Emergency in the Congo

DR. PHIMISTER: Distinguished guests, ladies and gentlemen. Eye witnesses to events are much sought after, for they bring us first-hand knowledge. Today we are very pleased to have as our speaker Dr. F. L. Lawson, who served with a Canadian Red Cross Society Emergency Medical Team in the Congo from April to July in 1961. Dr. Lawson had also served with the Canadian Army in the Far East during the Korean War period, with the rank of Major. For a time he was Surgeon to the British Commonwealth Division. At the present time he is Surgical Consultant to the Ontario Hospital at Cobourg, and he carries on a private practice there.

The Congo: has been much in the news lately, and the efforts of Katanga to remain separate, and the attitudes of the great powers to this effort, have provided a puzzling situation for the casual newspaper reader. Dr. Lawson, who bears a name honoured in The Empire Club, has been an eye witness to events in the Congo and it is a pleasure for me to introduce him at this time, when he will speak on the topic "Emergency in the Congo."

DR. LAWSON: It was not many days ago that a report

from Washington, summarizing President Kennedy's first year in office, had this to say: Overseas there is little to cheer about. East and West Germany are more separated than ever by The Wall. Laos and South Vietnam are extremely shaky. NATO is deeply divided over the defence of Europe, the liberation of Africa, and the increasingly complex role of an assertive and financially bankrupt United Nations. And the Congo is the Congo, only worse.

"The Congo is the Congo, only worse." In the short time at my disposal it will not be possible to go into the complex political and military situations in the Congo, nor need I, for I am sure that you will be just as confused by reading about it in the daily press as if I tried to explain it to you. However, just to consolidate your confusion, I will remind you that this ex-Belgian land currently occupying so much space in the newspapers, this country to which Katanga may or may not belong, is now known as the Republic of the Congo and not the Congo Republic. The latter is a completely separate and peaceful little country on the near side of the Congo River, just across from Leopoldville.

It would be futile, and not even desirable, to gloss over the fact that the Congo crisis of 1961-61 was no natural disaster. Two human factors were involved, the Belgians and the Congolese: The Belgians, of course, are people like ourselves, and some of those present here today may very well be of Belgian origin. The Congolese, on the other hand, are very different from us: they are different in colour, their culture is different, their health and longevity are different, their standard of living is different, their philosophy of life is different, very definitely their opportunities are different and, for seventy-five years or more, they were a subject people. Yet, despite these differences, in many ways the Congolese are similar to the people of Canada, similar to you and to me. For example, there are very few geniuses amongst them, many of them are not overly fond of work, a certain percentage get drunk on Saturday night, they get involved in brawls, they not infrequently injure one another with hunting weapons, more than occasionally one of them sleeps with the wrong spouse, they like political power and some are not above embezzlement and graft, they commit murder and rape, they catch tuberculosis and venereal disease, they work in many cases for extra-territorial employers, their women like to paint up their faces, they get the doctor up at night to see their sick child, they live as primitively as the people who summer at Muskoka, and they have their psychiatric problems. As you can see, when viewed in this light, they are not so different from ourselves. Certainly they are neither better nor worse than we are. About 14,000,000 of these native people live in the Congo and their ancestors were there long before the white man came. For the most part they are Bantus, of that same race which the South African considers to be inferior, but there is an admixture from many sources. Composed of some 200 tribes speaking 38 main languages and a multitude of dialects, the native population has never been well-united, for intercommunication has been a problem.

The Belgians for 52 years, from 1908 to 1960, occupied the Congo and operated as a colony this vast and wealthy land which extends some l,500 miles from one extreme to the other. They lived in the Congo about 60,000 strong and ran the country in a very humanitarian manner, in the strongest possible contrast to Leopold 11, whose domain it had been in previous years. They leaned over backward to avoid racial tension at all costs. They built large, beautiful and modern cities, such as Leopoldville, Stanleyville, and Eliazbethville, with separate sections for whites and blacks. They constructed roads, though to be sure all too few and too poor. They established plantations and dug mines, and provided much in the way of gainful employment for both European and African. And they set up an efficient and up-to-date medical and public health service, through which the native Congolese received medical and surgical care essentially free of charge.

