The General Referral Hospital of Panzi (GRHP) is located Bukavu, capital city of the South Kivu province of the Democratic Republic of the Congo. It is located 8 km south of the city of a national road going west between Bukavu and the Uvira territory, lying along the Ruzizi River in the Mushununu quarter of the Ibanda zone.

The GRHP was established in 1999 in response to the atrocities being committed on the population of Bukavu during the "war of liberation" of 1996. As a result of the war many people were displaced for the security. Access to medical care was severely compromised and the death rate among the population, specifically the maternal death rate rose sharply. Pregnant women had the choice of either walking 8km north to the nearest medical center or laboring and delivering at home. As well transport was highly unsafe in this area and women or their infants needing urgent care could not reach the medical center in time.

Thus in 1998, UNICEF agreed to help build a maternity center for the population. This was done with the AUSTRIA organization who offered a mobile hospital. The hospital was however looted during the war, destroying all donated materials. One year later a Swedish organization called PMU Interlife, rekindled the project. A lot of land, given by the Congo to the 8^th CEPAC, contained two old buildings that were rehabilitated in order to start the center. Subsequent buildings were built giving rise to the present campus housing 334 patient beds and providing services in Obstetrics, Gynecology, Pediatrics, Internal Medicine, general and specialized Surgery, Ophthalmology, Dental and Nutritional. Service is as well available for victims of sexual violence. It also boasts its own laboratory, radiology, ultrasonography and endoscopy units. A pharmacy is also present on campus.

During the inauguration of the hospital, there were ten healthy deliveries and the first patient was operated on, who was a victim of sexual violence and had sustained a gunshot wound to the lower extremity. Since then the hospital has received multiple victims of sexual violence. It is these victims, who we shall heretofore refer to as survivors, who make up the bulk of patients being cared for at this institution. Of 350 patients received, 250 (71%) are survivors. Some are still awaiting treatment. Thus the GRHP has becoming the main referral center of South Kivu and North Katanga (Kalemie), occasionally receiving patients from other parts of the Congo.

The mission of the GRHP as a not-for-profit institution is:

1. Improve the quality of medical care for the population
2. Reduce the maternal and infant death rate
3. Provide treatment of the survivor of sexual violence and surgical repair for women suffering from fistulas of the urogenital tract
4. Serve as a referral center for other health centers
5. Preach the gospel to the population receiving services at the center

1. Administration
2. Financial services
3. Medical (as above listed)

1.MEDICAL STAFF ( 46 )

1. Specialist Medical Doctors (OBGYN, Pediatrics, General Surgery, Internal Medicine): 5
2. General Practitioners : 7
3. Nurse Midwives (A1) : 3
4. Nurses (A2) : 23
5. Nurses (A3) : 1
6. Nurse Midwives : 6
7. Nurse Anesthetists : 1

2. ANCILLARY PERSONNEL ( 50 )

1. Administrators : 1
2. Accountants : 6
3. Pharmacy : 3
4. Laboratory : 3
5. Engineering : 2
6. Drivers : 3
7. Workers : 32

The gynecologists at the GRHP have been practicing in the province for 25 years. A new pathology has emerged as a result of the war: genitourinary fistula secondary to sexual violence. These acts are committed not by known persons within the survivors circle, but by perpetrators from outside. The aim is the destruction of the community within which she lives. Once committed the survivor, her husband, children and extended family become traumatized and humiliated as well as members of the community. It aims to ruin relationships thus promoting dysfunctional family units. The Christian values that normally exist strongly within the Congolese communities have been lost as a result of the atrocities. As well our research has been limited by focusing on the medical statistics with no mention of the psychological trauma experienced by these women.

One such story involves a young woman and her aunt coming from the field in Baraka, a village in the south of South Kivu. Upon reaching the river, they were intercepted by seven solders who forced them to carry each of them on their back in order to cross the river. After carrying the soldiers the young lady was forced to have sexual intercourse with each soldier. The last soldier inserted the point of a gun within her vagina and shot a bullet causing destruction of her vagina, bladder, rectum and buttocks. She was taken to a medical center in Baraka, from where she was transferred to GRHP by the ICRC. She underwent six surgical procedures before being transferred to Addis Ababa for further treatment.

This triggered an outcry from our institution. Our denouncement of sexual violence towards the population has been heard by Doctors without Borders, Amnesty International, and Human Rights Watch. Observers from these organizations have been dispatched to these villages and after a report from Human Rights Watch our issue has been heard by the international community. We have been fortunate to receive donations and investments by many organizations and hospitals. Experts in psychological war have also become involved in attempts to put an end to the practice of abusing women as an instrument of war. Since 2002, humanitarian efforts have intensified and the international community sensitized to the issue, making our cause a globally recognized issue.

Assistance for women having experienced sexual violence comes in the form of medical, psychological, spiritual, socio-economical treatment. As well, we assist in rehabilitation and reintroduction into the society and have training groups for adolescent mothers.

A. AMBULATORY MEDICAL THERAPY AT PANZI

This category of patients comes in the form of transport to the hospital from satellite centers by local and international organizations. Patients present from North and South Kivu as well as countries bordering the DRC. Patients are triaged. Those who are deemed necessitating treatment include patients suffering from tuberculosis, malnutrition, and psychosis. Often these women are sex slaves of the armed forces. Patients are screened for HIV (with consent), syphilis, and vaginal infections. As well psychological screening and treatment are provided.

B. AMBULATORY THERAPY BY THE MOBILE TEAM

This is provided by a mobile team in conjunction with UNICEF. Visits are made to there home in attempts to prevent dislocation which can result in stigmatization. Patients are triaged in their village to determine those needing hospitalization.

3. IN HOSPITAL CARE

This service is provided to those needing surgical treatment resulting from rape or childbirth trauma. Usual cases include urogenital fistula, enteric fistula, and trauma to the perineum to name a few.

A team of psychologists and five welfare workers are involved in the psychological aspects of therapy in order to better succeed in their integration into society. Screening of the patient is done by a welfare worker or social assistant. Based on the severity of their trauma (classified as mild, moderate or severe) and coping skills they may then be referred to the psychologist. Therapy incorporates dealing with prevention, education of their illness, moral support, problem resolution and decision making. Counseling is also provided for patients infected with HIV. Their progress is monitored during treatment and once ready welfare workers help them during reintroduction. Attempts are made to assess the patient’s receiving party upon reentry into their community. Approximately 52% of patients presenting to our center, 36% of which is classified as mild, 14% moderate, and 2% severe trauma.