DRC: Catastrophic health events (Measles, Cholera, Polio, and Chikungunya outbreaks)

Inside a MSF Cholera Treatment Center (CTC)

DRC 

"A public health worker explains to a choleric patient the importance of good hygiene."

Photo: Gwen Dubourthoumieu/IRIN

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“All the conditions are ripe for an explosion of the epidemic” of cholera.

--(Laurence Sailly, MSF’s Medical Coordinator in DRC)

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Catastrophic health events are looming in the DRC. Some would dispute this characterization and call it overblown. A catastrophic health event (CHE), in the US government terminology, entails a sudden occurrence of cataclysmic proportions (caused by a bioterror attack, for instance) able to prevent thousands of citizens to access healthcare facilities and resources, thus resulting in equally high number of casualties. In a fragile environment of the DRC, such a scenario wouldn't be that far fetched if vigorous countermeasures aren’t taken soon to stymie the disaster currently in the making.

Multi-pronged viral outbreaks have been flaring up nationwide for the last two years. And the government’s systemic impairment and dereliction of duty account in large measure for these catastrophic events.  The outbreaks are exacerbated by the chronic lack of preparedness of the government and its inability to earmark meaningful funds and resources for preventive healthcare, immunization, public hygiene, etc. Furthermore, to this day there’s no centralized agency or ministry to deal with catastrophic events, including humanitarian and major disasters or accidental events.  Add to that mix the lack of an integrated network of transportation infrastructures, then the near term situation would look bleak even to die-hard optimists.

Laurence Sailly of MSF, in the quotation above, was describing the arc of the southwestwardly moving front of cholera along the Congo River as an “explosion of the epidemic.” She made that statement in June, when MSF and other organizations were hopelessly trying to prevent cholera, which had already hit the outskirts of Kinshasa, from reaching the harbor area of the capital city—a nevralgic point—in its steady and inexorable advance downstream.  Luis Encinas, Operations Coordinator for MSF, couldn’t have been more frantic about the gathering catastrophe: “The port of Kinshasa is the point of embarkation for thousands of people each day heading up and downstream on the Congo river. If the epidemic takes root in Kinshasa the consequences for people living in the capital could be disastrous.”  

The disaster has now reached and crossed the gates of the capital: Kinshasa has become a cholera hotbed.  

Below are just two vignettes of the catastrophic health events spreading across the DRC—measles and cholera— though, according to Victor Makwenge Kaput, the minister of public health, the country “is also grappling with new cases of the wild polio virus, with a total of 62 cases recorded by 7 July” (despite three successive countrywide aggressive vaccination campaigns that started in March of this year).

As if these woes weren’t enough, an outbreak of the mosquito-borne chikungunya viral disease, closely related to the dengue fever, has hit the neighboring Republic of Congo for the very first time in the recorded public health history of the region, with 900 cases counted by June 12, 2011, in the capital city of Brazzaville. Facing each other across the banks of the River Congo on the same spot, Kinshasa (left bank) and Brazzaville (right bank) are the two closest capitals of the world, with massive daily traffic of merchandise and people.  To put this chikungunya outbreak within the regional context, Congo-Brazzaville was the ground zero of the wild polio virus epidemic now spreading through Congo-Kinshasa.

 

MEASLES. According to IRIN, the news organ of the UN Office for the Coordination of Humanitarian Affairs (OCHA), from September 2010 to the first half of July 2011, outbreaks of measles have been igniting and spreading in 7 provinces countrywide: Bas-Congo, Equateur, Kasaï-Occidental, Kasaï-Oriental, Katanga, Maniema, and South-Kivu.  In these provinces, the measles cases registered and the related death toll are staggering: 115,000 measles cases and 1,145 deaths.

The WHO official quoted in the IRIN report blames squarely the epidemic on Kinshasa: “a lack of government funding halted follow-up mass immunization activities in the regions, leading to the measles outbreak.”

To curb these measles outbreaks, the first part of mass vaccination campaigns had been planned for this month of July in the affected regions as well as Kinshasa and 2 additional provinces. In the meantime, WHO and UNICEF are scuttling to raise $9m for the follow-up campaign scheduled for September 2011 and the first semester of 2012.   

CHOLERA. The Congo River is the only trade and communication waterway between the riverside residents and the major ports of Kinshasa, Mbandaka, and Kisangani. It’s all the more cruelly ironic that it should also serve as the channel of the cholera epidemic.  

This Monday July 21, the Congolese public health ministry and WHO released a 3-page joint report on the situation of the cholera epidemic in the DRC. The report also includes a map (see below) of the epidemiological monitoring of the cholera outbreak that shows how the killer virus has been following the meanders of the River Congo for the past 4 months—from its point of origination in Kisangani (March 2011), steadily spreading southwestwardly, then hitting the outskirts of Kinshasa by mid-June, before the appearance of flashpoints in several communes of the capital city in July.

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The color legend at the bottom left of the map gives the cholera cases reported by health zones as of July 20: from white (0 case) to red (more than 500 hundred cases). The yellow star shows the operational Cholera Treatment Centers (CTC) able to admit choleric patients for treatment (see what a CTC looks like in the MSF interactive image here). There are thus only 5 CTCs in the regions affected.

The map also gives the southwesterly trek of the outbreak along the Congo River waterway from Kisangani in March to Kinshasa and beyond (June).

The accompanying table preceding this map gives a snapshot of the epidemiological situation in the country. As of July 20, there were: 97 new cases (including 7 in Kinshasa); 4 new deaths; a total of 265 deaths (including 10 in Kinshasa); a total of 3,896 cases; and a lethality rate of 7%.

Ever since hitting Kinshasa in mid-June, the cholera outbreak clang to a few pockets by the Congo River: the fishing communities of Maluku and Kingabwa. But according to a Radio Okapi report of July 20, the epidemic has now spread to other neighborhoods of Kinshasa: Kalamu, Masina, and Ngaba. This is dangerous, especially because the statistics of the joint report released by the ministry of public health and WHO show that the lethality rate of Kinshasa is 10%, higher than the rate of the other affected areas since there is a shortage of cholera kits in the capital!