Dr. Jean-Gilbert Ndong at the MSF office in Kinshasa, Democratic Republic of the Congo on Friday.Elgal Gali/Supplied
The rapidly evolving Ebola outbreak is outpacing emergency responders in the Democratic Republic of the Congo, where the rare Bundibugyo species has infected nearly 300 people, with another 220 suspected cases – a toll that aid organizations warn is almost certainly an underestimate.
“The reality today is that nobody knows the true scale and severity of this outbreak,” Alan Gonzalez, deputy director of operations for Médecins Sans Frontières (Doctors Without Borders), said in a statement on Saturday.
There have been no cases of Ebola in Canada. Last week, the federal government suspended electronic travel authorizations and temporary and permanent resident visas for 90-days for people currently in the Democratic Republic of Congo, Uganda and South Sudan.
Opinion: Suspending immigration over Ebola is misguided and goes against international law
On Monday, Ontario Health Minister Sylvia Jones said that the province has been in communication with the federal government and will make two beds available in an Ontario hospital with the capacity to treat Ebola patients, if they are needed by anyone in Canada.
To get a better sense of what’s happening in the DRC, The Globe and Mail spoke with Jean-Gilbert Ndong, medical co-ordinator with MSF in the DRC, who is currently based in the capital Kinshasa – about 2,800 kilometres west of Ituri, the outbreak’s epicentre.
Dr. Ndong said outbreak responders are struggling to catch up with the spiralling outbreak, and what the region urgently needs from other countries is funding and human resources – not travel restrictions.
This interview has been edited and condensed.
Irenge Biringanine Prince, leader of the 'U Report Goma' community, dressed in protective equipment at Alanine market in the Democratic Republic of the Congo.JOSPIN MWISHA/AFP/Getty Images
How does it feel in the capital right now? Are people noticeably concerned or scared?
To be honest with you, they don’t care. The majority of the population seems to not be very interested. For them, the epidemic is still far away, and they are not even imagining the epidemic in Kinshasa.
Even at the level of the authorities … there is not a clear contingency plan on Ebola. The hospital that’s going to host the patient, the people who make sure that infection prevention and control is well done, how we are going to communicate – we don’t have this information.
How likely is it that a case will eventually make its way to Kinshasa?
We know that people are moving. We also know that this epidemic started somewhere around March, and people have been travelling by that time from Ituri to Kinshasa.
Kinshasa is a city of more than 15 million inhabitants, and we do have places where people are lacking water, lacking electricity. All of those risk factors are going to worsen the management of an epidemic so we are not feeling comfortable with such a scenario.
What’s it like for you? Are you scared?
I’m not scared, because it’s not something that we don’t know. This is the 17th [Ebola] epidemic in DRC, so people know what to do. The problem here is not really about responding to the epidemic. The problem is about the challenges that the country is facing in terms of the fragility of the health system. Congo is about two million square kilometres, so it’s a very big country, with a lot of logistical challenges and issues.
Young members of the 'U Report Goma' group continue their awareness activities at the market.JOSPIN MWISHA/AFP/Getty Images
What are some of those challenges?
Two or three days ago, we faced a shortage of cartridges [used to] diagnose the Ebola samples. When we cannot do the tests, patients or suspected cases stay in the hospital without knowing if they are positive or negative. So we may have positive cases mixed with negative cases.
The hospitals are packed; there is no access to non-Ebola care. For example, if you have a child who is suffering from malaria, you cannot take him. If you have a pregnant woman who wants to deliver, there are not enough places. And at the same time, you have to make sure that infection prevention and control measures are efficient in all those facilities.
We still have a malaria, we still have measles, we still have cholera. So we have to make sure that despite the fact that we have this Ebola epidemic, we also give support to the non-Ebola diseases.
But the major problem that we’re having now is community awareness. Our team in the field have been facing a major security issue. On the 23rd, one of the [patient isolation] tents in Mongbwalu, where MSF is responding to the epidemic, was put on fire. The next day, some of the young people in the community came to take the corpses of their friends, who were suspected cases of Ebola. The police were around and started shooting in the air.
All the team members were locked in the safe room. They’ve resumed the work, but this situation was tense.
Medical team from the Alliance for International Medical Action (ALIMA), an international NGO, dress up in personal protective equipment as they set up a treatment centre for the Ebola response.Gradel Muyisa Mumbere/Reuters
What’s your understanding of why this happened?
They are angry because they don’t have the real information. It’s difficult for them to believe that there is an epidemic, even though there are people who are dying in their respective villages.
It’s a place where there’s been fighting for more than 30 years, between the government and some rebels. There are 40 to 50 armed groups who’ve been in the region for years and years. The place is not developed; some of the health centres, they have some water, but sometimes no electricity. It’s not easy to live there – and now they have the Ebola epidemic.
What is some of the misinformation circulating?
People are all talking about “Ebola business” – that this is something that was brought from abroad to make money. At the beginning for them, it was not the real disease; they were more talking about witchcraft. We have to fight what we are calling the infodemic.
In this area, only 30 per cent of the population have access to the radio. Very few people have access to social media. It’s one reason why the right information is not getting to them.
UNICEF staff and airport workers receive an Echo humanitarian aircraft carrying medical supplies and personal protective equipment for the Ebola response at the Bunia National Airport.Gradel Muyisa Mumbere/Reuters
Other countries, including Canada, are implementing travel restrictions or bans. Front-line workers like yourself say this can hinder the outbreak response. Can you speak to this?
If each country is closing their border, then we are not going to get a handle on the situation.
Ebola is not COVID. Ebola is not an airborne disease. Contamination is through direct contact with the body fluid of a positive case. People have to understand this.
Right now, Uganda and Rwanda’s borders with the DRC are closed and we are not able to move our human resources who are coming to respond. We are not able to move medication. We are not able to move even tests for diagnosis from those countries. So yes, this is definitely negatively affecting the response.
It’s all going to take time – getting information, gaining trust, building capacity. But do we have time? This outbreak was identified so late.
Unfortunately, we don’t have time. We are definitely running towards the epidemic, so the epidemic is more ahead. We have to work hard.