In running the Congo and its people, the Belgians were doing what in many ways was a wonderful job. They were proud of their accomplishments and felt that they were doing the right thing by the natives. In truth, the Congolesse people probably never had it so good. They had jobs, they had money, they had free medical care, and they had white people to think for them. But the Belgians had a blind spot. They were too paternalistic. Some of them believed that the natives had minds of limited capacity and were quite uneducable. Many recognized that the Congolese could be taught, but thought that their assumption of the white man's role would take decades if not centuries. Still others were determined, whatever the natives' capacity to learn, to keep the white supremacy. But whatever their thinking, the Belgians were blind. Despite the fact that 16 other colonies and protectorates in Africa were to assume nationhood in 1960, they failed to appreciate until too late that nationalism was rampant, that ready or not the natives were going to take over. And take over they did, on June 30, 1960. Even up to the last moment the Belgians might have been able to arrange a partnership, and the Congolese would have been better off if they had. But the Belgians were blind. So they lost the Belgian Congo, their fabulous African treasure.

With the coming of Independence, the position of many of the Belgians became untenable. Those who had treated the Congolese harshly or had acted as lord and master had to flee. Others, though well-accepted by the natives, were not too happy with their new status, servants of the new Congolese administrators, and left. To be sure, some of the Belgians loved the country so much that they stayed on regardless. However, whatever the men did, in most regions of the country it was considered unsafe for white women to remain in the Congo in the early days after Independence. It was difficult to reason with a people so proud, so stubborn, so impulsive, and still so close to the savage state. The Congolese men could see no reason why, when they took over the jobs of the whites, they should not take over their homes and their wives too.

The blind spot of the Belgians brought about an unprecedented situation after Independence. Because of their paternalistic policy, no native professional people whatsoever had been trained, no senior civil servants, no army, navy or air officers, no doctors or dentists, no lawyers, no architects, no engineers, no scientists, no political figures. The fantastic nature of this mistake-or miscalculation or mismanagement, call it what you will--can be appreciated when one considers how the British have prepared their colonies and protectorates for independence, by training military men and civil servants to the highest rank, and sending key political, economic and scientific figures to universities at home. After Independence most of the 760 doctors in the Congo (all white) left, a few because they were forced out, others because their families were no longer safe, but most because they no longer wished to work in hospitals where they had ceased to have authority. Even in countries with great poverty, and illness, like China and India, there are native doctors, many of them, and good ones. Not so in the new Republic of the Congo. When the Belgian doctors departed, it left much of the country virtually without professional medical care. This presented a great public health problem with international .implications. Malaria, sleeping sickness, amebiasis, hookwork, yellow fever and other tropical diseases know no .boundaries. It was essential to keep these diseases under control in the Congo, so that they would not spread to other countries. And quite apart from the communicable diseases, the Congolese required personal medical and surgical care, for they are subject to many of the ordinary ills of mankind. Without question it was a medical emergency, of sudden onset and almost unprecedented magnitude. This was quickly appreciated by the World Health Organization of the United Nations, which without delay turned for help to that body which exists for the emergency situation, for the relief of suffering, and for the saving of lives, namely the Red Cross.

At this point I wish to digress for a moment to answer two questions that may come to your minds: (l.) How was it that the United Nations in the guise of WHO was right on the spot in the Congo even as the crisis developed? (2) What form of organization permitted the Red Cross to help in a situation like this?

