/ 28 December 2003

Fighting Africa’s measles epidemic

They say the cheetah is the fastest thing on the savannah, but in the Congo bush that honour belongs to the Yamaha motorbike.

A medical team on motorbikes is just leaving Tshikapa — a town of diamond miners and market stalls — and is already pushing 65kph, racing through alleyways, over boulders and around craters.

The dirt track, punctuated by stretches of mud and sand, is the road to Kamona, a remote village where the staff of Médécins sans Frontières (MSF) want to investigate a measles epidemic.

As the number of mud-brick dwellings thins so does the track, until it is the width of a pencil, and the foliage — so thick the sunshine does not get through — lashes our faces and arms.

It is early morning, and the plan is to reach Kamona by 10am. As we approach a clearing, a man wearing a yellow shirt and a blue beret, and with a cold stare, steps from behind a tree, followed by three others. It is a roadblock. Here policemen take hours to scrutinise documents. Farewell timetable.

So it goes in the Democratic Republic of Congo. Imagine a place the size of western Europe with no roads and little infrastructure in the messy aftermath of a horrendous war. Poverty, disease and corruption are widespread.

Children make up almost half the country’s population of 50-million. They share crowded homes and beds, are malnourished and have weak immune systems. It is a recipe that turns measles into a mass killer.

Measles is a viral disease spread by infected droplets during sneezing and coughing, and by touching contaminated objects. It causes fever and rash, and can lead to convulsions, pneumonia, bronchitis, mental retardation and death.

In the rich world, it is seldom fatal because infected children eat well and have proper medical care, and because immunisation has restricted epidemics over the past 30 years.

But in poor countries it kills 800 000 children every year. More than half of them are in sub-Saharan Africa, and about 50 000 in Congo, according to Lieven Desomer, a vaccine specialist with Unicef, the United Nation’s children’s agency.

”It is one of the most contagious diseases known,” he says. ”To stop epidemics we need to routinely vaccinate more than 90% of newborns.”

Since fragile peace accords opened up previously inaccessible areas, immunisation has increased — but still about half of all children go unprotected. At less than $1 per shot, including the cost of transport and training, the vaccine is more cost-effective than most other health interventions.

”But Congo is basically 11 countries. It’s huge and it’s not normal. Here the challenge is logistics,” says Desomer.

An ambitious effort to immunise all children aged between nine months and 15 years was started last year by the Health Ministry, Unicef and NGOs.

Rickety Antonov cargo planes offload ”cold boxes” of vaccines at remote airstrips, from where they are transported by four-wheel drive, canoe, foot and motorbike. Ideally, they stay frozen until just before use — a huge task when fridges, generators and fuel are scarce.

MSF’s job over the next few weeks is to help the authorities reach 900 000 children in the southern part of Kasai Occidental, an area the size of Belgium, where an epidemic is spreading swiftly.

”For this campaign to be effective, we need to be very fast,” says Dr Paul Lame, a senior health official in Tshikapa.

The policemen blocking the medical team’s three Yamahas on the way to Kamona feel no such urgency. Why have our papers been stamped only at Kinshasa and Tshikapa airports and not at Tshikapa’s police station?

Laboriously they transcribe, in duplicate, copies of all documents before ordering us back to town for the missing stamp. There a police major finally sends us on our way, two hours late.

To avoid sinking on sandy stretches the motorbike riders hit 96kph. On this terrain it is a frightening speed, which blurs forest and savannah into flashes of brown and green.

Two of the bikes collide outside a village called Ntumba Kapanga. A pause to recover turns into a long stop when villagers besiege the team for advice. In an impromptu clinic, Dr Bertin Munanga of the Health Ministry and Dr Olaf Valverde of MSF examine more than a dozen infants.

”They have their own word for measles — katenbele — and that’s important. It means it’s recognised,” says Valverde.

We reach Kamona five hours late. Gathered under a manioc tree are more than a dozen feverish children with wheezy breaths and protruding ribs — symptoms of measles-related respiratory infections. The village nurse, Jose Mutshipayi, almost cries with relief at seeing the team.

”Thank God you’re here,” he says. ”The epidemic is terrible.” — Guardian Unlimited Â