or just

(21:45):
almost like well it's going to be painful and I
don't know what else get out of it. Yeah, that's
very true. Um. And but the other part of this
is the problem with um, you know, Western medical missions
kind of issue of you know, like we show up
and then you know, the white doctors are there, and
everybody wants to get seen. And because we're going to

(22:06):
solve the day, and that's not the way that this
is gonna the world is going to get better. The
world is going to get better by m empowering locals
to do the work, the same work, because we are
not the you know, all powerful people. Um, We're just
the same as everybody else, right. And I just I
just want to add like one last point, like one,

(22:27):
I just like recalled and instance, when I was working,
uh like a refugee camp in Jordan's and this group
of I forget which newspaper they're working from, they wanted
to come in and interview the children and they were
working on like a specific topic, Like their question was
like what do you dream about? And like in sort

(22:48):
of organizing this and watching how the children failed to
comprehend this question because they were just like, what do
you mean what we dream about? Like we dream about
our old homes, like being at home, like we left
our houses like um. And I think that's kind of
where maybe Western media fails a little bit, is like
taking these questions that we think our audiences are would
be interested in, but are completely out of context for

(23:11):
the population that they're trying to interview. And I don't
know if I'm like articulating this correctly, but like that
question was like so out in left field for those refugees,
like they were like, I don't even understand what you're asking.
But for us audiences, like a Western audiences, like oh,
what do you dream about? It's like such a high consciousness,
like surreal topic that for them, you know, they can't

(23:33):
even get food or water, Like what does it matter
what they dream about? Yeah? I think that's perfect cook of. Yeah, well,
now you have any two questions I need to ask?
You're putting so much out here. Um. The first question
I did, I want to ask how many. Did you
have a lot of women that were willing to come forward? Um?
Wasn't easy to obtain that information because obviously they probably

(23:56):
all interact with again, groups of people that come, they're
trying to get an assess in or maybe try to
help or not. How often would you have pushed back
and how often would you have like a flood of
people coming in, Yes, I want to talk, I want
you to know what's happening. I think we had mostly
like floods of people who are willing to talk to us.
But I think it was more under the assumption that

(24:17):
we were there to do something or like fix it. Yeah, no,
I agree, and um, working with our partners Safeco, UM,
they kind of, um you know, said hey, they're coming
and they want to talk to you. And so we
would have you know, hundreds of people there in the morning,
UM that wanted to talk to us, and we're willing.
But again the problem was that we really could do

(24:38):
very very little for them, and some of them like
walked from nearby villages like just to be seen. Um.
And I mean we we did whole you know, like
clinical hours where like we did clinical work, like we
asked them what their ailments were and then we you know,
had sent them to our little traveling pharmacy. Um. But
you know, by and large for like this huge, large

(25:00):
a myth of an issue of like s GBV, Like
we really could only just talk to them, right, And
that was really sad. Yeah, and that could be especially
if you're in the medical field and you want to
fix things as well. Um. And then the other part
was as you were talking about people coming in and
this Western nice idea one of the big issues that

(25:21):
I've had for so long when it comes to mission
trips and we know Western civilizations saying we're gonna go
fix things. Guy, I want to go to Africa. The
whole white savior complex. How often have you been running
into that? And can you kind of speak on the
damages that can do constantly? And I think so, like

(25:41):
it's really sexy. I think for organizations to be like, oh,
we're gonna go for two weeks and like do this thing,
and these are our benchmarks, key performance indicators, how many
people serve, how you know, how much drug supplies we delivered.
But like there's very rarely kind of a plan for
sustainability because you know, that's a long term investment. It
requires money, it requires like investments and energy, like supplies

(26:05):
and stuff. It could be like years, whatever. And I
think a lot of organizations just don't have the capability
for that type of long term vision. And it's not
necessarily their fault, right Like, you know, we're volunteer organizations,
were by nature limited in the scope and our funding.
I think lacking this makes this kind of industry sort

