It is around midday in Bukama, in the Democratic Republic of Congo (DRC). Under a leaden sun, MSF's 4x4 climbs the rocky path leading to Kabamoma Hill. A repetitive song rises over the noise of the vehicle's cabin being jolted by the bumpy road. There is a file of roughly ten men, women and children, their progress raising a cloud of red dust behind them. The men are carrying a little cardboard box in their arms, barely a metre long.
"It's a funeral," sighs Paul, the MSF driver, who stops the car to allow the mourning procession to pass. "A few weeks ago, children were being buried every day in Bukama. Funeral processions have become much rarer since MSF started its project here, but as you can see, they still happen from time to time..."
Why are children dying in Bukama? During the last days of 2006, the Katanga Province region, in south-east DRC, situated at the mouth of the Congo River, was affected by terrible floods. The water destroyed numerous homes in the neighbourhoods located near the river. Now, several months later, the ruins of these houses are mixed up with thousands of stones which lie scattered over the paths of the city. Some people here claim that Bukama means "Town of Stones" in a local language.
"The water took everything and lasted for three months. The football pitch is still flooded and people have even started fishing there," explained Céline Zegers, MSF nurse and Head of the Emergency Operations in Bukama. "Around 2,000 people fled towards the hill and have found refuge in the camp of Kabamoma, where they survive in straw shelters covered with old pieces of plastic sheeting and surrounded by stones.
"Others have moved in with members of their extended family or are starting to rebuild their houses. We estimate that a total of 32,000 people were affected by the floods - which amounts to half the population of Bukama."
When the floods hit at the end of 2006, MSF's Congo Emergency Pool, a 30-strong team consisting of international volunteers and Congolese staff, was already in Bukama, responding to a cholera epidemic. They quickly began to offer free care to those affected by the disaster and are now supporting two facilities in the devastated neighbourhood of Kisanga wa Byoni and at the entry to Kabamoma camp. These health centres are receiving more than 1,000 patients a week, mostly suffering from malaria and respiratory infections.
MSF was also concerned about the nutritional situation as plantations, which are frequently located next to the river, and have been completely ravaged by the floods and the next harvest destroyed. A rapid evaluation conducted by MSF teams has indicated an alarming number of children suffering from malnutrition.
To respond to this need, MSF opened a nutritional programme in Bukama in early May. Some 450 children have already been admitted to the programme to date, mostly coming from displaced families. MSF offers medical follow up and supplies of therapeutic food for malnourished children through its outpatient therapeutic nutrition centre.
Those suffering from medical complications are hospitalised, receiving round the clock medical surveillance in a special wing of the centre. Here, patients receive nutritional milk and therapeutic food several times a day until they are fit enough to return home and be reintegrated into the outpatient part of the programme.
"The main challenge lies with the social component of the programme," explained Joseph Musakana, the nurse in charge of the nutritional programme. "We have trained around ten social workers, who are also displaced themselves, to routinely look around the community and identify children requiring our care."
These social workers are then responsible for the follow up of these children throughout their nutritional treatment and beyond, to the point where they have completely recovered.
"Out of the 77 children admitted into the programme this week, 75 were brought to us by the social workers. They therefore play a crucial role," he added.
A third of the children suffering from malnutrition have also been stricken with measles, a disease which particularly affects children with lowered immune systems. MSF treats the measles cases in the two health facilities it supports, and vaccinates children aged between six months and 15 years in order to contain the epidemic.
MSF has vaccinated more than 120,000 children spread over the health zone of Bukama in a little over one month.
"We can really see the difference now compared to the crisis situation prevailing a few weeks ago, when we saw funeral processions every days," said Céline Zegers. "But even if mortality rates have been reduced to an acceptable level, the displaced population still needs blankets, mosquito nets, construction material, and so on. They need the basic materials required to be able to rebuild their lives."
MSF has been working in the DRC since 1981. At present, nearly 2,500 Congolese work alongside more than 200 international volunteers in the provision of medical assistance to the Congolese population in 26 programmes throughout the country.
Measles on all sides
The measles epidemic is not just raging in Bukama, an area situated at the crossroads of several communication routes, including the railway and the Congo River. Cases of measles have also been recorded in a number of other health zones in Katanga province.
The MSF teams have provided case management for more than 3,000 children with measles in Mulongo and Malemba Nkulu, two locations situated to the north of Bukama, and continue to treat 300 more children per week. MSF is evaluating the possibilities of carrying out new vaccination campaigns. Other MSF teams have already vaccinated 15,000 children in the Nyunzu area, further to the east of the province.
At the same time, measles epidemics are raging in large parts of the neighbouring province of Maniema. MSF offers an emergency response to these deadly outbreaks via free case management of sick children as well as carrying out more vaccination campaigns.
Since early May, 30,000 children have already benefited from these vaccination activities in the south of Maniema.
In early 2006, MSF teams had already vaccinated some 360,000 children in Mbuji Mayi, in the province of Kasai Oriental, neighbouring Katanga, to halt a serious measles epidemic.