Ebola: the keys to successful combat on the ground

 

The 15th of November 2014 marked the official end to the Ebola virus epidemic in the Democratic Republic of Congo (DRC). It suffered 49 deaths (21 confirmed and 28 probable). The country can be proud of the work it has undertaken in the fight against the epidemic in Boende health district, in the Province of Equateur.UNICEF knew how to confront the emergency: more than 40 tonnes of equipment were sent (medical and hygiene equipment, vehicles, school kits, water purifying and hand-washing systems, awareness raising support, and logistical elements); human resources were mobilised (6 to 10 members permanently on the ground); and financial resources were committed.“Fighting Ebola is all encompassing work.”
Antoine Saka Saka, a Development Communications specialist for UNICEF in Kinshasa, was on the front line in the response to the crisis in Boende. The specialists knew the Ebola virus only too well. He had made his skills available during the last epidemic suffered in the DRC, in 2012. “We may have been lucky enough to escape Ebola once, but surely not twice,” he told us.“The only way to escape it is to never drop your guard. I still laugh about the logistics guy who walked around with his bucket of chlorine to dunk his bottle of beer in!”The suffering of the West African countries facing the illness meant that Mr. Saka Saka decided to get out into the field: the experience of the DRC represents hope for these countries. It was vital to act quickly: if the disease had managed to reach the city of Mbandaka, then Bangui in Central Africa, it could have reached Chad through migration, or Brazzaville and Kinshasa along the Congo River.

With the first case identified, the Congolese government took effective leadership in the fight against the epidemic. UNICEF, one of the government’s partners, had its first expert on the ground one week after the start of the epidemic. Because it’s a simple truth, that in the case of an epidemic, we need to act fast.

(c) UNICEF DRC

Teamwork
“The fact that we were staying in the same hotel, working in the same offices and pursuing the same objectives made us a true team. Above and beyond the almost inherent solidarity of our situation, we shared anecdotes and knowledge of the area which were indispensable to the fight. We knew that without the work of the others, our role and even our lives were at threat. This interdependence made us a strong team.”

The fight was organised in teams in which each member was an indispensable link:

  • The government was responsible for managing the operations. After recognising the quality of its leadership, our expert added, “those affected and their families don’t trust a group of outsiders who turn up in their villages with more vehicles than they have ever seen before, suddenly ready to help them when up until that point no one had been interested in them.”
  • UNICEF took as its mission supporting the government in its coordination of the actors. Our expertise in communication was particularly important for encouraging the populations to accept the activities and decisions relating to the response to the epidemic, without recourse to force. “UNICEF offered its communication services for negotiating the populations’ acceptance of these measures,” Antoine Saka Saka told us.
  • The supervisors, mainly agents of the World Health Organisation (WHO), were responsible for identifying people presenting symptoms of the disease and for referring any cases detected to the hospitals. They were helped in this by community representatives who they trained on the characteristics of the Ebola virus.
  • Hygienists, made available by the Congolese and Togolese Red Cross, ensured that the disease did not continue to spread. They were responsible for transporting the infected people; for disinfecting their houses; for surveys identifying anyone who had been in contact with them, who might have been infected; for monitoring the access routes into the area affected by Ebola; and for burials. “Their work is essential. For example, disinfecting the accommodation of infected people avoids the house being burnt down and the inhabitants finding themselves on the street, a common measure in the first few hours of the epidemic,” explained a local man.
  • Doctors without Borders (MSF) was responsible for the medical care of the patients at the hospital. “It is with these teams that contact is most difficult because isolation and medical care is seen by the population as kidnapping, a manipulation more dangerous than curative,” noted an awareness-raising specialist.
  • The work of psychologists and anthropologists was indispensable. Their task was to connect a more than necessary, but rigid, health protocol with a population attached to its beliefs and confronted.
  • MONUSCO provided crucial logistic support. “Thanks to MONUSCO, we have had the water, rations and chlorine necessary for our own security,” added Antoine. In 2012, there wasn’t even water for their own consumption.

(c) UNICEF DRC

Challenges overcome
Faced with the epidemic, we had to be everywhere. “We learnt of the death of a young girl whose mother was obliged by tradition to stay shut away for some time to mourn. Anxious to respect her solitude, we posted a team there for 21 days to assess the mother’s condition from a distance and to test her stools,” an expert told us.

The populations affected odten live by hunting and gathering and are affected by chronic malnutrition. Too poor to own cattle, they have no other choice than to eat bushmeat. “The World Food Programme only had corn in stock, while people here eat cassava. They had to explain how to cook it and to encourage people to eat it even if they didn’t like it,” explained Mr. Saka Saka.

“The teams are first-hand witnesses of painful moments. UNICEF decided to organise an emergency plane to deliver milk to a 6-month-old orphan that no one wanted to breastfeed for fear of contamination.”

Communication, key to success
The turning point in the battle against the epidemic was when the populations changed their perception of the humanitarian workers and the disease. For the communications expert, the success in the fight against the epidemic lies in the success of the dialogue established between the traditional and community systems, and the health and humanitarian assistance systems.

The most important thing is to make a connection between the populations, their perception of the disease, their culture and the necessities imposed by science. UNICEF was the driver in this area, through the involvement of anthropologists and psychologists.

For the population, the perception often was that death wasn’t caused by a virus, but by witchcraft. A healer was himself infected by sucking the blood of an infected person to extract what he thought was a poison. Dead animals are often seen as offerings to the gods and are therefore eaten without question.

The role of the anthropologists was central to understanding the populations’ perceptions of the disease. If it is difficult for the teams to understand these beliefs, it is also difficult for the populations to understand the measures imposed. “Everything must be negotiated.”

The psychologists helped the teams to find the right words to convince them. “One man didn’t accept that his sister had been put in isolation. Our expert allowed him to see her. This allowed him to understand that we weren’t harming her and that in contrast we were taking care of her.” The man then joined the communication teams to help convince his own people to help and listen to the actors working in response to the epidemic.

“If I could give some advice to the West African teams, it is that the health services can’t be expected to resolve the problem on their own. Fighting Ebola concerns us all and we have to act in a team with the populations affected. This is why I took part in training in Kinshasa for agents working in West Africa: teamwork and sharing should continue for there to be, I am sure, new victory,” concluded Antoine Saka Saka.