We are now three months into the 10th Ebola outbreak in the Democratic Republic of Congo. The epicentre has moved from the small village of Mangina, where the first cases were reported, to the bigger town of Beni; more cases are also being reported in the even larger city of Butembo. With over 300 cases and almost 200 deaths, and numbers rising every week. Our range of activities includes patient care, vaccination, infection prevention and control, alert investigation through a rapid response team. One of the main hurdles for the response teams has been the community’s resistance to the intervention: Ebola is a scary disease and its nature and dynamics are often not understood by the local population; there is significant mistrust which often results in new cases being hidden, patients attempting to default, treatment centres being perceived as “places where people go to die”.
Of course, Ebola’s a really specific disease, with its many cultural aspects and potential for causing a widespread epidemic. But what really makes it different is the human element, because it’s a disease that exacts a real emotional toll.
Emmanuel Berbain, doctor
I work with MSF in the Ebola treatment centre here in Mangina in North Kivu, a province of the Democratic Republic of Congo.
CARTON: The Ebola outbreak in DRC has killed over 140 people out of over 240 confirmed cases in three months
The protective clothing imposes the setting up of very specific nursing and medical protocols, due to the time it takes and the fact that it restricts movement a little bit. It also affects our contact with our patients. They can’t see our faces so sometimes we draw a little face on our foreheads or write our names. Because all staff are constantly exposed to the disease, we have a procedure limiting physical contact. For the entire duration of the mission, we never share the same glass or kitchen utensils. And we never touch one another, we don’t even shake hands. The only exception is when we’ve put the protective clothing on. Two people find themselves totally protected and uncontaminated because they haven’t been into the zone yet, so we can give each other a quick hug or shake hands. It can be quite a special moment
CARTON: MSF teams have been deployed since the beginning in several sites across the region.
The basic treatment focuses on symptoms such as re-hydration, psychosocial support and antibiotics. It’s the same as in previous years but more specific molecules for treating this particular disease are currently being developed. There are five, antivirals or drugs based on antibodies that enable the body to combat the disease faster and more vigorously. These molecules have their differences. Four are administered intravenously but they are very different to put into practice, which is important given that we’re in protective clothing. Each differs in terms of treatment duration, surveillance required and potential side effects that have to be monitored. This is how we select the molecule.
With this treatment, it’s really important to have the patient’s cooperation and consent. We explain to the patients, or to their relatives in the case of minors or people unable to give their consent, the pros and cons, why we’re doing it and our reasons for choosing this particular molecule. It’s a disease that exacts a real emotional toll, notably due to its evolution. Unfortunately, right from the start of treatment, we’re able to identify when and which patients will potentially have complications that could be extremely serious and, sad to say, in some cases fatal. The disease is more dangerous for children who have a higher mortality rate.
It’s vital to emphasise the importance of establishing human contact with our patients, especially when their condition deteriorates and supporting them becomes even more crucial. I think you can never be immune, and who would want to be, to these kinds of feelings.