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, 2006consult this article only
DEMOCRATIC REPUBLIC OF THE CONGO - South Kivu
One coordination base: Bukavu Three main bases of operation: Baraka, Kilembwe and Uvira Seven (later five) health care zones: Lemera, High Plateau of Uvira, Kimbi-Lulenge, Nundu, Fizi, Uvira and Ruzizi
15 expatriates: 1 head of operations, 1 program coordinator, 1 administrative and financial coordinator, 1 medical coordinator, 1 logistics coordinator, 1 logistician, 3 project managers, 1 psychosocial adviser, 3 medical advisers, 1 pharmacist, 1 epidemiologist
120 local staff members (medical, logistic and administrative)
»BENEFICIARIES 795,000 men, women and children (970,000 in the seven health care zones)
»FUNDING European Commission Humanitarian Aid Office (ECHO), The Global Fund, Swiss Agency for Development and Cooperation (DDC), Paris City Hall, Fondation de France, United Nations Pooled Fund, Mr. and Mrs. Pierre Moussa, A.M.I.
Between 1996 and 2002, armed conflict claimed four million lives in the Democratic Republic of the Congo. A peace process was begun in 2003 and a transition government composed of all armed groups in the country managed to stabilize the situation for a few years. Free democratic elections were held in 2006, and a President and Parliament were elected.
Although the situation has improved since the beginning of the transition period, it remains unstable, with pockets of resistance, especially in North and South Kivu, where tensions erupted in 2007. Deep-rooted problems have not been solved, despite the Nairobi-Goma agreements of 2007-2008.
The process of demobilization and reinsertion of former combatants is still ongoing, and major tensions persist. The United Nations Mission for the Congo (UNMC), with 17,000 peace-keeping forces, is the largest of its kind in the world; however, fighting resumed at the end of 2008, opposing government and rebel CNDP forces and displacing thousands of inhabitants.
The Congolese health system is depleted, and in South Kivu, rural health care centers were deprived of their personnel. This has severely limited access to health care for the population and confronted them with a situation of emergency.
A.M.I. has been working in South Kivu since July 2001, rebuilding the health care system there. After having progressively expanded and consolidated its activities, A.M.I. now plays an important role in primary health care in seven geographic areas of South Kivu: Lemera, The High Plateau of Uvira, Kimbi Lulingu, Nundu, Fizi, Uvira and Ruzizi.
A.M.I.’s main objective is to facilitate access to primary health care. A.M.I. aims to reinforce the capabilities of local health care personnel, help prevent the spread of HIV/AIDS, and optimize access to both comprehensive and specialized health care (with particular attention given to reducing risk for mothers and infants).
» Access to treatment
Within the context of its health care access program in 2008, A.M.I. lent support to 78 health care structures in seven geographic areas: Lemera, the High Plateau of Uvira, Kimbi-Lulenge, Nundu, Fizi, Uvira and Ruzizi.
A.M.I.’s support consists of rehabilitating health care structures, supplying equipment and medicines, providing training and supervision, all adapted to each geographical area, in order to better respond to the needs. Accordingly, in vulnerable areas, quality health care is guaranteed at low cost.
In 2008, A.M.I. withdrew from two of the seven areas of operation, Uvira and Ruzizi, comprising 13 health care centers. This measure, which was part of the transition towards ensuring independence in health care areas, was a reasonable yet progressive action.
» Support for local health care teams
An essential part of A.M.I.’s programs in the Democratic Republic of the Congo is the consolidation of local health care structures in preparation for their transfer to local personnel.
This involves training and monitoring for the CODESA, Committees for the Development of Health Area. The CODESA serve as a link between the people of the country and their health care structures, and are responsible for the management of health care centers, health care education, drawing up lists of indigents, etc. A.M.I. renforce également les capacités des autorités sanitaires en matière de gestion des centres de santé.
» Improvement of access to comprehensive and specific health care
In their goal to improve access to comprehensive and specific health care (pediatrics and obstetrics; establishing seven blood transfusion stations), A.M.I. has lent support to four hospitals (comprehensive care hospitals and hospital centers). This action includes:
> cholera prevention: A.M.I. teams lend support to nine cholera treatment centers (CTCs).
> care for victims of sexual violence: A.M.I. works (in 43 centers) in partnership with NGOs and local treatment centers offering medical care such as emergency contraception, HIV testing and surgical referral, as well as psychosocial care, for victims of sexual violence.
> emergency support program for reducing risk during pregnancy and delivery: This program provides support in the health care areas of Fizi, Kimbi-Lulenge and the High Plateau of Uvira, to improve detection and care of high-risk pregnancy.
» Prevention of HIV/AIDS
A global program to prevent the spread of HIV/AIDS is ongoing in the health care areas of Uvira, Ruzizi, Kimbi-Lulenge, Lemera and Fizi. The program lends support to four voluntary testing centers as well as to 14 MTCT (mother-to child transmission) prevention structures, in addition to medical care for HIV-positive pregnant women. In a “package” approach comprising all aspects of patient follow-up (medical, nutritional, psychological and social), A.M.I. activities also support associations which increase awareness and monitor those living with HIV.
Plans for A.M.I.’s mission in 2009 include:
> consolidating local health care workers’ capabilities with a view to withdrawal of other health care providers
> constant improvement in the quality of care via supervision, training and monitoring
> continuation of primary, comprehensive and specific health care access programs; continuation of HIV/AIDS prevention
> assessing the possibilities of designing a training magazine for health care personnel along the lines of the A.M.I. Health Messenger Magazine.
• 4 bases : Uvira, Baraka, Kilembwe [operation bases] and Bukavu [coordination base]
• 6 health zones : Lemera, Ruzizi, Uvira, Nundu, Fizi and Kimbi-Lulenge
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]consult this article only