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The Ebola outbreak that was declared in August in Equateur province of the Democratic Republic of Congo (DRC) has not yet been contained. The Ebola response teams, including 50 members of Médecins Sans Frontières/Doctors Without Borders (MSF), are currently working in very difficult conditions.
A lack of roads in the area, the misinformation in the local communities about the disease and the risk of not treating those who might have been in touch with the virus are making MSF's work challenging.
Two treatment centres 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 died. Since the beginning of the intervention, 42 admissions have been registered in the Ebola treatment facilities. From 20 laboratory-confirmed cases, 12 people died and seven patients were able to defeat the virus and 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 centres 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 centres, and the precautions to be taken in an Ebola outbreak often clash with local practices. The population has a certain degree of resistance to the messages we are communicating,” says Nanclares.
“That is why all actors involved need to multiply their efforts in the sensitisation of the population. Messages about preventive measures and the importance of a timely identification of cases need to be constantly passed on,” adds Nanclares, further explaining that increased health promotion activities are required to face this challenge.
Surveillance activities, such as looking for patients with signs of Ebola in the community 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 them, it is cooperating with the Ministry of Health and World Health Organisation staff to ensure a more comprehensive surveillance system. However, logistical constraints are complicating the intervention.
MSF is concerned by the current impossibility to accurately map the outbreak.
“A lot of efforts are currently being made, but the challenge remains to break the population’s resistance to come to the treatment centres and to disclose their recent contacts, and to be able to reach the dead among the community in time to ensure safe burials,” Nanclares adds.
“In the first phase of the intervention, activities were focused on setting up the treatment centres. In Lokolia, it was particularly challenging because there are no facilities and we had to start from scratch,” explains Nanclares
“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,” she comments.
Despite the hard conditions, MSF has so far mobilised more than 54 tonnes 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, but there are some completely isolated villages. All this significantly limits our capacity to understand the real extent of the outbreak.”
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