H5N1

MSF: Massive mobilisation urgently needed to curb fast-spreading measles outbreak

MSF.org has published Massive mobilisation urgently needed to curb fast-spreading measles outbreak. Excerpt and then a comment:

KINSHASA – Médecins Sans Frontières (MSF) has called for a massive mobilisation of national and international organisations to help combat a measles epidemic in the Democratic Republic of Congo (DRC), after the Ministry of Health declared an outbreak of the disease. Resources are urgently needed to vaccinate more children and treat patients affected by the disease.  

Measles is a highly contagious viral disease for which no treatment exists. The only way to prevent the spread of measles is through vaccination. 

Since the beginning of 2019, MSF teams in DRC have: 

VACCINATED 361,079 CHILDREN 

PROVIDED MEDICAL CARE FOR 14,785 PATIENTS 

The measles epidemic in DRC is likely to be the deadliest since the disease made a strong resurgence in the country in 2011-2012. In the first five months of 2019, more than 1,500 measles-related deaths were officially recorded, accounting for nearly 75 per cent of the total number of deaths recorded throughout 2012 during the deadliest epidemic of the last decade.

“MSF teams, in collaboration with the teams of the Ministry of Health, are doing their utmost to cut the chain of transmission of the disease by providing vaccination responses as soon as cases of measles are reported, and by providing care for patients,” says Rachel Séguin, MSF Medical Coordinator in DRC. “But in addition to the efforts already made in recent months, more resources and organisations are needed. Ensuring the supply of vaccines and medicines is essential – the sooner the better.”

Since the beginning of 2019, MSF has been fighting the measles epidemic alongside local teams of the Ministry of Health in 10 provinces of the country: Haut-Lomami, Haut-Uele, Ituri, Lualaba, Kasai, Kasai Central, North Kivu, South Kivu, Tanganyika and Tshopo. 

Given the scale of the epidemic, we are strengthening our control capabilities and deploying teams to new health zones to combat the spread of the highly infectious disease.  

“Measles has caused so much damage in my village,” says Albertine, a resident of the health zone of Kamwesha where MSF launched an emergency response in Kasaï province in May. “There were deaths in almost every house. Some families have lost two, three or even four children.”

Meanwhile, the #Ebola hashtag is saturated with alarmist tweets about supposedly Ebola-ridden Congolese migrants turning up by the hundreds on the Texas-Mexico border. Given the low vaccination rates in Texas, and the widespread nature of the DRC measles outbreak, the alarmists would be better occupied getting themselves and their kids vaccinated right away.

DRC: MSF warns about measles outbreak likely to be deadliest, with already 1,500 deaths

Via 7sur7.cd, a sobering report: DRC: MSF warns about measles outbreak likely to be deadliest, with already 1,500 deaths. Excerpt from the Google translation and then a comment:

The measles epidemic that particularly affects children continues to wreak havoc in the Democratic Republic of Congo, killing more than 1,500 people since the beginning of 2019.   

Following the statement of the Ministry of Health confirming that this pathology is widespread throughout the national territory, Médecins Sans Frontières (MSF) requests the involvement of all national and international actors for the care of affected people and the vaccination of children, the one and only way to prevent this epidemic.

According to Rachel Séguin, Medical Coordinator of Médecins Sans Frontières in the DRC, a titanic work is being shot on the ground by MSF response teams in collaboration with those of the Ministry of Health to stem this epidemic. in several provinces of the DRC.  

"MSF teams, in collaboration with the teams of the Ministry of Health, are making every effort to cut the chain of transmission of the disease by offering a response vaccination to populations as soon as cases of measles are reported and by caring for affected patients, but in view of the scale of the epidemic, in addition to the efforts already made in recent months, more resources and actors are needed, ensuring the supply of vaccines and medicines is urgently needed," she said.   

In view of the scale of the disease, MSF says it has strengthened its response and has deployed teams to new health zones to combat the spread of the epidemic. 

Dr. Ousmane Moussa, Chief of Mission of Médecins sans Frontières, for his part, spoke about the factors leading to the resurgence of measles.  

"The factors leading to the resurgence of measles are numerous, but given the recurrence of the disease, it is vital that a stable vaccine supply system is provided in the country.

"Several programs are planned to increase immunization coverage later on in the year but in the immediate future, it is urgent to contain the impact of the epidemic to save a maximum of lives by ensuring the immunization of children and the free care of affected patients with targeted and flexible strategies according to the evolution of the epidemic in each health zone," he said.

