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Slumped on the ground over a mound of dirt, Divine Wisoba pulled weeds from her daughter’s grave. The 1-month-old died from mpox in eastern Congo in August, but Wisoba, 21, was too traumatized to attend the funeral.
In her first visit to the cemetery, she wept into her shirt for the child she lost and worried about the rest of her family. “When she was born, it was as if God had answered our prayers — we wanted a girl,” Wisoba said of little Maombi Katengey. "But our biggest joy was transformed into devastation.”
Her daughter is one of more than 6,000 people officials suspect have contracted the disease in South Kivu province, the epicenter of the world’s latest mpox outbreak, in what the World Health Organization has labeled a global health emergency. A new strain of the virus is spreading, largely through skin-to-skin contact, including but not limited to sex. A lack of funds, vaccines and information is making it difficult to stem the spread, according to alarmed disease experts.
Mpox — which causes mostly mild symptoms like fever and body aches, but can trigger serious cases with prominent blisters on the face, hands, chest and genitals — had been spreading mostly undetected for years in Africa, until a 2022 outbreak reached more than 70 countries. Globally, gay and bisexual men made up the vast majority of cases in that outbreak. But officials note mpox has long disproportionately affected children in Africa, and they say cases are now rising sharply among kids, pregnant women and other vulnerable groups, with many types of close contact responsible for the spread.
Health officials have zeroed in on Kamituga, a remote yet bustling gold mining town of some 300,000 people that attracts miners, sex workers and traders who are constantly on the move. Cases from other parts of eastern Congo can be traced back here, officials say, with the first originating in the nightclub scene.
Since this outbreak began, one year ago, nearly 1,000 people in Kamituga have been infected. Eight have died, half of them children.
Challenges on the ground
Last month, the World Health Organization said mpox outbreaks might be stopped in the next six months, with governments' leadership and cooperation.
But in Kamituga, people say they face a starkly different reality.
There's a daily average of five new cases at the general hospital, which is regularly near capacity. Overall in South Kivu, weekly new suspected cases have skyrocketed from about 12 in January to 600 in August, according to province health officials.
Even that’s likely an underestimate, they say, because of a lack of access to rural areas, the inability of many residents to seek care, and Kamituga’s transient nature.
Locals say they simply don’t have enough information about mpox.
Before her daughter got sick, Wisoba said, she was infected herself but didn’t know it.
Painful lesions emerged around her genitals, making walking difficult. She thought she had a common sexually transmitted infection and sought medicine at a pharmacy. Days later, she went to the hospital with her newborn and was diagnosed with mpox. She recovered, but her daughter developed lesions on her foot.
Nearly a week later, Maombi died at the same hospital that treated her mother.
Wisoba said she didn't know about mpox until she got it. She wants the government to invest more in teaching people protective measures.
Local officials can't reach areas more than a few miles outside Kamituga to track suspected cases or inform residents. They broadcast radio messages but say that doesn't reach far enough.
Kasindi Mwenyelwata goes door to door describing how to detect mpox — looking for fevers, aches or lesions. But the 42-year-old community leader said a lack of money means he doesn't have the right materials, such as posters showing images of patients, which he finds more powerful than words.
ALIMA, one of the few aid groups working on mpox in Kamituga, lacks funds to set up programs or clinics that would reach some 150,000 people, with its budget set to run out at year's end, according to program coordinator Dr. Dally Muamba.
If support keeps waning and mpox spreads, he said, “there will be an impact on the economy, people will stop coming to the area as the epidemic takes its toll. ... And as the disease grows, will resources follow?”
The vaccine vacuum
Health experts agree: What’s needed most are vaccines — even if they go only to adults, under emergency approval in Congo.
None has arrived in Kamituga, though it’s a priority city in South Kivu, officials said. It’s unclear when or how they will. The main road into town is unpaved — barely passable by car during the ongoing rainy season.
Once they make it here, it’s unclear whether supply will meet demand for those who are at greatest risk and first in line: health staff, sex workers, miners and motorcycle taxi drivers.
Congo’s government has budgeted more than $190 million for its initial mpox response, which includes the purchase of 3 million vaccine doses, according to a draft national mpox plan, widely circulating among health experts and aid groups this month and seen by The Associated Press. But so far, just 250,000 doses have arrived in Congo and the government’s given only $10 million, according to the finance ministry.
Most people with mild cases recover in less than two weeks. But lesions can get infected, and children or immunocompromised people are more prone to severe cases.
Doctors can ensure lesions are clean and give pain medication or antibiotics for secondary infections such as sepsis.
But those who recover can get the virus again.
A new variant, a lack of understanding
Experts say a lack of resources and knowledge about the new strain makes it difficult to advise people on protecting themselves. An internal report circulated among aid groups and agencies and seen by AP labeled confidence in the available information about mpox in eastern Congo and neighboring countries low.
While the variant is known to be more easily transmissible through sex, it’s unclear how long the virus remains in the system. Doctors tell recovered patients to abstain from sex for three months, but acknowledge the number’s largely arbitrary.
“Studies haven’t clarified if you’re still contagious or not ... if you can or can’t have sex with your wife,” said Dr. Steven Bilembo, of Kamituga’s general hospital.
Doctors say they're seeing cases they simply don’t understand, such as pregnant women losing babies. Of 32 pregnant women infected since January, nearly half lost the baby through miscarriage or stillbirth, hospital statistics show.
Alice Neema was among them. From the hospital's isolation ward, she told AP she'd noticed lesions around her genitals and a fever — but didn’t have enough money to travel the 30 miles (50 kilometers) on motorbike for help in time. She miscarried after her diagnosis.
As information trickles in, locals say fear spreads alongside the new strain.
Diego Nyago said he'd brought his 2-year-old son, Emile, to the hospital for circumcision when he developed a fever and lepasions.
It was mpox — and today, Nyago is grateful he was already at the hospital.
“I didn’t believe that children could catch this disease,” he said as doctors gently poured water over the boy to bring his temperature down. "Some children die quickly, because their families aren’t informed.
“Those who die are the ones who stay at home.”
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AP reporters Jean-Yves Kamale in Kinshasa, Congo, and Maria Cheng in London contributed.
