Ruminations

Penetrating Suspicion, Delivering Vaccines

"There is today a health zone called Vuhovi."
"We are having huge troubles to access it."
"We need to really be able to join hands and work together on this [inoculating vulnerable isolated villagers in Democratic Republic of Congo]."
Dr. William Perea, incident manager, WHO

"I heard someone shouting, 'bring the matches'."
"And then I felt the heat of the fire from my bed."
Kavu Mate, Ebola patient, Butembo, Democratic Republic of Congo

"They hit me with wooden sticks and they broke the car."
Gilene Barati, epidemiologist, WHO

This health clinic, specialised in treating Ebola victims, was destroyed during an attack by armed militants. The photo on the right shows a burned out vehicle belonging to French medical charity MSF. (Photos by our Observers Bienvenu and Djiress Bakoli)

Ebola has proven resilient, adaptable and opportunistic, feeding on the ignorance of isolated tribes and a climate of suspicion from people who have suffered violent discrimination for as long as they can recall, and who are suspicious of government representatives purporting to be interested in preserving their lives. The contagious, deadly virus has broken out in what is virtually a conflict zone. Responding to the outbreak in such circumstances is doubly difficult, fraught with danger for those who enter.

An Ebola treatment centre in Butembo in the east of the DRC experienced first-hand the difficulties of tending to the needs of the medically fragile when rebels with machetes and guns ran amok in the medical centre and set fire to many of the tents. Hooked to drips, weak patients faced another deathly threat; if the virus didn't kill them the terrorists just might. Somehow it was the tents containing the pharmacy, archive room, washing station and cars that were set aflame, sparing tents with patients.

Research for Medecins Sans Frontieres (MSF) established that 43 percent of Ebola patients had no links to other cases, adding to the difficulty of following the infection's spread, though it is well established that Ebola spreads through contact with bodily fluid and the virus is alive and hugely contagious on the bodies of the dead which tribal custom dictates be washed and tended before burial. MSF pulled out of Butembo following attacks on two treatment centres by Mai Mai rebels.

This photo shows part of the burned out health center in Butembo. (Photo taken on February 28 by Bienvenu Lutsumbi.)

The rebels appear particularly incensed at the presence of health workers in the area, targeting them for attack. A WHO team of epidemiologists who had travelled to a nearby village hoping to trace a patient's contacts was attacked, just another in a long string of attacks targeting Ebola centres in North Kivu province in the past month alone in a region where, since the summer the disease has been infecting the population at a steady rate.

This is a volatile region where conflict erupted and continued for over two decades, where an estimated 120 armed groups prey on the population.The spread of the disease has been significantly halted thanks to a new vaccine. "If it weren't for the vaccine, the disease could have killed thousands by now" commented Dr. Oly Hunga, minister of health for the DRC. Over 80,000 people have been inoculated in a concerted effort between the ministry and the World Health Organization.

Because some of the villages in the region represent rebel strongholds they are impossible to enter. And when health teams appear in some of the villages hoping to trace patient contacts and vaccinate them, suspicion is raised to an even higher level when they're accompanied, for safety reasons, with police escorts. "For one ill person, ten cars come with the police and people in masks", observed Alexis Kasserka a skeptical villager.

One villager expressed the opinion that the government was responsible for deliberately spreading the disease; far-fetched paranoia at first listen, until the realization strikes that the people of his tribe have faced massacres over the years. "Ebola is a game bought by white people to make money from us", offers another villager, newborn baby on her lap. The struggle to convince these communities that prevention is key to battling Ebola faces many obstacles.

"Unfortunately, the safe method of burial doesn’t correspond with traditional practices and it ends up angering the many people who aren’t allowed to touch the body or take it out of its body bag." "Recently, the number of attacks has increased and grown more serious in Butembo-Katwa. There were two more attacks in February, aside from the tragedies in Vuhovi and Katwa. We hope to see the results of our efforts to raise awareness."
Dr Jacques Katshishi, supervisor, Red Cross Ebola program