August 29, 2017

A cholera epidemic is surging through South Kivu in Democratic Republic of Congo (DRC), with more than 1,200 patients treated by Médecins Sans Frontières/Doctors Without Borders (MSF) since late July. The region’s poorly equipped health centers are overwhelmed and there is a high risk the situation will spiral out of control.

At the cholera treatment center in Minova, Elisabeth Chihemba sits quietly next to her three-year-old son, Elris Kamo. The child barely moves as a thin tube feeds fluids directly into his veins. They are in the area reserved for the most severe cases. All around them, rows of beds are filled with children lying or sitting listlessly as their mothers weave in and out of the tent, some wringing mops, others trying to encourage their children to drink. Here and there are beds filled by adults, shrunken and ill.

This August morning, the waiting room at Minova cholera treatment center is full. Patients in an extreme stage of dehydration—mostly children—are swiftly put on intravenous fluids; others, after a quick triage, are whisked away to one of three treatment areas, depending on their degree of infection. As this routine unfolds, relatives huddle anxiously outside.

When a team from MSF arrived in Minova to assess the situation, they found the main health center struggling to manage the situation. “There were only 19 beds for 46 patients and several people were sprawled on the floor in extremely unhygienic conditions,” says MSF emergency coordinator Aude Thomet. “There was only one nurse present, with no system for triage. The regional health authorities had little or no intravenous fluids, oral rehydration solution, or chlorine to treat water, all of which are essential to contain cholera.”

Faced with patient numbers doubling from one day to the next, MSF responded rapidly, bringing the cholera treatment center up to international standards, adding more than 100 beds, and bringing in essential supplies and experienced staff to manage the epidemic.

Currently, DRC is in a dry season and a severe water shortage has provided the spark for the epidemic to explode. Minova’s close commercial ties with neighboring Goma—the capital of North Kivu, where a cholera epidemic was declared in June—is likely what brought the disease to this area. The two towns are only 25 miles apart and people move between them frequently, making it easy for cholera to spread.

In the byways of Minova, the intensity of the water crisis is stark. Alleys are packed with children, adolescents, and women carrying yellow jerry cans they try to fill with water.

“Minova does not have clean water,” says Chihemba. “Morning and evening, I have to travel for over an hour to get drinking water from one of the few functioning taps in the town. For the rest, I draw water from the lake like many others.”

The lake water in Minova is likely to be contaminated. But, despite knowing that it may contain contagious microbes, many people have no option but to draw water from it. MSF medical records show that more than 50 percent of patients at the Minova cholera treatment center come from the part of town closest to the lake and furthest from sources of clean water.

A dozen chlorination points where lake water can be made safe have been set up by local health authorities working with the Red Cross. But these are nowhere near enough for the 200,000 people who live in the area.

“To stop the epidemic from spiraling out of control, there’s an urgent need to reinforce preventive activities,” says Francesco Otero y Villar, MSF general coordinator in DRC. “More chlorination points need to be set up, affected areas need to be sprayed with chlorine immediately, and a mass awareness campaign needs to be launched. At the same time, arrangements must be made to increase the supply of clean water and equip health centers with the necessary supplies to treat cholera patients.”

With few aid organizations working in South Kivu, mobilizing resources has been difficult, which has delayed the response. MSF has extended its support to health centers in the towns of Bulenga and Bukavu, where the number of cholera cases continues to rise. A few community organizations are also trying to respond but, with limited finances, their range of activities is restricted.

One day later, Chihemba’s son Elris is showing little sign of improvement. He is moving a bit, but is still weak, with drooping eyelids. “He vomited four times last night and twice already this morning,” she says.

Meanwhile, new patients continue to arrive at the cholera treatment center. With roughly equal numbers of people arriving and being discharged each day, patient numbers are now relatively stable. There are currently some 70 patients under care in Minova, 67 in Bukavu, 22 in Baraka, and 18 in Bulenga. Since late July, MSF has treated more than 1,200 people for the disease.

By evening, Elris has stopped vomiting and his eyes are wide open. The IV line feeding him fluids have been removed. Elris will be kept under observation for another day before he moves onto the next treatment stage, where he will need less intensive care.

“I feel better now that he is gradually improving,” says Chihemba. “If it continues like this, I hope we’ll be home in another two days.”

 

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