Sierra Leone Telegraph: December 15, 2018:
It could have been several days before the ebola epidemic in the DRC would expand into urban centers or spill over into neighboring countries.
The ebola epidemic in the Democratic Republic of the Congo is expanding – to date there have been 458 cases, including 271 fatalities. It is particularly worrying that cases have been identified in some urban areas.
The big questions are: why is the epidemic spreading and what can be done to prevent this?
While writing in Theconversation.com, Mosoka Fallah attended massive outbreaks in Liberia in 2014 and 2015, which was last under control.
What can you tell us about the spread of Ebola in the DRC?
The situation is very serious. So far In two provinces in the country there were 458 cases, including 271 fatalities. This could make a lot worse. In the case of Liberia, for more than two years, 4810 people they lost their lives in Eboli.
I think it might be a few days before the DR Congo epidemic will spread to several urban centers or spill over into neighboring countries. I said this because of the way the outbreak develops.
First, they are infected by healthcare professionals. According to our experience in Liberia, but for most outbreaks, infected health workers can be super distributors. They can infect the people they treat or those who care for the sick.
Secondly, there are now cases (living and dead) in communities that were not on list of contacts. This is the list of people who may have come in contact with the infected person. If there are people who are infected who were not in the list, this means that proper tracking is not happening.
It also means that people do not trust or fear ebola responses and turn to home treatment, including traditional remedies or prayers. This could jeopardize the wider population.
If you want to include an ebola outbreak, it is crucial that the 100% contact list is documented and tracked. If this is interrupted, spreading should be expected.
Why could the state not be able to contain the spread during this time?
The failure to cope with this outbreak is a result of various factors.
Because of the civil war and the vast number of people living in poverty, such as in Liberia, there is widespread distrust in the government and its institutions. This means that people will find it difficult to trust the Ebola team.
This is a big problem because restraining Ebola is based on trust. Workers' responses can not be in every house and therefore rely on individuals in the community to warn them. If they do not trust, cases are not reported. Mistrust can also cause violence – as we have seen in common attacks against respondents in the Democratic Republic of the Congo. These attacks delay the response when the speed is critical.
These reactions are because the reaction of Ebola is contrary to the usual tendency of families and friends to look after their sick. Instead they are isolated and kept away. To help people accept this, they need to entrust them with health professionals.
People who are very poor and ignored by the state do not trust the authorities. And they will probably not accept the necessary radical changes. This, in turn, leads to resentment and violence.
What steps should be taken immediately?
The first steps must be to address some basic needs of people. For example, foods and utility tools and services, such as water pumps and functional clinics, should be provided to endangered communities. However, they should be distributed through local trusted leaders.
Secondly, some Ebola responses must go to the local community. The first step is to identify key, trusted leaders who can lead a response. They can invite them to propose solutions and support them in the implementation of these measures. In addition, local young people and religious and traditional leaders must prepare and pay for the active monitoring and sensitization of the community.
They need to share resources (financially and logistically) in the Ebola response.
What lessons from Liberia?
One big difference is that there is an active war in the DRC. In addition, there are some clear parallels between the outbreak in Liberia and this.
The first example of Ebola in Liberia was reported in March 2014. Five months later, in the 51st anniversary of West Africa, we represented 51% of all cases – we spread across Liberia, Guinea and Sierra Leone. But we have shifted the epidemic curve and in September 2015 we became the first country in the region to report on a voluntary basis.
This was because of our work with the community. I supported the joint initiative with the support of the Ministry of Health, the United Nations Development Fund and the World Health Organization. We advocated communities and quickly and effectively supported them.
Every day we met with national responses and international partners organized within the framework of the National Emergency Operations Center.
These are the steps we made:
- Local communities were involved in meetings in order to express their concerns and propose solutions.
- We then asked them to map all households in their communities and employ members of the community to cover 40 households. We should deliver messages, look for sick people, dead people and visitors. We will then forward this information to us
- Visitors to log booths had a local community table. This has allowed us to see where visitors come from and where they are at risk
- Precautionary observation was adopted. Here, they could be infected at home and restricted movement for 21 days. During this time they were provided with food and comfort – such as electricity
- The mobile application was deployed on the phones of community members who reported cases of infection or death. This allowed us to quickly analyze and respond
- Cultureally sensitive burial teams – for example observing the Muslim tradition – have been developed and developed
- We have employed more than 5700 community members. By the end of the answer they earned nearly 3 million dollars for everyday work.
Many of these steps could be replicated. But time is essential.
About the author
Mosoka Fallah is the Deputy Director General of the National Institute of Public Health of Liberia and visiting scientist of the Harvard Medical School.