(l) The reason that the World Health Organization saw and recognized the public health crisis in the Congo arising at first hand was that since 1952 it had been taking an increasingly active interest in the health of equatorial Africa as a. whole, working in Nigeria, Ghana, and many other countries. Through its Regional Office established in that year, the WHO had been assisting these governments in their efforts to improve health conditions in Africa. This was accomplished partly by training personnel at all levels from the medical doctor to the most humble health auxiliary in the bush; partly by developing field services for maternal and child welfare, nursing, nutrition, environmental sanitation and hygiene, and health education; and partly by setting up pilot areas for the study, research and treatment of malaria, leprosy, sleeping sickness and other equally serious tropical and non-tropical diseases. Specialists were provided both by organizing training courses locally and by awarding fellowships for study in other countries, the latter an example of international co-operation at its best. These various means of assistance accounted for some 90% of the combined budgets for Africa of the WHO, the UN Technical Assistance Board, and the UN International Children's Emergency Fund (or UNICEF). You may ask: What have been the results of all these efforts over the past ten years? My answer is: in terms of improved health for millions of Africans, they have been astronomical, but their cost has been only that of two days' preparation for a flight to the moon.
(2) The Red Cross emblem, a red cross on a white ground, is the symbol of the Geneva Conventions, one of the world's greatest codes of law. The Charter of the Canadian Red Cross Society, in keeping with this, states that the purposes of the Society are: To furnish volunteer aid to the sick and wounded of armies in time of war; to carry on and assist in work for the improvement of health, the prevention of disease, and the mitigation of suffering throughout the world, during peace or war. In fulfilling its Charter, the Canadian Red Cross Society provides services to the armed forces and veterans, disaster services, health services, nursing services, and welfare services, in addition to international relief. Falling within its province in Canada are such varied and important activities as the National Blood Transfusion Service, the Water Safety Service, the Outpost Hospitals, and the Red Cross Lodges, as well as many others. These tasks now occupy the volunteered time of many thousands of Canadians, working out of some l,200 branches throughout our country.

The Canadian Red Cross Society is but one of 87 national Red Cross societies which are linked together by common ideals and common purposes in a world federation known as the League of Red Cross Societies. The League is primarily a co-ordinating body, particularly in the field of international relief. The supreme governing body in the world of Red Cross is the International Red Cross Conference which includes representatives from all national Red Cross societies, from the League, and from the International Committee of the Red Cross. This latter is the direct heir of the Committee of Five, which founded the Red Cross in 1863. It is an autonomous and neutral body, composed entirely of Swiss citizens, limited to 25 in number, whose services are strictly voluntary. It is the guardian of the Geneva Conventions and of the Red Cross emblem. Most important, this International Committee is the recognized neutral intermediary between belligerent powers in time of conflict, and as such was able to assume responsibility for all international Red Cross action in the Congo.

Let us return to our story. It was an emergency situation. The World Health Organization had turned to the Red Cross for help. The International Committee of the Red Cross, in co-operation with the League of Red Cross Societies, offered the new Congolese Government to provide medical relief for six months, by which time it was hoped that a more permanent solution might be found. When the offer was accepted, the national Red Cross societies of some twenty countries quickly recruited medical teams which were dispatched at once to the Congo, where they were posted to various hospitals throughout the country. There were teams from Poland, Czechoslovakia, Yugoslavia, East and West Germany, Japan, India, Pakistan, Egypt, Denmark, Finland, Holland, Sweden, Norway, Ireland, Greece, Australia and Canada, though none were recruited from Belgium or from the great powers, the United States, Russia and Great Britain. Early in the emergency a Canadian Red Cross team including Dr. Jonathan Sinclair and Nursing Sister Korlu of Toronto was sent into the Coquilhatville district, and Canadians served also in Leopoldville and elsewhere. Later on Canadian teams were limited to men only, because it was felt that women might not be safe. When the six months promised were up, that is at the end of December, 1960, the emergency still existed. Sufficient replacements had not been found by that time for the departed Belgian doctors, so perforce the Red Cross relief period was extended another six months to June 30, 1961.