(26:25):
of very myopic in its application, because when we arrived
in some of these places, they were like, oh, so
you brought us drugs, right, Like, you're here to see
our patients, so our doctors don't have to work for
the days that you're here, Like they really just expect
you to do this work for them and then they'll
just go back to life as normal, and then another
group will come do that work and then they'll go

(26:46):
back to life as normal. Yeah. No, I completely agree
with that on all sides, right um, Because you know,
as the Westerners going, you know, people think, oh I'm
gonna I'm gonna go help for two weeks, um, but
that's really just barely aband aid, right um. And really
what needs to happen is a longer term solution. I

(27:07):
mean and of course, there are emergency situations two weeks
is perfect, right, like a typhoon or a hurricane or
an earthquake. You know that that's no problem. You can
do that acute care. But for the most part, you
need longer term care. And you know that's why Global
Outreach Doctors has been able to UM, you know, connect
with these thirty plus you know psych advisors from the
United States to start doing some education UM in the

(27:31):
Congo with the providers that have joined us as part
of our DRC group. UM. So that helps. So I think,
like what makes sort of our outlook on this Congo
mission a little bit unique is like we are trying
to implement like a much longer term plan UM and
not necessarily in terms of like sending teams over and

(27:52):
over again, but sort of like empowering the like the
local providers to take charge and ownership of like their
own health care system, like we've with like suffrago UM
and like our local partners have to help, you know,
nominate these community champions who could potentially apply this clinical
psychology training to their own communities and like hold workshops

(28:13):
for their own people instead of you know, having these
muzbu doctors come in and speak to them and then
leave for two weeks. Um. And I think sort of
if this idea could be more widely adopted by other organizations, UM,
it could really like change the face of humanitarian work. Yeah, definitely.
And UM, I mean I remember one example for me was, UM,

(28:35):
we were inundated with hundreds of people wanting to be seen,
and I was kind of doing my ear nurse triage
and there was one lady who was completely concerned about
UM and said, you know, she has to come next.
She just was not acting right in any way. And
I didn't really know what was going on in terms of, oh,
this was the one that fainted in the middle of
the line. No, no, no, not that lady, and this
is actually stories. Yeah. But and so I said, you know,

(29:00):
we have to see her next, and and all the
locals just came up to me and said, oh, no, no,
don't worry about her. She's just crazy, you know. And UM,
they kept saying, okay, yeah, she's crazy. UM, and we
I finally got I pulled her in next to be seen, right,
So she kind of slipped ahead in the line because
she definitely looked the sickest in the line. Um. And

(29:21):
as an ear nurse, that's what I'm used to doing,
is peaking the worst and um, you know, and and
it became quite obvious that she was schizophrenic. Um and
you know, I was having some major problems and we
don't know why because she's just not able to communicate
in that way at all at that point. Um. But
but more than getting her any help, it was the

(29:42):
other Congolese realizing that, like, she was a real person
and did have real problems. It wasn't just oh, she's
crazy and we can leave her there, um, and we
all get to get seen because you know, we have, um,
some other issues that you know, those are the major
issues that need to get dealt with, right. But I
mean you think about it in sort of their point
of view, like how often does a person get dismissed

(30:04):
for just like being a little off or like crazy,
But it's actually like maybe having like PTSD or like
some really serious underlying medical issue that they just you know,
get brushed off as like oh, she's crazy, don't worry
about her or whatever. Right. Yeah. One of the first
episodes we did together, we did a mini series on trauma.

(30:26):
When we first started. UM, so we've we've talked about
those kind of health those negative health outcomes that can
be associated with it. A lot of the stories I
read just seeing like things like STI is in pregnancy,
all these just things, Um, that's sort of yeah, yeah,
I mean women used to get burned for existing pretty much, right.

