Transforming Children's Lives on Idjwi, the forgotten island

PLEASE HELP US TO BRING LIFE-SAVING MEDICINES TO CHIDLREN IN REMOTE EASTERN CONGO

A baby girl born today on remote Idjwi island in Lake Kivu in the Democratic Republic Congo has a shockingly low prospect of reaching her 15th birthday. Cut short by a lethal combination of constant infection, catastrophic malnutrition, and lack of healthcare, life expectancy is just 25 years.

Malaria, the leading cause of death, kills quickly. Schistosomiasis, another deadly parasite, kills slowly. Lymphatic filariasis (better known as elephantiasis) is less deadly but causes appalling disability and disfigurement. Intestinal worms are very debilitating and a common reason for school absence. Vaccine-preventable diseases such as rubella causes needless congenital devastation; tetanus afflicts infants, measles is a common killer of under-fives and polio cripples infants up to teenagers. Monkeypox, or mpox, is the most recent deadly threat to young kids.

Because Idjwi’s island status has largely spared it the armed conflict that plagues much of eastern Congo, it is sometimes referred to as “the “forgotten” island. Three times larger than Manhattan, home to 270,000 people, including 65,000 children, “invisible” might be more accurate, since this island is unknown to the scores of UN agencies and NGOs based in Goma and Bukavu, unseen by international aid workers who pass it by every day on the six-hour ferry trip between these major Congolese cities.

Idjwi's low profile also means this peaceful enclave doesn't benefit from the massive humanitarian aid delivered to the mainland. Its isolation means it is also essentially cut off from government services.

The vast majority live without safe water, electricity or sanitation. Health services are rare. The north, better serviced, has less than a dozen doctors. In the southern tip, the only time children see a doctor is when we visit. Since 2015, I've been providing health services to Buhumba School, which has 530 students, and is supported by Idjwi Island Education Fund. Half the students are girls!

Every child is malnourished – the result of a diet of cassava and beans, dirty drinking water and near-constant infestation with worms and parasites. Mortality from preventable and treatable diseases is extremely high. On the mainland, life expectancy averages 60 years, but on Idjwi it is estimated at just 25 years -- more like the 19th century than the 21st.

Until a few years ago, Idjwi was even 'missing' from many maps of Lake Kivu. Today, it is ignored by the international humanitarian response to the ongoing MPOX outbreak.

This December, I am returning to Idjwi on a critical mission bringing life-saving medicines for malaria and other diseases that are deadly without treatment.

In recent months, malaria cases have increased significantly. Although monkeypox is typically more annoying than dangerous, the recent outbreak of is due to a new strain that is particularly deadly for children. Without local and systemic antibiotic treatment, infected vesicles cause sepsis and death. Many more children are sick with measles and pneumonia. Teachers report that fever and rash are widespread -- and fear of mpox is preventing parents from sending kids to school.

Our team takes a boat across from Iko island, where we stay, to Idjwi every day. Then we hike for two hours to reach Buhumba school.

Together with Dr Bisimwa, Nurse Faida, medical student Mara, translator Josselin, fixer Terrence and the indispensable Janda, we will first treat the intestinal worms that make children too weak to walk to school and cause too much pain to learn. By doing this first, it increases absorption of the antimalarial, antibiotic, anti-parasitic and anti-fungal medicines. While this is happening, I start seeing children individually, while Dr Bisi tests for malaria and measures Hb (anaemia). We will stop mpox, chickenpox and scabies from turning into sepsis and from evolving into rheumatic heart fever and chronic kidney disease, and prevent trachoma from turning into irreversible blindness.

Based on previous visits, we anticipate needing to test more than 500 children for malaria, and treat between 250-300. Most children will receive azithromycin for trachoma and ivermectin for scabies. We will also provide Vitamin A to all kids for night blindness and iron for anaemia. Because malaria prevalence and mortality is so high, and since so many of these appalling diseases also require repeat treatments, Dr Bisi and Nurse Faida will make another trip in 3 months, and I will make another trip next June. The generous support provided in 2022 funded two intensive missions for care of 528 children on Idjwi and 80 more on Iko, including 1300 tests and 400 treatments for malaria. It also supported repeat visits by local health workers over 18 months. On that basis, we project total costs of US $10,750 for the next 9 months. Please help us to give these children better lives and brighter futures.

Malaria, the leading killer of infants and young children across DRC, is endemic. First, we test all children. This is extremely important since fever is also a symptom of many other infections, and because not all children with malaria develop a high fever because chronic protein deficiency reduces the normal response. Also, seeing the positive test increases compliance with treatment enormously. Using combination therapy, we typically treat more than 20 children successfully. For infants just a few months old, I grind up the tablets and syringe into their mouths directly and get the mothers to return the next 2 days for repeat treatments. Since 2019, when 87% of children tested positive, we have gotten the prevalence down to about 50%. In 2023, for the first time, malaria nets were distributed to southern Idjwi. Our malaria program and messaging from the school to the surrounding communities helps to reinforce the importance of sleeping under nets.

