NEW YORK, SEPTEMBER 7, 2018—In its first month of responding to the Ebola outbreak in North Kivu, Democratic Republic of Congo, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has treated 65 people with the virus—more than 80 percent of the total number of confirmed patients hospitalized in the region’s Ebola Treatment Centers so far. Of the patients confirmed positive in MSF’s Mangina Ebola Treatment Center, 29 have recovered and returned to their families while three people remain in treatment.
“We are at a crucial point in the epidemic,” said Berangère Guais, MSF’s emergency coordinator in Beni. “Yes, the number of patients in the treatment center has reduced significantly, but new cases from a number of different chains of transmission have emerged in recent days. We must continue to work with the community to build trust and ensure that everyone presenting with symptoms of the Ebola is isolated and tested quickly. We just cannot let down our guard until the epidemic is declared over.”
On the eve of the August 1 declaration of North Kivu’s first Ebola epidemic, MSF teams working in a hospital in Lubero arrived in Mangina, the epicenter of the outbreak. They immediately began working alongside the Congolese Ministry of Health to mount a response against the outbreak. In the days that followed, experienced MSF staff arrived from across DRC and around the world to help train local staff and work with them to care for the sick and curb the spread of the outbreak.
“We knew we had to act fast,” said Patient Kamavu, a nurse from MSF’s Congo emergency pool who arrived on site on August 3. "When we arrived, we saw that the local health center in Mangina was overwhelmed. A number of health staff were ill, and the number of patients was increasing each day. Everyone was crowded together in one ward of the hospital. We had to work quickly to improve the situation for both the patients and the staff.”
By August 6, MSF had improved the safety of the isolation unit for suspected and confirmed cases in a ward of the Mangina Health Center and constructed another inside the Hospital General de Reference in Beni. The team had also begun constructing a treatment center in Mangina. The Mangina Ebola Treatment Center, with a capacity to care for 68 patients and expand to 74 beds, if needed, opened on August 14. Thirty-seven patients were transferred from the Mangina isolation ward to the Ebola Treatment Center that day. The Beni isolation ward was completed and handed over to the Ministry of Health who assigned its management to another NGO.
“We focused on patient care while our logistics and water and sanitation teams worked day and night to complete a treatment center,” said Kamavu. “It was incredible. We’d make visits to the site just one day later and see a totally different hospital appearing.”
MSF also constructed and opened a seven-bed transit center in Makeke on the North Kivu-Ituri border on August 28 in response to a number of cases in the area and community resistance to transferral in Mangina as a temporary measure while another organization builds an Ebola Treatment Center. Now, people who have the virus can be isolated and tested for the Ebola virus close to their homes and will only be transferred by road to one of the treatment centers if they test positive.
During the course of this epidemic, MSF has also been able to offer new treatments to those with confirmed Ebola infection under a compassionate use protocol—specifically the Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) protocol, which allows new drugs that are not yet registered to be offered to people affected by outbreaks of deadly diseases. These treatments are given only with the informed consent of the patient (or a family member if they are too young or too sick to consent) and are provided in addition to the supportive care, like hydration and treatment for the symptoms of Ebola like diarrhea and vomiting, that MSF offers to those with Ebola.
“It’s a great relief to finally be able to offer patients more than supportive care,” Kamavu said. “Statistically, Ebola patients have had less than a 50 percent chance of survival. This is devastating and terrifying to families and the community.”
Outside of Ebola Treatment Centers, MSF teams working in the Beni and Mangina area as well as in Ituri, between Mambasa and Makeke (on the border with North Kivu) are visiting health centers and training staff on the proper triage of Ebola suspects, donating crucial protection material as well as setting up isolation areas where patients suspected of carrying the virus can be safely cared for while an ambulance arrives. Health centers in Mangina and Beni that have seen positive cases are also being decontaminated.
“Sadly, in this epidemic we have seen at least 17 health workers infected with Ebola,” Guais said. “Health staff caring for patients with illnesses like malaria and pneumonia, or assisting women to give birth, must be protected by a proper triage system which identifies and isolates suspect Ebola patients before they enter a hospital. This will not only protect health workers but also their patients and prevent health centers becoming centers of amplification for the spreading of the virus.”
MSF has recently received approval to begin a vaccination campaign for frontline workers in the area between Makeke and Biakato.