(30:50):
I Mean that was definitely one of our big conversations.
And that's. Um. I've been in social work before this world.
And one of the things that Georgia and the US
has finally started talking about is trauma based and evidence
based therapy instead of just diagnosing with random things here
and there and saying, oh, that's just their behavior, understanding
a majority of their diagnosis and their behavior is due

(31:12):
to trauma, and knowing that that's only starting now for
the U. S can't imagine what that looks like for
the rest of the world. Kim, do you remember that
one patient, She was like an elderly lady and she
came to us like genuinely fearing for her life because
she was like ostracized by her village because some kind
of like sexual trauma happened to her. And then I

(31:33):
think she had a family member dies within her village.
Like I thought she was a witch or something, and
then she was like ostracized in her tent, like people
don't approach her, um, Like sometimes they threw stones her,
like do you remember that one? And she was like
begging us, like please help us, like I can't stay
here and I'm gonna die, like they're gonna kill me.
Remember that? And I think that that's I mean, that

(31:55):
wasn't the only time I heard that. You know, after
some sexual based violence happens, that then you're considered you know,
um ostracized, untouchable. I mean even so much so that
the children of rape cannot go to the normal schools
you know have to um, you know, are are also ostracized.
So it's a it's a continual process. Yeah, And so

(32:19):
we had we had this one like super young teenage girl.
Um she was getting raped and then to the point
that she had like a rectal anal fistula um. And
she like did not speak for I think two years,
and even at like our interview, like she refused to
say anything to us, like she I think her mother

(32:39):
or her aunt or something like talked for her and
recounted her experience, and she was just like catatonic, like
zero aspect UM. Yeah, it was. It was really depressing. Yes, yes,
I think that we're going to backtrack a little bit
just to get all the information. But can you because
you've said it a few times and obviously it was

(32:59):
we were with the can you explain Global Outreach Doctors
and what it doesn't what its mission is? Sure, so
Global Outreach Doctors we are a nonprofit medical organization. UM.
We send volunteer teams of healthcare providers to you know,
like high needs, low resource areas parts of the world.

(33:20):
And our missions range from like healthcare augmentation to like
various responses to like assessments. Really so I can name
a few like recent ones. Obviously this Congo one, it
was a healthcare assessment. UM. We did another assessment in
the Gonder Mountain region in Ethiopia last year. UM we

(33:42):
also went on like supplied volunteers for there was a U. S.
Southcom Navy trip in and around the Caribbean and South
America sort of to help out with the Venezulan refugee
crisis and all the IDPs and refugees that were displaced
from that conflict. UM we've also like sent people to
a most whole in two thousand seven during the anti
isis offensive. Currently we're like working on a project to

(34:07):
support the Dangai fever outbreak and like the Marshall Islands.
So I mean there's a variety of missions that were
involved in and they're not always sort of like in
the same sphere um, but I think in general we're
sort of moving more towards like this long term sustainable
development like local empowerment type, whereas I think a lot
of our like pure organizations sort of are more into

(34:30):
like the quick in, quick out, like high speed, low
drag type of like two weeks patch, patch, patch, and
then get out type missions. And if you're interested in
more information, obviously we have a website shameless plug. It's
www dot Global Outreach Doctors dot org. Awesome normal spellings.

(34:50):
That's great, exactly what we need. Okay, So going back
to to this mission in the DRC, could you get

(35:11):
what was kind of a general just day like there
and then what data did you end up with if
you can have is there any like analysis or like
from what age to what age? How many women did
you see? Are people I can talk a little bit
more about like the day to day stuff because I
managed the legistics and then I'll kick it over to

(35:31):
Kim to talk about the data stuff because she was
definitely more involved with that part. Um. I wouldn't say
that we had any day in like the two weeks
in some extra days mission that were the same. Like
every day was either moving from one place to another,
We're seeing patients at this one place, We're getting ready
to go to another place. At one point, like we
had questions about our security because the area we were

(35:51):
going into, you know, there's been known rebel activity and
violence in that area. Um So, then we had to
take a flight in. But then it had to be
like a minuscal helicopter because like the charter flight cancel
so that our team got split. Um So, then like
the people who had flights out of Rwanda really early
went on the un helicopter, but the rest of us
were like stuck in this enemy surrounded mountain village for

