Marcel Osekasomba, 48, head nurse at the Yalolia health centre, and Theopiste Maloko, 42, a local health official, check the progress of Lisungi Lifafu, 12, who is suffering from monkeypox, while his father Litumbe Lifafu and mother, Lituka Yenga, watch, in Yalolia village, Yakusu, Tshopo, Democratic Republic of Congo, October 3, 2022. Without treatment Lisungi can only wait for the illness to run its course. Ahead of him lies a myriad of possible outcomes including recovery, blindness, or, as was the case with a family member in August, death. "These children have a disease that makes them suffer so much," said Lisungi's father Litumbe Lifafu. "We demand the government provides medicines for us poor farmers, and the vaccine to fight this disease." REUTERS/Arlette Bashizi
At a village clinic in central Congo, separated from the world by a tangle of waterways and forests, six-year-old Angelika Lifafu grips her dress and screams as nurses in protective suits pick at one of hundreds of boils that trouble her delicate skin.
Her uncle, 12-year-old Lisungi Lifafu, sits at the foot of her bed, facing away from the sunlight that pours through the doorway and pains his swollen, weeping eyes. When nurses approach, he raises his chin, but cannot look up.
Dr. Fabien Kongolo gives a morning briefing to nurses and trainee doctors at the Yakusu General Hospital, in Thsopo, Democratic Republic of Congo, October 5, 2022. "I'm the one who detected the first case in Yaboya health area. The case was notified but unfortunately there was no response to our request. The outbreak had to be raging in the West for it to be declared in the DRC as well," Dr. Kongolo said. "We have no support for this disease." REUTERS/Arlette Bashizi
The children have monkeypox, a disease first detected in Congo 50 years ago, but cases of which have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people.
Global health bodies have counted far fewer cases in Africa during the current outbreak than in Europe and the United States, which snapped up the limited number of vaccines this year when the illness arrived at their shores.
But the outbreak, and death toll, in Congo could be much greater than recorded in official statistics, Reuters reporting shows, in large part because testing in underequipped, rural areas is so limited and effective medicines are unavailable.
Theopiste Maloko, 42, a local health official, and a nurse collect skin samples from Angelika Lifafu, 6, to test for monkeypox, at the Yalolia health centre, in Tshopo, Democratic Republic of Congo, October 3, 2022. Without treatment, Angelika can only wait for the illness to run its course. Ahead of her lies a myriad of possible outcomes including recovery, blindness, or, as was the case with a family member in August, death. "These children have a disease that makes them suffer so much," said Angelika's grandfather Litumbe Lifafu. "We demand the government provides medicines for us poor farmers, and the vaccine to fight this disease." REUTERS/Arlette Bashizi
During a six-day trip to the remote region of Tshopo this month, Reuters reporters found about 20 monkeypox patients, including two who had died, whose cases were not recorded until reporters visited. None of them, including Angelika and Lisungi, had access to vaccines or anti-viral drugs.
The shortage of testing facilities and poor transport links makes tracing the virus nearly impossible, more than a dozen health workers said.
Asked about undercounting, the Africa Centres for Disease Control and Prevention (CDC) acknowledged that its data did not capture the full extent of the outbreak.
Lituka Wenda Dety, 41, who is suffering from monkeypox, has lesions on her face examined by Alingo Likaka Manasse, (R), head nurse at the Yalanga Health Centre, and Theopiste Maloko, 42, (L) a local health official, in Yakusu, Tshopo, Democratic Republic of the Congo, October 2, 2022. At the height of her illness in August, Dety's throat was so sore she struggled to swallow her own saliva. Round scars still dot her body, and her bones ache. When she was ill in hospital, her six-month-old son caught monkeypox and died. He is buried in a patch of sandy earth beside her mud brick home. "We want there to be a vaccination campaign," she said. "Going by what we have suffered, if many people catch this disease it will be catastrophic." REUTERS/Arlette Bashizi
In the West, only about 10 people have died of monkeypox this year, figures from the U.S. CDC show. Europe and the United States have been able to vaccinate at-risk communities. Suspected cases are routinely tested, isolated and treated early, which improves survival rates, experts said. Case numbers in Europe and the United States have stabilized and begun to fall.
But in poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all in Congo, according to the Africa CDC.
No monkeypox vaccines are publicly available in Africa.
Lyatali Lofemba, whose three-year-old child died from monkeypox, sits in front of her house in Yaboya village, Yakusu, Tshopo, Democratic Republic of Congo, October 4, 2022. Monkeypox was first detected in Congo 50 years ago, but cases have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. In poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all in Congo, according to Africa Centres for Disease Control and Prevention (Africa CDC). REUTERS/Arlette Bashizi
Without treatment, Angelika and Lisungi can only wait for the illness to run its course. Ahead of them lies a myriad of possible outcomes including recovery, blindness, or, as was the case with a family member in August, death.
