Democratic Republic of Congo: AMI’s reaction to the cholera epidemic in the Uvira health zone (South Kivu) - August 2006

A cholera epidemic has been spreading throughout the Uvira health zone since August 2006. Cholera is endemic in South Kivu, with epidemics becoming more and more frequent due to disruptions in water supply and lack of hygiene, both of which are consequences of the various conflicts that the country has endured since 1996.

AMI’s field teams, in close collaboration with the local health authorities (Health Zone Central Office), have set up emergency medical facilities to deal with confirmed cases of cholera. At time of writing, this has allowed 260 patients to be treated, and no deaths have been recorded.

AMI’s actions have involved:

* Providing medical care for patients at the CTC (Cholera Treatment Center) :

• In-kind donations: medical items such as catheters, and medication such as doxycycline, paracetamol, etc.
• Supervision and continuous training of CTC health staff by an AMI nurse specifically delegated to help with this epidemic.
• Financial participation for the recruitment of extra health staff: a nurse and a hygiene supervisor.

*Overall hygiene within the CTC :

• Thorough cleaning of the CTC.
• Providing instructions on hygiene to patients, carers, health staff and hygiene supervisors.
• Distributing preventive medicine (doxycycline) to carers.
• In-kind donation by AMI of products and equipment.

* Participation in the rehabilitation of the CTC :

• Digging a new refuse pit.

• Supply of water for the CTC.

AMI’s actions were made possible thanks to the support of UNICEF (in-kind donations), to financing by ECHO, and to effective coordination with the health authorities and other agencies present in the area (OCHA, WHO, International Rescue Committee, Tear Fund…)

Cases of cholera have been reported in other less accessible health regions such as the Uvira High Plateau. Aide Médicale Internationale is monitoring these areas from a distance, and providing in-kind donations for the local health authorities to cope with these cases.

Uvira, September 6th, 2006

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AMI in Démocratic Republic of Congo

Democratic Republic of Congo – South-Kivu

Context

Despite the peace agreement signed in 2003, insecurity remains widespread in South Kivu as the national army still has no control over foreign armed groups [Interhamwe, Rasta, FDLR] and Maï Maï rebels. The years of war in South Kivu [five wars since 1993] completely destroyed the health system: disengagement of authorities, under-equipment, advanced degradation, frequent medicine and product shortages, flight of qualified staff, diminished training infrastructures for health care staff, etc. In 2005, 30% of the population still had no access to health care and this number may further increase due to the return of many people being repatriated from Tanzania. Aide Médicale Internationale helps local structures trying to start rebuilding the health system in South Kivu. Its projects target the most vulnerable people, with 76% of consultations concerning at women and children. The democratic process launched in late 2005 [constitutional referendum] should facilitate NGOs’ activities.

Improving health care access for populations of four health areas

Working in six health zones in the south of the South Kivu province, AMI is recognized by the provincial health inspection as the referent for primary health care. AMI’s programs bring an answer to a medical emergency situation for people living in zones newly accessible, such as Lulengue and Fizi, whereas in stable zones, like Uvira, Nundu and Lemera, AMI ensures the quality and accessibility of health care. AMI’s activities consist of supportive actions [rehabilitation, supply of medicines and material, training] for 58 health centers, 5 cholera treatment centers, 5 blood transfusion posts, 37 structures treating victims of sexual violence, as well as the pediatrics and maternity services of the Uvira hospital. AMI also helped to set up 58 health committees in order to promote community self-reliance and development.

Results

Preventive and curative activities:

Retrospective nutritional and mortality survey. Health care offer survey. 487,521 health care interventions including:

• 59,465 prenatal consultations
• 65,703 consultations of children under five years old
• 14,506 deliveries: 11 308 deliveries in a health center and 3,198 in secondary structures [hospitals and reference health center]
• 464 women and children under five years old treated in therapeutic nutrition centers
• 2,031 people screened as part of the mother-to-child transmission prevention program
• 2,698 cases of cholera treated
• 7,922 blood transfusions
• 5,254 children hospitalized in the pediatrics service of the Uvira hospital
• 744 hospitalizations in emergency surgery

Treatment of victims of sexual violence

• 3,603 victims of sexual violence treated, of whom 2,423 were referred to a psychosocial support cell and 157 referred for surgical reconstruction
• 2,610 people screened for HIV [8.2% screened positive]
• 453 preventive treatments of sexually transmitted diseases and 2,669 curative treatments

Training:

• 114 people trained in psychosocial treatment
• 14 home visitors trained in nutrition watch
• 120 health care staff benefited from training sessions
• 350 health care staff benefited from itinerant teaching provided by AMI’s superviser

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Project Definition

Localization

• 4 bases : Uvira, Baraka, Kilembwe [operation bases] and Bukavu [coordination base]

• 6 health zones : Lemera, Ruzizi, Uvira, Nundu, Fizi and Kimbi-Lulenge

Beneficiaries

Direct beneficiaries : 352,278 people

Population covered : 873,000 people

AMI’s team on this mission

 14 expatriates : head of mission, medical coordinator, logistics coordinator, doctor, lab-technician, midwife, pharmacist, project manager, medical referent, etc.

• 96 local staff : logisticians, supervisors, doctors, nurses, community health officers, etc.

Sources of Funds

European Community Humanitarian Office [ECHO]

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