Paul Jawor, a Doctors Without Borders/Médecins Sans Frontières (MSF) water and sanitation expert, has just returned from Equateur province in the Democratic Republic of Congo (DRC), where MSF is responding to an Ebola outbreak, alongside the Congolese Ministry of Health (MoH) and other organizations. Paul was working in and around the remote village of Iboko, where 23 cases of Ebola have been confirmed. Here, he explains the challenges MSF teams are facing on the frontline of the ongoing outbreak.
We arrived in Mbandaka city by plane on the morning of May 20. Mbandaka is the main city in the province where the current Ebola outbreak has been declared. Some cases have been reported in the town and MSF has set up an Ebola treatment center (ETC) in response. But our team’s job was to go and start an intervention in and around Iboko, a very remote village about 120 kilometers [about 74 miles] south of Mbandaka, where a patient had just been confirmed as infected with the Ebola virus.
There was no helicopter available for two days, so we hit the road an hour after landing, with three rented cars, full of all the provisions and materials we could find. With an outbreak like this, it’s a race against time, as one Ebola patient with symptoms can infect several people every day. The best way to contain the disease is to put all measures in place as soon as possible. And so the race was on.
It was a long journey and we arrived in Itipo—a village on the way to Iboko which has also been affected by the outbreak—at night after having suffered mechanical problems and having to repair numerous broken wooden bridges along the way. One of our vehicles even drove off the edge of a bridge and it took us what seemed like hours to put it back on track in the dark.
After spending the night in tents on the terrace of a nunnery, we set off again for Iboko, another two to three hours' drive away.
Iboko is a village made up of mainly grass huts with a church in the center. It has a functioning hospital that serves a large area and numerous surrounding villages. My colleagues met with the community and its leaders to explain what we were coming to do and to raise awareness about Ebola, how it is transmitted, and the sanitary measures to take for prevention. The villagers welcomed us, but we could see they were very scared of the disease.
On my side, I enrolled some local staff and we focused on one of the first priorities: building an isolation ward, including a latrine, shower room, dressing and undressing rooms, and a waste management area. This was done in a deserted building with five rooms near the health center. It was ready in 24 hours to receive suspected Ebola patients, who would be tested for the virus and receive initial care.
Any confirmed cases would be, for now, transferred to the Bikoro ETC. Over the following days we planned and started building a 13-bed ETC that could be extended to 26 beds if needed. This meant that Ebola-confirmed patients could be treated in Iboko itself.
