Medical students and faculty urged increased awareness and resources to address gender-based violence, mental health issues, infectious diseases and other pressing health challenges affecting communities in the Democratic Republic of Congo (DRC) at an event on Friday.

As part of Stanford’s inaugural Congo Week, the panel was held at the Li Ka Shing Learning and Knowledge Center and co-sponsored by the School of Medicine’s Racial Equity to Advance a Community of Health (REACH) Initiative and the student-led Organization for Global Health (OGH). 

Esther Elonga, a third-year M.D.-Ph.D. student who is originally from DRC, moderated the discussion. Featured speakers included Nyota Babunga, a Congolese women’s rights activist who serves as the program advisor at the International Rescue Committee in New York, and two members of the medical faculty, Wendy Bernstein and Tyler Evans of the Wellness Equity Alliance. 

The use of gender-based violence as a weapon of war has led to significant mental health issues for women in conflict-affected regions of DRC, including South Kivu Province, Elonga said at the event. Ongoing violence has embroiled the eastern region of the country — including South Kivu Province — in a conflict that has caused the deaths of nearly six million people and displaced over seven million others for nearly three decades.

Bernstein, an adjunct clinical instructor at the Department of Psychiatry and Behavioral Sciences in the School of Medicine, had previously treated severely mentally ill refugees and other vulnerable populations from the Congo and other developing countries.

During the panel, Bernstein highlighted the lack of training of mental health professionals in DRC. Evans said there are only three public psychiatrists for over six million people in South Kivu Province. 

“We know that the impacts [of violence] are profound, and at the same time, this is an area with very little developed resources,” said Bernstein, citing a study that found almost half of women in South Kivu had suffered from PTSD. Nearly 20% had died by suicide. 

Evans, an infectious disease and public health expert who has served on the frontlines of the ebola and HIV outbreaks in DRC and other African countries, said there is a lack of funding to provide the necessary resources to address mental health issues. Evans noted the application of Integrated Behavioral Health (IBH) — a program which he said has been effective in the U.S. — to the Congo. 

“It’s really important to highlight how systemic violence is a public health problem,” Evans said. “Violence impacts every element of society, from economics to community health, mental health and physical health. It is impacting people by not being able to access health services.” 

Babunga illuminated the role of gender in Congolese society prior to colonization and ongoing violence, and its evolution over time.

“The pride of the Congolese people themselves was their women,” she said. To dominate the Congolese, colonizers had to “break [their] women,” she added. 

She noted there exists a level of impunity in DRC that prevents victims of sexual violence and abuse from obtaining retributive justice, which is “what is making gender-based violence grow in the country.” 

Congolese women who have been sexually violated are also discriminated against in their own communities, Babunga said. This phenomenon has led to a “culture of violence and gender disparity towards women,” especially in conflict zones. She said the social dislocation experienced by those returning from the military, including child soldiers, makes them more likely to commit gender-based violence due to the economic and psycho-social challenges associated with societal reintegration.

Babunga said the lack of emphasis on formalized modern treatment for mental health has contributed to government underfunding for mental health services in the country.

Mental health “is still very much new. It is not known or practiced in Congo,” she said. “It is mainly focused on women who have been sexually violated, or psychiatric facilities [for mentally unstable individuals].”

To adapt psychiatric care to contemporary issues in Congolese society, Bernstein and Evans emphasized the importance of working with community organizations on the ground in DRC.

Bernstein serves as the Medical Director of Project ECHO, a system of telehealth that provides training on the recognition of mental illness and basic treatment to healthcare providers in DRC and other countries.

“What was really remarkable was just how open the providers were to learning despite the stigma around mental illness and survivors of psyche violence in the region,” Bernstein said. “In working together, you can really find ways to build resilience.” 

Regarding infectious diseases such as HIV, ebola and mpox, Evans said he has learned a tremendous amount from African physicians. He noted the effectiveness of programs like the United States’s President’s Emergency Plan for Aid Relief (PEPFAR) have laid the groundwork for distributed networks of healthcare delivery. 

At the same time, Babunga highlighted that the most recent and ongoing mpox epidemic in the Congo has laid bare the unpreparedness of the country’s health infrastructure to address outbreaks of infectious disease, mainly due to a lack of government funding. In August, the World Health Organization called the outbreak of mpox in DRC a public health emergency of international concern, with the number of cases comprising 90% of all cases of the disease in Africa.

In particular, individuals living in areas with an industrial mining presence face extreme poverty and are more vulnerable to the spread of disease, she said. She also noted that unlike Western countries, the concept of “social distancing” does not exist in Congolese culture.

“It’s family and bond,” Babunga said. “It’s not just the same house, it’s the same village. We take each other as family. That’s how [disease] spreads quickly.” 

Parts of the Congo that are most affected by mpox include the internal regions, where it may be more difficult for medical providers to access afflicted communities.

“Sometimes people have to walk miles and miles to go to the center that is treating them,” she said. “Sometimes they will unfortunately die on the way.”

“The government hasn’t put in place a better system to be able to fight infectious diseases. Unfortunately, most of the time, we rely on international communities that come in and try to be able to support the country to be able to fight the disease,” she added. “We hope one day the health system will be strengthened and the government can do something. But right now, it is really exposed.” 

Despite the health challenges facing the Congo, the speakers remained optimistic. Bernstein said patients who have suffered the most unimaginable trauma can rebound with “just a little bit of care and support.” 

“Part of what keeps us going is wanting to make sure that the providers in DRC are getting the skills because there’s so much that they can do to be able to help people, to be able to give back to their lives,” Bernstein said.