The Canadian Red Cross medical team, which I joined in the spring of 1961, was serving in the little town of Gemena in the province of Equateur in the north-west part of the Congo, at the opposite extreme of the country to Katanga, where so much strife has been going on in recent months. I replaced Dr. Khazei and served alongside Dr. Sarkis. You will recall that these two doctors were mentioned at length in Ralph Allen's article on the Congo in Maclean's. Gemena is a place about the size of Cobourg or Port Hope, but that is as far as the similarity goes. It has a rather central portion in which, prior to Independence, a small number of white people lived in well-constructed, good-looking homes, and a great suburb where lived many thousand of natives in very primitive dwellings.

As Gemena is the central point, and now I believe actually the political centre, of the Ubangi District, a milliondollar hospital with about 200 general beds plus some 130 outlying beds for tuberculius patients had been built there ten to twelve years ago. This hospital is one of those which lost their medical staffs with the coming of Independence. From September, 1960, to February, 1961, medical relief in Gemena had been providel by a Pakistani Red Cross team consisting of two doctors and three technicians, who under very unfavourable conditions had done a tremendous amount of work during that period. Things had finally become intolerable for the Pakistanis after months, and they had geen replaced by the Canadian team which I subsequently joined. At the time I was in Gemena there were only about six doctors for the entire population of about l,000,000 people in the Ubangi District.

From a distance the Gemena Hospital was an attractivelooking place, with its sprawling architecture and its red tin roof. However, close-up things did not look so good. The place had been largely built of cement and stucco, and was difficult to keep clean. There were large covered balconies but these cut off the light from the wards, which were in consequence very dark. The new Congolese administrator had been politically appointed from the nursing ranks, and did not enjoy the respect and co--operation of his staff. The staff morale was poor: the nurses, who were almost all male, came to work late and did not come to work at all if it rained; they disappeared when things seemed slack and frequently got drunk when on night duty. Equipment was not too bad, but maintenance service was lacking. There were beds in the hospital, but no mattresses on the beds; the patients had to sleep on the bare bed springs or on straw or bamboo mats which they had brought with them. Mattresses had apparently been supplied on several occasions, only to be carried off like spoils by the patients' on their return home to the jungle. When the Congolese came into hospital their families usually accompanied them, and it was often a question who would sleep on the bed and who under the bed, the patient or his family. No food was served in the hospital; either the patients had to search out food for themselves or their families had to cater for them. Usually the cooking was done in the woods close by but, whenever the opportunity presented, the families moved onto the balconies and cooked there. Their diet consisted mainly of bananas and manioc (or tapioca), and was greatly lacking in protein. For this reason the disease kwashiorkor, due to protein deficiency, was prevalent. When the Red Cross sent in relief supplies, consisting of dried fish, milk powder, biscuit, sugar and rice, this food came as a godsend. The patients clamoured for it, and usually the families ate more than the patients.

The Red Cross relief food had to be sent in by United Nations aircraft. This proved to be a problem, for the Armee Nationale was on shooting terms with the United Nations in Gemena, despite the fact that both were working toward the same goals. For this reason special dispensation from the Armee had to be obtained and observed for the relief planes. The food came in lots of several tons, and usually was unloaded by prisoners form the local jail, of whom there were many. (The prisoners were mostly political or by choice, though Gemena was not without conventional crime.) The sacks and bales of food had to be divided up for distribution at the various hospitals and missions in the area, and it was very cheering to see the Belgian nuns and the Protestant missionaries working together on this project.

The actual work in the hospital was quite frustrating and rather depressing. Despite great backlogs of patients the staff would work only from eight to twelve in the morning and from two to four in the afternoon, and it was difficult to find any nurses outside of these periods for emergency cases. (The Congolese had not-and, I am sure, have not yet-learned that freedom and independence demand more work and more responsibility, not less.) You can appreciate the difficulty of operating in the middle of the night without ancillary staff and adequate laundry. Yet because of the free medical service that they had had for so many years under the Belgians, the patients themselves were quite demanding. They were all anxious to have their troubles fixed at once. Every patient carried a medical document, and he continually waved this in front of the doctor, asking that something be done for his relief. Most of the patients in our hospital lived almost like sub-human creatures, but this was in part because they lacked the education, the financial means, and the physical facilities to live otherwise. Certainly I think that we saw the Congolese at their worst in hospital. Their troubles included the ordinary medical and surgical conditions which we see here in Canada and of these they were particularly prone to hernias and obstetrical complications. Some 75 operations per month were carried out at Gemena, but these just scratched the need. In addition, many of the Congolese were afflicted with one or often several tropical and non-tropical infections, a few of which I enumerated before. A number of these diseases have become more prevalent since the slackening of public health measures which followed Independence.