Lake Kivu, which serves as the default sanitation system, is a constant source of schistosomiasis, another parasitic infestation with devastating consequences if left untreated. Fortunately, it’s not difficult to treat (1-4 tablets of praziquantel). However, treatment has to be repeated every year, as reinfection is common -- since Lake Kivu also serves as a common bath, when children and adults swim or even wade, larvae from infected snails penetrate the skin.

Trachoma, a bacterial eye infection spread by flies and by touch, is increasingly common. Untreated, it turns into trichiasis – (eyelashes turn inwards and scratch the cornea) and causes irreversible blindness. On Idjwi, the lack of sanitation means waste sites become breeding grounds for flies. Large families (an insurance policy against the high child death rate) are crowded into unhygienic huts. Without enough water to wash hands and faces, trachoma spreads easily. Three days of treatment with azithromycin are effective, but tablets have to be broken in half for ground up for very young children, it tastes awful and so compliance is terrible. I mix it with Lotus Biscuit Butter to make the medicine go down and incentivize children and get mothers to bring back children for consecutive days.

Soil-Transmitted Helminths (worms) hamper children's cognitive development and are a common reason for school absence. Intestinal worms steal nutrients from kids and the resultant anaemia makes them too weak to walk to school. When they are in school, the pain from intestinal worms makes it difficult for children to concentrate. Studies show that deworming students decreases absenteeism by as much as 25%, and drives primary school graduation, particularly of girls.

Giardia, a gut parasite which spreads through fecal-oral means – including water, food, touch, surfaces -- is incredibly common. A single treatment with tinidazole (1-4 tablets) is hard to swallow but very effective.

Night blindness, caused by Vitamin A deficiency, is common because of the limited nutrients in the daily diet of cassava and beans (banana trees were wiped out by banana virus: experts treated this in Rwanda, but neglected Idjwi as not important enough).

Almost all children have scabies. Untreated, scabies goes on to cause chronic renal disease and (probably) rheumatic heart disease. Two doses of Ivermectin 5 days apart is a very effective treatment.

An essential element of my continued visits is not just the clinical care but training local physicians and medical students. My recurring trips almost every year since 2015 have built extraordinary trust, which enables the local team to continue visits in between trips. This is essential because so many of these appalling diseases require repeat treatments.

Every day on returning to Iko we set up a “pop-up” clinics on tiny Iko island. As word on the island spreads of our return, we anticipate a high demand. Students bring young siblings, mothers walk several miles or come in canoes prone to capsizing to bring sick babies to Iko.

Success of the mission depends on local team. The local dialect, Kiavu, is unique to Idjwi, so a chain of translation is needed from Kiavu to Swahili to French and English. Translator Josselin is joining, myself, Dr Bisi, Mara, Terence and Janda.

Dr. Samy Shamamba -- a 2nd-year medical student in 2015, is now graduated and working under Dr. Jean Muyembe, but still an essential part of 'Team Idjwi'.

IMPACT

For the majority on Idjwi Island, used to short, dark lives, a long and healthy life is unimaginable. We are turning that around. The incredibly high mortality rate and lack of healthcare mean that our impact is immediate, and lasting. Because so many children are critically ill and almost all of them are malnourished, providing healthcare can make the difference between life and death, between blindness and sight, between being healthy enough or not to walk the 1-5 miles to school -- to learn, to complete the school year, and ultimately to graduate. In short, it can make the difference between heartbreak and hope – and a brighter and longer future.

It is a huge privilege to save the life of a single child. It’s exceptionally rare to have the opportunity to make such a difference to so many lives, to so many futures, to lift the health of whole communities.

Your donations will support this high-impact medical mission serving more than 500 children their families and communities – and convey a sense of connection to the school, the families and the kids – knowing their lives, locally invisible, are internationally recognized and matter.

Local Partner -- Idjwi Island Education Fund

To make a tax-deductible donation to support this mission, please donate directly to the Idjwi Island Education Fund at the webpage linked here. On Giving Tuesday, December 3rd, Global Giving will match each donation, furthering the impact of your contribution to support these children.

Since 2015, Dr. Annie Sparrow, a pediatrician and public health specialist from the Icahn School of Medicine at Mount Sinai, has been working with the Idjwi Island Education Fund to provide child health services and train local health workers. The main focus of the IIEF is the Buhumba primary school on the southern tip of Idjwi. It has several hundred students, almost half girls -- evidence of the local recognition of the importance of education. However, frequent bouts of malaria, constant parasitic infestation and other preventable infections mean up to half the students miss school, and few girls make it to the sixth grade and graduation. Annie’s first visit in August 2015 led to an impromptu, on-the-spot clinic at a football game. Scores of children, who otherwise had no chance to see a doctor, lined up for hours as she diagnosed and treated them for worms, malaria, pneumonia, eye and skin infections, parasites, and poxes -- until time and medicines ran out. Almost every child was stunted. Teachers and parents and reported that after the two-day visit, the children had much more energy and fewer symptoms of disease. The kids themselves said that it was very satisfying to poop worms out of their bellies! It was a great start to the 2016 academic year. That first visit led to a longer-term relationship with IIEF. Annie then began to visit annually, working with and training local health personnel to care for the children in the interim.