* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Behind every Ebola 'case' are real people that are afraid. It will not be possible to end this outbreak without building the trust of those affected.
Valérie Gruhn is a nurse who has worked for MSF in DRC, Iraq, and Kenya. She is based in Brooklyn, New York, where she is a registered nurse.
In February, I worked as a nurse with Doctors Without Borders/Médecins Sans Frontières (MSF) in Katwa, North Kivu — a town in the Democratic Republic of Congo in the epicenter of the current Ebola outbreak — until attacks on two of our treatment centers forced us to evacuate.
February 15-19, 2019
Several colleagues and I arrived in Beni, in the most affected province. We joined a long line of other passengers, all waiting to wash our hands with chlorinated water to disinfect and get our temperatures checked to verify we weren’t sick.
The two-hour drive to our final destination, Katwa, took us on rusty colored roads on a mountain that gave us a view of Virunga rainforest, one of the most beautiful countries I’d ever seen. Hidden away, between large tree trunks, flashes of orange started appearing through the thick morning fog: it was the Ebola Treatment Center (ETC). It was the size of a football field, and within was a complex maze which separated the low-risk zones from the high-risk zones, where people who exhibit Ebola-like symptoms waited, with a passage in between for families to visit their loved ones at a safe distance.
I didn’t know what to picture when I thought of an Ebola patient. I had never seen this disease before. One woman was a “positive case” — someone who tested positive for Ebola. She was very weak and complained of abdominal pain and chills. There were no hemorrhagic symptoms. She looked exactly like so many sick patients I’d taken care of back home.
February 20, 2019
I donned the Personal Protective Equipment (PPE), layers of equipment we wore in high-risk zones to minimize our exposure, and grabbed an umbrella to protect my goggles from fogging from the rain before I entered her room. The clinical status of the woman I saw the day before dramatically declined in just a few hours. I felt myself moving in slow motion because of the weight of the suit and was struck by my reflection in the window. I felt guilty that I was dressed the way that I was, and that the last person she would see was a random stranger wearing what looked like a yellow spacesuit. I felt like I was treating a disease, a biosecurity threat, less a person who was a mother, a daughter, and a human being.
She died several hours later.
February 21, 2019
Adama* is a precious seven-year-old girl; she was my favorite patient. Her parents were unable to go into her room, so Ebola survivors who couldn’t contract the disease again cared for her. She smiled at me as I walked over to her window. I put my hand against the plexiglas separating us and she put her small hand against her side of the glass to touch mine. That’s the closest contact I could have with her from our separate sides if I wanted her to see that I was smiling back at her.
February 22, 2019
In December, DRC’s Independent National Electoral Commission excluded Ebola-affected regions from voting in the presidential election to prevent the outbreak from spreading.
As more money and international responders poured in, rumors started developing and circulating: “The response is benefiting outsiders,” “Ebola is a political ploy.”
People were suspicious about the motives of organizations. People wanted answers: “Where were you all when our families were being massacred over the years and when our children were dying of other diseases?”
February 23, 2019
A man we were monitoring for several days was fighting to survive. I watched as his brother and father waved at him from several meters away, behind the fence. Was this really their last goodbye? A distant wave instead of a last hug and kiss. I walked away to hide my own tears.
February 24, 2019
The activity of the hospital drastically decreased over the week. People preferred to die at home than be forced to treatment centers where they say “people walk in alive but come out dead.”
A young woman was brought in dead. This created a lot of tension with the family and community because they had to wait to bury her. Outside, a crowd of people began lining our center. A little further, kneeled on the floor in the field was that woman’s family member screaming and crying from the pain of not only losing her but also every bit of control she would have had over her burial in a normal situation.
February 25 - 28, 2019
I woke up to the news that our treatment center was attacked. Unable to withstand the blaze of the fire, parts of the hospital laid on the ground in ashes. Everyone was safe, except the brother of my patient from a couple days before who was found dead nearby. A second, more violent attack occurred two days later on our nearby center in Butembo.
As we evacuated, I looked back one last time at the city that did everything in its power to protect itself from the response.
Conclusion
Behind every Ebola “case” were real people that were afraid—afraid to have their limited belongings burned to prevent the disease from spreading, afraid they wouldn’t be able to celebrate the lives of their loved ones when burying them, afraid they would be taken against their will into a treatment center.
We focused on only the ones who got infected and their families that we referred to as contacts. However, we missed everyone else who lived in fear of becoming the next case. We spoke of survivors as those who survived the disease, but not people who survived the violence of their past and the new hostility we created.
The messages diffused lacked hope and the response lacked humanity. We failed to act on their needs and suffering, and therefore, we failed to gain their trust. The heavy, strictly enforced intervention generated fear and resentment among the population. Hence, they fought what they considered to be a greater threat than Ebola: the international response.
It will not be possible to end this outbreak without building the trust of those affected. We have to listen to the needs of communities, see them as people, give them choices when it comes to managing their health, and involve them in every aspect of the Ebola response.
*Name has been changed to protect her privacy.
