"Kabimba" says the sign painted on the wall of a rural health clinic in South Kivu. The letters are bold—deep yellow with black shadows—and convey an orderliness and determination that defy the challenges this clinic faces.
Byakupita Wabinwa, president of the management committee that oversees the Kabimba health clinic, is standing below the sign. He is a small and serious man with a serious problem—one that plagues not only his community but that crops up frequently in this region of Democratic Republic of Congo: cholera.
Here, in the eastern provinces where years of conflict have taken a toll on social services, outbreaks of the waterborne disease are just one of the consequences of underinvestment in everything from roads, to health clinics, to clean water.
Sometimes, if maintenance of the simple delivery system has been lax, the water at this clinic doesn't run at all. That's why an enormous black cylinder is lying on its side in the clinic's front yard. It's a storage tank, waiting for installation as part of Oxfam's program to help ensure the clinic has a reliable reserve of water as well as decent sanitation facilities. In the back of the yard, a pair of pit latrines and two bathing stalls are under construction. And nearby, deep in the ground, lies the newly dug "placenta pit"—the local solution for disposing of hazardous medical wastes including afterbirth from the maternity ward.
A shortage of beds
Though it has no doctor and just five nurses, this is a busy place—serving an area with nearly 14,000 people. About 75 make their way here each week—some walking two hours down from the mountains—to receive treatment for malaria, to get tested for tuberculosis, to fight the cholera that erupts from time to time, especially during the rainy season.
Tacked to the door of one of the buildings is a sign, warning with explicit detail in Swahili, about the symptoms of cholera. It urges those who've got them to head for the nearest health clinic as soon as possible.
On this day, there are no cholera sufferers at the Kabimba clinic. But sometimes, during outbreaks, as many as 20 people a week come for treatment, though there is hardly the space for them. People lug their own bedding with them and spread it on the floor. A small building—about 30 feet long by 15 feet wide—serves as a quarantine area.
"But how can you put 20 people in that building and keep them healthy?" asks Wabinwa.
Inside, the walls are grimy with stains and the ceiling is collapsing. Of the original 10 cholera beds—mattresses with holes in the center beneath which buckets can be placed—only three remain. The plastic covering on one of the mattresses has pulled away, exposing the foam around the hole and leaving it like a sponge to sop up germs. A rickety wooden rack serves as a post for the intravenous drip.
As primitive and ill-supplied as the Kabimba clinic is by western standards, Trish Morrow, Oxfam's public health team leader for rural villages around Uvira, assures visitors that it's better than many that serve some of Congo's 62 million people, vast numbers of whom live in poverty. Few have the resources to pay for much medical care at all, but many live at risk of contracting serious diseases—like cholera—to which that poverty, with cruel irony, exposes them.
Hot spot between the rivers
Nowhere is that more clear, perhaps, than along the stretch of land between the Mulongwe and Kavimvira rivers just outside of Uvira, South Kivu province.
It's there, between those two central sources of water, that the greatest number of cholera cases in the area erupt, says Jill Markvorsen, Oxfam's program manager for Uvira. During the first week of January, an outbreak almost reached epidemic proportions. At the cholera clinic in Uvira, workers charted 64 cases of the disease&mdasdh;one shy of the number that would have triggered the implementation of Uvira health zone's cholera contingency plan. Instead, officials, staffers from Oxfam and other aid groups, and volunteers from the Red Cross managed the flare-up by chlorinating water sources, making public health announcements on the radio, and providing information to people about measures they could take to improve hygiene and sanitation.
A few months later, in mid-March, both banks of the Mulongwe River are teeming with activity. Not far from one edge, a bare-bottomed boy dashes behind a bush and squats to relieve himself. Pigs root in a heap of rubbish that inches, black and slippery with mud, almost into the water. It rushes by filled with silt. Men wash their clothes. Others drive trucks and cars into the shallows to rinse off the dust and dirt. Up stream, a market crowded with people hugs the bank.
For those who have no other source, the Mulongwe River also serves as their supply for drinking water. It's no wonder then that cholera, caused by ingesting water or food contaminated by the bacterium vibrio cholerae, is one of the ugly facts of life for people living in this war-torn region.
At the Uvira cholera clinic, Oxfam helped to install a large tank that stores a backup supply of water—collected from the roof during rainstorms and precious for its relative purity. Two large rooms—one for men and the other for women—serve as sick wards. Simple beds—wood frames with sheets of rugged plastic stretched taut across and cut in the center with a hole—are scattered about the rooms. Others are piled outside.
The wards are empty on this mid-March day—a good sign.
Morrow, the public health team leader, says that the medical staff in Uvira has been trained well to provide patients with good care. Though there is not so much it can do to prevent people from contracting a disease that's so closely linked to the lack of public services—like potable water—the staff has been successful, says Morrow, in stemming the tide of cholera deaths.
And in a place where basic precautions take on ominous importance, blue buckets filled with a mixture of water and a heavy dose of chlorine dot the perimeter of the clinic's yard. All visitors are advised to scrub their hands with that solution before they leave. Most do—and duck out smelling like a swimming pool in the western world, but grateful for it.