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Ebola in the Democratic Republic of Congo – expert sets up critical lessons in Liberia



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Sierra Leone Telegraph: December 15, 2018:

It may be a matter of days before the Ebola epidemic in the Democratic Republic of Congo spreads to the city center or spreads to neighboring countries.

The Ebola epidemic in the Democratic Republic of the Congo is spreading – so far there have been 458 cases, including 271 deaths. What is particularly important is that the cases have been identified in some urban areas.

The big questions are: why is the epidemic spreading, and what can you do to stop it?

Writing in theconversation.com, Mosoka Fallah shares lessons from the massive outbreak in Liberia 2014 and 2015, which eventually took control.

What can you tell us about the spread of Ebola in the Democratic Republic of Congo?

The situation is very serious. Still There have been 458 cases, including 271 deaths, in two of the country's provinces. It can get a lot worse. In Liberia's case, over two years, 4810 people lost their lives to Ebola.

I think it may be a matter of days before the DRC's epidemic spreads to more neighborhoods or extends to neighboring countries. I say this because of the development of the outbreak.

First, healthcare professionals are infected. In our experience in Liberia, and in most outbreaks, infected healthcare professionals may be more scattered. They can infect the people they treat or those who take care of the sick.

Secondly, there are now cases (living and dead) reported in communities that were not on contact. This is a list of people who may have come into contact with an infected person. If there are infected people who were not on the list, it means that proper tracking does not happen.

It also means that people do not trust or fear the Ebola response and are looking for home treatments, including traditional cures or prayers. These may expose a larger population to infection.

To contain an outbreak of Ebola is crucial for 100% of the contact list being documented and traced. If this is broken, a spread should be expected.

Why has the country not been able to contain the spread this time?

Failure to control this outbreak depends on a variety of factors.

Because of the civil war and with a large number of people living in poor poverty – as in Liberia, there is a wide mistrust of government and its institutions. This means that it will be difficult for people to rely on Ebola's response.

This is a big problem because the Ebola inclusion is based on trust. Respondents can not be in all houses and they are dependent on individuals in communities to warn them. But if they are not trusted, cases will not be reported. Misstro can also lead to violence – as we have seen in the usual attacks against respondents in the Democratic Republic of Congo. These attacks delay the response when the speed is critical.

These reactions are because the Ebola response goes against the normal tendency for families and friends to take care of their sick. Instead, they are isolated and kept away. To help people accept this, they need to trust the health workers.

People who are very poor and have been neglected by the state do not trust the authorities. And they will not likely accept the radical changes that are required. This in turn results in resistance and violence.

What action must be taken immediately?

The first steps must be to address some of the basic needs of the people. For example, risk groups should have access to food and useful tools and services – such as water pumps and function clinics. But these must be distributed through locally trusted leaders.

Secondly, some of the Ebola response must go to the local community. The first step would be to identify key, reliable leaders who can lead the answer. They can also be invited to propose solutions and support to get them implemented. In addition, local youth and religious and traditional leaders must pay in and pay for active monitoring and community sensitization.

They must share the resources (economics and logistics) in the Ebola response.

What lessons are there from Liberia?

The big difference is that there is an active war in the DRC. Apart from that, however, there are some clear parallels between the outbreaks in Liberia and this one.

The first case of Ebola in Liberia was reported in March 2014. Five months later, we responded to 51% of all cases in West Africa – spread across Liberia, Guinea and Sierra Leone. However, we changed the epidemic curve and became the first country in the region to declare Ebola in September 2015.

This was due to our work with society. I joined the community-based initiative supported by the Ministry of Health, the United Nations Development Fund and the World Health Organization. We were advocating for the communities and supported them quickly and efficiently.

We held daily meetings with national employees and international partners organized under the National Emergency Response Center.

Here are the steps we took:

  • We engaged local communities in meetings to allow them to express their concerns and propose solutions.
  • We asked them to map all households in their communities and recruited members of society to cover 40 households. They would have to forward messages, search for the sick, the dead and the visitors. This information would then be forwarded to us
  • Local social chairs received visitor logs. This made it possible for us to see where the visitors came from and if they were at risk
  • Cautions were encouraged. Here, those who were able to stay at home stopped and restricted their movement for 21 days. During this time they received food and amenities – like electricity
  • A mobile app was distributed on phones from community members who reported cases of infection or death to us. This enabled us to analyze and react quickly
  • Culturally sensitive burial groups – for example observance of Muslim traditions – developed and rolled out
  • We recruited over 5700 members of society. By the end of the answer, they had earned almost $ 3million for their daily work.

Many of these steps can be replicated. But time is the essence.

About the author

Mosoka Fallah is Deputy Director General at the National Public Health Institute of Liberia and visiting researcher, Harvard Medical School.

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