(36:15):
like a few days with internet. I don't know if
you've ever seen like this movie called like the Tears
of the Sun, but one of my security contractor friends,
when I told him about it, he was like, Cocoa,
that's literally the plot. Like if you were there for
a few more days, and I didn't hear from you
like we would have sent several bearded men to go

(36:35):
rescue you guys. I mean, obviously it didn't come to that. Um.
I mean it was a beautiful place to be stranded
and like the locals treated us like family and it
was amazing every day dealing with some aspect of the
logistics of being in that part of the world. Early. Yeah,
So then UM, talking about the data, So, UM, we

(36:56):
did assessments in all the different hospitals are clean X
that we went to on both depression and mental health. UM.
So the the scoring systems we used for the pH
Q two UM in PHQ nine, which are both regularly
used in the United States for depression, and we also

(37:17):
use something called the Refugee Health Screening fifteen UM, which
has obviously been studied only for refugees and or traumatized patients.
So people would come to us and we would say,
you know, are you a refugee or do you have
some serious trauma? And if they said yes, then we
would use that RHS fifteen. If they said no, then
we would just use the PHQ two. And if the

(37:38):
PHQ two is positive, then you move on to the
PHQ nine. So obviously to add that like refugee is
a broad term, also like including I d p s
because a lot of these internally, these people you know,
moved around DRC because of like nearby violence and stuff
like that. Yeah, that's very sorry, continues that thinks. Um so,
but most people said yes to the been I they're

(38:00):
a refugee, I d P or had some severe trauma,
and so we would score them on the um RHS
fifteen and UM a hundred percent of the people that
we use that on scored positive for severe trauma. And
then the PhD. You were like at one point you
like ask you got to question for and that just
like didn't bother asking the rest of the question because

(38:21):
you were like, they're positive, let's move on. Yeah, very crue. Yeah,
we were so overwhelmed and so busy with so many
people that I didn't we didn't always get to every
single question because once somebody was positive had a positive
score for it, then I was just like, they're positive.
I don't care for the rest of the questions, and
we just need to get them to some assistance if
we can. UM And really, again, this was more about

(38:44):
teaching the local providers, UM, that these are important questions
to ask on every single patient because you don't know
if the lady who shows up with belly paine is
really there because she has um some mental health issue um,
rather than just you know, giving her some medicine for
her supposed belly paint and sending her on her way. UM.

(39:04):
So that was I think the big learning experience. And
for me, sitting with local nurses and teaching them how
to ask these questions appropriately and realizing why it was
important was really the highlight. You know, getting to know
these nurses and getting them to understand that this is
important to their community and how they can help their community. Yeah.

(39:25):
And I think so we also did like gendered focus
groups um. And obviously we had larger groups of women
who are involved with these focused groups and like the
men's groups, but like even being able to explain to them,
like you know, in like in a safe like crowd setting,
that like, not all of your symptoms are because you're sick,
like you're you could be like semantic sizing your psychological issues.

(39:46):
And I think a lot of that a lot of
them just didn't know that that was a thing. So
you know, you might not have headaches because you have
a brain tumor or something. You could be having headaches
just because you have psychological trauma and it's manifesting as
this physical issue. You right, what was the age range
of people you saw right right wide? Yeah, I mean,

(40:08):
you know, I would say it was the entire range.
I mean in terms of STBV. Obviously, the babies weren't,
you know, nobody mentioned that, although I think we had
four year olds or stuff with STBV, but we just
certainly saw you know, babies with malnutrition and malaria and
other things. But then all the way to as old
as as possible, I mean, like definitely post menopausal age um.