As you can see, the medical relief problem in the Congo is not one of easy solution. The Belgians were apparently prepared to supply white doctors to the Congo on an indefinite and continuing basis, and undoubtedly financed this from the economic gains that they made from the country. The same situation prevailed also in other fields, such as engineering, architecture, finance, law, and so on. If the nations presently assisting the Congo, including Canada, carry on in the Belgian way, they too will have to do soon an indefinite and continuing basis, perhaps for generations to come, and they must be prepared to finance the effort out of their own economies. Obviously this cannot be the answer-nor is it the answer that the Congolese want and need. There is only one answer to the problem-education-EDUCATION spelled out with capital letters-that the Congolese may produce their own engineers, their own lawyers, their own doctors and dentists, their own public health officers, indeed their own professional people of all kinds. It is only in this way that they can become self-sufficient and able to take their proper place in the world. Judging from the propress of aboriginal peoples in other lands, including our own, the time of training will not be short, but already beginnings are being made in the educational field. When well-fed and healthy, Congolese youth are proving to be just as energetic, intelligent and alert as our own, and they are just as anvious to get ahead.

Until a very few years ago the Belgians left education of the native population almost entirely in the hands of the missionaries. The efforts of the latter are now starting to pay off, in that native teachers are now available for many of the primary schools. In consequence, the missionaries are finding themselves free to develop secondary and higher education and, in a co-operative effort with the Congolese Government, certain great philanthropic foundations, and other extra-national agencies, are beginning to set up secondary schools. Plans are in the wind for polytechnical, agricultural and even medical schools. The United Nations, too, are playing a great part in many phases and at many levels of education. For example, U.N. courses have been given in public administration, social affairs, veterinary science, agriculture, nutrition, farm mechanics, agronomy, customs training, teaching, air traffic control, weather forecasting, postal service, police training sanitary engineering, nursing, and public health. Students in various fields of endeavour have been selected for fellowships in other countries, and although I do not have the latest. figures, I do know that to June, 1961, the World Health Organization had sent 68 Congolese to France and Switzerland for training as doctors. Louvanium University near Leopoldville, which was built prior to Independence as an adjunct to Louvain University in Belgium, is now taking in an ever increasing number of Congolese students. (Louvanium had the first and possibly still the only atomic reactor in Africa, but this is only fitting, for the uranium for the first atom bomb came from the Congo.)

We in Canada have a greater part to play in providing the Congolese with the means to education. To be sure, there is a student from Leopoldville at Laval University this year, and two other Congolese at the University of Montreal, but these are not enough. McGill University's geographical analysis has not yet been carried out for this year, but the University of Toronto definitely has none. More opportunities for higher learning must be provided both here and in the Congo. I cannot foresee any Congolese exposed to the comforts of a Canadian, European or American university who would wish to go back to work in the jungle, but such people could go back as teachers in the secondary schools and universities which are developing in their homeland. It is there in the Congo that the great mass of capable students should and must go, and it is there that teachers from our world can be most useful for many years to come.

May I say a few words about the present role of the United Nations in the Congo? It is important to realize that the United Nations is like a ship, partly beneath the surface and partly up in the public view. Down in the depths of cooperative effort the hidden portion of the U.N. ship is painstakingly and effectively working for the betterment of mankind as an individual and mankind as a whole, and its services are widely sought after and widely appreciated by peoples of all colours, races, creeds and political leanings. It works through such bodies as the Food and Agricultural Organization (FAO), the Educational, Scientific and Cultural Organization (UNESCO), the International Civil Aviation Organization (ICAO), the World Health Organization (WHO), the International Bank for Reconstruction and Development, and so on. So varied are the many activities of the United Nations that they can be listed under some 122 headings.

