/ 15 April 2020

Grassroots mobilisation is key to fighting an outbreak

Response Lags Behind Rapid Shifts In Ebola, Says Msf
As health workers in the DRC deal with the news that Ebola has not yet been defeated, they reflect on the lessons the epidemic has taught them

Last week health workers in the Democratic Republic of Congo (DRC) were getting ready to take a collective sigh of relief. The Ebola outbreak in the country — the second-largest on record — was about to come to an end.

But last Friday, the country’s health ministry confirmed that a 26-year-old man in Beni in eastern DRC had died from the virus. 

News of another death, this time of an 11-month-old girl, quickly followed — dashing hopes the outbreak would be considered over as the fight against the coronavirus intensified.

“This is a bit of a nightmare scenario for us,” said Robert Ghosn, head of operations for the International Federation of Red Cross (IFRC) in Goma, 242km south of Beni.

“We were really hoping that Ebola would recede before Covid started hitting this part of the DRC. And that did not happen. So it is very, very difficult.”

By Tuesday there were 235 cases of Covid-19 in the country and 20 deaths. Most of these cases are in the country’s capital, Kinshasa. 

The DRC “is probably the most fragile place on Earth today”, Ghosn says. “There was a lack of provision of basic services already before Ebola, which hit the DRC for more than 18 months and now is still ongoing. Now Covid is coming. And all this is obviously cumulative. So you can imagine the impact.”

Ghosn says another danger is that the resurgence of the Ebola outbreak coincides with a coronavirus crisis that has caused some governments to “look inwards”. 

“We need the support of everyone,” he tells the Mail & Guardian.

But he adds: “More importantly we need the support of the communities here and, to be honest, I’m very impressed by their resilience.” 

The fight against the Ebola outbreak has come with a number of lessons for health workers now arming themselves for the Covid-19 battle. One of these is knowing what the end of an outbreak looks like.

In a statement after the resurgence of Ebola in eastern DRC, IFRC’s director of health Emanuele Capobianco said the news is “a stark reminder that when conditions that allow diseases to thrive and spread remain, flare-ups can be a reality”.

He warns that relaxing regulations and lockdowns will not spell the end of the coronavirus. “Unfortunately ending the lockdown will most likely bring more new cases,” he tells the M&G.

“Because where the lockdown has been able to reduce the number of cases, once people will start to circulate again, we will see the number of cases probably going up. The magic here will be to open up the interaction within societies in quite a cautious way.”

But Ghosn says the most important lesson from the fight against Ebola relates to the mobilisation of people in the wake of a public health crisis.

“Top-down messaging does not work. It creates resistance. It feeds into rumours. It’s not the way it works. Communities don’t just follow instructions. You need to engage with them. You need to talk to them and help them adapt the ways of thinking to their own reality,” he says. 

“And that is a lot of work. It’s really about working with the people: listening to them more than talking at them.”

He says this is crucial now, as governments impose strict regulations and lockdowns to curb the spread of the coronavirus.

Ghosn adds that health workers cannot be “separated from their communities”.

“We tend to think that we need to protect health workers in the health care centres. Because we don’t want them to get sick because they are the first line of response, which of course we completely endorse … However, they can get sick from their communities,” he explains.

“So if your only effort is to keep the healthcare sector safe, we’re not keeping anyone safe. So the idea that you could slice the problem in an outbreak, that you could say here is safe, here is not safe, is actually also something we’ve learned the hard way. It doesn’t work that way.”

Ghosn emphasises his main point: no intervention against an outbreak should deliberately hurt the communities affected by it.

“We have to work with them. And if their feedback is: ‘Okay, but I still have to feed my family.’ This is something we have to hear. We cannot just ignore it and say, ‘No no no. We actually know better.’”