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Ndosho CBCA Hospital, Goma, North Kivu, Democratic Republic of the Congo. Chimène (7) was injured during fighting in Pinga. The ICRC treated her in Ndosho where she had to have her left arm amputated. The other girl is her fellow-patient Fazili. CC BY-NC-ND / ICRC / Elodie Schindler
"How am I going to carry my little brother? How am I going to wash him and change him? How am I going to fetch water to help mummy?" Chimène bursts into tears. Not knowing how to deal with her new body makes the physical pain even worse.
Like most residents of Pinga, in the DRC's province of North Kivu, Chimène and her family are suffering the effects of the violence that has rocked this region for the last two decades.
In January 2014, fighting between government forces and armed groups changed their lives forever. Bullets passed right through the mud walls of their house, hitting Chimène and her older sister as they lay in their shared bed. Chimène survived, but her sister died of her wounds shortly after.
"Chimène was hardly reacting when she reached hospital, because of all the blood she'd lost," explained Andrea Marelli, the ICRC's head nurse at Goma Hospital. "Her arm was totally mangled. She was rushed to the operating theatre, where a surgeon did all he could in an attempt to save the limb.
Sadly, her arm had to be amputated a few days later. Otherwise, she might well have died as a result of infection." The hospital carried out the amputation after obtaining the consent of Chimène's parents via her mother's sister, the only member of the family who was at the hospital.
Physical sufferingÂNdosho CBCA Hospital in Goma. Chimène plays football, watched by psycho-social delegate Claudia Ibarra López and Andrea Marelli, head nurse for the ICRC surgical programme. / CC BY-NC-ND / ICRC / Christian Katsuva
Chimène was inconsolable for days after losing her arm. She was in pain, she was afraid of what the future might hold and she was missing her mother, who had stayed behind in Pinga for her sister's funeral. But above all, Chimène was angry with the "muzungu" (Swahili for "white") who had stolen her arm. She needed physiotherapy to get her back on her feet, but would allow no-one to touch her stump.
When Chimène's mother arrived in Goma, the nurses called in Olivier Kima of the ICRC's psycho-social team, known as "Papa." The team helps patients who find it hard to come to terms with their situation or deal with the trauma, or are finding it difficult to follow their treatment.
Chimène and Papa met for the first time three days after her operation. "I wanted Chimène to tell me her story and explain what she was worried about, so I could start to understand the degree of physical and mental suffering she was going through," explained Olivier. "My job is not to treat the patients, but to give the medical team the keys to do so. Chimène was afraid of suffering more pain, and that's why she wasn't letting anyone touch her."
Reprendre confianceÂNdosho CBCA Hospital in Goma. Chimène looks at the photos that ICRC communication delegate Christian Katsuva has taken of her. / CC BY-NC-ND / ICRC / Elodie Schindler
During the second session, Olivier brought Chimène a doll. She grabbed it immediately. "I'm going to look after her straight away!" she exclaimed determinedly.
Psycho-social work with children requires creativity and the right tools. "One day, I gave her a drawing of a little girl with a missing arm. I called the girl Pepita," recalls Claudia Rocio Ibarra López, the ICRC's mental health specialist in Goma. "We started talking about what Pepita would be able to do if she were in the same position. Would she be able to go to school? Play with her friends? Wash herself? Answering these questions showed Chimène what she could do."
With the help of the psycho-social team, she began to realize that she could still do many things, and a few new ones. "To build her self-confidence and encourage her to play using her good arm, we started kicking a ball around on the hospital lawn. A month after the incident, she's doing at least as well as the children she plays with!" explains physiotherapist Jean Fiasse.
The role of the familyChimène's mother took part in her daughter's psycho-social care sessions. She is a psycho-social assistant herself, and had already undergone ICRC training for her work at the Pinga "maison d'écoute." The maisons d'écoute (literally "listening houses") are centres where psycho-social assistants care for victims of sexual violence and other types of conflict-linked trauma, referring them to health facilities so that they can receive medical treatment if necessary. The ICRC supports the maisons d'écoute, mainly by training staff, supplying equipment and providing funding.
"My own daughter has become one of the victims, and that's really hard," explains Chimène's mother. "I'm angry with the people who did this, and I feel guilty for not having been able to protect her. I'm frightened to go back to our village, because it's still dangerous there."
Chimène is also a bit scared about going back, but she is looking forward to eating the bananas from her village again. "I really want to go back to school, but all my exercise books got burnt on that day," she says. While she waits to to return to her village, Chimène plays ball with Fazili, another little girl from Pinga. Fazili got off lightly during the attack; the bullets only grazed her back.
Chimène shows that she can look after her doll, despite her handicap.
