Ebola in Congo: One month on, scale-up of response still not enough

Congo now has more than 780 confirmed cases and 180 deaths, while Uganda has recorded 19 confirmed cases, including two deaths.

In the field, the response has been widespread. About 400 beds are now available and four laboratories are operational.

Two of them alone can process nearly 1,000 samples every day. But despite these improvements, the World Health Organization (WHO) believes that the efforts made are still far from what is needed to control this outbreak.

“On a scale of zero to ten, compared to the response required, I’d say we’re at a scale of three or four,” said Dr. Rose Belizaire, Emergency Response Lead at WHO Africa, in an interview with UN News. “The outbreak is evolving rapidly, and all partners (…) need to increase their efforts on the ground to keep pace with the evolution of the epidemic.”

Eleven pillars

Currently, when someone is reported as a suspected case in a community, an investigation team is immediately deployed. If the alert is confirmed, the patient will be referred to a transit center, where they await laboratory results before being transferred, if necessary, to a treatment center.

But Ebola the response goes far beyond medical treatment.

“The response is structured based on 11 pillars in the field,” explained Dr. Belizaire.

Community surveillance, investigation teams, transit centers for people awaiting diagnosis, laboratories, treatment centers, infection prevention and control, and data management are among the many components mobilized under the leadership of Congolese health authorities.

This response also includes broad support for patients, their families, and people exposed to the virus.

“We now have psychosocial support and nutritional support providing assistance to confirmed patients, their families, and the contacts we are monitoring, so that we can take a holistic approach to this outbreak,” the WHO official said.

On the ground, this approach takes a very concrete form.

“Contacts received food rations,” said the epidemiologist. Meanwhile, for hospitalized patients, “they receive hot meals three times a day.”

The response also includes infection prevention and control measures aimed at limiting transmission.

“This includes disinfection and destruction of items contaminated with the virus,” said Dr. Belizaire. “It’s a whole machine that has to be implemented.”

We have the expertise, the resources must follow

During his recent visit to Beni, one of the areas worst affected by the outbreak, Dr. Belizaire said he was surprised by the level of preparedness of local teams.

“I am very satisfied with their technical abilities in carrying out the response. They know what needs to be done. They also have technical expertise,” he said.

What they lack, however, are the resources needed to match their abilities.

“What they’re really missing is the means. They lack the human resources, and they also lack the logistical support necessary to provide a robust response.”

Women on the front lines

The outbreak is also growing demographically.

At the start of the outbreak, men aged 20 to 49 were the most affected group. Currently, women are the group most affected, while cases among children are increasing.

For Dr. Belizaire, this change is not surprising.

“In infectious disease outbreaks, women are generally the ones most affected. They are the ones who care for their family members, husbands, parents and children.”

Listening response

For WHO, adapting responses to realities on the ground has been an important part of the fight against Ebola.

“We try to meet with all segments of society to understand their needs and adapt responses to the realities they experience,” explained Dr. Belizaire.

During his trip, the WHO official said he had met with various groups, including women, local businesspeople, motorbike taxi drivers and community leaders.

Concerns vary from one group to another. Businesspeople are concerned about the impact of the outbreak on their ability to earn a living, while motorbike taxi drivers, who provide the majority of transportation in the affected areas, are among those hardest hit.

“Outbreaks always occur in specific contexts. Therefore, we must adapt our response to people’s real needs and the realities of their movements.”

Porous borders

This fact is especially clear in the border region between Aru in Congo and Arua in Uganda, where Dr. Belizaire last weekend took part in a meeting that strengthened cooperation between the two countries and helped determine a joint action plan.

“When you look at borders, you don’t really see dividing lines or differences between populations,” he said. “The names are almost the same – Aru and Arua. This is because they are the same population living there and they speak the same local language.”

“Interactions are very intense, whether commercial exchanges, family exchanges or just human exchanges,” he added.

Therefore, the two countries have agreed to deploy these troops joint team along the border, strengthening laboratory capacity and establishing treatment centers jointly managed by Congolese and Ugandan teams.

The aim is also to bring health services closer to people living in the Congo region to reduce the need to travel to Uganda to seek treatment.

‘I want to say thank you’

Over the past month, Dr. Belizaire was filled with coordination meetings, field visits and discussions with affected communities. These meetings are also punctuated by memorable ones, and this week was no exception.

“While I was in a meeting, there was someone who was determined to meet me at any cost,” he recalled.

When she finally goes to see him, she finds out that he is a WHO colleague. After exchanging greetings several times, he asked her:

“But Doctor, don’t you recognize me?”

He didn’t. He then explained why he was so eager to meet her.

“I want to thank you. Thank you for saving my life. You are one of the people whose actions allowed me to stay alive until now.”

The man was a survivor of a previous Ebola outbreak in Congo. Currently, he works as an epidemiologist for WHO.

He also reminded him that he was among the first to raise a warning during this outbreak after a priest told him that there were bodies bleeding from the nose and mouth at a funeral in Aru.

For Dr. Belizaire, this meeting illustrates how experience gained from successive outbreaks continues to strengthen the current response.

“This is probably my best pay this week,” he said. “Seeing the people whose lives we helped save become my colleagues and work in the same organization as me.”