 On January 4, WHO reported 602 Ebola cases, 370 of them fatal. As of June 9, we have 2,062 cases, 1,390 of them fatal.

In other words, since the start of this year, measles has killed more Congolese than Ebola, while receiving a fraction of the attention we have given to Ebola. 

Oxfam reaction to the number of Ebola cases in the DR Congo reaching 2000

An Oxfam news release: Oxfam reaction to the number of Ebola cases in the Democratic Republic of Congo (DRC) reaching 2000.

In response to the number of Ebola cases in the Democratic Republic of Congo (DRC) reaching 2000, Oxfam’s Country Director in the DRC, Corinne N’Daw said:  

“It is clear the current response to tackle Ebola isn’t working. No matter how effective treatment is, if people don’t trust or understand it, they will not use it.  

“Our teams are still meeting people on a daily basis who don’t believe Ebola is real. While we are working to challenge that, many cases are going un-noticed because people with symptoms have been avoiding treatment. This lack of trust makes it impossible to break the chain of transmission. 

“Also, the number of violent attacks over the last few months has meant most aid organizations, including Oxfam, have had to repeatedly suspend activities. This has seriously hampered the ability to vaccinate people, decontaminate houses and carry out safe burials, resulting in a peak in cases. We fear another peak could happen in the next few weeks.  

“Since the UN has stepped up their leadership in the Ebola response and is going to scale-up humanitarian aid, there’s an opportunity to reset the response and make sure it is focused on building this crucial trust with communities, without which we won’t be able to win the fight against Ebola.”

Sudan: The ICRC on the medical situation

Thanks to Chris Hanger for emailing me with this message:

A short message on the situation in Khartoum, Sudan:

It’s vital that people in need receive adequate medical care. The ICRC yesterday provided wound-dressing kits, antibiotics and other supplies to Khartoum’s Royal Care International Hospital. Today we will try and get supplies to East Nile Hospital, Almoaalim Hospital, and Bahri Hospital. Free movement for ambulances, medical personnel and supplies is critical.

We are providing the following to each medical facility:
Dressing sets (with each set for about 100 people)
Anaesthesia drugs
Antibiotics
Surgical materials
Surgical gloves
Infusions and injection materials

The above is attributable to Crystal Wells, spokeswoman in Nairobi, Kenya for the International Committee of the Red Cross.

MSF: DRC Ebola outbreak crisis update

MSF.org has published an excellent report: DRC Ebola outbreak crisis update - May 2019 . Excerpt:

Current situation

More than 20 health zones across Ituri and North Kivu provinces have reported cases of Ebola.   

We have new tools and improvements in the medical management of this epidemic, compared to previous Ebola epidemics, such as new developmental treatments; a vaccine that has given indications of being effective; Ebola treatment centres are more open and accessible for the families of patients; and provision of a higher level of supportive care. The outbreak has not spread to other countries or regions, which can be considered as a success.  

However, ten months into the outbreak, the situation in the Ebola-affected areas of DRC is deteriorating and the number of Ebola cases continues to increase: more than 1,900 cases and more than 1,200 confirmed deaths have been reported to date.  

The response has been marked by community mistrust towards the response; attacks on our Ebola Treatment Centres (ETCs) in Katwa and Butembo in February 2019 led us to withdraw from running these centres.  

The mistrust and violent attacks against the Ebola response show no signs of abating. High levels of insecurity continue to hamper the efforts to control the epidemic and have a negative impact on its evolution: the violence further discourages people from seeking care in Ebola treatment centres, resulting in an increased likelihood of the virus spreading across the healthcare system. 

Many people continue to die in the community – either at home or in general healthcare facilities – and significant numbers of new confirmed cases cannot be traced to an existing contact with Ebola. 

The unrest, such as fighting between the army and armed groups in early May and the killing of a WHO doctor in April in Butembo, have brought many outbreak response activities to a standstill. Vaccination of contacts, contacts of contacts and frontline workers in Butembo and Katwa (the epicentre of the outbreak) is sometimes temporarily suspended because of threats to the safety of vaccination teams.

The response to the current outbreak 

The DRC Ministry of Health (MoH) is leading the outbreak response, with support from WHO. The MoH team sent to coordinate the response in Beni was dispatched from Kinshasa and is the same team that coordinated the response in Equateur province. The WHO emergency pool was mobilised in the area upon the declaration of the outbreak. 

We believe it will not be possible to end this outbreak if there is no trust built between the response and the affected people. Response authorities and workers must listen to the needs of communities, restore people’s choice when it comes to managing their health, and involve the community in every aspect of the Ebola response. This includes integrating Ebola care in the overall provision of healthcare in the region. 

