Doctors Without Borders: Escaping Ebola in the Democratic Republic of Congo … again

Summer Wyatt-Buchan explores the benefits of NGOs during a health crisis and the impacts of epidemics on developing nations.

A critically ill Ebola patient inside a ‘cube’ in the DRC
Artwork courtesy of @amygeography

Escaping Ebola is not easy, especially in the Democratic Republic of Congo where the fight has been long and hard. The crisis is known to be the second largest global Ebola outbreak, and the worst ever within the nation. Declared a new epidemic by the DRC’s Ministry of Health in 2018, Ebola was recognised by the World Health Organisation as a public health emergency in July 2019. This was the country’s tenth outbreak of Ebola in forty years. However, two years after what seemed like a never-ending deadly cycle, there was finally a light at the end of the tunnel.

On the third of March 2020, Semida Masika was discharged from a Doctors without Borders (Médecins Sans Frontières) treatment centre in the North Kivu province and celebrations that were long overdue could finally take place. The significance of this event is immeasurable;  Masika was the final patient confirmed to have had Ebola. Given that no new cases emerged in the following few weeks, the epidemic could be declared over by the middle of April. Unfortunately for the DRC, no such luck would prevail. Just three days before declaring the outbreak as over, a new case of Ebola was recorded in Beni – devastating the hard work of so many. Not only was this catastrophic to the fight against Ebola, but to the response efforts being built to fight the inevitable arrival of the coronavirus in the DRC.

Doctors without Borders has been active in the DRC since 1985 and plans to stay until the needs of the people are met. The organisation’s efforts to revive the DRC to a state of normality has not gone unnoticed. It is important to recognise the challenges of battling an epidemic in a country where conflict, violence and political unrest prevents access to medical care.

With Ebola, treatment centres alone are not enough. Connecting with the communities and building mutual trust is key to get the outbreak under control

Roberto Wright, MSF anthropologist in Katwa

Working in one of the world’s poorest nations, the Doctors without Borders health workers are having to develop a targeted approach in order to eradicate Ebola in the DRC. Gaining the trust of communities that are sometimes hostile and uncooperative, accessing extremely remote locations, developing technology that protects health workers from contracting the very disease they are trying to eradicate and administering over 3,000 vaccinations to limit the spread of the deadly virus – to some who don’t understand what a vaccine is and so are understandably afraid. 

A primary concern for those fighting epidemics hitting areas within the DRC is the lack of information or misinformation which results in making those who are already vulnerable even more vulnerable. Some believed that Ebola had been imported for financial gain and others even believed that the disease did not exist. These conspiracy theories made it difficult for humanitarian aid workers to trace the contacts of those infected and provide vaccinations and treatment. It was not just Doctors without Borders facing these challenges, organisations such as the WHO were also forced to change their approach.

One way that Doctors without Borders established trust with communities was by using ‘the cube’: a transparent containment unit with air-conditioning that allowed medical teams to treat Ebola patients without having to wear anonymising protective gear. These cubes also allowed for family visitations without risk of infection and for treatment with a reduction of uncertainty. People were no longer afraid of treatment centres; this technological innovation helped health workers obtain the trust of families and lead to over five hundred lives being saved in these cubes alone.

Doctors without Borders pride themselves on putting patients and communities first. Engaging with local people and existing health facilities in order to establish needs and promote working collectively in vital in an epidemic. Moreover, having the trust of local communities is essential to successfully defeating the current health crisis facing the DRC. By acknowledging and embracing the cultural traditions within the DRC those working for Doctors without Borders can learn local ways of life and limit disruption as much as possible. Doctors without Borders also builds infrastructure for clean water, sanitation and hygiene, working on strengthening existing health care facilities to give local communities the independence they need to sustain themselves.

The Ebola outbreak has further damaged the DRC’s already delicate health care system and phasing out the Doctors without Borders Ebola intervention is going to have far reaching implications. It is important that the local communities remain vigilant and aware that the outbreak is by no means over. Discussions regarding the DRC’s need for humanitarian aid in the future should begin now, considering the many other urgent health requirements of the population.

Overall, the use of humanitarian organisations to control health in developing countries can be blighted by the use of superficial solutions rather than addressing the underlying causes. Using the DRC as an example, it is only a short term solution to treat those with ebola rather than educate the local community of why and how the disease prevails or to build water tanks for poorer communities, rather than long term solutions such as tackling the power imbalance of why there was no access in the first place. Doctors without Borders are an example of where an NGO takes into consideration the larger implications of their actions by including raising community awareness regarding current issues (such as how to prevent them and where to seek help) in their aid plan.  Therefore, by taking a holistic approach to aid it is possible to equip the developing nation with a strong foundation to facilitate their own growth in the future without having to rely on foreign aid.

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