(40:33):
And like they you know, whatever age range, like they
had legit questions, Like there were elderly ladies who asked
us questions about like what to do about certain sexual situations,
like just as like the young ones do um, and
you know, mothers who were asking like what should I
do for my six year old daughter who was a
getting rape? Like so and and one lady so like,

(40:54):
she didn't ask this to me, she asked my colleague.
So like her question was so like, well, can you
what advice can you give us you know, as a
Congolese woman in this environment, like what can I do?
And so our colleague answered this question and I wasn't there,
but maybe you were like she handled it very well,
because I definitely I would not have had any idea

(41:16):
what to say. Um, but she was like, you know,
I know your situation looks really bleak, but it's important
to have this kind of solidarity, feel open with each
other and support each other. I can't like replicate her
super eloquent answer, but it was just like a lot
of those types of questions that made you turn your

(41:37):
head a little bit and do a double take on yourself.
Hm hm yeah. And I sort of going off of that,
I m a lot of news media called the DRC,
like you know, the rap capital of the world or
the most dangerous place for a woman, And I did
read a lot of articles from written by Congolese women.

(41:59):
You were saying like, yes, the situation is really bad,
but there's also a lot of sisterhood and solidarity and
strength here and resilience. Do you have one of like
the enlightening, eye opening things I think we encounter was
how many kind of like just informal women's support groups
there were right, because like one of the questions we

(42:19):
asked on these like interviews was like, um, so, what
are some activities that you do to kind of like
seek support? And I think most of them said that
there's some kind of like a local community like women's
group that they go to. But obviously the issue is
like that if there was a leader for these groups
you or they're not really trained in clinical psychology, they

(42:40):
might not be giving out appropriate advice. But I mean
there was like what I felt was like this hunger
for like something better or like something to improve the
current situation with within this like gender meeting group, support
group thing. Would you agree with him? Yeah, definitely, Um yeah,
there seemed to be a lot um you know, and

(43:01):
I don't think that there has to be some really
specific training. I think, you know, just sometimes you know,
sitting down and and listening to each other is all
that's really needed, and and having that ability to say, hey,
I have had these problems. But the problem with that
in the congo, what I was told was that then
you know, then you become a victim for you know,

(43:21):
more violence because you have ostracized yourself of you know,
talk with other women sort of thing. So that's actually
I can't remember which religion was, but like someone was
telling us how, um, she was being targeted because she
was like championing this effort and then that was kind
of like a target on her back because she was
sort of sticking her neck out on behalf of these
other women. Right. Well, we even had that one woman

(43:43):
who had been just attacked and michett ied um uh
just you know, in the last week because she was
a champion for it. Yeah. Um. But the other part
of that I also want to mention is, I mean, although,
you know, going back to the Western media kind of question, is,
although it's important to discuss all these things and realize
that this is happening in the world, I think it's

(44:05):
also important to discuss how beautiful and great the Congo is.
I loved it there. Um. Recently I was asked where
is my favorite place in the world, and I said
bukabu um which is in South Kivu, Congo. Um. I
really really enjoyed the country. It was beautiful, that people
were amazing, and so you know, I think we need

(44:26):
to also realize that good things happen in these places. Um.
It's just not all the trauma and badness, and I
think some of the stuff is forgotten. Yeah. So actually
two things I want to add to that where I
think back to your question about where media fails. I
think we're so eager to highlight all of these like
negative problems and paint this like shocking picture almost kind

(44:47):
of you know, like people stopping on the side of
the road to stare at this grotesque accident. But like,
I don't think we do enough to sort of highlight
all these amazing initiatives that are coming out of this place,
like telling stories of these champions who are like willingly
making themselves a target in order to stand up for
their sisters, or you know, these amazing women in these

(45:07):
communities who are empowering like the local girls to do
this thing, or you know, like being the person that
they can go to, or like providing housing and like
a safe place for other women to speak up. I
don't think we do enough to highlight those stories. And
then the second thing is I'm going to make a
shameless plug for tourism because I got to go to

(45:29):
Arunga Park um the companies Viega Park and also as
part of the Arunga Park trip, I got to hike
Narago Volcano, which is the largest persistent lava lake volcano
in the world. Um and I have been to a
lot of African countries and I have never experienced amazing
hospitality at the level that I experienced it when I

(45:50):
did my Arunga trip. Like the tourism industry there is
really really starving for tourists and for obvious reasons, you know,
the violence, like the people people. They know that people
don't want to go there. So when they have tourists
who you know, are I guess crazy, you're brave enough
to visit there, they're like they express their gratitude in