In order to respond to people’s needs, earn their trust and improve our early detection of new cases, those responding to the outbreak need to support local health centres through training to identify suspected cases and manage isolation while people are waiting for their Ebola test results.  

MSF RESPONSE 

MSF has been involved in the outbreak response, working with the Ministry of Health, since the declaration of the epidemic on 1 August 2018. 

Since our withdrawal from Katwa and Butembo following the attacks on our ETCs in February 2019, MSF is no longer running ETCs and is currently not providing care to confirmed Ebola patients. 

We continue to undertake prevention and treatment activities of suspect cases, managing Transit Centres for suspected Ebola patients, and supporting health structures. Our activities include helping the healthcare system to provide support in general healthcare (beyond Ebola) such as treating common illnesses and improving water and sanitation, and implementing and strengthening triage and infection prevention and control activities (IPC).  

In addition, our teams are reinforcing health promotion and community engagement in the areas where we are working. We are also working towards strengthening the disease surveillance system in our regular project areas, including in Goma.

Congo Ebola response must be elevated to maximum level, UN told

Via The Guardian: Congo Ebola response must be elevated to maximum level, UN told. Excerpt:

The UN has been urged by charities to ramp up Ebola prevention work in the Democratic Republic of the Congo to the highest level of emergency response.  

Only three crises – Yemen, Syria and Mozambique – are treated as the equivalent of a level-three response, activated when agencies are unable to meet needs on the ground.  

Charities including Mercy Corps and Oxfam said the same declaration should also be made in DRC, following a recent acceleration in the spread of Ebola. 

Almost 2,000 cases of Ebola have been recorded since the outbreak began in August. As of Monday, 1,287 people have died from the disease.  

Violence by armed groups and community mistrust have severely undermined attempts to halt the epidemic, forcing health workers to suspend vaccination and treatment work.  

Whitney Elmer, country director of DRC for Mercy Corps, said that declaring the equivalent of a level-three emergency would bring “manifold benefits” by clarifying the roles of agencies, allowing greater access to resources and attracting greater global attention. 

“There has never been an epidemic of this complexity or size in the DRC,” said Elmer, adding that the crisis requires a new structure in line with its scale.  

The global humanitarian coordination body, Inter-Agency Standing Committee, will consider the call when it meets on Wednesday. Among the factors to be considered are the scale and complexity of an epidemic, and the risk of a failure to respond effectively. 

A level-three emergency, now known as a system-wide scale up, does not indicate the severity of the crisis, but is activated where there is a mismatch between need and agencies’ ability to respond. 

On Tuesday, Mike Ryan, assistant director-general of the World Health Organization’s emergency preparedness and response programme, said progress had been made in fighting Ebola, including a drop in transmission of the disease in health facilities. 

But insecurity has continued to undermine the response, he added, repeatedly preventing work to identify and vaccinate people at risk of Ebola. There have been 174 attacks on health facilities so far this year, a threefold increase compared with the period from August to December 2018.  

In some areas, health workers are afraid to wear protective equipment because they fear they will be targeted by armed groups, according to the WHO. 

Médecins Sans Frontières warned it is “extremely worried” about the unpredictability of new cases.

MSF: Most new Ebola cases were not known contacts

Via The Washington Post, a report by The Associated Press: Aid group: Most new Ebola cases were not known contacts. Excerpt:

GENEVA — The World Health Organization emphasized progress in the fight against Ebola in eastern Congo even as Doctors Without Borders warned Tuesday that efforts to trace new cases to previous ones are largely failing. 

WHO emergencies chief Dr. Michael Ryan told reporters in Geneva that disease surveillance has improved even as the number of attacks against health workers rose three-fold over the last five months. Five health workers have died since the outbreak began in August.  

“We’ve also managed to improve surveillance performance in terms of the proportion of cases coming off contact lists,” he said. Disease transmission has “decreased significantly” over the last couple of weeks in the epicenters of Butembo and Katwa though challenges remain there, he added.  

Doctors Without Borders, which pulled out of Ebola treatment centers in Butembo and Katwa earlier this year because of the violence, said contact tracing is still too low. 

“As few as 32 percent of the new confirmed cases were linked back to known contacts,” the group said in a statement. “This means that the listing of contacts and surveillance are not effective. Contact tracing is essential to control the evolution of the outbreak.”

