DR Congo: Cholera outbreak in Mbuji-Mayi Appeal No. 35/02 Interim Final Report

This Ops Update is intended for reporting on emergency appeals.
Launched on 26 November 2002 for 164,919 CHF for 3 months; Programme extended for three months to May, 2003.

Disaster Relief Emergency Fund (DREF) allocated: CHF 10,000

Beneficiaries: 250,000

Period covered: 01 February to 30 April 2003; the full Final Report with the final financial annex will be issued by August, 2003

"At a Glance"

Appeal coverage: 64%
Related Appeals: 2003 Annual Appeal for the Democratic Republic of Congo (no. 01.43/2003)

Summary

The Democratic Republic of the Congo (DRC) has experienced a particularly long and serious cholera epidemic (since 19 September 2002) which struck the Kasai Oriental Province (the city of Mbuji-Mayi, and the outlying districts and villages) resulting in 4,329 recorded cases and 237 deaths (a death rate of 5.68%).

The epidemic lasted a particularly long time (six months) for two reasons: first, the inadequacy of family latrines. Since the soil in Mbuji-Mayi is stony it is difficult to dig pit latrines. Only about 17.37% of the compounds visited have latrines (opinion poll carried out in January 2003 by the Red Cross). Second, the poor access of the population to good quality water. Nearly 21.3% of the families visited use the Regideso (local water company) water and the remaining part drink water from the wells or non protected streams or springs located along populated zones where latrines are shallow (one metre deep).

Red Cross and Red Crescent Movement -- Fundamental Principles and Priorities

The intervention of the provincial Red Cross in the Kasai Oriental province comes within the framework of the fundamental mission of the Red Cross Movement: to alleviate the suffering of the vulnerable persons. The Red Cross, through the cholera project, has provided relief and assistance to respond to this outbreak. The Red Cross action was considerably assisted by volunteers, in line with the Movement's principles. Volunteers involved in the operation were males and females. Through the social mobilisation and sensitisation campaigns, the message about other epidemics such Ebola, HIV/AIDS, etc. were conveyed (in accordance with the and the African Red Cross and Red Crescent Health Initiative (ARCHI).

Co-ordination

As soon as the epidemic was officially declared by the Ministry of Health, a Crisis Committee referred to as STOP CHOLERA was created, composed of the Ministry of Health, the Red Cross Provincial Committee, Health Net, MSF-B, OXFAM-Q, COOPI, etc. The Red Cross, in the framework of its mandate, became immediately and actively involved in the fight against the epidemic, focusing on three main objectives, namely:

• carrying out social mobilisation campaign in the community;
• disinfecting the contaminated persons' houses; and
• burying dead persons and promoting water and sanitation activities.

The operation was initially planned for a three month period, but was extended for another three months to achieve the third objective, that is, the construction of public and family latrines. Support for this has been provided in particular by the Swedish Red Cross, the Netherlands Red Cross and the Canadian International Development Agency through the Canadian Embassy in Kinshasa and the technical support of a regional resource person from the Congolese Red Cross.

The team that co-ordinated Red Cross activities during the operation was composed of a regional resource person and health co-ordinator, and a Federation contact person, under the supervision of health delegates in Kinshasa and in Mbuji-Mayi; a provincial co-ordinator of the operation (Red Cross provincial secretary), a supervisor for Mbuji-Mayi and three supervisors for the districts of Mweneditu, Ngandajika and Tshilenge. Other actors in the field include Government officials and the representatives of a handful of humanitarian operational partners (ICRC, OXFAM-Q, MSF-B, UNIEF, WHO, CARITAS, PATS, etc.).

The STOP Cholera crisis committee is led by the Governor, assisted by the mayor of Mbuji-Mayi and the Provincial Medical Inspector. The committee has several technical subcommittees (the epidemiological surveillance subcommittee, the social mobilisation subcommittee, health care and water and sanitation subcommittee and the logistic subcommittee). At the district level, the crisis committee has the same structure. The Crisis Committee co-ordinates all the operations in the field and centralized all the inputs. All the humanitarian international NGOs in the province are part of the committee.

