DRC: Treating Ebola Under Extremely Difficult Conditions in Equateur Province

The Ebola outbreak that was declared in August in the Equateur province of the Democratic Republic of Congo (DRC) has not yet been contained. The Ebola response teams, including 50 Doctors Without Borders/Médecins Sans Frontières (MSF) staff members, are currently working in very difficult conditions because of the lack of roads in the area, misinformation in local communities about the disease, and the risk of not treating those who might have been in touch with the virus. Two treatment centers have been established: one in Lokolia (40 beds) and one in Boende (10 beds).

According to health authorities, there have been over 70 cases, of which 41 have been fatal. Since the beginning of the intervention, 42 admissions have been registered in the Ebola treatment facilities. Of 20 laboratory-confirmed cases, 12 people died and 7 patients recovered and were able to return to their communities. One patient is still in care.

“There is no cure for Ebola but if you provide good care to patients, the body has time to develop immunity and beat the virus,” explains Carolina Nanclares, medical advisor in Lokolia. The sooner the treatment is administered, the better the chances of healing. Therefore, it is extremely important for patients to go to treatment centers as soon as symptoms appear.

Raising awareness among the population remains one of the main challenges of this intervention. “There are a lot of misconceptions and superstitions around Ebola and what happens inside the treatment centers, and the precautions to be taken in an Ebola outbreak often clash with local practices,” sans Nanclares. “The population has a certain degree of resistance to the messages we are communicating. That is why all actors involved need to multiply their efforts in the sensitization of the population. Messages about preventive measures and the importance of a timely identification of cases need to be constantly passed on.”

Surveillance activities, such as seeking out patients with signs of Ebola in order to treat them as soon as possible, and contact tracing and follow-up, are fundamental to limit the spread of the outbreak. While MSF is not directly responsible for these activities, it is cooperating with Ministry of Health and World Health Organization staff to ensure a more comprehensive surveillance system. However, logistical constraints are  complicating the intervention.

“A lot of efforts are currently being made, but the challenge remains to break the population’s resistance to come to the treatment centers and to disclose their recent contact, and to be able to reach the dead among the community in time to ensure safe burials,” Nanclares says. “In the first phase of the intervention, activities were focused on setting up the treatment centers. In Lokolia, it was particularly challenging because there are no facilities and we had to start from scratch. We are carrying on other fundamental activities as well, such as health and hygiene promotion, transportation of patients towards our facilities, decontamination of houses, and preparation of bodies for safe burials. We also offer psychosocial support for patients and their families.”

Despite the challenges, MSF has so far mobilized more than 54 tons of material and deployed dozens of staff. “Access to the affected areas is very difficult,” explains Julien Binet, logistical coordinator of the team. “We are in the middle of the equatorial forest, where roads are few and in bad condition. Where a 4X4 cannot reach we send bikes or even pirogues [small boats], but there are some completely isolated villages. All this significantly limits our capacity to understand the real extent of the outbreak.”