"These children have a disease that makes them suffer so much," said Lisungi's father Litumbe Lifafu at the clinic in Yalolia, a village of scattered mud huts 1,200 kilometres (750 miles) from the capital Kinshasa.
"We demand the government provides medicines for us poor farmers, and the vaccine to fight this disease."
Angelika Lifafu, 6, who is suffering from suspected monkeypox, sits on a bed at the Yalolia health centre, Tshopo, Democratic Republic of Congo, October 3, 2022. Without treatment, Angelika can only wait for the illness to run its course. Ahead of her lies a myriad of possible outcomes including recovery, blindness, or, as was the case with a family member in August, death. "These children have a disease that makes them suffer so much," said Angelika's grandfather Litumbe Lifafu. "We demand the government to provide medicines for us poor farmers, and the vaccine to fight this disease." REUTERS/Arlette Bashizi
HISTORY REPEATS
The World Health Organization last year called out the "moral failure" of the COVID-19 pandemic response, when African nations found themselves at the back of the queue for vaccines, tests and treatment.
But those failures are being repeated a year on with monkeypox, the health workers consulted by Reuters said. This risks future flare-ups of the disease in Africa and globally, experts said.
Lisungi Lifafu, 12, has his eyes checked by a nurse at the Yalolia health centre, in Yakusu, Tshopo, Democratic Republic of Congo, October 3, 2022. Without treatment, Lisungi can only wait for the illness to run its course. Ahead of him lies a myriad of possible outcomes including recovery, blindness, or, as was the case with a family member in August, death. "These children have a disease that makes them suffer so much," said Lisungi's father Litumbe Lifafu. "We demand the government provides medicines for us poor farmers, and the vaccine to fight this disease." REUTERS/Arlette Bashizi
While the sudden demand from Western countries sucked up available vaccines, poor countries such as Congo, where the disease has existed long enough to be endemic, have been slow to seek supplies from the WHO and partners.
Congo health minister Jean-Jacques Mbungani told Reuters Congo was in talks with the WHO to buy vaccines, but no formal request had been made. A spokesperson for Gavi, the vaccine alliance, said it had not received requests from African countries where the virus was endemic.
A WHO spokeswoman said that in the absence of available vaccines, countries should instead focus on surveillance and contact tracing.
Lituka Wenda Dety, 41, who is suffering from monkeypox, prays with her family at the grave of her baby who died when she was six months old of the same disease, in the village of Yalanga, in Yakusu, Tshopo, Democratic Republic of Congo, October 3, 2022. At the height of her illness, Dety's throat was so sore she struggled to swallow her own saliva. Round scars still dot her body, and her bones ache. When she was ill in hospital, her six-month-old son caught monkeypox and died. He is buried in a patch of sandy earth beside her mud brick home. "We want there to be a vaccination campaign," she said. "Going by what we have suffered, if many people catch this disease it will be catastrophic." REUTERS/Arlette Bashizi
"History repeats itself," said Professor Dimie Ogoina, president of the independent Nigerian Infectious Diseases Society. Time and again, he said, disease containment in Africa does not get the funding it needs until wealthier nations are at risk.
"It happened with HIV, it happened with Ebola and with COVID-19, and it is happening again with monkeypox."
Without adequate resources, the true spread of the virus is unknowable, he and other experts said.
Nurses arrange medicine on a table, at the Yalanga health centre, in Yakusu, Tshopo, Democratic Republic of Congo, October 2, 2022. The village of Yalanga is a day's journey from Yalolia by land and boat. Surrounded by jungle, it has no phone network or electricity. When the light fades, patients at the health centre lie in the dark on beds of hard bamboo. The clinic, a small building with a tin roof and five rooms, has had three monkeypox cases in the recent months. To notify authorities of a new case, nurses must travel half a day to get phone reception. When they are busy, getting away is impossible. The recent cases were recorded weeks late, said nurse Alingo Likaka Manasse. REUTERS/Arlette Bashizi
"In Africa we are working blind," said Ogoina. "The case counts are grossly underestimated."
Monkeypox is spread through close contact with skin lesions. For most, it resolves within weeks. Young children and the immune compromised are especially vulnerableto severe complications.
The Africa CDC says that Congo has had more than 4,000 suspected and confirmed cases and 154 deaths this year, based in part on health authority data. That is far lower than the 27,000-odd cases recorded in the United States and 7,000 in Spain. African nations with outbreaks include Ghana, where there are about 600 suspected and confirmed cases, and Nigeria, where there are nearly 2,000.
