“Bringing in the community is really critical in a couple of ways,” he said. “There’s outreach and engagement: you need to get people the right information, because there’s a lot of misinformation that’s being spread. The second thing is tracking different cases. Once somebody has been identified, you have to track all the people they know. And right now, in this environment, the only way that can happen is through community involvement, or community training and getting them involved in that.”
A third factor is improving and better equipping the local health facilities that are the first responders in the crisis.
“These health facilities have been underfunded for years. And so they don’t have the proper equipment and the proper processes to address cases as they come into those facilities,” he said, adding that many lacked proper water and sanitation infrastructure to prevent infections from spreading.
“So, where Ebola has broken out, the health systems there have been weak. A weak health system doesn’t necessarily mean you’re going to get something like Ebola, but it definitely creates the conditions for it to really rise and to break out,” he said.
Too often, the international community solves one problem, Ebola, and then their withdrawal makes the situation worse by leaving a weaker or shattered health system.
“What we saw in West Africa in the previous outbreak was weak systems in Liberia and Sierra Leone and Guinea. And then you had this massive influx of resources to address it specifically. All the while, malaria, malnutrition, all these other things are happening simultaneously.
“And it cracked a very weak health system wide open. And then everybody leaves,” he said. “And that’s what the international community does. They decide that they’ve put the money in, they’ve addressed it, it’s over. But the recovery of those local health systems is long and lingering. I was looking at some numbers that showed those West African countries didn’t get back to their pre-Ebola indicators until three to four years after.”
Santos noted that the DRC has a very decentralized health network divided into over 550 geographical zones. “It actually has a structure that could address this,” he said. “But they’re completely under-resourced.
“So now they’re trying to address this really difficult situation, and then what happens? And this is part of the resentment you’re finding in these communities. Big white vehicles come along, they put these tents up and then when it’s over — they leave.
“So for me, what’s critical is: How do we look at this, not just through the crisis itself, but post-crisis? To be able to leave the health system, if not in better shape, at least it’s not shattered when we leave it,” he said. “And frankly eastern Congo, even when we get through this, is going to be in a place where the health systems are still going to be very weak and they’re going to need continuous support.”