‘I have been responding to different disease outbreaks in the Democratic Republic of the Congo for 18 years, yet I have never seen anything as challenging as containing Ebola in an armed-conflict zone,’ writes Dr Eric Mukama of the aid agency Care in a report in The Guardian.
Mukama writes: “DRC is facing its 10th Ebola outbreak, but this epidemic, which broke out in August, is the country’s first in an area where fighting is ongoing. Since 2014, about 2,000 people have been killed in clashes between armed groups.
“I’m a doctor stationed in Beni, in the north-eastern province of North Kivu. It’s the epicentre of the current Ebola outbreak. Here, any aid worker, especially us locals, can be in imminent danger. Active shooting is common. A few weeks ago, a vehicle of humanitarian staff moving an Ebola patient’s dead body to be buried was attacked and passengers were injured. I cannot access entire villages. Not because of the unequipped terrain and unpaved dirt roads but because these villages act as front-lines between the different armed groups.
“Ebola is a fatal disease. Because it is a viral infection, it does not have an effective cure. People here in Beni have never encountered Ebola and in many cases have never even heard of it. There is strong resistance from people to accept the existence of the disease and cooperate with people like me working to eliminate it.
“Recent reports have said the epidemic has been controlled. This is not true. We still have new confirmed cases, almost on a daily basis. To confirm an Ebola epidemic is under control we need to wait for at least six weeks after the last confirmed case, which involves inspecting all the direct contacts of every infected person, and ensuring that during that period we have not had a single new case.
“Despite communities’ resistance, people are becoming aware of the disease and its danger. But even the most basic ways to counter it are almost impossible to implement in some inaccessible villages. These include installing hand-washing stations and refilling them, conducting awareness-raising sessions, or doing some basic distributions of much-needed items such as soap, buckets and hand sanitisers. In some areas we cannot confirm if the symptoms and even deaths occurring are due to Ebola. This is why we have some ‘probable’ cases.
“One of the biggest challenges is providing direct help to infected people, while ensuring caregivers do not get infected. When you walk around the city and visit response sites and clinics, no one shakes hands. When we want to greet each other, we do it through touching elbows, to avoid any possibility of spreading the virus, which is only transmitted through direct contact of body fluids.
“At every location there is at least one water cooler and everyone is obliged to wash their hands. You can smell the chlorine on your hands for hours afterwards, but this is a mandatory precaution to ensure no aid workers, especially health staff, get infected, as this will risk losing the trust of local communities.
“The basic health precautions we promote to eliminate Ebola are the same standards that should be applied all the time, with or without an epidemic. Sadly, this outbreak has revealed a gap there, which could be due to lack of awareness, or lack of tools and infrastructure. To be better able to protect communities from epidemics, some basic services need to be enhanced. In Beni, for example, water networks do not reach everywhere, and schools do not have enough bathrooms.
“In schools, awareness-raising campaigns are carried out, and they are provided with hand-washing stations and thermometers. Similarly, we make sure clinics are well-equipped and completely clean from the virus, by providing hand-washing facilities, gloves, and the necessary training to volunteers and paramedics. If it is possible to prevent the infection of all the staff and volunteers responding to the epidemic, then it must be possible to eliminate Ebola completely.”The Guardian report