Miracle Kidicho, 3, who is suffering from monkeypox, sits at home in Yalokombe, Yakusu, Tshopo, Democratic Republic of Congo, October 4, 2022. Monkeypox was first detected in Congo 50 years ago, but cases have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. In poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all in Congo, according to the Africa Centres for Disease Control and Prevention (Africa CDC). REUTERS/Arlette Bashizi
"Yes, there is an undercount," said Ahmed Ogwell Ouma, acting director of the Africa CDC. "The communities where the monkeypox is spreading generally don't have access to regular health facilities." He said the CDC could not currently say how big the undercount was.
Congo's health minister Mbungani said testing capabilities were lacking outside Kinshasa but did not respond to a request for comment about missed cases.
THE FRONT LINE
Beyande Kidicho, whose children Miracle Kidicho, 3, Dorcs Kidicho, 9, and Nathan Kidicho, 6, are all suffering from monkeypox, holds a bush rat brought home by his eldest son in the village of Yalokombe, Yakusu, Tshopo, Democratic Republic of Congo, October 4, 2022. Monkeypox was first detected in Congo 50 years ago, but cases have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. In poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all in Congo, according to the Africa Centres for Disease Control and Prevention (Africa CDC). REUTERS/Arlette Bashizi
African countries hoped that the WHO's decision in July to declare monkeypox a public health emergency of international concern would mobilise resources.
WHO dispatched some 40,000 tests to Africa, including 1,500 to Congo, said Ambrose Talisuna, WHO's monkeypox incident manager on the continent.
This month, Congo's National Institute for Biomedical Research began a clinical trial of the antiviral drug tecovirimat on monkeypox patients. While no vaccines are available for public consumption, trials are underway on health workers in Congo with Bavarian Nordic's Imvanex vaccine, health minister Mbungani said.
Theopiste Maloko, 42, a local health official, leaves a room in which a probable case of monkeypox is being treated at the Yalolia health centre, in Tshopo, Democratic Republic of Congo, October 3, 2022. Monkeypox was first detected in Congo 50 years ago, but cases have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. In poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all of them in Congo, according to the Africa Centres for Disease Control and Prevention (Africa CDC). REUTERS/Arlette Bashizi
But in central Congo, little has changed.
Yalolia, where Angelika and Lisungi are patients, is reachable only by motorbike tracks that thread tunnel-like through the dense jungle, or by canoes carved from felled tree trunks. An old road connecting to nearby villages was cut off years ago when a series of wooden bridges collapsed.
In August, Lisungi's older brother developed a rash and had trouble breathing. The family thought it was smallpox. When his condition worsened, a doctor put him on an intravenous drip. He died before it was empty.
Lituka Yenga walks her granddaughter Angelika Lifafu, 6, to the toilet after having skin samples collected to test for monkeypox, at the Yalolia health centre, in Yakusu, Tshopo, Democratic Republic of Congo, October 3, 2022. Without treatment, Angelika can only wait for the illness to run its course. Ahead of her lies a myriad of possible outcomes including recovery, blindness, or, as was the case with a family member in August, death. "These children have a disease that makes them suffer so much," said Angelika's grandfather Litumbe Lifafu. REUTERS/Arlette Bashizi
Grief stricken, Lisungi hugged his brother's infected corpse. Two weeks later, in early September, he too developed a rash and his eyes swelled shut. Then Angelika fell ill.
Lisumbe took the children to Yalolia where they were diagnosed with monkeypox based on their symptoms. He sold his belongings to buy medicine to reduce their fevers.
The nurses caring for them seethe at the lack of treatments.
Theopiste Maloko, 42, a local health official, and a nurse, consult documents containing information about monkeypox after taking samples from patients at the Yalolia health centre, in Yakusu, Tshopo, Democratic Republic of Congo, October 3, 2022. Monkeypox was first detected in Congo 50 years ago, but cases have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. In poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all in Congo, according to the Africa Centres for Disease Control and Prevention (Africa CDC). REUTERS/Arlette Bashizi
"If there is a vaccine, it is us who should have it. If there is a treatment, it is us who should have it," said nurse Marcel Osekasomba.
None of the cases were reported to authorities until Reuters visited Yalolia with a local health official called Theopiste Maloko. He only went to the village at Reuters' suggestion.
Without test results, they are now logged as suspected cases.
