MSF battles series of cholera epidemics in the DRC

MSF has sent staff and medical supplies to the provinces of East Kasai and Katanga in the Democratic Republic of Congo (DRC) to deal with a series of ongoing cholera outbreaks. There have been a high number of cases - with subsequent deaths - with treatment made all the more difficult given the vast territory where the outbreaks are taking place. About two weeks ago an MSF team, consisting of two staff members (a doctor and a logistician) and two doctors from other involved parties (Ministry of Health and WHO), as well as medical materials, were flown to Lusambo in East Kasai province of the DRC. The medical supplies will be used for the re-hydration of cholera patients and for preventive measures aimed at halting the spread of the disease. MSF is also providing training for local health staff, and has undertaken prevention activities, installation of cholera treatment centers, active case finding, setting up of an epidemic surveillance system and installation of correct treatments. "Cholera is a highly contagious disease and has a dramatic impact in this part of the world. Between mid September 2002 and the end of August 2003 , mostly in the area around Mbuji Mayi alone, there were some 7,253 cases, including 375 deaths. But cholera is fairly simple to treat. If appropriately managed and isolated, the impact on the lethality is huge, but the areas to cover are vast and reacting in time is the biggest challenge," explained Maureen Billiet, MSF medical polyvalent in Brussels. To emphasize the point, as an epidemic was coming under control in Mbuji Mayi, a new outbreak was then discovered further north-west in the Lusambo district. Between August 4 and mid-September, 74 cases were recorded, with 31 proving themselves fatal. The high death rate was mainly due to a suspected under-reported number of cases and also a lack of knowledge about effective cholera treatment amongst health workers, combined with a lack of knowledge on preventive measures amongst the general population (cholera epidemic only having appeared in the province in 2002). The number of cholera cases has also been increasing in Kinkondja, in Katanga province. Between the last week of July and mid September, 149 cases and 8 deaths were recorded. In the Rwanguba Hospital in North Kivu, MSF started a cholera intervention on August 27. An MSF team went there based on high figures of suspected cases. Since the beginning of the intervention, 75 cholera patients have been treated, and no patients have died. Besides this, some 20 non-cholera diarrhea patients come to the MSF clinic every day. They get Oral Rehydration Solution (ORS) as well and are sent home if they are not cholera patients. The MSF team based in Goma has provided a team of three nurses as well as supplies to the facility. MSF teams are currently working in the areas to investigate cases, provide the population with information for prevention and treatment, organise trainings for nurses in the cholera treatment centers and set up a system of epidemic surveillance. Another MSF team, equipped with medical and sanitation supplies, has been dispatched. "Our teams are working at full tilt in difficult conditions, but there is much more to do as the rainy season is about to start and this again increases the risk of new cholera outbreaks," explained Billet. Cholera is endemic in eastern DRC and is a highly contagious disease. Symptoms are heavy watery diarrhea and vomiting. This diarrhea causes a high risk of the patient becoming dehydrated and getting into a shock. If cholera is not treated the chances to die are very high. The treatment of the disease is fairly simple, aimed at rehydrating the patient, either by drinking lots of ORS or intravenously. Once cholera cases are properly managed and isolated - and necessary preventative hygienic measures put into place - the health threat diminishes significantly.