Extract from Amy's blog: "Finished with work the other day, to my surprise and pleasure I was shortly joined by a mama carrying one little girl. Her daughter had been sick in the clinic for nearly a week she told me, as the little girls looked on shyly. This mama, Myriam, explained to me that she was orphaned as a small child, her parents and most of her family died, she and her little sister were raised by Catholic Sisters in another part of the city (this was why her French was perfect, poor and under-resourced as she was)...

She was fairly young, maybe five years older than me, and had four other young children? unfortunately, the husband was nowhere to be seen. He?d stayed around long enough to weigh her down with the standard allotment of children, and then disappeared to the East. To get by, to make sure her children at least don?t starve, she grows salable crops on her little piece of squatter-land on the side of our mountain. She normally sells enough to be able to feed the family, but it doesn?t always stretch far enough to get to her mouth too. As for any other needs ? well, she pointed at her own outfit and said there hasn?t been money for clothes for a year. In other words, she and her children are the picture-perfect definition of Just Scraping By. The family that can?t face a crisis and be sure of coming out intact on the other side. When her little girl got sick, Myriam couldn?t very well leave her alone at the clinic ? here it?s bare-bones service and children are often treated from their mother?s laps. This meant, however, two weeks of zero income.

Two weeks you wonder? But didn?t I say the little girl had been sick for less than a week? Yep, I did: she?d been well for a whole week but they couldn?t leave yet. No money to pay the healthcare bills ? about 6 000 CF, or eight dollars ? and with no husband or family or income to help out, no one could be sure when they would leave.

Myriam told me all of this without much prodding, she seemed eager to share if only as an excuse to strike up a conversation with me (yes, in other words I am a celebrity in these parts). She didn?t want money, and didn?t even seem like she was looking for sympathy. All she did want, it turned out, was a photo: me, her and her little girl. Embarrassed I couldn?t do more (or wouldn?t? this is not, unfortunately, a glamorous story about how I saved a family, much as I thought about trying to, and continue to wonder what I should do in cases where the cost of an Elephant?s sandwich could keep a desperate family afloat, at least until the next hole appears in its meager raft. I?m still bothered by my failure to act, still trying to decide what level of involvement I ought to have with the people I work with or see on the street here?afraid that if I start I might become nothing but the green and white dollar sign I?ve tried so carefully to avoid?), I happily obliged with the photo.

Myriam?s tale, obviously, is not entirely unique coming from the poorest neighborhood of a poor capital of a broken country, but neither is it hopeless. I once defined ?Lisungi?, the name of my clinic as ?aid?, but even just in the last week I?ve learned more about the title as well as the philosophy behind the work done, the approach to patients, and how some of these unhappy situations are solved.

Lisungi has a deeper meaning than simply ?help? ? it has to do with people working together to create a better situation on both sides. Thus, patients don?t simply come in, demand service, and head off again; here relationships are established, and people come from all corners of the city ?

In Congo all health care centers are legally obligated to provide the first step in care whether a patient can pay or not. In other words, stabilize a wound, pack ice around a strain, make sure the patient?s still breathing. At some facilities, if money ? a substantial amount ? is not provided forthwith for the cost of treatment (everything down to a single surgical glove or a cotton ball must be accounted for, in advance), that?s it.

What is not so common is Lisungi?s approach to account-settling. True to its name, there is a ?help us help you? attitude. Mamas who can?t pay (those go hand in hand ? if there?s a papa around it?s much more likely there will be cash around to pay these bills) get put to work. 6000 CF bill? (Standard ? the cost of an IV perfusion treating malaria.) You work for us for a day and we?re even. Laundry, sweeping, scrubbing, mopping ? in a place like this there?s always work to be done. The hands are willing, everyone maintains their dignity, and precious lives are protected until the next round."