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Democratic Republic of Congo :: a constant state of emergency - An interview with Dr Charles Kisamba For the casual observer the recent chronology of Congo can be filtered down to a few defining outbreaks of violence or disease; violence in Bukavu in March 2004; before that Ituri in July 2003; Ebola striking the headlines from time to time. Yet these are the tip of the iceberg. For 12 months a year the four Médecins Sans Frontières Congo Emergency Teams, known by their French acronym, PUC (Pool d'Urgences au Congo), cover emergencies non-stop. Based in Kinshasa, Mbandaka, Lubumbashi and Kisangani, the teams reach across the length and breadth of the vast territory.
Dr Charles Kisamba works in the Kisangani-based PUC (in the north east of the DRC) which covers the Eastern Provinces as well as the northern zones of the Maniema Province. As he explains, "our PUC in Kisangani is capable at a stretch of three simultaneous interventions. Two is more reasonable." By the end of June this year, they had already received 27 appeals for assistance, with 10 coming in January alone. From those, the PUC carried out 14 exploratory missions, of which 6 required interventions. Currently, one team is dealing with a measles epidemic in the health zone of Yahuma. "This started right at the beginning of August when we received an alert from our mobile team in Lobutu, verified by village chiefs and nurses from the local health centres," explains Dr. Charles. "So we were off. To investigate and intervene." On this occasion, the outbreak was extremely serious, 326 cases in two weeks across four villages, so the team had to work fast to stop the spread. "We quickly set up four diagnostic and treatment centres. First, treating the infected cases and creating isolation facilities to cut the transmission chain, and for the rest, we began a public awareness campaign to inform parents to separate healthy and ill children. And also that measles is nothing mysterious, just a disease like any other." Due to a lack of medicine and education, combined with old cultural habits, people see measles as a mystery, a spell. So they go to a traditional healer. It is only when the healer sees complications he can't deal with that the child is brought to a health centre. "Sometimes it's too late and the child dies," continues Dr. Charles, "sometimes we can turn the tide." Measles is one of the biggest threats in the region and is particularly difficult to stop once an outbreak has occurred, especially with certain factors against the team. "Vaccination coverage is very low, malnutrition is rife, and due to the war, the health system is in ruins. These factors help the rapid spread of disease and children are just not protected." Battling 13 diseases Measles is only one of the 13 diseases covered by the PUC. Others include common killers such as Cholera, Malaria and Diarrhoea-related diseases, as well as the more unusual, such as Ebola, Meningitis and the Plague. The PUC are also currently preparing an intervention in Dingila in the north of the Eastern Province to deal with Monkey Pox. The mortality rate for this unpleasant-looking disease is only 15%, but it is virtually unknown to the medical profession and therefore extremely difficult to treat. “This is an animal pox, for squirrels and monkeys, which can unfortunately be transmitted to humans,” explains Dr. Charles. “Hunters often get infected as well as those who've been in contact with dead animals. People pick them up thinking it a stroke of good luck, but it's a trap." The eruptions which break out on the skin are entry points for other microbes and are points through which organ fluid and electrolytes are lost. This can cause death. With isolation and public awareness, the transmission chain can be cut, but without Médecins Sans Frontières assistance, the local hospitals don't have the means to correctly treat patients. As the animals are a rare source of meat, convincing the population to avoid them is not so difficult. "Not once they have seen a victim or we have shown them some photos of what the disease does," explains Dr. Charles.
Facing a plethora of difficulties Dealing with little known diseases is only one of the difficulties faced by the PUCs. "There are several levels," continues Dr. Charles, "the first level of problems concerns infrastructures. Health zones are deprived of absolutely everything, a state heightened by the war and the poverty." A further difficulty comes with dealing with authorities in the field. "Sometimes they co-operate, sometimes quite the opposite because they ask for things that we are not in a position to give them. Otherwise, the state of the roads can be an obstacle, especially in the rainy season. But we try to progress the best we can and with enough determination we usually manage to get through." The legacy of the front line which until very recently cut a swathe across the Eastern Province, is that the region remains highly militarised. And after years of fighting, insecurity can also be a problem. "When you come across militias or armed groups who aren't willing to understand our work, then you come out the loser," notes Dr. Charles. "Either they steal everything or they physically attack you. I just thank God that we haven't been killed. But none the less, it leaves you ill at ease." "In February," he recounts, "we had some problems between Lubutu et Walikali with armed groups on one side, and the military forces on the other. Everything is stolen without distinction when you're faced with armed people, who are drugged up and illiterate. They don't know what Médecins Sans Frontières stands for and even less the flag. But at least with our surveillance system we have good information before heading out to the field. In some cases we've just had to cancel a mission and wait for security to improve." But through all of this, what holds the most fear for him? "Suspected cases of viral haemorrhagic fever," he replies with a barely a moments' thought. "For this you need a maximum of precaution and good preparation. We do rehearsals before going to the field because if you commit the smallest error, there is no safety net. But we do our job as doctors. We care for the patient and the lucky ones make it while the unlucky ones die." "In January, I went to Bafwasende to treat and take blood samples from suspected cases," he explains. "They were positive, but for the West Nile and Chikunguya viruses, from the same family as Ebola, just less fatal." This year is something of a break from the past, the transition is heading towards elections as early as June 2005 and there is at least a semblance of peace. But is the situation for the Congolese actually improving? Dr Charles' sigh is as good a response as any, but after a pause, he concludes, "Congo is faced with an array of problems. I don’t think that we’re at the beginning of the tunnel yet, but we hope to get through in the end." James Lorenz
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