Koegler, Erica

Public Health

PhD

Democratic Republic of Congo

DR Congo-Microfinance Intervention for Survivors of Violence in Rural Democratic Republic of Congo

The study is funded by the NIH/National Institue of Minority Health and Health Disparities to evaluate the effectiveness of a village led animal husbandry microfinance intervention on the health, economic stability and reinteration of survivors of violence in 10 rural villages in South Kivu province of Eastern DRC. The research team works in partnership with local Congolese NGOs to implement the study. The research team is conducting interviews with 600 individual households randomized to either the microfinance or delayed control groups and then followed for approimately 24 months to assess the health, economic and social outcomes.

After following the situation in the Democratic Republic of the Congo for several years, I was surprised to find that in Bukavu, I did not feel threatened in the community.  The local teams we were working with were very aware of the security situation at all times.  A couple of times I experienced expectations of bribes from police, but this was not very different from previous encounters I had experienced in other East African countries and I never had to pay any bribes.  The biggest challenge I experienced was working in a setting where the primary language used was French, which I speak very little of.  I had taken a few French classes prior to my trip, but I was not able to be functional in the language.  Fortunately, my colleagues were able to translate conversations for me into the two languages I know, English and Swahili.  Despite the challenge, listening to French and having a French tutor while at site helped me to increase my language ability.  I continue to take classes to prepare me for my next visit.  I found other differences in culture to be relatively easy to adapt to due to the support of colleagues from Congo and the US as well as my previous experience living in Tanzania.

Access to healthcare in DRC can be difficult for those who do not have enough money to pay for services or transport.  Even more difficult to come by are adequate mental health services, the area of my interest, which are important because the population has survived many years of conflict.  Both of the organizations that I was able to work with through this partnership with the Center for Global Health and Professor Glass are addressing health and mental health in unique indirect and direct ways.

PAIDEK’s extensive microfinance portfolio allows small and larger loans to be given to members of the community to support livelihoods.  When people have access to finances and ongoing income they are able to pay for the health services they are in need of.  I believe this method of being financially able to support oneself is preferred to a dependency model as the community is psychologically empowered to seek out one’s own health services thus make demands on what they are paying for versus being dependant on whatever free services are available and potentially having less say in one’s care.

FORAL targets health through a mobile clinic in rural areas where the population has few options for care.  Through their solidarity groups, women in the community come together to learn new skills, start new enterprise, and farm.  During the hours that women farm together, they naturally speak to each other about both the mundane and things of great importance forming key relationships for mutual support.  I was very impressed to learn about the groups’ cotisation efforts.  When one member of the group had a death, birth, or marriage in the family, the other group members would organize to collect supplies and funds to help the family through their difficult situation.  Although this may often be done in the U.S. and elsewhere, it was heartwarming to see it being done amongst a group who has few financial resources and has experienced years of economic hardship. 

It appeared to me that there is no better way to rebuild communities after years of conflict, then for locally based, highly motivated organizations to take the lead in determining and implementing what is best for their own community.  This being said, I believe there is room and need for international support to assist in facilitating, documenting, and scaling up effective locally based efforts.  By documenting effective efforts in one setting, they can be adapted and utilized in other settings. 

I would highly encourage other students who are considering applying for a global health established field placement to do so.  There are diverse options available and it is likely that one or several of the options coincide with the student’s own interests.  Regardless of if the student has previous experience working in an international health setting, this experience will likely inform the next steps in the student’s career.  For me, living and working in the DRC for ten weeks has confirmed that I wish to conduct my dissertation research in this setting and with the amazing colleagues I was able to meet.    

People

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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