(46:10):
such a genuine, almost heartbreaking way that like I don't know,
like I bought a stuffed guerrilla even though I like
rarely buy souvenirs, I bought the stuff guerrilla just because
it supports like the local community there, because like the
women there, they make it and they you know, the
money goes back to the rangers who protect the guerrillas
and stuff. So it's you know, your audience, whoever is listening, Like,

(46:35):
visit Congo. It's perfectly safe. You will have an amazing trip,
and the hospitality there is amazing, and you will not
regret it. Like literally I was within feet distance of
the guerrillas and it was like a spectacular experience. And sorry,
I forgot that it is much cheaper to do this

(46:57):
like guerrilla trek uh in Congo than Rwanda, for example.
So like my entire four day itinerary for the Ruina
Park and the New York and Volcano costs maybe, whereas
in Rwanda just the permit, the trekking permit itself costs,
not including accommodations all that. So it is very like

(47:19):
cost like your value for money, you definitely get more
bang for your buck if you do this in Congo.
All right, there we go side notes, So yeah, I
love this. We got too shameless plugs. And then off
of that, what else can listeners do UM if they're

(47:39):
interested in in helping out in any way supporting anyway
UM the situation and dear c well, I mean certainly
go docs always needs UM support, so both UM tears
and from so financial support. So you're welcome to visit
our website again, will Lota doctors dot org UM doesn't

(48:02):
it doesn't have to be It doesn't have to be us,
you know, like if you're passionate about a particular issue
like there, I'm sure there's no shortage organizations that are
working on that issue. UM. I would say, like, do
your research. I always try to support like sort of
more grassroots local organizations than like large international ones like
I c r C or Red Cross, just because like
I want my money to go where I wanted to go,

(48:24):
as opposed to like overhead UM. And if you can
find if you do your research in a particular area
or issue that you're interested in, you find an organization
that works, and you know, I would just reach out
to them. Maybe you are you maybe you run a
podcast that could highlight some of these issues. If you
have deep pockets, you know, like you know, money goes

(48:47):
a long way in parts of the world like that.
And also if you have skills and will like to volunteer,
you know, like go Dogs and some of the other
organizations that work with We're aways looking for like volunteers
who can come on and join us on these trips. UM.
So there's there's definitely an abundance of ways to get involved. Yeah,
And it's just important to realize what's important to you

(49:08):
and how you want to use your time and resources
UM In terms of you know, do you want to
work on saving grillas to you know, want that help
with STBV. I mean there's thousands and thousands of different
groups out there who each help in their own little
teeny way. Yeah. And also I think just like keeping
the conversation alive goes a long way too. As a society.

(49:31):
There are certain topics that we kind of shy away
from talking about just because it makes people uncomfortable or whatever.
Sometimes when I mentioned instances of like sexual assault that
happened to me, like a lot of my guy friends
are like, what that happens? And it's like, yes, I'm
a woman, um, but like, you know, keeping that topic alive,

(49:52):
like bringing awareness to it, not just as people who
live in the West, but like, you know, did you
know that in Congo blah blah blah happens or in
this other part of the world blah blah blah happens.
I'm like, what are we doing about it? You know,
if if you keep it in someone's you know, like
the back of someone's mind, like and they happen to
be in a position where they can do something like

(50:12):
influence policy in any way, you really never know when
some of these topics and connections may come in handy. Yeah,
I mean, and another part that reminded me is um
eve in slur with the vagina monologues came out of
the drc UM. That's where she originally worked with Dr mccoige. So,
I mean even that has standard the conversation a little

(50:33):
bit awesome. Yeah. So one of the things we we ask,
as you've been sharing with what you do, I can
see I would say it's very stressful. It can be
very stressful over apps. What are things you do to
take care of yourselves? Actually, so I'm not very good

(50:56):
at this. My strategy for coping is just to myself
as busy as possible to the point where I don't
have any time to dwell. Um. So, like I finished
my contracting Afghanistan a few weeks ago, and since then
I've just been on the road NonStop, and in fact,
I'm calling you from Moldova right now. Appreciate that. Yeah,

