Treating measles in a remote province of the Democratic Republic of Congo

On the road between Kindu and Kibombo, transporting medical and logistical materials. © MSF

In March, the measles epidemic that has raged in the Democratic Republic of Congo (DRC) for more than six months reached the remote province of Maniema. Despite the logistical challenges, Médecins Sans Frontières teams are organising an emergency response to treat patients who need care.

Organising and treating in an emergency

Since late March, Médecins Sans Frontières teams working with the Ministry of the Health have set up eight outpatient treatment sites for patients with simple measles cases and three treatment centers for complicated cases in the health care regions of Kibombo and Samba, the most affected areas in the province of Maniema. A team also provides regular support to the Tchuki referral center, in the Kabambare health zone, in the eastern part of the province.

"We had to rely on community networks and medical staff to inform the population that we were here because most people did not seek treatment at medical facilities," says Dr. Bobo Makoso, Médecins Sans Frontières medical coordinator in Maniema. "The community awareness efforts worked well. In Likeri, for example, patient visits rose from approximately 30 to more than 100 per day."

Since launching its activities, Médecins Sans Frontières has treated more than 2,000 patients across all sites. Nearly 250 of them required hospitalisation.

Overcoming logistical challenges to reach the population

"Maniema is a logistical challenge," says Roudy Jeantal, a Médecins Sans Frontières logistician. The infrastructure is in poor condition, which makes it difficult to reach the sites and discourages many health care actors from organising programs in this part of the country. Médecins Sans Frontières is among the few present in the province today.

The teams rely on an array of transportation methods – canoes, motorcycles and cars – to reach the furthest populations and deliver medical supplies. "You've got to be prepared for every eventuality.  The roads are impassible, cars get stuck in the mud when it rains and the bridges are destroyed. You've always got to be creative" adds Roudy Jeantal.

When patients cannot reach the health center for lack of transportation or time, Médecins Sans Frontières sets up outpatient treatment centers and sends medical personnel out to local areas to provide greater coverage. "Our mobility has allowed us to reduce the mortality rate in the areas where we are working," explains Dr. Makoso.

Supporting the national vaccination campaign

A mass vaccination campaign is the only way to stem the epidemic but the national response has been slow. Médecins Sans Frontières teams are prepared to assist the Ministry of Health by providing logistical support, including transporting vaccine and maintaining the cold chain in the health care regions of Kibombo, Samba and Tunda.

"Treatment is critical but vaccination is essential to prevent cases from spreading," Dr. Bobo says. "The vaccination campaign is in the organising phase, but we have to continue to provide treatment while we are waiting to launch prevention efforts, so that's what we're doing now."

Médecins Sans Frontières is also working in Katanga, South Kivu and Eastern Kasaï, providing an overall emergency response to measles. Médecins Sans Frontières teams have already vaccinated more than 2.4 million people in these three provinces.