“To get to the MSF treatment centre, we spent all night travelling down the Congo River,” Mr. Wetchi continued. “At first I thought my son had malaria, but after a week of treatment in our village he was still throwing up and having diarrhoea. I heard about the cholera epidemic on the radio and then I knew the only option was to get to the treatment centre as quickly as possible. That evening I held Eliezer in my arms and we got a place on the last motor-powered boat going to Mbandaka. All night I watched over him; I didn’t dare close my eyes for a second.”
Spreading down the Congo
“It was early June when the epidemic started exploding again,” said Félix Tran, Project Coordinator of MSF’s mobile emergency team in Congo. “The town of Bolobo in Bandundu Province started reporting three, then five, then 20 cases a day. We sent a small team of experienced emergency experts who built a treatment centre and have treated nearly 1,000 patients so far.
“Then it was Makanza, Lisala, Mbandaka and a string of other port towns along the river that started notifying cases. We do not have enough staff to mount a response in every town, so we monitor the epidemiological situation, we send a small evaluation team to the places that are reporting increasing numbers of cases and we go for a full medical response where we fear the highest potential for a major epidemic. That was why we chose Mbandaka, a big town with serious water and sanitation problems and a rising number of cases.”
The emergency team in Mbandaka
A steep learning curve
“One of my main roles is to train the Ministry of Health doctors and nurses in how to treat cholera patients. Ideally they will do most of the treatment and I will have a supervising role. So far we have treated more than 350 cases so it is busy, and I have a lot of supervision to do, particularly at night. In other cholera emergencies I have done, if patients die it is usually at night. The patients don’t stop being ill if the staff are tired and are paying less attention. I am here during the day and I also visit at 11pm, 1am and 3am to check that each patient is being properly cared for.”
Fear of cholera
“When I got back from the market I was surprised to find Ebengo already in bed at five pm. Just as I approached the bed he started violently throwing up. Three times that night he had bad liquid diarrhoea. His eyes were sunken and he was pale and weak. I got very frightened and I started crying and praying. I started thinking he might die. I had lost control of the situation. Then I remembered the radio announcements they had been playing about the cholera epidemic.”
Spreading the word
“The port of Kinshasa on the Congo River sees thousands of people embarking and disembarking every day. If the epidemic takes root in Kinshasa the consequences could be disastrous,” said Luis Encinas, Operations Coordinator for MSF. “This is why it is absolutely essential to immediately take major preventative measures: reinforce the epidemiological surveillance; limit the spread of the disease; and treat each end every patient who falls sick from cholera.”
The three major factors that have promoted the spread of cholera in other towns along the Congo River are all currently present in Kinshasa: dense urban population; a lack of hygiene and little access to clean water; and the confirmed presence of the disease in several locations. MSF is building a CTC in the crowded suburb of Kingabwa that will be used to treat patients and also to provide a training centre for all medical and non-medical personnel involved in the capital’s outbreak response.
Preparing to go home
“I have mixed emotions; I am so relieved for my son, but at the same time I'm worried for the other people with the same symptoms in my village. There are many people with the same illness but they don't know it's cholera and they may not have the same instinct as me, to come to Mbandaka for treatment. But the important thing for me is that Eliezer's much better - they say that soon he'll be able to go home."