Ebola patients are human beings, not biosecurity threats

Via Thomson Reuters, an opinion piece by an MSF nurse: Ebola patients are human beings not biosecurity threats. Excerpt:

In February, I worked as a nurse with Doctors Without Borders/Médecins Sans Frontières (MSF) in Katwa, North Kivu — a town in the Democratic Republic of Congo in the epicenter of the current Ebola outbreak — until attacks on two of our treatment centers forced us to evacuate. 

February 15-19, 2019  

Me and some colleagues arrived in Beni, in the most affected province. We joined a long line of other passengers, all waiting to wash our hands with chlorinated water to disinfect and get our temperatures checked to verify we weren’t sick.

The two-hour drive to our final destination, Katwa, took us on rusty colored roads on a mountain that gave us a view of Virunga rainforest, one of the most beautiful countries I’d ever seen. Hidden away, between large tree trunks, flashes of orange started appearing through the thick morning fog: it was the Ebola Treatment Center (ETC). It was the size of a football field, and within was a complex maze which separated the low-risk zones from the high-risk zones, where people who exhibit Ebola-like symptoms waited, with a passage in between for families to visit their loved ones at a safe distance.  

I didn’t know what to picture when I thought of an Ebola patient. I had never seen this disease before. One woman was a “positive case” — someone who tested positive for Ebola. She was very weak and complained of abdominal pain and chills. There were no hemorrhagic symptoms. She looked exactly like so many sick patients I’d taken care of back home. 

February 20, 2019  

I donned the Personal Protective Equipment (PPE), layers of equipment we wore in high-risk zones to minimize our exposure, and grabbed an umbrella to protect my goggles from fogging from the rain before I entered her room. The clinical status of the woman I saw the day before dramatically declined in just a few hours. I felt myself moving in slow motion because of the weight of the suit and was struck by my reflection in the window. I felt guilty that I was dressed the way that I was, and that the last person she would see was a random stranger wearing what looked like a yellow spacesuit. I felt like I was treating a disease, a biosecurity threat, less a person who was a mother, a daughter, and a human being.  

She died several hours later. 

February 21, 2019  

Adama [not her real name] is a precious seven-year-old girl; she was my favorite patient. Her parents were unable to go into her room, so Ebola survivors who couldn’t contract the disease again cared for her. She smiled at me as I walked over to her window. I put my hand against the plexiglas separating us and she put her small hand against her side of the glass to touch mine. That’s the closest contact I could have with her from our separate sides if I wanted her to see that I was smiling back at her. 

February 22, 2019  

In December, DRC’s Independent National Electoral Commission excluded Ebola-affected regions from voting in the presidential election to prevent the outbreak from spreading.  

As more money and international responders poured in, rumors started developing and circulating: “The response is benefiting outsiders,” “Ebola is a political ploy.”  

People were suspicious about the motives of organizations. People wanted answers: “Where were you all when our families were being massacred over the years and when our children were dying of other diseases?”

Ebola: Two journalists threatened with death by militia in eastern DR Congo

This Actualite.cd report, published in the safety of Kinshasa, may also help to explain the silence of Radio Moto Butembo-Beni since May 16: Two journalists threatened with death by militia in eastern DR Congo. The Google translation and then a comment:

Journalist in Danger (JED) is extremely worried about the situation in recent days, two journalists forced to live in hiding after receiving a series of death threats by Mai Mai militia in the East of the Democratic Republic of Congo.

This is  David Munyanga, director of Radio FM Ondese, community station broadcasting Kiliba in the South Kivu Province; and  Fiston Matsanda , a journalist with Bashu Community Radio in Beni territory, North Kivu province.   

According to our sources, David Munyanga went into hiding since May 22, 2019. The day before, his home was attacked by a group of Mai Mai militia armed with firearms. After brutalizing him, one of his attackers wanted to shoot the journalist. David Munyanga was saved thanks to the intervention of his neighbors.  

These militants reproached him for having disseminated information that would be the basis of the arrest of a Mai Mai element by the Armed Forces of DR Congo (FARDC).  

While preparing to leave the locality of Kiliba, David Munyanga received a phone call from a militia leader who made threats to him:  "We did not want to kill you that day by this that you were with your children. Your radio will be burned and yourself murdered if our element is not released."  

Contacted by JED, David Munyanga said it's been more than a month since he saw threats from these militiamen. "In April, I was ambushed by the Mai Mai militia in the Ondes-Kabulimbo section. These gunmen took me to the bush where I was detained for about five hours. I got my release thanks to the intervention of the local authorities who made phone calls to my captors. My laptop and my phone have been confiscated until today. Two days after my release, the same Mai Mai chief seriously threatened me on the phone for allowing my radio to broadcast information about my kidnapping. Faced with this series of death threats, I officially seized the head of the city whom I asked for protection."  

