Falling to the ground on a hill, the divine Visoba pulled weeds from his daughter’s grave. The one-month-old baby died of mpox in eastern Congo in August, but Visoba, 21, was too traumatised to attend the funeral.
On her first visit to the cemetery, she cried in her shirt for the child she lost and worried about the rest of her family. “When she was born, it was like God answered our prayers: we wanted a girl,” Wisoba said of Maombi Katengei. “But our greatest joy turned to destruction.”
Her daughter is one of more than 6,000 people who authorities believe have been infected in South Kivu province, the epicentre of the latest global outbreak of the mpox virus, which the World Health Organisation has declared a global health emergency. The new strain of the virus is transmitted primarily through skin-to-skin contact, including but not limited to sexual contact. Lack of funding, vaccines and information is making it difficult to contain the spread, disease experts say.
Mpox, which mostly causes mild symptoms like fever and body aches but can cause severe cases with visible blisters on the face, hands, chest and genitals, was largely unknown in Africa for years until the 2022 outbreak reached more than 70 countries. Worldwide, gay and bisexual men account for the majority of cases in this outbreak. But officials note that mpox has disproportionately affected children in Africa for a long time, and say cases are now rising significantly among children, pregnant women and other vulnerable groups, with many types of close contacts responsible for the spread.
Health officials focused on Kamituga, a remote gold mining town of about 300,000 people that attracts miners, sex workers and traders who are always on the move. Cases elsewhere in eastern Congo have been traced back to the first incident at a nightclub scene, officials said.
Since the outbreak began a year ago, nearly 1,000 people have been infected in Kamituga. Eight people have died, half of them children.
Problems on the ground
Last month, the World Health Organization said the mpox outbreak could be stopped within the next six months with leadership and cooperation from governments.
But in Kamituga, people say they face a completely different reality.
The general hospital receives an average of five new cases each day and regularly approaches capacity. In South Kivu as a whole, new suspected cases have risen from 12 in January to 600 in August, according to provincial health officials.
Even this is likely to be overlooked, they say, because of rural access, the inability of many residents to seek care and the transient nature of Kamituga.
Local residents say they don’t know enough about mpox.
Before her daughter fell ill, Visoba said she herself was infected but did not know it.
Painful sores appeared around her genitals, making it difficult for her to walk. She thought she had a common sexually transmitted infection and asked the pharmacist for medication. A few days later, she went to the hospital with her baby and was diagnosed with mpox. She recovered, but her daughter suffered a leg injury.
About a week later, Maombi died in the same hospital where her mother was being treated.
Wisoba said he was not aware of mpox until now. He wants the government to invest more in educating people about protective measures.
Local authorities are unable to reach areas more than a few kilometres from Kamituga to trace suspected cases or notify residents. They broadcast messages by radio, but say it is not enough.
Kasindi Mwenelwata goes door to door to describe how to identify mpox: look for fever, pain or lesions. But the 42-year-old community leader said lack of money doesn’t mean she doesn’t have the right materials, such as posters displaying pictures of patients, which are more powerful than her words.
According to programme coordinator Dr Dally Muamba, ALIMA, one of several aid groups working on mpox in Kamituga, lacks the funds to set up programmes or clinics to reach some 150,000 people and its budget will run out by the end of the year.
If support wanes and MPOX spreads, he said, “there will be an impact on the economy, people will stop coming to the area because the epidemic will take its toll… And as the disease increases, will the resources follow?”
empty empty
Health experts agree that vaccines are needed most, even if only for adults, in the Congolese emergency.
Authorities said no one had arrived in Kamituga, even though it is a priority town in South Kivu. It is unclear when and how they will arrive. The main road leading to the town is paved, making it barely passable by car during the rainy season.
Once they get there, it is unclear whether the supplies will meet the demand of those most at risk and on the front lines: health care workers, sex workers, miners and motorcycle taxi drivers.
According to the draft national MPOX plan, the Congolese government has allocated more than $190 million for the initial MPOX response, including the purchase of 3 million doses of the vaccine, which was distributed this month to health experts and aid groups and was seen by the Associated Press. But according to the Ministry of Finance, only 250,000 doses have entered Congo so far and the government has contributed just $10 million.
Most people with mild cases recover in less than two weeks. But lesions can become infected, and children or people with weakened immune systems are more likely to have severe cases.
Doctors can make sure wounds are clean and give painkillers or antibiotics for secondary infections like sepsis.
But those who have recovered can get the virus again.
New version, lack of understanding.
Experts say a lack of resources and knowledge about the new strain makes it difficult to advise people to protect themselves. The internal report circulated among aid groups and agencies, and the AP found that confidence in existing information about mpox in eastern Congo and neighboring countries is low.
While this variant is known to be easily transmitted through sexual intercourse, it is not known how long the virus remains in the system. Doctors recommend recovering patients abstain from sex for three months, but admit the figure is largely arbitrary.
Dr Stephen Bilembo of Kamituga General Hospital said: “The investigation has not determined whether you are still contagious or not… whether you can have sex with your wife or not.”
Doctors say they see cases they don’t understand, such as pregnant women losing babies. Hospital statistics show that of the 32 pregnant women infected since January, nearly half have lost their babies as a result of miscarriages or stillbirth.
Alice Nima was among them. From the hospital’s isolation ward, she told the AP she noticed wounds around her genitals and a fever, but did not have enough money to travel 30 miles by motorcycle and seek help in time. She became pregnant after her diagnosis.
As information comes in, locals say fear is spreading along with the new tension.
Diego Nyago said he took his 2-year-old son Emily to be circumcised when he developed a fever and sores.
It was mpox, and today Nyago is grateful that health workers noticed her symptoms.
“I couldn’t believe that children could contract this disease,” she said as doctors gently poured water over the girl to bring down her temperature. “Some children die quickly because their families are not informed.
“Those who die stay at home.”
Mednik writes for the Associated Press. AP writers Jean-Yves Kamale in Kinshasa, Congo, and Maria Cheng in London contributed.
