When the first case of Covid-19 pandemic was confirmed in Rwanda on March 14, the country was admittedly plunged into a state of uncertainty. The next couple of weeks would see authorities battle the pandemic, especially in the capital Kigali and Rusumo border area.

Indeed, the rest of the country was largely spared early on, at least for a while. Isolated cases would be spotted here and there in pockets of the country but, thanks to an aggressive response that included a lockdown, there were no notable clusters beyond the capital.

At least until April 24. That is when it emerged that a cargo truck driver with the deadly virus had found his way to Rusizi District, which lies over 200 kilometres south of the capital. The situation quickly evolved and the district of 458,000 people was already a major hotspot a month later.

It soon emerged that Rusizi was no longer just a cluster but it was experiencing community transmissions, the first and only community infections in the country, public health experts say.

In June, the Central Command Post in Kigali would dispatch a multidisciplinary team to Rusizi whose task was to assess the scale of the outbreak and advise on the best way to respond.

Unlike in Kigali where frontline workers were actively tracing and testing contacts of positive cases with relative ease, Rusizi was a different animal.

The situation there was complicated by the fact that the virus had spread across almost all corners of the border district and it was hard to figure out where to start from.

To compound the problem, there was no laboratory in the district with capacity to test the virus, and so Covid-19 responders would collect samples, put them on a helicopter to Kigali where the tests would be conducted. They would do this every evening.

Frontline workers also faced the challenge of accommodation as many people had been deployed to the district to help contain the outbreak.

Other challenges included limited knowledge about the virus among the population and the local culture of homes sharing almost everything, which increased the risk for transmission.

According to Dr Fabrice Iradukunda, one of the responders who arrived in Rusizi in June, at some point medics decided to take samples from whole cells (the second largest grassroots administrative unit), regardless of whether one had come into contact with a positive case or not.

Cases were being detected on a daily basis, sometimes 40-50 or more people, he noted.

A local hotel was used as the treatment centre but it was overwhelmed just days after it received its first patient. 

Authorities then turned a University of Rwanda campus into an additional Covid-19 treatment and isolation facility.

Today, Rusizi accounts for 1000 Covid-19 cases, almost a fifth of all the confirmed cases in the country.

‘Dire situation’

"The situation in Rusizi was dire,” said Dr Menelas Nkeshimana, the Team Lead for Covid-19 Case Management, who coordinates national response in Western Province.

He recalled that the first response group that travelled from Kigali to Rusizi with the task of only collecting field information was unable to make the return journey thanks to the scale of the problem. "There was just too much demand on the ground.”

Then, the Government sent a second group to collect data but these too could not return.

"Rusizi was in a very bad shape,” he said. "The situation on the ground called for tough measures and well-tailored strategies for social protection, including distribution of foodstuff to the most vulnerable population.”

One of the strict measures was a total lockdown – along with another western border district of Rubavu – even as Covid-19 restrictions were generally being eased elsewhere in the country.

To avert potentially larger outbreaks in Western Province, the Government would also dispatch expert teams to all the seven districts of the region.

Their mission was broken into file components; epidemiology, case management, Infection Prevention and Control, laboratory, and data Science.

The teams included medical students in their 5th year as well as medics who had returned from studies in China, United States, among other foreign countries.

Their daily engagements included tracing, testing, treating and paying visits to communities to raise awareness about the virus.

Two weeks without a case

"My father initially said ‘no’ to me when I told him I wanted to go down to Rusizi to help,” recalls Iradukunda.

Today, while the pandemic is far from over, Rusizi has gone more than two weeks without registering a Covid-19 case.

Authorities and public health experts now can look back with a degree of satisfaction.

Dr Sabin Nsanzimana, the epidemiologist who heads Rwanda Biomedical Centre and has been at the centre of national coronavirus response effort, said on September 3 that no patient was still in treatment centres in Rusizi.

This, he said, came after 14 days without registering any new case in the district.

Subsequently, the last few days have seen many of the public health experts who had pitched camp there leave the district and return to Kigali.

Since May 31, @RwandaHealth @RBCRwanda deployed experts to support @RwandaWest on Covid-19 response. Join me to thank them as they return to Kigali & hand over to well-trained local teams,” Nsanzimana tweeted.

In a way, the progress in Rusizi mirrors the situation at the national level with Covid-19 cases considerably going down over the last few days.

Nonetheless, authorities have warned against complacency, underlining the need for strict observance of prevention measures, including social distancing, wearing masks and washing hands.