Congo-Kinshasa: Reducing Ebola Risk Through Voluntary Isolation

Dr Keïta, World Health Organisation Beni Field Coordinator, congratulates Masiko Muhaso, the last patient to leave the Ebola treatment centre,

Beni — In the epicentre of the Ebola outbreak, in the city of Beni in North Kivu, the World Health Organization (WHO) and the Democratic of the Republic of the Congo's Health Ministry adopted a strategy once used during the Ebola outbreak in West Africa to simplify vital work of monitoring contacts of patients.

Since December 2019, high-risk contacts, who are most likely to become infected and potentially pass on the illness, have the option of staying in community-based accommodation for the entire 21-day incubation period. On the site, specially adapted for contacts, all meals are provided and volunteers have several medical checks a day, reducing both their own risk, through early detection, and the risk to the community, by limiting the possibility of spreading the disease.

In Kanzuli Nzuli area, where 46 people have chosen to be voluntarily isolated in a partially-built hotel, Brigitte Asiya Madola cooks and serves a hearty lunch of potatoes and peas. She is an Ebola survivor and therefore immune, meaning she can work with high-risk contacts like the people staying here, many of whom are relatives of Ebola patients.

"We eat well here," says 30- year-old Doti Kavugho, who chose to come here for voluntary isolation with three of her children after her nephew died of Ebola. "People tell the cook what they would like to eat and she makes a plan for the week. We're comfortable here."

Zoe Kyavaghandi works on the community engagement team and now runs this isolation site on behalf of WHO. "The more we put contacts together, the more we minimize reinfection," she says. "They're more closely monitored. In the community, they can do whatever they like, but when they're here, the people they're in contact with are also limited."

When there is a case of Ebola and contacts are identified, Zoe visits them accompanied by a psychologist and a member of a surveillance team to explain the risks of their status and the advantages of the isolation programme. Contacts can then opt to visit the site, where residents and staff are ready to answer their questions. This is usually the deciding factor, Zoe says, because afterwards people can describe the site to their families and communities and dispel any myths surrounding voluntary isolation before deciding to be isolated themselves. "Consent is very important," says Zoe. "The visit to the site gives the process credibility in the community."

For Papy Musas, WHO Team Lead in Beni, the strategy of voluntary isolation has been a valuable tool not just for slowing the spread of the epidemic but also for reducing the number of fatalities. "The earlier a person is tested, the better their chances of recovering. We prefer that they're in a very safe place where they can be monitored twenty-four hours a day. This system allows us to take people out in time and they have better chances of being cured."

Inside the compound, accommodation is basic but comfortable. While some families sleep in rooms, others share large tents, with beds and mosquito nets. Hygiene is crucial, so each family gets a washing kit on arrival, and hand washing stations are placed at regular intervals throughout the compound. Since women are most likely to take the role of caring for the sick, as well as looking after the children, mothers and their children make up most of the population of the isolation site. The children are provided with toys and there is a television room.

Still, it is not always easy to persuade people to be voluntarily isolated. "Some resistance is normal," says Zoe Kyavaghandi. "We're in Africa, everyone is attached to their family and their home. That's why we organize sessions with psychologists to help them, but we also try to do whatever we can to help them overcome any problems they have. If they need anything urgently and we can do it for them, we do that, to give them confidence."

Resident Doti Kavugho encourages others to follow her example. "The message I would give to others is that we live well here: we eat well, we sleep well, we have a good follow-up from the Ebola response team."

While some people find it hard to adapt, Zoe says most understand the importance of voluntary isolation for their communities and for their own health. And as those who leave the isolation site return home, they bring with them a greater awareness of hygiene and Ebola prevention measures which can benefit their communities for far longer than 21 days.

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