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Why The Ebola Response Is A Success In Goma — But Not Elsewhere In Congo

Aug 30, 2019
Originally published on September 5, 2019 8:53 am

Even at Sunday Mass, you cannot miss the signs of Ebola.

Parishioners at St. Francis Xavier Catholic Church in Goma line up behind buckets to douse their hands with a solution of bleach and water. Then they get in another line where a team of health care workers check their temperature with an infrared thermometer.

The bells from the church tower toll. Girls run around in formal dresses. They flit around posters warning of Ebola symptoms, as the health workers look out at them from behind protective goggles.

This scene was very different a few weeks ago, says Jean Roger Paluku Lula, the team leader from Congo's Health Ministry. People were angry. They did not want health workers in their community.

The Democratic Republic of Congo is as familiar as any place with handling outbreaks of Ebola. The virus was discovered here in 1976, and the country has controlled the previous nine outbreaks without major problems. But the current outbreak — the 10th in its history — is now more than a year old, has killed 2,000 people and has become the second-biggest outbreak in history.

The outbreak started in a small town called Mangina but worked its way south through the densely populated towns of Beni and Butembo. Eventually, in July, the virus made it to this sprawling city of 2 million. It's a transit hub with an international airport and is just across the border from Rwanda. When Ebola reached Goma, the World Health Organization declared the outbreak a public health emergency of international concern, and funds and resources poured into Eastern Congo.

People in Goma reacted as many people did up north. They threw rocks at health workers, suspicious that they were profiting off the response. In this neighborhood, they barricaded roads; they refused to wash their hands.

"At first, they believed the thermometers we were using were actually a tool that infects people with Ebola," Lula says.

Ministry of Health officials go out into neighborhoods in Goma to educate residents about Ebola, as well as take temperatures as a way to check for symptoms of the virus.
Samantha Reinders for NPR

But health workers did what they've done many times here in Congo: They went deep into the neighborhoods, explaining the disease and the treatments. They talked to leaders. They convinced more than 1,000 people to take an experimental vaccine, and here, at least, people understood. And the outbreak was controlled.

A health worker marks off the number of people who have washed their hands and had their temperature taken at an Ebola checkup station.
Samantha Reinders for NPR

Lula looks around with satisfaction. A family of six had been found to have high fevers. Just a week or two ago, this would have been a tense moment. The crowd, he says, would have likely rallied around the family, afraid that they would be taken to an Ebola treatment center.

But the family listened to health authorities. They shared their travel history. It turned out they had been nowhere near an Ebola outbreak zone. They were sent home, and everyone else at church continued with their day.

That's the way an Ebola response is supposed to work.

Dashed Hopes

In a lot of ways, when this outbreak began, there was hope it could be quickly controlled. Unlike the 2013-2016 outbreak in West Africa, scientists had new tools: an experimental vaccine and two treatments that have been proven highly effective.

Rehema Kabuo of Goma gets an Ebola vaccination.
Samantha Reinders for NPR

In fact, Congo's ninth outbreak was declared over just days before this one began. Authorities in Equateur province had successfully used this new vaccine to form a protective ring around active cases. In less than three months, the outbreak was contained, limited to 54 confirmed cases.

But Natalie Roberts, operations manager for Doctors Without Borders, says the vaccines and treatments had worked in very different settings.

"This is not sort of dealing with it on paper," she said. "It's dealing with it in a very, very difficult context — the Eastern Congo being a very, very complicated environment in which to work."

As soon as you leave Goma, for example, the infrastructure crumbles; the security situation deteriorates. And everything becomes harder: Moving around, keeping vaccines cold, tracking down who is at risk and vaccinating them.

The scene in a Goma neighborhood during a Ministry of Health official visit.
Samantha Reinders for NPR

In Goma, authorities say they have been able to work every day. They haven't been hampered by attacks on facilities or violent protests. In a lot of ways, that explains why they've been able to stop secondary infections in Goma. But in Beni and Butembo, the outbreak seems to have no end in sight.

Not only that, Roberts says, but those cities are in a part of Congo that experiences so much other suffering.

This year, for example, more people have been killed by measles than Ebola. Since January, the World Health Organization says more than 3,000 people have died of measles; each year in Congo, malaria kills 48,000 people.

Roberts and her colleagues say in parts of Ituri province, where violence has displaced hundreds of thousands, some of the health centers they are building now have to have separate isolation units for Ebola and measles.

"This population and this context have 99 problems, and Ebola is just one of them," Roberts says.

A Survivor's Story

The first case of Ebola in Goma was confirmed on July 14 at a house not far from the church. It's a neighborhood carved out of volcanic rocks at the foot of Mount Nyiragongo.

Esperance Nabintu has pinned pictures of her late husband all around her home. He was the second case.

Esperance Nabintu posted this photo of her husband, Rene Daniele Fataki, who died of Ebola.
Samantha Reinders for NPR

"My husband was a good husband," she says. "He was handsome. He was well-created."

There are few jobs in Goma, so her husband had to travel hundreds of miles on a motorcycle to work at a gold mine up north. When he came back for a break, he was already infected with Ebola. He died shortly after being diagnosed.

Family and friends came together to pay tribute to Rene Daniele Fataki of Goma, who died of Ebola at age 46.
Samantha Reinders for NPR

Nabintu, 42, had 12 kids, but two of them died when they were babies from malaria.

She and her 6-month-old were both infected with Ebola, but they were saved by a new experimental treatment that was first tested and proven clearly effective in Congo.

A scene from the gathering to mourn and to celebrate the life of Rene Daniele Fataki, who died of Ebola.
Samantha Reinders for NPR

Nabintu says she feels lucky. The doctors and nurses treated her and her family with respect and even fed them, she says.

But then, as she thinks about her husband, her thoughts drift. She sighs.

"I can't stop thinking," she says. "I was married; I lost my husband, who was the head of the family. And now I have the children."

She beat the odds. She survived Ebola. But now, she says, she has to find a way to keep living.

Correction: 8/31/19

An earlier version of this story incorrectly stated that the first case of Ebola in Goma was confirmed on Aug. 16. It was actually confirmed on July 14.

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