Uphill struggle against Ebola in Congo

Marloes Humbeeck
23 April 2019
On 1 August 2018, four people in eastern Democratic Republic of Congo tested positive for Ebola, marking the beginning of the world’s second largest Ebola outbreak ever. The fight against this deadly disease remains a struggle in Congo.

For the 10th time in the last 43 years, Congo is being confronted with an Ebola epidemic, this time centred in North Kivu and Ituri, two provinces in the north of Congo. According to Médecins Sans Frontières (MSF), it is the country’s largest-ever Ebola outbreak.

Although a total of 96,000 persons have already been vaccinated, the epidemic continues to spread. Since the beginning of the crisis, a total of 1206 confirmed cases of Ebola have been reported, of which 764 died (situation on 10/04/2019). The fatality rate of the disease amounts to 63 percent. Katwa remains the main outbreak hotspot with 58 percent of new confirmed cases, but new cases continue to appear in Kyondo, Oicha and Vuhovi too. Even the number of infected health workers continues to rise. The fact that this epidemic remains uncontrolled and continues to grow relatively close to busy borders and cities is particularly alarming.

 

Overloaded treatment centres

Why is it so difficult to combat the epidemic? A major problem is the almost permanent overload of the ETCs (Ebola treatment centres), especially in Beni, Butembo and Katwa. This is partly due to the delay in receiving the laboratory results, but also, and above all, to an inaccurate warning system for alleged new Ebola cases.

Only one in five patients admitted to hospital are effectively infected. The rest are cases for examination. In other words: people with suspect symptoms are confirmed too quickly as Ebola cases and referred to the ETC to be tested. It is understandable that health professionals want to err on the safe side: if they release one infected Ebola patient, this person can in turn infect many other people. This approach does, however, overload the centres and could potentially infect healthy individuals. 

A major problem is the almost permanent overload of the ETCs (Ebola treatment centres).

Distrust from local population

A problem of at least equal importance is the distrust from the local population towards the Ebola response, in other words towards the aid offered by the Congolese government and organisations such as Médecins Sans Frontières. Many infected Congolese refuse to register with the research centres. Consequently, more people continue to be infected. Moreover, it is  difficult to get an idea of the scale of the epidemic.

The attitude of the Congolese towards the Ebola response can even be described as downright hostile. In February 2019, MSF had to withdraw from the epicentre (Katwa and Butembo) after several violent incidents and attacks on treatment centres.

Why is the population so hostile to the Ebola response? First and foremost, it should not be underestimated what a degrading and especially isolating disease Ebola is. The fear of infection is so deep-rooted that alleged Ebola victims are immediately kept at a distance because they are considered as a threat, a danger.

The treatment in the ETCs further enhances this isolation as patients are immediately placed in a separate room, subjected to various tests and disconnected from any human contact. Moreover, the centres are often far away from their home, family and friends. Being held in quarantine, far from home, surrounded by strange people in 'space costumes' who test you: not exactly a pleasant prospect.

That is why there will always be patients fleeing when the ambulance appears or trying to escape from the centres. Some of them go to traditional healers instead. This makes it much more difficult to contain the virus’ spread. 

‘Patients should be treated as patients and not as a kind of biological threat’, says Joanne Liu, international chairman of Médecins Sans Frontières, during the press conference MSF organised on the subject early March.

A man and a woman are educating about Ebola in a church.
© John Wessels/Oxfam

Involving the population

Liu emphasises that the local population is not the culprit. ‘The problem is that we fail to gain their confidence and encourage them to fight Ebola.’ That is why Médecins Sans Frontières is now arguing for an approach that creates a bond of trust between aid workers and patients.

'If we really want better results, we have to look through the eyes of the patient. We have to provide answers based on the concerns of the local population, not our own.’

So what needs to be done in practice, according to Médecins Sans Frontières? First and foremost, help must also be provided within the communities, so that potential Ebola patients are no longer forced to leave everything behind, but can be treated close to their family and friends. Secondly, the fight against Ebola must be integrated into the general health care system. For example, people want attention to be paid to malaria, cholera and AIDS, in addition to Ebola. Finally, people should not be forced to be hospitalised. They have to come to the treatment centres voluntarily. The idea is not to lecture people, but to work together with the local community.

People have to come to the treatment centres voluntarily. The idea is not to lecture people, but to work together with the local community.

Joanne Liu, international chairman of Médecins Sans Frontières

Stronger approach and funding

The international community will make efforts to combat Ebola more efficiently. A new plan is on the table that focuses primarily on breaking the chain that leads to the transmission of the disease. For February to July 2019, a budget of approximately 127 million euros will be needed for this purpose.

The new strategy focuses primarily on the factors that impede the containment of the epidemic. Hidden Ebola cases will be traced and contacts will be rigorously monitored. Strengthening communication on the subject of Ebola is another priority.

Extra support will be given to the laboratories in order to make the test results available more quickly, so that people do not have to stay in the ETC's unnecessarily. Finally, free health care and better food will be provided, also for people in remote areas, and risk groups will be vaccinated.

The epidemic remains unpredictable and imminent. There is fear that it will eventually reach big cities like Goma. By intensifying the fight against Ebola and involving the local population, the aim is to contain the disease as much as possible. 

What exactly is Ebola?

 

Ebola is a serious infectious disease often accompanied by internal haemorrhages. The first case of Ebola dates back to 1976. Since then, this disease has claimed more than 12,800 lives worldwide. The disease is mainly transmitted through body fluids. When people are infected, their immune system and organs begin to degenerate. The outcome of the disease is often fatal (50-90%).

A Congolese man washes his hands with chlorinated water at a market in Mangina (Congo).
© John Wessels/Oxfam
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