By Mark Doyle
BBC News, DR Congo
On the banks of the River Congo, a thousand kilometres upstream from the Congolese capital, Kinshasa, a young woman lay in a dugout canoe, writhing in pain and bleeding profusely.
Julie was having a miscarriage. Villagers had waved our boat down, pleading for help.
We had a doctor on board, Dr Pascal Ngoy.
Julie lost her baby, but Dr Ngoy gave the young woman first aid and antibiotics that probably saved her life.
It sounds harsh, but in the Congolese context Julie is one of the lucky ones.
Across most of the Democratic Republic of Congo, a country the size of western Europe, there is an acute lack of medical care.
Functioning public hospitals and clinics are rare - and those that do exist are in an appalling condition. The nearest hospital to Julie's village was several days by canoe, in the town of Lolanga.
The crumbling Lolanga Hospital - which was little more than a collection of huts really - had no running water, holes in the roofs and filthy, broken furniture.
These are innocent people, and the government is there with its big villas and cars. I cannot accept that
The operating table was a wooden bench with a black rubbish sack pinned over it.
The nurse in charge seemed well-intentioned but totally overwhelmed by the scale of the needs in the area.
I recently spent 10 days in DR Congo and every single woman I interviewed had lost at least one baby in childbirth. Most had had more than one die.
Dr Ngoy is one of the authors of a countrywide study by the medical aid agency, The International Rescue Committee (IRC) which estimates that over the past decade an astonishing total of 5.4 million Congolese have died from easily preventable causes.
That is 5.4 million deaths over and above the "normal" mortality figure that would be expected in a poor African nation.
It is a largely silent, unreported harvest of death.
"In general, people aren't dying dramatically in Congo," said Dr Rick Brennan of the IRC, another of the authors of the study.
"The Rwandan genocide was very dramatic. And in the Asian Tsunami people died acutely and dramatically. But in Congo people are dying day in and day out from undramatic causes."
The fallout from DR Congo's wars is one of the reasons. The mass displacement of people fleeing the conflict renders them vulnerable to hunger and disease.
But only a tiny proportion - a fraction of 1% - died from violence. Most died for mundane reasons associated with malnutrition, simple diseases or childbirth.
Pascal Ngoy is one of the authors of a new report on deaths in DR Congo
And the IRC believes that almost all of those deaths could have been prevented by basic health care.
It was not always like this. Although it may be politically unfashionable to point out, the Belgian colonial power left DR Congo with a functioning system of hospitals and clinics.
Of course, that system favoured whites and the rich, but at least there was a basic health infrastructure that others could sometimes access.
There are Congolese doctors who recall that in the 1960s the Kinshasa General Hospital was one of the best on the continent.
Patients would be referred there from South Africa. Today, that sounds like a sick joke.
Decades of dictatorship, followed by war and corruption, have left the health sector in tatters.
The current head of the accident and emergency department at the Kinshasa General, Dr Mbwembwe Kabamba, says he has no medical stocks at all.
No more bandages
On the day I visited the hospital a car accident victim was rushed in, his head pouring with blood.
The president has made it clear that health is a priority
Victor Makwenge Kaput
"I don't have any bandages," Dr Kabamba said, "my cupboard is bare. We will have to wait for a family member to come here with cash before we treat him."
That is now the normal procedure in the Kinshasa General. Dr Kabamba's ward is full of people waiting, and many dying for lack of basic drugs and dressings.
Two young boys there caught my attention, probably because they were about the same age as my own sons.
They were suffering from peritonitis; the contents of their bowels were leaking into their guts and poisoning them.
"I need 61,000 Congolese francs (about $120; £60) for the surgery," the mother of one of the boys said, "but I haven't managed to collect it."
Dr Kabamba is angry and frustrated:
"I am powerless," he said; "I have all these people, poor people, and they are waiting for treatment. Some of them will die for lack of an operation. That is the reality."
Hospitals in DR Congo have suffered a long decline
Dr Kabamba was once offered a way out from the blood-soaked wards of the Kinshasa General. He was offered a lucrative government job. But he turned it down.
"What would be the point of doing that for five or 10 years if after that you could not look people in the eye?" he asked.
"I am watching a lot of people dying and it hurts me. These are innocent people, and the government is there with its big villas and cars. I cannot accept that."
DR Congo Health Minister Victor Makwenge Kaput agreed that the current situation was "completely unacceptable".
He said the government was in the process of reorganising the structure and accountability of the whole public health sector.
"The president has made it clear that health is a priority", he said.
Dr Kabamba said there had to be a fundamental change in the way Congo was governed.
"If we had people who were really patriotic it would be different", he said.
"But until now we have just had people scrabbling for positions to make money."
For more on DR Congo's health crisis, you can listen to the radio documentaries Why They're Dying in Congo on the BBC World Service from 13 August.