Searching for measles

Thomas and the team travel by motorbike, boat and foot to trace an epidemic that's in its infancy...

The light violet dots appeared on his face two days ago, now the belly of the boy in front of us is full of exanthema - in common terms, a rash.

The dots do not itch. He has a fever and dry cough, he has a runny nose, but there are no signs of conjunctivitis. This boy has classic signs of measles.

We stand at a health centre in the Kapanga region in the far north-west corner of the Katanga Province where measles epidemic has been going on since March.

We are near the border with Angola. The landscape surges in green lush savannah and forest scenery. There are not many children with mangoes in their hands any longer, as the mango season is almost over.

Instead, the avocados have just become ripe, so now this is the addition to the cassava based diet. The rainy season has a firm grip. There is rain and thunder almost every day. The rain is needed, but at the same time we know that the further into the rainy season we get, the harder it will be to reach out to all children in the small villages.

During the first week here, it has been difficult to confirm any cases of measles. We have received reports about cases, but we have not been able to verify them.

We are actively searching for measles every day. We travel by car, motorcycle and sometimes boat to get to the villages.

Thomas Silfverberg DRC MSF

Boat selfie © Thomas Silfverberg

It is already clear to us that the measles epidemic here is in its infancy. We are in a situation where it is very important to show whether or not there are actual measles cases in the area or not. It will be a question whether we should vaccinate all children or not.

It is dark in the health centre. In the waiting room the patients sits along all the bricked walls waiting to meet with the nurse or his assistant.

I can see that no one has exanthema. We go further into a separate room. There we find a mother on a simple wooden chair with her boy in her arms. She has come to the health centre because the boy had a fever and rash.

People here know that they should seek care if their child has a fever. It is in everyone’s conscience that it can be malaria. But the malaria test for the boy was negative. The clinical signs, the story and the boy's state is in line with measles. He is the first probable case we have found here so far.

The coming week we will find more and more cases like the boy. We take blood samples from the children, to have laboratory verification of the cases. The samples must be kept cold and sent to the capital to be analysed.

We also send some samples to a laboratory in Europe. Overall, there are not many cases of measles, and so far we have not found any serious, complicated cases that need hospitalisation.

Working close with the staff in the health centres is an essential part of our work here. The local staff are the ones closest to the population. We educate and inform about measles to those working in health centres.

We explain the important aspects of the management. The hardest thing is to limit the spread of infection.

A patient is contagious four days before and five days after the rash appears. Before the diagnosis it is very difficult to limit the spread of the disease.

The children live close to each other, they play together, and they sit in the crowded waiting rooms, waiting for their turn. It is difficult to keep a safe distance.

This is why information is so important and why it’s one of the pillars of our work.