The measles epidemic that which has been raging in the Democratic Republic of Congo (DRC) for more than six months has reached the remote province of Maniema. Despite the logistical challenges, Médecins Sans Frontières teams are organizing an emergency response to treat patients who need care. 

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Overcoming logistical challenges to reach the population
"Maniema is a logistical challenge," says Roudy Jeantal, an MSF logistician. The infrastructure is in poor condition, which makes it difficult to reach the sites and discourages many health care actors from organizing programs in this part of the country. MSF is among the few present in the province today. 

The teams rely on an array of transportation methods – canoes, motorcycles and cars – to reach the furthest populations and deliver medical supplies. "You've got to be prepared for every eventuality.  The roads are impassible, cars get stuck in the mud when it rains and the bridges are destroyed. You've always got to be creative" adds Roudy Jeantal.

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When patients cannot reach the health center for lack of transportation or time, MSF sets up outpatient treatment centers and sends medical personnel out to local areas to provide greater coverage. "Our mobility has allowed us to reduce the mortality rate in the areas where we are working," explains Dr. Makoso.

Organizing and treating in an emergency
Since late March, MSF teams working with the Ministry of the Health have set up eight outpatient treatment sites for patients with simple measles cases and three treatment centres for complicated cases in the health care regions of Kibombo and Samba, the most affected areas in the province of Maniema. A team also provides regular support to the Tchuki referral center, in the Kabambare health zone, in the eastern part of the province.

"We had to rely on community networks and medical staff to inform the population that we were here because most people did not seek treatment at medical facilities," says Dr. Bobo Makoso, MSF medical coordinator in Maniema. "The community awareness efforts worked well. In Likeri, for example, patient visits rose from approximately 30 to more than 100 per day."

Since launching its activities, MSF has treated more than 2,000 patients across all sites. Nearly 250 of them required hospitalization.

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Supporting the national vaccination campaign
A mass vaccination campaign is the only way to stem the epidemic but the national response has been slow. MSF teams are prepared to assist the Ministry of Health by providing logistical support, including transporting vaccine and maintaining the cold chain in the health care regions of Kibombo, Samba and Tunda.

"Treatment is critical but vaccination is essential to prevent cases from spreading," Dr. Bobo says. "The vaccination campaign is in the organizing phase, but we have to continue to provide treatment while we are waiting to launch prevention efforts, so that's what we're doing now."

MSF is also working in Katanga, South Kivu and Eastern Kasaï, providing an overall emergency response to measles. MSF teams have already vaccinated more than 2.4 million people in these three provinces.     

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