(51:17):
And the day after tomorrow I'll be doing the medical
like a polar medical or anything in Norway, and then
I'll go back to the U S. And then literally
the day after I get back, I go straight to work.
So my strategy which personally works for me, but I
can't prescribe to anyone else. Is that I keep myself
literally so busy that I don't have any time to
dwell at anything else. Yeah, um, And I mean I

(51:39):
think this is a huge problem, um, you know with
medical professionals, even in the United States, even that don't
you know, adventure to any other place. And so I
think that's another huge topic that needs to be discussed,
you know, because I don't think we do a very
good job as a culture. UM. I certainly spent twenty
years in them are jency room and reached a burnout

(52:02):
phase and um and had to leave bedside nursing for
a while because of that problem. So, you know, recognizing
that it is a real thing, that it affects everybody. Um.
And it may not hit you on the call or
the situation or the mission that you think it's going to,
but you know something else it's going to hit you then, UM.
So recognizing it and just as we suggested with you know,

(52:25):
the women in the DRC seking, I think it's important
for us to talk that it happens to everyone. And
absolutely I think so you know, we should normalize conversation
about these types of issues, like people are not comfortable
talking about the state of their mental health because they're like, oh,
if I mentioned that I'm having, you know, feeling down

(52:46):
or suicide whatever, Like are my friends going to call
the cops enough or whatever? Because I've definitely had that
happened to my friends, and I've even had it happened
to me, you know. But like, I think we should
be more open about talking about these things, and we
shouldn't sort of like assume everyone who talks about it
is in some kind of dire emergency state. Maybe they

(53:06):
just want someone to vent to, Maybe they just needed
to get this off their trust, and if you just
listen to them, I was like, yeah, dude, like that
freaking sucks. No, I mean that makes perfect sense, because
you know, I know that I walked into the er
one day to work and um was crying hysterically and
told a friend, you know, I want to kill myself
right now. Um. And so then of course it became
a huge issue, and as she said, you know, police

(53:29):
and all that were involved, and it was just I
was burnt out and could no longer watch the parade
of car accidents and guns shooting victims come in the
door anylong. I actually so like I joke about sort
of maybe like some people consider morbid, but like I
joke about sort of morbid topics a lot. Like I

(53:49):
recently made a post that was like, does anyone get
this feeling where it's like, I'm not trying to actively
kill myself, but like if I walked on a grenade
or you know, if I stepped on a landline or
grenade landed in my lab, I wouldn't exactly be mad. Um.
And like a ton of people actually like message me privately,
I was like, dude, yeah, I know exactly how you feel.
And I think so many of us. It's not that

(54:11):
we're necessarily just like suicidal, but we have these kind
of self destructive, realistic feelings and we have no outlet
for it because we're so afraid of being ousted. Do
you know what I mean? Yeah, I completely agree. Yeah,
We've talked about that many, many, many times in this
show Burnout and especially especially in the medical profession. Yeah.

(54:35):
So yeah, normalizing it it's definitely something we should be
doing and hopefully moving that way. Okay, so what are
now that you've done this assessment mission? What are the
next steps what happens now. So now we have UM
the thirty plus advisor groups that are medical professionals mostly

(54:56):
psychiatrists from you know, places like Harvard, Columbia, Mountain, I
and I UM at their prestigious universities and medical centers
that are doing telehealth education providers in the DRC to
help them learn how to address some issues. We're trying
to gather a supply of medicines to provide them also,

(55:16):
but that's you know, a little bit harder, but at
least teaching them how to assess, um diagnose and then
treat people at a very basic level. Yeah, I think
so our long term goal with this project is to
sort of like be able to build up the local
indigenous capacity, like help them help themselves, like teach the

(55:38):
trainer or train the trainer initiatives if you will, UM,
And with these like weeklier monthly engagements, hopefully we can
build up the capacity and then those people can take
their training to other communities and be able to deliver
that information there. And you know, it is a bit
of a lofty goal UM in a place like Congo,
but we're i think pretty optimistic about it. And you know,

