Kikwit - The teams of MSF's 'Pool d'Urgence Congo' (PUC) are currently fighting a typhoid fever epidemic in Kikwit, Bandundu Province, around 500 km east of the capital Kinshasa. Since August 20, more than 650 cases of typhoid fever have been reported, including 90 cases of peritonitis and intestinal perforation and around 20 deaths.

MSF is supporting Kikwit Nord General Hospital offering free, quality treatment to patients with basic needs as well as those suffering from complications or perforation.

"Simple cases are given outpatient care and antibiotics, while complicated cases are hospitalised and perforated cases require a surgical intervention," explains Dr Jean Lambert Chala-Chala, from the PUC. "It is very important to ensure a good triage of patients coming to the hospital."

MSF also provides medicines to the hospital and trains the personnel of the hospital and health centres around the city, and ensures that an adequate case definition and treatment protocol are implemented.

Typhoid fever is a disease linked to unsafe drinking water, inadequate sewage disposal and flooding. Also known as the 'dirty hands disease', typhoid fever is caused by a bacteria that people contract via feco-oral transmission.

"Transmission can be direct. For instance, if one does not wash hands before eating - or indirect - when the bacteria passes through vectors like flies on food at the market place," says Chala-Chala.

Problem of access to water

Between January and April 2006, MSF had already carried out an intervention against typhoid fever in Kikwit. And figures from the same period last year also show an increase in cases of the disease at the beginning of the rainy season. This information indicates that typhoid fever is linked to a structural problem in terms of supply of quality water in Kikwit, as well as bad hygiene conditions in which most of the population lives.

In Kikwit, almost half the population does not have latrines, waste pits or any proper water source.

Along the sloping paths of Bongisa, in Lukolela municipality, water brought by the rainy season flows down between huts and green trees. A red-coloured mud carries rubbish and faeces that end up in the Lukemi River, further downhill. But given the water supply difficulties in Kikwit, a city of around 400,000 inhabitants, many families fetch water in a number of non-protected water sources and even in the rivers.

"In Kikwit, water supply is very difficult," explains Ibrahim Barrie, coordinator for the Kinshasa section of the PUC. "The population has to buy water at various water taps spread along the main roads of the city, where the water distribution company sells water for 1 Congolese franc a litre. For a family of six, this can amount to 3,600 CF (around 8 US$ )per month, an expense a many families cannot afford!"

Relays

An important part of MSF's work will now be to raise awareness among the population about basic hygiene practices.

"A team of community workers is currently training relays within the communities of Kikwit various 'health areas'," explains Barrie. "These people will then inform the population about simple behaviours that can help avoid contamination, like washing hands before eating, cooking food adequately, covering food at the market, etc."

However, in Kikwit, the task ahead to improve water and sanitation infrastructure and prevent typhoid fever epidemics from taking many more lives in the future, is immense.

MSF has worked in the DRC since 1981. Today, MSF More than 2,000 Congolese staff work alongside 150 international staff to bring medical assistance to the Congolese population, with around twenty programmes across the country.