Nurses working in fear: BBC visits mpox epicentre

Medical staff on the front line of the battle against mpox in eastern Democratic Republic of Congo have told the BBC they are desperate for vaccines to arrive so they can stem the rate of new infections.

At a treatment centre in South Kivu province that the BBC visited in the epicentre of the outbreak, they say more patients are arriving every day - especially babies - and there is a shortage of essential equipment.

Mpox - formerly known as monkeypox - is a highly contagious disease and has killed at least 635 people in DR Congo this year.

Even though 200,000 vaccines, donated by the European Commission, were flown into the capital, Kinshasa, last week, they are yet to be transported across this vast country - and it could be several weeks before they reach South Kivu.

“We've learned from social media that the vaccine is already available,” Emmanuel Fikiri, a nurse working at the clinic that has been turned into a specialist centre to tackle the virus, told the BBC.

He said this was the first time he had treated patients with mpox and every day he feared catching it and passing it on to his own children - aged seven, five and one.

“You saw how I touched the patients because that's my job as a nurse. So, we're asking the government to help us by first giving us the vaccines.”

The reason it will take time to transport the vaccines is that they need to be stored at a precise temperature - below freezing - to maintain their potency, plus they need to be sent to rural areas of South Kivu, like Kamituga, Kavumu and Lwiro, where the outbreak is rife.

The lack of infrastructure and bad roads mean that helicopters could possibly be used to drop some of the vaccines, which will further drive up costs in a country that is already struggling financially.

At the community clinic, Dr Pacifique Karanzo appeared fatigued and downbeat having been rushed off his feet all morning.

Although he wore a face shield, I could see the sweat running down his face. He said he was saddened to see patients sharing beds.

“You will even see that the patients are sleeping on the floor,” he told me, clearly exasperated.

“The only support we have already had is a little medicine for the patients and water. As far as other challenges are concerned, there's still no staff motivation.”

Another problem, he said, was that there was not enough personal protective equipment [PPE] for the medics.

“We try to do what we can to look after the sick and not put ourselves at risk either. We're not spared from disease.”

As you enter Lwiro community hospital, which is about an hour’s drive north of South Kivu’s main city of Bukavu, two main things hit you.

First the resounding and loud cries of babies. The second is the stench - a mix of urine and stagnant water.

The clinic is running out of clean water, meaning they have to ration what they have in the small jerrycans underneath their beds.

Within the last three weeks, the clinic, which usually treats about 80 patients a month, has been inundated with nearly 200 patients - who are getting younger.

“It’s sad to see my firstborn suffering from this strange disease. I have a lot of pain in my heart,” 18-year-old Faraja Rukara said.

Her son, Murhula, is currently the youngest mpox case at the clinic - at only four weeks old. This is the first time she, like many others here, have encountered mpox, which is caused by a virus in the same family as smallpox.

The disease causes a loss of appetite, leaving many of the children malnourished.

In an adjacent room, several women and children - nearly 20 - were crammed inside, sharing only seven beds and two mattresses that were laid on the floor.

The hospital’s first mpox case did recover - 10-month-old Amenipa Kabuya. But not long after being discharged, her mother, Yvette Kabuya, returned as she too has fallen ill with mpox.

Witnessing what the disease does to the body - the painful puss-filled lesions, the fever and the weight loss - means people are keen for the vaccines - unusual in an area that has witnessed vaccine hesitancy in the past.

Beatrice Kachera, 50, gently caressed the cheek of her three-year-old granddaughter who she had rushed here in a panic: “I just saw the child get sick, I didn’t even know the name of the disease.

“We can't wait for children and even adults to die. Bring on the vaccines,” she told the BBC.

But some fear the ongoing armed conflict in eastern DR Congo between the army and several armed groups, most notably the M23 rebels, is not going to make this easy.

"The conflict is having a profound effect on the vaccination programme in general,” Dr Gaston Bulambo, head of North Kivu Provincial Health Division, told the BBC.

“It's not just vaccination against mpox, but all vaccination programmes are suffering because of difficulties in getting vaccines to health zones. This is due to the insecurity."

South Kivu’s governor, who hails from Lwiro himself, told the BBC the intense fighting was driving many from their homes to his province, which was exacerbating the spread of the disease.

“We are accommodating thousands of IDPs [internally displaced people], and still struggling with many issues,” Jean-Jacques Purusi Sadiki said.

“Most of the money is being injected in tackling the war which is going on, to buy military equipment, to feed the military,” he said.

“The country is losing a lot of money in trying to address this war, rather than injecting [this money] into social development including the health sector.”

However, the governor believed that the rebel groups would not disrupt vaccine deliveries as mpox was also affecting people in the areas they controlled.

He said the government was doing its best to get medics what they need: “In the next two days, I am going to Lwiro myself. I will deliver definitely what is available in terms of urgent assistance for the population, until the government in Kinshasa can offer more support.”

The authorities say vaccinations will begin in October, with children under the age of 17, as well as those who have been in close contact with infected patients, first in line.

Governor Purusi Sadiki is convinced the outbreak in his province will be contained: “It’s a matter of political will. I am confident that we will succeed.”

It is a sentiment not yet shared by exhausted medics, like Dr Karanzo, at Lwiro hospital - but they are at least heartened that mpox awareness appears to be growing in their region.

People appear to be coming to the clinic as soon as they get symptoms rather than first going to traditional healers, which means the hospital is yet to experience an mpox fatality.

Yet with 5,049 confirmed cases since the start of the year in DR Congo, the clinic’s staff say speed is of the essence - only with a combination of vaccines, medicine and other supplies to allow for better hygiene, will the outbreak be curbed.