MSF increases role as cholera outbreak picks up speed in the DRC

MSF is now focusing its efforts in order to limit the spread of the epidemic, while aware that it could not be contained in time due to the lack of adequate resources deployed by authorities for the poorest population of this rich mining city.

A team of 15 from MSF's Congo Emergency Pool (PUC; Pool d'Urgence Congo) is currently working to fight a cholera epidemic that has been raging since the start of the year in the heart of Lubumbashi, the capital of Katanga province in the Democratic Republic of Congo (DRC). Lubumbashi, a mining city in the south east of the Democratic Republic of the Congo (DRC) with a population of 1.3 million, is the second largest city in the country (next to the capital, Kinshasa).

To date, 767 cholera patients have been treated in the MSF supported cholera treatment centre (CTC) and the number of patients is rising slightly. There were 278 new patients admitted over the course of last week - an average of 30 to 40 new patients every day.

Patients lying on the bare ground

The MSF team consists of a coordinator, three doctors, six nurses, five logistics specialists and a water and sanitation/disinfection expert. Highly contagious, cholera is a bacterium that is easily transmitted via stools and vomit and through drinking contaminated water. Two additional members of the MSF team are taking care of raising awareness among the population on ways they can protect themselves.

On January 10, 2008, while the PUC team was working in the city's only CTC, located in one of the general referral hospitals in the Kenya district, the number of patients rose so rapidly that hospital staff were completely unable to cope.

"On site, the result was people lying on the bare ground due to the lack of space, dangerous proximity between patients and those accompanying them, non-compliance with standards for disinfection with chlorinated water between the interior and exterior of the CTC," explained Bertrand Perrochet, Coordinator of PUC.

The MSF team first reorganised patient care by placing the entry and exit disinfection areas outside of the hospital, which also increased the centre's capacity. The severely ill, those suffering from severe dehydration due to vomiting and diarrhoea caused by the vibrio bacteria, are placed in an isolated room and put on an intravenous drip. They then go through various phases of treatment until the convalescence area.

In all, patients undergo four phases of treatment before full recovery.

"Normally, each phase of treatment is separated from the others." explained Perrochet. "At the Kenya CTC, we have had to divide the patients between the three rooms available to us. Given the significant number of hospitalised patients, 79 at present, we have increased the capacity of each room to 35 beds."

Nevertheless, it was necessary to open a second treatment centre. On Saturday, January 19, MSF opened a CTC in the Katuba district, eight kilometres from the Kenya district where 24 patients have already been admitted. Over several days, community awareness raisers informed the population about the imminent opening of the centre.

"We were able to reduce the overload on the Kenya centre and provide closer care to a greater number of patients," explained Elke Frans, an MSF nurse. The Katuba district is one of the largest focus areas of cholera in the city. Until now, due to the lack of a centre, patients had been crossing Lubumbashi before receiving treatment.

"This can have very serious consequences," continued Frans. "Not treated in time, cholera results in fatal dehydration in 50 percent of cases, but the quicker the sick are treated, the easier and faster their recover. The risk of contagion is also reduced and this is important in a big city like Lubumbashi, where a great number of people live in precarious and overcrowded conditions."

Illness of the poor

MSF is now focusing its efforts in order to limit the spread of the epidemic, while aware that it could not be contained in time due to the lack of adequate resources deployed for the poorest population of this rich mining city.

"The situation was entirely manageable for the health authorities," said Bertrand Perrochet. "But neither adequate tools nor sufficient resources were deployed to contain the cholera epidemic and prevent it spreading."

A serious epidemic previously hit Lubumbashi in 2003 and MSF provided assistance on that occasion. Once again, it is the people living in difficult hygiene conditions and without access to drinking water that are affected.

The PUC is an emergency support team that was created by MSF in 1995. It provides medical support throughout the DRC. Its aim is to reduce mortality and morbidity resulting from medical emergencies through early detection and treatment. The PUC provides assistance to victims of epidemics, malnutrition, natural disasters and population displacements through enhanced surveillance, rapid assessments and a quick and effective response. MSF has been working in the DRC since 1981.