“This has been the most challenging outbreak because of the context,” Clemmer, who has responded to two previous Ebola outbreaks, said. Health care workers are working in the midst of ongoing fighting in the area. The active conflict makes it difficult to reach people who need care and leads to distrust of outsiders.
“We’re in the most fragile part of the Congo,” Clemmer said. “There have been frequent attacks from various groups, and the people, the families, are in the middle of the fighting.”
‘Trust is paramount’
This conflict didn’t start with the Ebola outbreak; it’s been ongoing for several years. The fighting has led to extreme poverty in the area. Families live in fear of kidnapping and attacks. People lack access to health care facilities, and the ones that are working, lack the supplies needed to treat patients.
Although Ebola has captured the attention of the global health community in recent months, the local community worries more about the insecurity and malaria, which claims the lives of 300 children each day, Clemmer said. People don’t trust the health workers who have come in response to Ebola and wonder why those agencies didn’t help sooner.
Lack of cooperation by the local communities is a huge challenge to overcome in any outbreak. “You need the population to be a part of the fight,” he said.
IMA differs from some of the other organizations that have responded because it has been working in DRC since 2000 — and in the northeast region, specifically, since 2010. IMA led the USAID-funded Ushindi project from 2010-2017, working to combat sexual and gender-violence, and launched the follow-on project, Tushinde Ujeuri, earlier this year.
When the current outbreak of Ebola was discovered in August, IMA immediately mobilized and started to work with local health care workers, enabling them to care for people who arrive with symptoms.
‘Building bridges, building trust’
Once someone has been diagnosed with Ebola, there are two critical next steps: isolation and surveillance. Tracking down people who have possibly come in contact with Ebola not only helps to stop the spread of the virus but also increases a person’s chance of survival.
Nancy Stroupe, IMA’s senior advisor for monitoring and evaluation, recently conducted a two-day training with the local team, which includes partners Programme de Promotion de Soins Santé Primaires (PPSSP) and Tearfund.
Tearfund is conducting water, sanitation and hygiene activities—a key component in stopping the spread of Ebola—such as repairing latrines and rehabilitating water sources and hand-washing stations. PPSSP is partnering with IMA on the community mobilization, contact tracing, infection prevention and control, as well as ensuring health facilities, particularly small private clinics, are equipped with personal protective equipment and training them on how to use it.