In the Democratic Republic of Congo’s western province of Equateur, the people in the Bolomba health zone have been affected by an mpox outbreak over the past months. From the end of August to mid-October 2023, an MSF emergency team was on-site to help health authorities treat patients and combat the spread of the disease.
Mpox, previously known as Monkeypox, is a contagious viral disease of animal origin endemic in around ten countries in Central and West Africa. Characterized by rashes that can appear on the palms of the hands, soles of the feet, or in the mouth, mpox can be accompanied by fevers, sore throats, muscle aches, skin lesions, or pain in the lymph nodes.
"If the disease is not treated in time, it can lead to complications and death in those affected, especially if their immune system is compromised by other diseases," says Raphaël Kibwantiaka, head of MSF's emergency response in the Bolomba health zone. “As Bolomba was already grappling with a measles epidemic, we intervened against both diseases.”
Bolomba, situated more than 300 km from Mbandaka, the capital of Equateur province, is a densely wooded area rich in animals. It is isolated and difficult to access, with the population primarily relying on hunting and fishing. This natural environment is conducive to the development of diseases of animal origin, known as zoonoses, such as viral hemorrhagic fevers and mpox.
"Eating bushmeat, handling dead animals, and animal bites or scratches encourage the transmission of the virus from animals to humans,” says Kibwantiaka. “Infected individuals then become highly contagious and need to isolate themselves quickly to prevent widespread transmission."
MSF response to the outbreak
From the end of August to mid-October 2023, an MSF emergency team was present in Bolomba to support the Ministry of Health in the response. Our teams notably reinforced epidemiological surveillance at the community level and provided medical care in health centres as well as in the Bolomba general referral hospital (HGRB), where an isolation circuit and a dedicated treatment unit were set up.
"The disease is wreaking havoc in my village," says Ketenge Igbango, sitting next to her daughter, recently admitted for Mpox at Bolomba’s general hospital. “She's the fifth in the family to catch the disease. I contracted the disease too, and thank God I survived it. I've just been discharged from the hospital, and here I am again, looking after her.”
In two and a half months, more than 890 patients were treated for Mpox in the health facilities supported by MSF, including 72 people hospitalized for severe forms of the disease. Our teams also provided training in Mpox management for the local health staff. Additionally, MSF supported 11 health centers in remote, hard-to-reach areas.
“The medical strategy aimed to bring healthcare as close as possible to the affected people and refer severe cases here,” says Dr. Théophile Lukembe, an MSF doctor assigned to the HGRB. “We supported a home-based care approach, providing treatment while assisting patients in ensuring their isolation to avoid contaminating other family members. Only patients with complications were taken to health facilities for appropriate treatment."
More than 800 patients were followed up at home by our teams. Awareness-raising activities were organized in health facilities and the community to prevent the spread of the disease and combat stigmatization, as the disease has highly visible signs on the body, sometimes leading to the rejection of patients by the community.
"Logistically, this intervention presented challenges because some health areas could only be reached by pirogue, while others required hours on a motorbike along forest paths—often in pouring rain. This made it even more challenging for the teams and equipment to move around, but that's precisely why MSF is there: to reach people where others cannot," concludes Raphaël Kibwantiaka.
In addition to this Mpox response, MSF emergency teams also addressed a measles epidemic in Bolomba. They vaccinated 110,723 children against measles and provided treatment for 3,355 others. MSF also treated 827 children suffering from malnutrition and 2,583 with malaria.
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