In response to the worst Ebola outbreak ever recorded in Democratic Republic of Congo (DRC), Doctors Without Borders (Médecins Sans Frontières) is stepping up efforts to contain the epidemic.
Just over three months since the declaration of the latest Ebola epidemic centered in North Kivu, DRC, the intervention still faces serious challenges. To date, 341 suspected Ebola cases have been identified, of which 303 have been confirmed.
The epicenter of the Ebola outbreak has moved from the small town of Mangina to the larger city of Beni, where the number of new suspected and confirmed Ebola patients has risen steadily for weeks. MSF teams are increasingly busy with tracing suspected cases, as the epidemic has reached a new level. As many as 30 new suspected cases are identified every day and admitted to the Ebola treatment center in Beni.
MSF has opened a new transit center in Beni in response to the growing needs. “The objective of this transit center is to boost the overall capacity for patient care in Beni. Since the city became the new focus of the outbreak in October, new confirmed cases have been frequently appearing in several neighborhoods,” says Marie Burton, MSF project coordinator.
The new MSF transit center was built very close to an existing Ebola treatment center (ETC) that was operating at capacity. The proximity of the two facilities is intended to bring the various components of the Ebola response in Beni closer together. The MSF facility was built on a former football field measuring 8,000 square meters and required a week’s worth of fast-paced construction work.
Suspected Ebola patients will be admitted to the MSF transit center pending confirmation of their laboratory analyses. MSF medical staff will provide immediate care according to a person’s clinical status; once the diagnosis is confirmed, patients who test positive for Ebola will be transferred to the nearby ETC while those who test negative will be transferred to other health facilities where further care will be provided. Until recently, both confirmed and suspected cases were admitted to the ETC, although the two wards were isolated.
In the new MSF transit center, individual rooms were constructed to improve patient isolation. Partitions were fitted with large plexiglass windows to enable medical staff to more closely monitor patients, as well as make it easier for patients to see visiting family members and loved ones. The center’s initial capacity of 16 beds can be increased to 32, or up to 48 if needed.
Since August 1 the Ebola virus has killed 215 people in DRC. More than 100 patients have been able to recover so far. Active conflict and insecurity in the affected areas are making it difficult for health workers to reach the local community. MSF is working alongside several organizations to help contain the epidemic.
“Since the [epicenter] of the epidemic moved from Mangina to Beni, the outbreak has become harder to control. We now observe an increasing number of new cases further south, in the even bigger city of Butembo. We fear the situation might become even harder to manage, unless the response in this area is significantly strengthened,” says Gwenola Seroux, emergency cell manager for MSF.
The past few weeks have seen a noticeable increase in the number of new cases in Butembo, a regional hub for trade near the Ugandan border. More resources and attention are needed in the area, as there is a risk that this large city is becoming a new hotspot for the outbreak.
In addition to the challenges associated with a mobile population, Ebola responders are also confronting the community’s fear of such a deadly disease. These fears can complicate the relationship between communities and health workers. Our teams often observe a reluctance to report new cases, report to ETCs, or accept the intervention of the teams responsible for ensuring safe and dignified burial of Ebola victims.
“We observe the need for better, more effective communication by all players participating in the response, in order to win people’s trust. Mortality rates are very high. People may be led to believe that treatment centers are places where you go to die, when in fact dozens of patients were able to recover. Being admitted to a treatment center at an early stage of the sickness enhances one’s chances to recover,” says Dr. Axelle Ronsse, MSF emergency coordinator for the Ebola intervention.
MSF has been present in Beni since the start of the outbreak in August 2018 and is active on several fronts, aiming to contain the spreading of virus and address the needs of people in North Kivu. Along with other organizations involved in the response, MSF teams pay regular visits to 24 health centers to provide training and materials; they also hold regular meetings with local communities to share information about Ebola and ways to avoid contagion. As part of MSF’s infection prevention and control activities, teams provide decontamination to health centers following the identification and transfer of confirmed Ebola cases to the appropriate facilities.
MSF teams have vaccinated more than 600 people, with a focus on frontline health workers and potential contacts of Ebola patients in Beni in October. Vaccination was provided in Butembo in November.
Since the start of the Ebola epidemic on August 1, 2018, MSF teams have been active in the response in North Kivu and Ituri provinces. MSF opened treatment centers in the cities of Mangina, Butembo, and Tchomia (the latter is now closed), an isolation center in the city of Bunia, and most recently a transit center in Beni. Independent of any political, religious, or military authority, MSF acts with impartiality, according to its evaluation of medical needs. MSF is financially independent, with more than 90 percent of our income from private donors.