By Robert Kahumula
World Health Organization, Risk Communication and Community Engagement Officer
From 1976 to 2018, the DRC has been affected by 10 epidemics, almost all in rural areas. The current epidemic is more unique because it affects two provinces at the same time, in both urban and rural areas, with a large number of victims, and around 65% of cases resulting in death (MOH, April 28th). The Ministry of Health and its partners have developed several strategies that have proved ineffective (3rd strategic plan of January 2019).
Despite the deployed human resources both nationally and internationally, with high expertise by the DRC Minister of Health and its partners, including the World Health Organization (WHO), in addition to the local recruited people, the epidemic continues, with an average of approximately 70 new positive victims every week. These stats are less than they were before June 2019.
The population in Butembo and surrounding areas has problems perceiving the Ebola Virus Disease, due to the practices of the response agents, as well as the rumors around this disease. Contributing to rumors is the fact that the first people to talk about the EVD were foreigners, which is normal because the region had not experienced the Ebola epidemic before.
Explanations of this new disease in the area exceed the expectations of the residents, especially when the response agents practice what they prohibit the residents from doing, in terms of self-prevention. Several people including those who do not know anything came from all over just to get money from the response. These outsider efforts are causing the resistance and distrust of the teams.
In addition to what is written above, the health sector has a system in place that the population is used to. The government, though, responded by bringing foreigners to assist each of the commissions, while the population only has confidence in their local doctors and nurses who work in the different health centers and hospitals. Because most local health workers are not paid by the government, they are not considered in the response plans. That is why they are sometimes dissatisfied; they oppose the government response by hiding the patients who end up dying either in the health centers or in the community, thereby contaminating family members, caregivers and other patients. Additionally, many times they advise the inhabitants not to be receptive to the actions of the teams of the EVD response. It is also not understood that people will be infected if the health centers are in poor condition. The absence of a sorting system, water, sanitation, toilets, and isolated baths in these centers is a serious problem and causes many nosocomial infections of EVD. The population thinks that the response teams don’t want to end the Ebola epidemic because they earn money through the response.
Moreover, the population does not understand why they have to send a patient to Butembo or Beni, several kilometers from his home, for care, receiving clothes and meals for free, rather than to his doctor or nurse closeby. This is scary for everyone, especially because many people think that only foreigners work at the Ebola Treatment Center (CTE).
The wish is to install transit centers in hospitals where samples can be taken to Ebola centers. It's a way to bringing care closer to people. Some go further by wanting Ebola care to be integrated into the healthcare system, insinuating, for example, that if you build a hospital for only HIV, no one will go because of the shame and stigma attached to the disease.
The community does not seem to have the real leaders able to confront these challenges. Community leaders, religious and customary, who try to raise awareness, are accused of corruption by the response team. Some candidates even claimed during the last election campaign the illegitimacy of the disease. These people have gone unpunished.
New information and communication technologies are also used to reinforce misinformation and resistance: bad-will people post false messages and intimidate about announcing the attacks. These messages are distributed among young holders of smart phones, which prompts more resistance.
Currently, the number of EVD cases is decreasing mainly in Butembo, but remains scattered in peripheral areas with an average of 70 new cases a week in the whole operational zone. It is the result of the community commitment to accept and participate in the actions of the response and a certain free movement of the response teams in the city. This is not only because the Ebola response teams have improved their service, but also because the population especially the youth understood the risk and started collaborating with the Ebola outbreak teams, even if a few remain resistant.
The expectation of the local coordination teams is to end the epidemic as soon as possible. With the efforts of everyone, everywhere, all partners can start to think about development projects post the Ebola epidemic.