Theopiste Maloko, 42, a local health official, transports skin samples from the Yalolia health centre to Kisangani by motorcycle, in Tshopo, Democratic Republic of the Congo, October 3, 2022. To avoid spoiling, samples need to be kept cold and reach a laboratory within 48 hours, but they often do not, he said. The nearest testing lab is in Kinshasa, and results take weeks or months. "We are suffering. This is really our cry of alarm. We are raising our voices so that someone will hear," said Maloko. REUTERS/Arlette Bashizi
ISOLATED CASES
Tshopo, nearly as big as the United Kingdom, is heavily wooded and carved up by the Congo River and its many winding tributaries. Maloko's job is to track cases over an area spanning 5,000 square kilometres. But he cannot afford gasoline and has no means of transport.
When nurses took samples from sores on Angelika's leg and placed them in a polystyrene cool box strapped to the back of a motorbike, Maloko was sceptical.
Dr. Fabien Kongolo does his morning rounds, followed by nurses and trainee doctors at the Yakusu General Hospital, in Tshopo, Democratic Republic of Congo, October 5, 2022. "I'm the one who detected the first case in the Yaboya health area. The case was notified but unfortunately there was no response to our request. The outbreak had to be raging in the West for it to be declared in the Democratic Republic of Congo (DRC) as well," Dr. Kongolo said. "We have no support for this disease." REUTERS/Arlette Bashizi
To avoid spoiling, samples need to be kept cold and reach a laboratory within 48 hours, but they often do not, he said. The nearest testing lab is in Kinshasa; results take weeks or months.
"We are suffering. This is really our cry of alarm. We are raising our voices so that someone will hear," he said.
Sometimes samples are not even taken.
Theopiste Maloko, 42, a local health official, checks lesions on the arms of a woman who is suffering from monkeypox and recently lost a child to the same disease, in Yalokombe, Tshopo, Democratic Republic of Congo, October 4, 2022. REUTERS/Arlette Bashizi
The village of Yalanga is a day's journey from Yalolia by land and boat. Surrounded by jungle, it has no phone network or electricity. When the light fades, patients at the health centre lie in the dark on beds of hard bamboo.
The clinic, a small building with a tin roof and five rooms, has had three cases in recent months. To notify authorities of a new case, nurses must travel half a day to get phone reception. When they are busy, getting away is impossible. The recent cases were recorded weeks late, said nurse Alingo Likaka Manasse.
Lituka Wenda Dety, a 41-year-old mother, thinks she got sick from eating infected bush meat. At the height of her illness in August, her throat was so sore she struggled to swallow her own saliva.
Augustin Yenga Bosongo, 73, a nurse, gives medicines to Otikala Itawelo, 10, to calm his fever at the Yalanga health centre, in Yakusu, Tshopo, Democratic Republic of Congo, October 2, 2022. The village of Yalanga is a day's journey from Yalolia by land and boat. Surrounded by jungle, it has no phone network or electricity. When the light fades, patients at the health centre lie in the dark on beds of hard bamboo. The clinic, a small building with a tin roof and five rooms, has had three monkeypox cases in the recent months. To notify the authorities of a new case, nurses must travel half a day to get phone reception. When they are busy, getting away is impossible. The recent cases were recorded weeks late, said nurse Alingo Likaka Manasse. REUTERS/Arlette Bashizi
Round scars still dot Dety's body, and her bones ache. She is grieving. When she was ill in hospital, her six-month-old son caught monkeypox and died. He is buried in a patch of sandy earth beside her mud brick home.
At the end of the day, Dety and her family gather around the small rectangular grave. She whispers prayers.
"We want there to be a vaccination campaign," she said. "Going by what we have suffered, if many people catch this disease it will be catastrophic."
Women and their children wait for a consultation with Dr. Fabien Kongolo in the waiting area of the Yakusu General Hospital, Tshopo, Democratic Republic of Congo, October 5, 2022. Monkeypox was first detected in Congo 50 years ago, but cases have spiked in West and Central Africa since 2019. The illness received little attention until it spread worldwide this year, infecting 77,000 people. In poorer African countries where many people do not have quick access to health facilities, or are not aware of the dangers, over 130 have died, almost all in Congo, according to the Africa Centres for Disease Control and Prevention (Africa CDC). REUTERS/Arlette Bashizi
(Reporting by Djaffar al Katanty in Tshopo and Edward McAllister in Dakar; Writing by Edward McAllister; additional reporting by James Macharia Chege in Johannesburg and Stanis Bujakera in Kinshasa; Editing by Frank Jack Daniel)
Marcel Osekasomba, 48, head nurse at the Yalolia Health Centre, works in his office, in Yakusu, Tshopo, Democratic Republic of Congo, October 3, 2022. The nurses caring for monkeypox patients seethe at the lack of treatments. "If there is a vaccine, it is us who should have it. If there is a treatment, it is us who should have it," said Osekasomba REUTERS/Arlette Bashizi
Sign up to read this article
Read news from 100’s of titles, curated specifically for you.
