KAMITUGA, Congo (AP) - Divine Wisoba, slumped on the ground above a mound of dirt, pulled weeds from her daughter's grave. The 1-month-old baby died of mpox in eastern Congo in August, but Wisoba, 21, was too traumatized to attend the funeral.
On her first visit to the cemetery, she wept into her shirt for the child she had 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 little Maombi Katengey. "But our greatest joy turned to devastation."
Her daughter is one of more than 6,000 people officials suspect have contracted the disease in South Kivu province, the epicenter of the world's latest MPOX outbreak, in what the World Health Organization has declared a global health emergency. A new strain of the virus spreads largely through skin-to-skin contact, including but not limited to sex. A lack of funding, vaccines and information is making it difficult to contain the spread, alarmed disease experts say.
Mpox - which typically causes mild symptoms like fever and body aches but can cause severe cases with telltale blisters on the face, hands, chest and genitals - had been spreading largely undetected in Africa for years, until an outbreak reached more than 70 countries in 2022. Globally, gay and bisexual men made up the vast majority of cases in that outbreak. But officials note that mpox has long disproportionately affected children in Africa, and they say cases are now rising sharply among children, pregnant women and other vulnerable groups, with many types of close contact responsible for the spread.
Health officials have their sights set on Kamituga, a remote but bustling gold-mining town of some 300,000 that attracts miners, sex workers and traders who are constantly on the move. Officials say cases from other parts of eastern Congo have emerged here, with the first stemming from the nightclub scene.
Since the outbreak began a year ago, nearly 1,000 people in Kamituga have been infected. Eight have died, half of them children.
Challenges on the ground
Last month, the World Health Organization reported that mpox outbreaks could be stopped within six months if governments show leadership and work with them.
But in Kamituga, people say the reality is very different.
There are an average of five new cases per day in the general hospital, which is normally nearly full. In South Kivu, weekly new suspected cases have soared from about 12 in January to 600 in August, according to provincial health officials.
Even that is likely an underestimate, they say, given poor access to rural areas, the fact that many residents cannot seek care, and the temporary nature of Kamituga.
According to locals, there is simply too little information about mpox.
Before her daughter became ill, Wisoba said she was also infected but did not know it.
Painful lesions developed around her genitals, making it difficult to walk. She thought she had a common sexually transmitted disease and sought medication at a pharmacy. Days later, she took her newborn to the hospital and was diagnosed with mpox. She recovered, but her daughter developed lesions on her foot.
Almost a week later, Maombi died in the same hospital where her mother was being treated.
Wisoba said she didn't know anything about mpox until she got it. She wants the government to invest more in educating people about protective measures.
Local officials can't reach areas more than a few miles outside Kamituga to track down suspected cases or inform residents. They broadcast radio messages, but say that doesn't reach far enough.
Kasindi Mwenyelwata goes door to door explaining how to detect mpox - looking for fever, pain or lesions. But the 42-year-old community leader said a lack of funding has left him without the right materials, such as posters with pictures of patients, which he finds more powerful than words.
ALIMA, one of the few aid organizations working with mpox in Kamituga, does not have enough financial resources to set up programs or clinics that can reach some 150,000 people. According to program coordinator Dr. Dally Muamba, the budget will run out by the end of the year.
If support continues to wane and mpox spreads, he said, "it will impact the economy, people will stop coming to the area as the epidemic takes its toll. ... And will the resources follow as the disease grows?"
The vaccine vacuum
Health experts agree: vaccines are needed most, even if only for adults, which have been given emergency authorization in Congo.
No one has arrived in Kamituga, despite it being a priority town in South Kivu, officials said. It is unclear when or how they will arrive. The main road to the town is unpaved - barely passable by car during the ongoing rainy season.
Once they get here, it is unclear whether supply will meet demand for those most at risk and first in line: health care workers, sex workers, miners and motorcycle taxi drivers.
The Congolese government has budgeted more than $190 million for its initial MPOX response, which includes the purchase of 3 million vaccine doses, according to a draft national MPOX plan circulated widely among health experts and aid groups this month and seen by The Associated Press. But only 250,000 doses have arrived in Congo so far and the government has provided just $10 million, according to the finance ministry.
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 susceptible to severe cases.
Doctors can ensure that the lesions are clean and prescribe painkillers or antibiotics for secondary infections, such as sepsis.
But those who recover can get the virus again.
A new variant, a lack of understanding
Experts say a lack of resources and knowledge about the new strain makes it difficult to advise people on how to protect themselves. An internal report circulated among aid groups and agencies and seen by the AP said confidence in available information about mpox in eastern Congo and neighboring countries is low.
While the variant is known to be more easily transmitted through sex, it is unclear how long the virus remains in the system. Doctors tell recovered patients to abstain from sex for three months, but acknowledge that number is largely arbitrary.
"Studies have not made it clear whether you are still contagious or not... whether you can have sex with your wife or not," said Dr Steven Bilembo of Kamituga General Hospital.
Doctors say they are seeing cases they simply don't understand, such as pregnant women losing their babies. Of the 32 pregnant women infected since January, nearly half lost their babies to miscarriage or stillbirth, hospital statistics show.
Alice Neema was one of them. Speaking from the hospital's isolation ward, she told AP that she had noticed lesions around her genitals and a fever, but didn't have enough money to travel the 30 miles (50 kilometers) by motorbike to get help in time. She suffered a miscarriage after her diagnosis.
As more information comes in, locals say fears of the new variant are growing.
Diego Nyago said he took his 2-year-old son Emile to the hospital for a circumcision when he developed fever and leprosy.
It was mpox - and today Nyago is grateful he was already at the hospital.
"I didn't believe children could get this disease," he said as doctors gently poured water over the boy to bring his temperature down. "Some children die quickly because their families are not informed.
"Those who die are those who stay home."
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AP reporters Jean-Yves Kamale in Kinshasa, Congo, and Maria Cheng in London contributed.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.
