Providing lifesaving interventions against cholera in DR Congo

Cornelia Walther, UNICEF

MBANDAKA, Democratic Republic of the Congo (January 16, 2012) — "At the beginning I thought she had just diarrhea, but when she didn’t stop vomiting I took her to the hospital, where they told me it might be cholera," said Getou Bofala, 35.

She had been sitting at the bedside of her 1-year-old daughter, Rihanna, for the past 12 hours and could hardly keep her eyes open.

Cholera, an infection that causes severe dehydration, can be deadly if left untreated. But thanks to the staff of Mbandaka's Cholera Treatment Center (CTC)—which receives support from UNICEF, the World Health Organization and NGO partner Oxfam—Rihanna can smile again.

Six nurses and two doctors work in 12-hour shifts at the CTC, which can hold up to 80 cholera patients at a time. An additional six hygiene agents are tasked with spraying the center with disinfectant throughout the day.

"Whenever the chlorine smell fades, the rooms need to be disinfected anew. It is crucial to constantly eliminate the bacteria," said Esperance Nzabongo, a nurse at the CTC. "Lack of discipline is deathly."

High-risk surroundings

Mbandaka is located in Equateur, the province worst affected by the country's 2011 cholera outbreak. Over 3,000 cases and 165 deaths have been reported in the province. Throughout the country, over 21,500 cases have been reported, and at least 575 Congolese have died.

Modern sewage and water treatment systems virtually eliminated cholera in industrialized countries, yet the disease persists in locations where poverty or disaster force people to live in crowded conditions without adequate sanitation. According to the recent Multiple Indicator Cluster Survey (MICS), barely half of DR Congo's population has access to safe drinking water, and 72% of people are relegated to using unimproved sanitation facilities. The situation is worst in rural areas.

"Many families know that it is not good to drink straight water from the river, but they have no alternative," said Christian Bolondo, a UNICEF water emergency specialist in Mbandaka. "One Aquatab [water purification tablet] suffices to clean 20 liters—but not many can afford this for each drop of water they consume. They are aware that boiling water is efficient for disinfection, but they don't want or can't spend the money for the necessary firewood."

Motoki Kitalo, 27, has suffered the consequences of poor water and sanitation. He is about to be return home after spending three days in the CTC. "One of my neighbors had cholera a week ago, and the 12 people of our two families share the same latrine," he said.

Motoki and Rihanna were treated in time, but many are not so lucky. "At the beginning of the epidemic, families were waiting at home and came to seek treatment only when it was too late. Many died on the way, too weak to even reach the CTC," said Dr. Eli, who works at the center.

Making hygiene a priority

UNICEF is helping address both the immediate needs of cholera patients and the long-term causes of cholera. In addition to supporting CTCs, UNICEF is helping organize mass communication campaigns to raise awareness of important hygiene practices. Through partnerships established to fight polio—another disease that haunts the country, with 92 cases in 2011—these campaigns mobilize religious and traditional leaders, parents and authorities to spread and adopt healthy practices.

Families in areas at risk are also receiving safe water access through water chlorination points and free water purification tablets. And the "Healthy Villages" program, a government program supported by UNICEF, is helping communities defend against cholera through improved water infrastructure and hygiene, sanitation and behavioral changes.

Meanwhile, the outbreak appears to be winding down in the worst-affected areas, even as new cases are being reported in other areas.

"At this stage it looks as if we have the worst behind us," said Dr. Eli. But communities must remain vigilant against the disease. "Negligence of hygiene can destroy any progress made," he said.