"The MSF Congo Emergency Unit has a well developed contacts network across the Congo," explains Fabien Kabumgo - 'Dr. Fabien', as he is know here - a doctor from the unit.
"This is how the unit came to know about the epidemic in Mbuji Mayi. On February 9, we arrived here for a first assessment. On the Feb 15, it was decided to intervene. MSF provides medicines against measles and support health staff in administering them." After one month, about 700 measles cases had been treated in the four supported health centres. "And the number of sick people seeking treatment is on the increase," adds Dr Fabien.
"This happens because the epidemic is still raging in and around the city, but also because a sensitisation effort is taking place among the population." For a few weeks the message has been sent across in churches and in the media, and many families now go to the health centres for free treatment. This morning, as usual, Dr. Fabien goes to all three health centres of the city. The fourth one, located in the Tshishimbi zone outside the city, has been supported by MSF for a week. Behind Muya hospital - the only state hospital in town - two MSF tents have been erected. On average, 25 new consultations for measles take place every day.
"We have chosen this hospital because there are many measles cases in the area and the zone is quite easily accessible," said Dr Fabien. "The first tent is used both for consultations and hospitalisations. Four nurses have been seconded to the hospital to deal with measles cases. With Grace Nsambu, a nurse from MSF emergency unit, I manage their activities." The vast majority of patients are very young children. Under-five children are certainly the most affected by the epidemic. Here, as in other centres, straightforward measles cases are treated. Dr Fabien describes the main signs of the disease:
"Measles causes strong fevers, red sports around the mouth, runny nose, irritated eyes, rashes starting from the face and spreading to the neck, torso and the legs. There is a strict medication protocol for these children. The patient then gets antibiotics for fives days, a cream against conjunctivitis, vitamin A and, in case of dehydration, re-hydration salts. To prevent stomatitis (mouth infection), gentian violet is used." Opposite the consultation area, mothers are seated on beds holding their child in their arms.
"We hospitalise children with complications and therefore need to be monitored," said Dr Fabien. "This decision is not easy to deal with for mothers who often have more children waiting at home. When there is absolutely no way for them to stay at the hospital, we insist that they come back everyday with their child for consultation." Most complication are respiratory ones. They can lead to pneumonia or bronchopneumonia. Scars inside the mouth can also get worse and led to malnutrition.
"This is one of the greatest complication of the disease," highlights the MSF doctor. "It is crucial for the children to keep eating, even small quantities. On the other hand, children suffering with malnutrition are weaker to face the disease and therefore more at risk of complication." In the second MSF tent, some mothers have come back for the second, or even third time with their sick children. Antibiotics have not reduced the fever, scars in their mouths are getting worse, so mothers come for another consultation. Elsewhere in the city, in the zone of Bipemba, MSF supports a health centre managed by the sisters congregation of 'Christ Roi'. Here too, in collaboration with the centre's staff, free consultations are provided for measles cases. Cases with complications are referred to Dipumba hospital where two interns provide consultations. A dozen children are currently hospitalised. Since treatment was first provided, eight deaths have occurred in supported health centres. On the outskirts of the city, in the health centre of Bakwatshiimuna, MSF hired a nurse manages measles cases, which is widespread in that zone. The motorbike trip - almost the only way to move around in Mbuji Mayi - is quite tricky.
"I can only go to that health centre twice a week," says Dr. Fabien. "This is why we hired a nurse." In less than a week, he has already treated 35 people.