For his part, Fiston Matsanda of Bashu Community Radio in Beni, fearing for his life, has been forced to live in hiding with his family since May 2, 2019. The Mai Mai militias reproach him, among other things, for to have been actively involved in the fight against Ebola through his reports.  

According to our information, since the beginning of this disease in the east of the country, Fiston Matsanda has broadcast several reports in connection with the sensitization of the local population to eradicate this disease at the base of several deaths. His involvement in the campaign against this disease is at the root of a series of death threats he is currently suffering.     

Journalist in Danger (JED) vigorously denounces these death threats against these journalists by individuals without faith or law.  

JED urges the provincial authorities of South and North Kivu to do their utmost to ensure the physical safety of these two journalists and to put an end to the threats they face.

I've been looking for other North Kivu-Ituri radio stations with websites, and found none. A region with 10 million people has a lot of radio and TV stations, but so far I've found only sites dead for years or no sites at all. Now I suspect that even those still operating are saying very little about Ebola or the response, rather than see their reporters killed and their stations burned down.

Uganda: On high alert, ready for Ebola

Via ReliefWeb, a May 24 report from Medical Teams International: On High Alert, Ready for Ebola. The report makes a couple of disturbing points: the poor quality of care in some health centres, and how easy it is for people living in North Kivu to cross into Uganda:

It’s been five years since the world’s largest Ebola virus outbreak, which happened in West Africa. Medical Teams was on the frontlines then, as we are now, for the second largest outbreak ever. This time the virus is spreading through the Congo, directly across the border from where we work in Uganda. 

Why Ebola Spreads  

Ebola is a highly contagious virus. The virus causes a severe fever and internal bleeding and is spread through contact with bodily fluids. Without prompt detection and treatment, the virus spreads quickly throughout families and communities.  

Why is the virus spreading so fast in the Congo? An increase in insecurity and violence has disrupted efforts to contain the outbreak. Rebel groups target health facilities and workers as they attempt to treat Ebola cases. Every time a facility is attacked, precious time is lost in combating the outbreak. The sick are discouraged from seeking medical care, scared that they will be vulnerable to the violence. Health officials fear that this outbreak may spiral out of control if the violence does not stop. 

On High Alert  

Because of the conflict, thousands of Congolese are fleeing their homes, crossing over into Uganda. Medical Teams is the leading organization providing health screenings as refugees cross over. 

“The country here is on high alert, expecting that at any time we’ll receive a confirmed case,” said Andrew Hoskins, country director for Medical Teams International in Uganda. Hoskins led Medical Teams’ Ebola response efforts in Liberia during the disease’s deadliest outbreak in modern history. That outbreak, spanning 2013 to 2016, cut a deadly path through West Africa, killing more than 11,000 people. 

“Our goal is to be prepared for Ebola crossing the border. That means contain the outbreak and make sure it doesn’t become an epidemic,” Hoskins said. “Medical Teams International is working alongside the Uganda government to safely isolate and transport any suspected cases to regional hospitals, which have special wards dedicated to Ebola and other types of hemorrhagic fevers.” 

Whenever a refugee crosses the border of Uganda, Medical Teams staff checks their temperature and monitors them for symptoms of the virus. We’ve also trained community health workers to educate community members about the signs of Ebola infection and what to do if a case is suspected. 

Stories from Home  

Every day, newly arrived refugees bring with them stories of Ebola’s fast spread in the Congo.  

Patricia is a recent refugee from northeastern Congo, near one of the areas hit hardest by the disease outbreak.  

“My friend’s husband was taken ill one afternoon. Initially they thought it was malaria because of the fever, then the bleeding started,” Patricia said. “The health workers seemed to know what was happening but instead of telling the family what was going on, they left the health center and didn’t return.” 

With nobody to treat her friend’s husband, he went back home. Within a few days, his two children, 5 and 12 years old, started showing symptoms of Ebola. 

“When the children became ill, that was the moment my friend and her husband realized this was Ebola,” Patricia said. 

Instead of seeking further treatment, the father and mother set their house on fire. The entire family died in the blaze, Patricia said. 

To stop horrific situations like that from happening in Uganda, Medical Teams’ staff are working overtime to safely prevent the spread of disease. Your support ensures we’re prepared if Ebola crosses over the border. If and when that happens, your compassion will prevent suffering and save lives.