A typhoid patient in the general hospital, Kikwit, DRC. Photo © Fran ßois Dumont/MSF

Since August 20, more than 650 cases of typhoid fever, including 90 cases of peritonitis and intestinal perforation and around 20 deaths, have been reported in Kikwit, Bandundu Province, in the Democratic Republic of Congo (DRC). A team from Doctors Without Borders/Médecins Sans Frontières (MSF) is providing support to Kikwit's main hospital to ensure treatment of patients. Community workers are raising awareness among the population about basic hygiene practices, in order to halt this serious epidemic of the so-called "dirty-hands disease."

MSF is supporting Kikwit Nord General Hospital, which is around 500 kilometers east of the capital, Kinshasa, in order to offer free and quality treatment to simple patients as well as those suffering from complications or perforation. "Simple cases are given outpatient care and antibiotics, while complicated cases are hospitalized and perforated cases require a surgical intervention," says MSF's Dr. Jean Lambert Chala-Chala. "It is very important to ensure a good triage of patients coming to the hospital." MSF also provides medicines to the hospital, gives training to the personnel of the hospital and health centers around the city, and ensures that an adequate case definition and treatment protocol are implemented.

Typhoid fever is a disease linked to unsafe drinking water, inadequate sewage disposal, and flooding. Also known as the "dirty-hands disease," typhoid fever is caused by a bacterium that people contract via feco-oral transmission. "Transmission can be direct—for instance if one does not wash hands before eating or indirect when the bacteria passes through vectors like flies on food at the market place," says Chala-Chala.

Problem of access to water

Between January and April 2006, MSF had already carried out an intervention against typhoid fever in Kikwit. And figures from the same period last year also show an increase in cases of the disease at the beginning of the rainy season. This information indicates that typhoid fever is linked to a structural problem in terms of supply of quality water in Kikwit, as well as bad hygiene conditions in which most of the population lives. In Kikwit, almost half the population does not have latrines, waste pits or any proper water source.

Along the sloping paths of Bongisa, in Lukolela municipality, water brought by the rainy season flows down between huts and trees, creating a red-colored mud that carries rubbish and feces down to the Lukemi River. But given the water supply difficulties in Kikwit, a city of around 400,000 inhabitants, many families fetch water in a number of unprotected water sources and even in the rivers. "In Kikwit, water supply is very difficult," says Ibrahim Barrie, head of MSF's emergency team based in Kinshasa. "The population has to buy water at various water taps disseminated along the main roads of the city, where the water distribution company sells water for 1 Congolese franc a liter. For a family of six, this can amount to 3,600 CF (around $8) per month, an expense that many families cannot afford!"

Raising Awareness

An important part of MSF's work will now be to raise awareness among the population about basic hygiene practices like washing hands before eating, cooking food adequately, and covering food at the market, that can help prevent the disease. However, in Kikwit, the task ahead is immense to improve water-and-sanitation infrastructure and prevent typhoid fever epidemics from taking many more lives in the future.

MSF has worked in the DRC since 1981. Today, more than 2,000 Congolese staff work alongside 150 international staff to bring medical assistance to the Congolese population, with around twenty programs across the country.