Pangi is the last of the eight health zones originally included in UFAR's onchocerciasis elimination project in the Kasongo region of the Democratic Republic of Congo (DRC) that was scheduled to receive Mectizan in 2010 for the first time (Figure 1). It has a population of 78,669 distributed in 173 villages, and is divided into 14 health centers. The health zones of Pangi and Kampene are unique among our other health zones in that they are almost entirely situated in a dense tropical rainforest and are highly co-endemic for onchocerciasis and loasis. Consequently, increased incidences of severe adverse effects (SAEs) including coma following Mectizan administration were expected. Dozens of such cases were reported in 2009 during the initial Mectizan distribution in Kampene, all of which were promptly and properly resolved. Concerns over the expected increased SAEs during the distribution in Pangi and the excitement of reaching a landmark by distributing Mectizan to the one millionth individual during this second phase of Mectizan distribution in 2010 were the compelling reasons for my undertaking this trip.
The journey started at 10:30 AM on Wednesday, December 1, following a heavy all night rain (photo 1). Our vehicle was loaded onto the ferry for the 10-15 min crossing of the Congo River (photos 2, 3). Our first major destination from Kindu was Kalima, 106 km (66 miles) to the northeast of Kindu. In spite of the rain, the conditions of the initial 40 km (25 miles) of this paved national highway were generally great (photos 4, 5). Subsequently, they gradually and steadily deteriorated (photo 6), resulting in our arrival at Kalima at 5:30 PM, 7 hours later. Following a discussion with Merlin, a British NGO with local representation, we decided to spend the night at Kalima and continue our journey early the following day. Before arriving at Kalima, we had stopped along the way and had bought two smoked porcupines, one of my favorite meats. The cook at the old colonial era guest house (photo 7) recommended for our overnight stay was more than happy to treat us to a delicious dinner that evening, including one of the porcupines.
On Thursday morning, Merlin loaned us their chain saw and its operator and we resumed our journey toward Pangi at 9 AM. This phase of our trip covering about 160 km (100 miles) through a dense tropical rainforest threatening to take over the very poor narrow road. The trip was totally unimaginable, unpredicted and can best be described only through photos (photos 8-17).
Undoubtedly, our saving grace was a Land Cruiser equipped with a "tire fort" or a winch and a very able and seasoned driver. We arrived at Lusumba at 8:30 PM and planned to continue on to Pangi about 20 km (12.5 miles) away, but were strongly warned against it because of a bridge 1 km from the village that was almost completely under water. So we decided to spend the night at Lusumba (18, 19). Chief Mulembelembe (slide 20), the village chief, promptly provided comfortable sleeping accommodations for us in his own court. His three wives immediately prepared a dinner for us which included our second remaining porcupine (photos 21). We learned that the village population had received Mectizan just a few days earlier. We met two of the community distributors in charge of the distribution the following morning and we reviewed their register (photo 22). Several errors in data entry were noted and corrected. Just before our departure, one of the chief's wives invited me to the back of the main house and with her husband translating from Swahili to French, kindly offered their one and half year-old daughter to me as a wife (photo 23). Needless to say how surprised and shocked I was. I remained speechless for a several seconds and then with a broad smile, thanked them for this beautiful and priceless offer, and promised to discuss the gift with them on my next trip.
We left Lusumba at 9 AM on Friday, crossed the partially submerged bridge (photo 24), and arrived at Pangi at 1PM after experiencing several additional road difficulties. After checking into our lodging accommodations provided by Heal Africa (photo 25), we were headed toward the health zone of Pangi's central office when we were approached and asked to check on two cases of Mectizan-related severe adverse effects admitted at the hospital. We did and they turned out to be typical drug-related edemas of the face and lower extremities (photo 26), none of them life-threatening. We proceeded to the central office and got a nice bird's eye view of the Mectizan distribution efforts in progress throughout the health zone of Pangi including the village of Pangi by the "medecin chef de zone" (the health zone's chief medical officer) and his staff (photos 27-29). Pleasantly, our concerns on the possibility of wide-spread Mectizan-related SAEs seen in 2009 in the neighboring Kampene health zone did not materialize. While at both Kindu and Pangi, we made courtesy calls on Merlin, a medical charitable organization based in the United Kingdom and a major partner in our fight against Riverblindness (photo 30). We explained our Adopt-a-village (AAV) program during this trip and registered the interest of several village chiefs for their participation (photos 31, 32).
Satisfied with the overall outcome of our mission, our traveling team reversed course and left Pangi on Saturday, December 4 at 6:30 AM for Kindu via Kalima, arriving at Kindu safely but quite exhausted on Sunday at 3 PM. I flew back to Kinshasa on Monday, December 5. I had a very cordial and important meeting with Dr. Lokadi Pierre, the new Secretary General at the Ministry of Health on Thursday, December 9. It was the first time we met face to face although we had communicated several times by e-mail and by telephone. We discussed among other matters the critical issues delaying UFAR's expected assumption of responsibility as the NGO partner for the struggling CDTI Lubutu in the Maniema province. I also met with the newly appointed assistant director for the National Program for Onchocerciasis Elimination, Dr. Adrian Loka. Other relevant people I had hoped to meet within the Ministry of Health were out of the country on mission. I left Kinshasa for my return trip to the US the following day, Friday, December 10, 2010.
- A chain saw and good chain saw operator are indispensable components of any trip on very poor roads through dense tropical rainforest in DRC
- Always be prepared to respond kindly and diplomatically in uncomfortable and unexpected situations!!!!!!!
- Thumbs up for Toyota Land Cruiser equipped with tire fort or winch, the best vehicle in rural and remote communities in DRC