Doctors without borders, motards with grit: A malaria emergency in the forest region of North Kivu

In Remeka, North Kivu, Democratic Republic of Congo (DRC), motorcycle drivers – or “motards” in French – are an integral part of MSF’s emergency response team. In this remote area of the country’s conflict-addled East, most roads are impassable by car and the only way to move around is on two wheels.
Since an emergency malaria intervention began in October, the MSF motards have racked up thousands of kilometres transporting staff members, medicines, mosquito netting and other supplies throughout the region. Presently, 22 MSF personnel are supporting the local reference health centres in Remeka and Katunda, running mobile clinics in neighbouring villages, sensitising the community on hygiene and avoiding illness, and distributing mosquito nets to people in need.
Unprecedented case numbers
Remeka is not the only area of North Kivu to see unprecedented numbers of malaria cases this year. Since the beginning of 2015, MSF has also intervened in the Rutshuru and Nyabiondo areas in response to soaring malaria caseloads, providing treatment to thousands of people.
The causes of this spike in malaria cases are not yet clear. It could be linked to a number of factors: higher rainfall or warmer temperatures in the region, for example, or a new, more violent strain of the malaria parasite. The ongoing conflict in North Kivu province surely plays a role.
“The majority of people in Remeka have been displaced by violence, some as recently as last year. They left their possessions behind when they fled, and now have no way to protect themselves from mosquitos. Perhaps they are coming from somewhere where there is no malaria, and are now getting sick, because they do not have the antibodies necessary to fight it,” says Dr Hervé Gando, medical referent for the project.
“Normally it is children under five years old who get cerebral malaria – the severe form that attacks the brain – because they haven’t yet developed immunity against the parasite. But in Remeka, we’re seeing it in teenagers, and even in adults,” says Dr Gando.
The problem is compounded by poverty, a lack of infrastructure and the cost-recovery system operational in DRC. Health centres are not equipped to deal with even the simplest malaria cases for lack of personnel, medicines and the appropriate supplies. In both private and public healthcare structures, people are required to pay for certain or all parts of their treatment; and most patients cannot afford the sums demanded.
Bringing healthcare to patients
The best strategy for saving lives is to treat patients early, before the illness becomes severe. But how do you do this, given the poverty and logistical challenges people in the region face?
“Rather than waiting for sick people to seek healthcare, the healthcare must come to them,” says Dr Gando. The MSF team of doctors, nurses, logisticians and health promoters are therefore providing hospital care to patients alongside Ministry of Health staff, consulting patients in “mobile clinics” in at least five different villages each week, and carrying out exploratory missions to identify new hotspots. The medical staff is seeing up to 500 patients each day – which means the motards have their work cut out for them.
“We spend nearly every day on the bike, and in really rough conditions,” explains Samuel, one of the 12 motards currently on duty in Remeka. “The roads are so bad that it’s actually easier to drive when it’s pouring down rain! The runoff makes the mud thin. When it dries up, it gets thick and sticky, and the motorcycle becomes really hard to control. But rain or shine, this job isn’t easy.”
Sometimes it is downright harrowing. In the first weeks of the intervention, the only way to refer seriously ill patients to the reference hospital in Ngungu, about 30 kilometres away, was by motorcycle. The alternative, transport on a stretcher by foot, could take up to 7 hours – far too long for someone suffering from malaria’s cerebral form to wait. The motards were obliged to take on some very unwell passengers. Some of them died on the way.
“When MSF arrived in Remeka, there was next nothing in terms of healthcare infrastructure. It was impossible to care for the sickest of the sick here, and they had to be referred on,” says Alfred Davies, MSF project coordinator in Masisi, North Kivu.
“We’ve reinforced the capacity of the health centres here, and most cases can now be treated on-site – this is great news. Even for a person in good health, travelling in this region is a physical challenge. Now imagine doing it with anaemia and a fever of 40°C,” says Alfred Davies.
Emergency phase
The MSF teams are working to minimise the number of deaths and to bring the high numbers of malaria cases under control. Once they do so, the emergency intervention will come to a close. But the local health structures in this remote, conflict-affected area require longer-term support for after the emergency is over.
For now, the needs are still huge: in the first week of December, the MSF team tested 1 200 people for malaria, 1 000 of whom were sick with the parasite. And when they’re not negotiating the steep hills and muddy roads on their bikes, the motards are pitching in where they can, acting as translators, handymen, and crowd controllers – even driving instructors.
“Using a motorcycle is nothing like using a car; especially here, in what they call ‘the land of a thousand bridges’!” says Samuel, just before he demonstrates how to safely cross a rickety-looking footbridge made of rotted tree stumps.
“But you could learn! You’d get the hang of it, with lots of practice.”
Since the emergency intervention began on 19 October, the MSF teams have treated more than 9 000 people for malaria, 600 of whom have been hospitalised, and distributed more than 2 000 mosquito nets. MSF has been working in DRC since 1981, and has had a permanent presence in Masisi territory since 2007.

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