The portion of the U.N. ship which everyone can see deals with the inter-relationships of mankind, with politics, with disagreements between nations, and with war. Up amongst the waves of controversy it must steer a path between socialist and capitalist, between communist and democrat, between native and imperialist, between Christian and non-Christian, between black and white. Little wonder that from some countries there are cries of: "Let us get out of the United Nations." "Let us give them no financial support." "Let us pull our troops out of the Congo." Man being what he is, this is inevitable, and will continue. But let not disagreement with the political and military activities of the United Nations be a reason for our destroying it, disregarding it or failing to support it. The purposes of the political and military efforts of the U.N. is also the betterment of mankind, but the exact direction which they take will be largely determined by the countries (probably the Middle Power Countries) which provide the strongest and most enlightened leadership to the United Nations organization. In the Congo the political and military situations are extremely confusing. On the military side there are three armed bodies, the Armee Nationale, the Katangan Army, and the United Nations forces, each an extremely polyglot lot. On the political side what can one expect of an emergent African people, inevitably conditioned by a torrid environment, a state of widespread ill-health and malnutrition, and a retarded social and political evolution.

As you must appreciate by now, the U.N. is doing a tremendous job in the Congo in ways that do not get into the newspapers. Just as the Red Cross has been the answer to the emergency medical and relief situation in that unfortunate country, the United Nations must be the answer to its problems of the coming years. For not only does the future of the Congolese people depend on the United Nations, but so also does the future-in-Africa of our kind of people. If the U.N. is forced to get out, from lack of men, lack of money, or lack of support fromthe people at home, it will leave a vacuum into which the Communists will surely move. The United Nations has had many tasks: to prevent clashes between Belgians and Congolese, to get rid of the Belgians where they are no longer wanted, to discourage inter-tribal strife, to assist the political development of the country, to provide security for the actual sessions of the Congolese parliament, to organize and promote educational advancement, to alleviate famine and help refugees, to provide communication, to organize long-range public health and medical programs, and to attempt to end Katanga's secession. Two facets of this work might be mentioned. Firstly, the Royal Canadian Corps of Signals under the United Nations is providing the only dependable communications service throughout the country, and units of this Corps are stationed at many points. Secondly, the Red Cross emergency medical teams, which were sent to the Congo until the United Nations got organized, have now been replaced by physicians and surgeons recruited by the World Health Organization of the United Nations. In Gemena Dr. Sarkis' place was taken by a competent young WHO physician from Spain, and mine was taken by a WHO surgeon from Haiti. I have learned through the missionary grapevine that the latter, not trusting the Congolese nurses, sets his alarm clock for the middle of the night, so that he may get up and personally give the medications necessary at that time.

The work of the Red Cross is never ended. One never knows when natural disaster will strike, and when things are quiet it is often only the lull before the storm. But eventually the natural catastrophe occurs and finally is over and one sits back to wait for the next one. Africa is different. It has ceased to be an emergency situation in the ordinary sense, but sickness and famine go on and on and on. There may be no end to the relief required. Where the facilities for help are limited, much thought has to be given to the question: How best can the available means be evpended so that in the long run illness and death can be prevented to the maximum extent. On direct medical care as the Belgians gave it? On food donations? On the principle that an ounce of prevention is worth a pound of cure? Or on EDUCATION, that the African may learn to feed and care for himself? Just as it did in North Africa, in Chile, and in many other places, the Red Cross has done a big job in the Congo, both for the Congolese themselves and recently also for more than 100,000 refugees from neighbouring Angola. I am sure that it will be equal to any task that lies ahead.

THANKS OF THE MEETING were expressed by H. V. Cranfield.