On the front line of Congo’s Ebola outbreak

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Leaving the airport takes longer because of mandatory health checks. Along the road to the hotel, billboards carrying Ebola prevention messages line the streets. On the radio, public health programmes urge people to protect themselves. By the time the World Health Organization declared the outbreak a Public Health Emergency of International Concern in May, the virus had already been spreading undetected for weeks through the mining town of Mongbwalu, Rwampara and Bunia before reaching neighbouring provinces. The outbreak is caused by the Bundibugyo strain of Ebola. It is generally considered less deadly than some other strains, but there is no approved vaccine, making early detection critical. Our first stop was the Ebola treatment centre at Bunia General Hospital. Built to accommodate 50 patients, it was already full. Construction was under way to add another 86 beds. John Katabuka, who heads the hospital, says this strain presents differently from previous outbreaks. “Clinically, it moves through your body silently without you noticing it. We used to think Ebola meant bleeding and fever. But with this type, the symptoms only appear at the final stage, when you’re almost dying. It moves through your body without you even realising you’re sick.” We also met Tresor, who asked us to conceal his identity. His wife recently tested positive for Ebola, and he has only been able to see her from a distance. He is waiting for his own test results. “People need to be educated. They have to understand this virus is real. We must accept that. I don’t want to take this disease lightly.” The Congolese government is leading the response alongside partners including the Africa Centres for Disease Control and Prevention (Africa CDC) and the United Nations. Diedonne Mwamba, head of the National Institute of Public Health, is leading the mission. He is no stranger to Ebola outbreaks. He says they are dealing with far more than a health emergency. More than 1.3 million people are living in displacement camps after years of conflict. “It’s still a challenge to deal with those situations. To control the Ebola outbreak, we have to trace contacts. Some are in the camps, and sometimes we need to reach areas that are difficult to access. For that, we work with the authorities and negotiate safe access.” We then made our way to Rwampara, about an hour’s drive from Bunia. It is a densely populated town where many residents are cattle farmers, supplying Bunia with milk and meat. The local health centre also serves as an Ebola treatment facility run by the Alliance for International Medical Action (ALIMA). Gabriel Tshiwisa showed us around. He says at least one person dies from Ebola every day. But fear, mistrust and rumours are making the outbreak even harder to contain. Some people still do not believe the disease exists. Others claim it was brought by outsiders seeking to profit from the crisis. Dr Tshiwisa says: “The biggest challenge is helping the community understand the outbreak and what we’re doing here. We are working hard with the community to improve awareness.” Several treatment centres, along with health workers, have come under attack. In mid-May, isolation tents in Rwampara were set on fire by angry relatives and friends of a young man believed to have died from Ebola after they were prevented from taking his body for burial. The body of someone who dies from Ebola is highly infectious and safe burials are essential to prevent further transmission. We accompanied a team of Red Cross volunteers to bury a woman on the outskirts of Bunia. Marie was 60 years old. She died at home. Her relatives said she had been unwell for some time, but every death is treated as a suspected Ebola case until testing is complete. David Benga, her mother-in-law, said, “People are dying every day. It makes us afraid. So when someone dies, we report it to the Red Cross, and that’s why we asked them to come and help.” The burial process is both intimidating and emotional. The volunteers are dressed in full protective equipment. One walks ahead, spraying disinfectant with every step. In ordinary times, funeral preparations would last for days, following local customs and traditions. The ceremony itself would draw large crowds. On this day, only a handful of mourners were present. Red Cross volunteer Richard Lifungula says he has buried more than two dozen people since the outbreak began. The work is dangerous. Many of the attacks on responders happen during burials. He says, “When we get to the cemetery, sometimes we are met by hostile people — those who don’t understand this disease or the importance of our work.” Alex Lock, who leads communications for the International Federation of Red Cross and Red Crescent Societies, says volunteer safety remains a major concern. “Three weeks ago, we had volunteers who were injured. Both had to be evacuated to Kinshasa. That’s why the message remains important. We are here to support the community, but that is not possible if the community is not part of the response.” Those leading the response say much more still needs to be done. Yap Boum heads preparedness and response for Africa CDC and is working alongside the Congolese Ministry of Health. “We have seen significant improvements in laboratory capacity, surveillance and treatment centres, but at the same time the number of cases and deaths continues to rise. We are looking at how we can fast-track decentralisation, deploy more health workers and expand treatment capacity.” But there is hope: More people are surviving Ebola. We attended a thanksgiving prayer service, where we met Gladys Munguromo. She lost three relatives in just one week. She became infected after attending a funeral in Mongbwalu, where the outbreak began, and sought treatment at the Rwampara treatment centre when she fell ill. Today, she is an Ebola campaigner, taking the message to every village, every home and every person. Others have returned to treatment centres to care for patients. Survivors are unlikely to be reinfected, making them invaluable to the response. Their message is simple: If you stay home sick, you will die. 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