20 February 2019

Congo-Kinshasa: First Person - to Stop Ebola, Ask the Rebels to Help

Photo: Dr Jean-Christophe Shako/IRIN
Dr Jean-Christophe Shako with Mai-Mai fighters after a discussion about Ebola and negotiations with their leader in Rutshuru.
opinion

Butembo — "I had heard so many scary stories about Mai-Mai fighters that I didn't know what to expect"

The Democratic Republic of Congo is in the midst of its 10th Ebola outbreak. Since the first case was declared in the northeastern town of Beni in August 2018, almost 800 cases have been confirmed in 19 different health zones, and more than 500 people have died.

I've worked on four Ebola outbreaks across Africa and have often found myself in tricky situations with local people who view outsiders with suspicion. During the 2014 outbreak in Guinea, for example, my team and I were threatened by villagers who ran after us with machetes.

It only took a few days in Butembo, responding to the current outbreak in eastern Congo, before I was surrounded by an angry mob chanting "kill him", after they refused to allow our surveillance team to investigate a death in their neighbourhood.

Such experiences have taught me that keeping your calm and speaking respectfully are the best ways to de-escalate tense and violent situations.

But I still wasn't prepared for my first experience of going face-to-face with Mai-Mai rebel leaders to negotiate access in Congo so our health teams could reach affected communities.

Since this outbreak erupted in North Kivu province last August, health teams knew they would face big challenges. The virus had resurfaced in a densely populated, heavily travelled urban region where about 100 armed groups operate, restricting the response. The risk of rapid geographic spread was very high.

Ebola is a highly contagious virus, and when a person contracts the disease all those they come into contact with need to be screened for symptoms.

As the Ebola response coordinator in Butembo, my role was to organise surveillance activities to find these contacts as quickly as possible - that means before they start showing symptoms, become contagious, and spread the virus.

Very early on in this outbreak we got an indication of just how hard this was going to be. Six days after I arrived in Beni, the epicentre, we heard that 30 contacts of confirmed Ebola patients had fled to Butembo, about 60 kilometres away and home to over a million people.

Finding people who don't want to be found is not an easy task. It's made even more difficult when those affected live in inaccessible areas controlled by armed rebel groups, including the Mai-Mai - self-defense militias feared by the local population because of years of crimes, including torture, kidnapping, and indiscriminate killings.

Less than two months after I arrived in Butembo, we heard that the body of an eight-month-old boy who died from Ebola was in the Mai-Mai village of Tinge. Because the risk of Ebola spreading is most severe immediately after a patient dies, I knew we needed to gain access to people in Tinge as our only way of saving lives and avoiding disaster.

I told our health teams and international partners we had to go to that village to vaccinate people. Everybody thought I was crazy.

The Mai-Mai are known to be well armed and unafraid of the authorities. Even our national police and army don't dare venture into some of these rebel-controlled zones. Only my driver and the titulaire - the nurse overseeing that health zone - agreed to join this uncertain and risky mission.

The following morning, I got into the car not knowing if I would even come back alive. After a 45-minute drive on windy roads, followed by a 35-minute walk along muddy forest trails, we finally reached Tinge. About 50 people were gathered under big dark green tarpaulins, mourning the baby boy.

We were greeted by a woman who asked what we were doing in their village. I told her I had to see the village chief because I had something important to tell him. She pointed me to his house.

As an epidemiologist with a specialisation in molecular biology, my colleagues jokingly nicknamed me "the complete man" because I can perform all the tasks in the surveillance toolkits: investigate and validate alerts, take samples from suspect cases, and even test these samples in the laboratory.

However, in this situation, my skills weren't that useful. What we needed even more was to find a way to convince the sceptical local community to collaborate with us and stop Ebola.

As I entered the house of the village chief, my heart was racing. I had heard so many scary stories about Mai-Mai fighters that I didn't know what to expect.

In the house, I saw five men at the dining table, waiting for lunch to be served. They were covered with the amulets the Mai-Mai use to protect themselves. The chief was sitting on a chair with large banana leaves beneath his feet.

To my surprise, when they saw me, they invited me to join them at the table. A woman brought a small stool and hot water to wash my hands, before we were served pondu (cassava leaves), fufu (cassava flour with water) and one piece of meat.

My hosts remained silent, observing and analysing my behaviour. Only when I began eating did the atmosphere lighten. My hosts started smiling and talking. The chief told me they appreciated my humility by agreeing to eat with them.

That is when our conversation finally started. They had never heard about Ebola nor the vaccination. So I spent more than 30 minutes explaining the virus to them, how it spreads, what the preventative measures are, and how the vaccination works.

Without saying a word, the village chief went outside and gathered the villagers. He said a few words in their local dialect while making big gestures. Then he allowed the titulaire to list all those who had been in contact with the baby boy so we could follow the chain of transmission. In total, 75 people came forward.

Before leaving, we agreed to meet the next day in a neutral zone where vaccination teams and police agents would be allowed to come. At 8am, everyone arrived and our teams began vaccinating.

Not a single person in that village developed the virus.

After making contact with the chief of Tinge, I was able to meet other Mai-Mai chiefs, including a group that controls the area linking Butembo to the major city of Goma. I visited their village in December, where I spoke to a group of fighters for two hours, answering all the questions they had about Ebola.

Later, in a one-on-one meeting with the chief, I called the Minister of Health and arranged for them to speak. The chief warmly thanked the minister for his commitment to ending the Ebola outbreak, guaranteeing that his fighters would not harm the response teams. A week later, I returned to the village with several boxes of medicines the minister sent the Mai-Mai to cement this collaboration.

Earning trust during such a deadly outbreak is always hard. Which showed me yet again that respect, compassion, and humility can go a long way - even saving your life and the life of an entire community.

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