(56:02):
of course there's always the potential for future teams to go,
particularly like working in clinical psychology, like a little more
on hands training, like bringing up these community champions um
and giving them not only like the in person tools
that they need, but maybe also sort of like some
of the clinical knowledge like prescriptions or like pharmacology and

(56:23):
stuff like that. That brings us to the end of
our interview. But we do have a little bit more
for you listeners, but first we have one more break
for a word from our sponsor, and we're back. Thank

(56:46):
you sponsor. And we did want to end on some
positive things on the horizon for the d r C
that will hopefully improve the sex and gender based violence
going on there. One thing is getting more women in
positions of power. To that end, in a group of
NGOs and their local partners formed a movement called Nothing
Without the Women to advocate for the Parity Act to

(57:07):
get more women involved in all aspects of public life,
although it did not come with specifics, and to push
for a law that required at least one woman be
listed on electoral ballots or the ballot cannot be registered.
They received over two hundred thousand signatures after a march
that drew more than six thousand people. The Parody Act
was signed that same year, which is awesome. So just

(57:29):
a little history of the Congolese women and politics. So Congress,
women are not effectively represented and have never really participated
in the governance of the countries ninety which is the
year of the independence of the country. No woman has
ever been head of State or head of government slash
Prime minister, which neither have they in the US. So
there's that um And there are a lot of reasons

(57:50):
behind the lack of participation from women, including the mere
family responsibility and sometimes the general fear in running for leadership.
Although women constituted six a DRC electorate, the current overall
representation of women is only seven point two percent in
the high positions of recently established institutions Parliament as well
as in the government. The DRC, Government, National Assembly and

(58:12):
major institutions are all essentially run by men. Ironically, several
of the organizations that are for women and support women
are largely run by men as well, and according to sources,
right now, there's no woman member of the Office of
the Senate and there's only one woman among the seven
members of the Office of the National Assembly. Out of
the eight senators are only six women. There are forty

(58:32):
three elected women out of five hundred elected members of
the DRC National Assembly. Out of the forty five members
of the government, there are only five women, of which
four ministers and one vice minister, and there's no woman
governor or vice governor of the eleven current provinces of
the Republic. Getting more women in politics is really important
for several reasons. Several things we touched on, one being

(58:54):
finding from the International Peace Institute that when women are
included in peace talks the chance of lasting peace goes
up by thirty and also having women's spearhead these movements
or laws around women's issues just kind of makes sense,
right And as we know as we were having the
interview with both Kim and Coco, there are women that

(59:17):
are gathering together and it's incredible what you can see
when women gather together. So hopefully we'll see even bigger progress. Shoot,
they might exceed us on the levels absolutely, and we
wanted to end on this quote from Justine Massica Biamba
from The Guardian, we do not see ourselves as the

(59:38):
capital of the world. Instead, I agree with Liberia's noble
Prize Laureate Lima Wilbe, who called my nation the world
capital of sisterhood and solidarity. Congolese women have decided to
take our future into our hands. We have few resources,
but we have an enormous amount of No how it
really does seem like they do, just in the conversations

(59:58):
and the glowing law of the Coco income had for
that community. That sounds a powerful, powerful group of women,
very much so, and it was so worthwhile to to
have this conversation. We would love to have further conversations. UM.
I know frequently we focus on the United States because
we're based in the United States, but we don't want
to be limited in that scope. So yes emails send

(01:00:22):
us suggestions of what issues around the world we should
be talking about, and you can send those to our
email at Stuff Media, Mom Stuff at iHeart meia dot com.
You can also find us on social media on Twitter
at Moms offt podcast or on Instagram at stuff We
Never Told You. Thanks as always to our super producer
Andrew Howard, thank you, Thanks to our guest Cam and Coco,

(01:00:45):
thank you, and thanks to you for listening Stuff I've
Never Told You. The protection of iHeart radios, how stuff works.
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