Ebola in the Democratic Republic of Congo (DRC) has garnered a huge international response – yet Congolese people are more likely to be affected by other diseases, violence-related displacement and malnutrition. Médecins Sans Frontières (MSF) has been delivering medical aid in DRC since 1981. The following is a snapshot of some of the ways our teams are providing care.
Marathon journeys to access care
Moulasi, a mother of eight living in South Kivu, eastern DRC, is tired. She has walked for two days to reach the MSF hospital in Lulingu, trekking 40 kms from her village. A walk of this length would be arduous for anyone, but even more so for Moulasi: she is eight months pregnant.
Moulasi’s story is not unique. Health facilities in remote areas of South Kivu are few and far between and paved roads are rare. This makes patient access, as well as transporting staff and supplies, difficult. During the rainy season, trails become rivers of mud and days-long journeys on foot or motorbike can double in duration. Adding to these challenges, sporadic conflict often causes people to flee their homes, with little knowledge of where to seek care for wounds or other health issues when they become displaced.
“Too often, people avoid the journey to a health centre because of the fear of being attacked.”
The lack of infrastructure has life-threatening consequences for patients needing medical care – and children and pregnant women are the most at risk. “Delivering without medical assistance poses risks to both the mother and the child’s health, but most women simply have no choice as the journey is too difficult to make by foot in their condition,” says Luz Linares, field coordinator in Lulingu.
Epidemics of cholera and measles
Cholera, a highly contagious disease which causes severe diarrhoea and vomiting and rapid dehydration, is endemic in nine provinces of DRC, but the high mobility of people in certain areas can cause it to spread like wildfire. In 2018, the country faced one of its worst cholera outbreaks, affecting 24 of 26 provinces. The epidemic occurred during a prolonged drought, which forced people to seek alternative – and often unsafe – sources of water. Cases reached the capital, Kinshasa, home to 12 million people, and by November there were 25,000 people infected and 857 dead. MSF’s ‘Congo Emergency Pool’ increased support to two cholera treatment units to ensure round-the-clock patient care in the most affected health zones, and installed rehydration points, epidemiological surveillance activities and an ambulance service.
Perceptions of cholera increase the difficulties of reaching care. When Marie, a MSF patient, became ill, she asked her husband to take her to the health centre. “I was very weak and so we tried to take a moto-taxi, but everyone refused us,” she says. “Here in Kinshasa there’s a lot of stigma attached to cholera, it’s a shameful illness. My husband had to carry me on his back for three kilometres to get me here.”
DRC is also prone to measles epidemics. In March 2018, an outbreak was declared in the former province of Katanga, spreading to every health zone in the region by December. Children in this region face severe health needs, and upon contracting measles they become more vulnerable to severe malnutrition and other serious illnesses like respiratory tract infections.
MSF launched a response in Haut-Kananga, where teams vaccinated 231,646 children and treated 3,334 children with measles by September 2018. Teams are now working in Haut-Lomami, where they had vaccinated 64,629 children and treated 3,350 cases by February 2019. The remoteness of some communities is an ongoing challenge. “We suspect that many children never manage to reach medical treatment and never get vaccinated,” says emergency operations manager Dr Natalie Roberts.
Displaced and vulnerable to illness
In 2017, 4.1 million people were internally displaced across DRC. For example, in Nizi, in the north-eastern Ituri province, some 10,000 people remain in limbo more than one year after intercommunal violence saw entire villages burned and many forced to flee.
Melchior lives in Limani, an informal settlement where people have settled since arriving in February 2018. “Children are suffering because they don’t eat,” he says. “The lack of food is affecting their health.” In nearby Tsé Lowi camp, people shelter in makeshift straw huts with little protection from the rain – and a lack of mosquito nets threatens a rise in malaria.
MSF has provided more than 57,000 consultations across nine health centres and two hospitals in the region since April 2018, and has trained community members in informal settlements to help identify common diseases at an early stage. But a survey conducted in Nizi in October 2018 found mortality rates were above average in these sites. “The environment in which displaced people live increases the risk and impact of diseases,” says head of mission Dr Moussa Ousman.
“Delivering without medical assistance poses risks to both the mother and the child’s health, but most women simply have no choice as the journey is too difficult to make by foot in their condition.”
In isolated Masisi, North Kivu, teams are seeing the impact of displacement on child mortality. Violence causes families to flee for safety, restricting their access to healthcare. “Too often, people avoid the journey to a health centre because of the fear of being attacked,” says Ahmosi Twengererwe Bembeleza, mobile clinic nurse supervisor. Many children don’t reach therapeutic feeding centres until a late stage, when they are suffering from advanced malnutrition and even the team’s best care is not enough.
For the foreseeable future, the people of DRC face varied, complex and longstanding crises. Whether these are oubreaks of Ebola, cholera, malaria or measles, or the exacerbating effects of conflict and displacement, MSF teams will continue to work for improved access to quality medical aid.