In addition to the Federation which supports the local branch with some specific inputs to fight the epidemic, Oxfam and MSF-B appear to be also actively involved in the fight in water and sanitation, sensitisation and social mobilisation activities.

Objectives and Activities Implemented

Objective 1: Scale up activities to reduce the rate of the cholera epidemic

In total 234 volunteers have been trained in six sessions in social mobilisation, communication techniques, knowledge of the movement, cholera transmission mode, preventive measures against the cholera, etc. Of these 234 volunteers, 150 have been trained by the Federation, 32 by the ICRC and MSF-B and 54 were auditors. The following table shows the allocation of the trained volunteers by branch:

Sensitisation of the population against the cholera: proximity sensitisation activities were carried out at three complementary levels, namely in households, in public places (churches, schools, markets) and in Cholera Treatment Centres and dead persons' households. Two hundred and five volunteers among those trained carry out education sessions in households using door-to-door strategy in the areas affected by the epidemic. Up to 30 March 2003, 157,625 households with 872,007 persons were sensitised with a coverage rate of 25.18, as the table below shows:

IEC activities were also carried out in public places by a team of 12 volunteers: 36 sessions in churches, 35 in schools and 37 at the main market places. 136,904 persons were sensitised in 108 sessions as shown in the following table:

In CTCs and in dead persons' households, the four disinfecting and burying teams carried out educative campaigns sensitising infected persons. In total, 3,200 campaigns were carried out and 23,840 persons sensitised from September 19, 2002 to March 30, 2003.

With the technical, logistic and financial support from the Federation, the ICRC and MSF-B, four teams composed of five volunteers each were posted in the four CTCs in Mbuji-Mayi. They disinfected the infected and dead persons' clothing, materials, houses, and soiled latrines as well as means of transport used to take them either to CTCs or to the cemetery. Another team of five volunteers was responsible for picking up, transporting, disinfecting and burying the persons dead of cholera epidemic in Mbuji-Mayi and in the outlying villages.

In total, 2,643 houses were disinfected and 282 persons were buried in Mbuji-Mayi and its surroundings from October 30, 2002 to March 30, 2003 by the Red Cross volunteers.

Objective 2: Support the provincial health authorities with medical supplies at CTCs

The co-ordination mechanisms were supported by the Red Cross.

Earlier in the operation, a cholera kit from the Federation's regional stock was provided to the Ministry of health authorities for use at the CTCs.

Funds from the Federation's DREF, the Swedish and the Finnish Red Cross have allowed the purchase of 50 aprons, 50 blankets, chlorine, 70 pairs of gloves, 50 kg of sugar of salt, 100 1 litre plastic bottles, 30 plastic cups, 30 boxes of soap of 38 pieces, 4 bikes, 3 cooking pans, 2 mobile phones, pens, reams of papers, notebooks, 30 body bags and 10 torches (lamps).

Objective 3: Support water and sanitation activities to reduce the cholera epidemic including diarrhoeal diseases in the community.

With the financial support of the Canadian International Development Agency, the locations for public latrines have been identified by the Red Cross, the political and administrative authorities, and members of the community. After visiting five main and secondary markets places, three were identified, namely Congo, Site Tchibombo and Comptoir Mukangala. A modern public toilet is being built near the Congo market place with eight seatless latrines whereas for each of the two other market places, two blocks of four latrines are being built.

For family latrines, two neighborhoods most affected by the epidemic have been chosen in the communes of Dibindi (Misesa Quarter) and Bipemba (Muya Quarter). The first 20 families in Misesa and eight families in Muya have dug their pits according to the requested dimensions, that is, 1m20 x 1m20 (at least 2 metres deep). Thirty volunteers helped in building these latrines, with the support of a local firm called MUJE.

Of the most affected quarters, only that of Misesa in the commune of Dibindi has got three water supplies (watering places), as a result of the local water supply firm (Regideso) extension of its water distribution network and the substantial support of the Red Cross.

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