“We’ve got six measles cases,” Asumani, the director of nursing told me when I arrived at the hospital.
They were a family of six children from a remote village in neighbouring Maniema Province. Their parents had woken them in the dark and they had walked for 12 hours through the bush, along narrow tracks, to get to the hospital. The oldest son, stricken with a severe pneumonia and too weak to walk, was pushed by his father on an old bicycle.
Measles is a highly contagious viral illness. In a country like DRC, many children are malnourished, their immune systems already under attack from malaria and other illnesses and a measles infection and its complications – diarrhoea, pneumonia, malnutrition – can kill.
In 1980, measles took the lives of an estimated 2.6 million children. Vaccination against measles saw this estimate drop to 139,300 in 2010, according to the World Health Organisation. But adequate vaccination coverage relies heavily on good communications, political and economic stability and a well-functioning health service – of which DRC has none.
I thought back to my epidemiology training the previous year. We spent three days roaming the stuffy, narrow corridors of the London School of Hygiene and Tropical Medicine, quizzing staff and students primed with epidemiological clues, to investigate and respond to a mock cholera outbreak. What I learned is that you have to react fast and on several levels at once to contain an outbreak which, with six measles cases in one day, is what our already overwhelmed hospital now had on its hands.
After treating the six children, most of whom had malaria as well, I met with the hospital staff to plan what to do next. At the hospital we arranged for the isolation of cases – luckily we had a small tent that had been emptied the previous day when our malnourished kids moved into a bigger one. We sent a vehicle to the town of Misisi to pick up a stock of measles vaccines stored at the health centre there to start immunising all eligible children admitted to hospital.
Serge and Albert, the hospital’s doctors, and I agreed we needed to get more information on the outbreak. But how? The remote village the family had come from, and a string of other settlements close to it, is only accessible by motorbike or foot. Our 4x4s wouldn’t be able to pass the overgrown, muddy paths. My idea of walking was quickly put down but Asumani, the director of nursing, broke the impasse and volunteered to go by motorbike to make an assessment while we arranged for an urgent supply of MSF vaccines to be sent to the project.
Asumani returned at the end of the next day, exhausted. He’d documented 67 cases, among whom were three deaths, and found that almost none of the area’s estimated 1,400 children had been vaccinated.
As ever in DRC, access remained the main obstacle to an urgent vaccination campaign. But the hospital staff and MSF put together a plan to use teams mounted on motorbikes, the passepartouts of the Congo. They carry whole families, jerrycans of petrol, bunches of bananas – I’ve seen one leave our hospital with the deceased carefully propped up between the rider and a relative.
The MSF logistics team improvised saddlebags using old flour sacks to carry the syringes, cool boxes and other equipment. Jeff, the project coordinator, bargained hard with the local motorbiking fraternity for transport and named the campaign “Operation Easy Rider”. Our MSF teams elsewhere in South Kivu arranged for the prompt delivery of 5,000 measles vaccines while we trained the teams.
Meanwhile, Asumani had headed back to warn village leaders of the planned campaign. You can’t just head off into a neighbouring province and start vaccinating kids without telling anyone. You have to have the agreement of the authorities. But the officials we needed to contact weren’t answering their mobiles, understandable here where there is often no network, a shortage of top-up tokens and where our own satellite link went down for three days. There was a tense wait as cases began to mount at the hospital but with our coordination in the regional capital Bukavu working the phones, we finally got the green light. We were “go!”
The motorbikes were loaded up at dawn, the petrol tanks filled and, with everyone looking anxiously at the grey clouds as it started to spit rain, 11 machines revved and roared as they made their way out of our compound, headed for Maniema.
The teams found and vaccinated 1,500 children – 100 more than we thought were in the area -and left behind medications to treat further measles cases at health posts along the way. We will need to remain vigilant and on the look-out for new cases. But I like to think that we, in our small way, lived up to the definition of MSF: “aller là où les autres ne vont pas” (going to the places where others don’t).
This post was first published by the Guardian online
Chris appeared on BBC Radio 4′s Midweek programme on Wednesday 4th July. You can listen to Chris and the other guests online if you have access to the BBC iplayer.