Ebola: Stubborn and Stigmatized
When West Africa was declared Ebola-free in January 2016, the international community vowed to never again allow a weak health system threaten global health security. Thus, unprecedented attention and funding were allotted to high risk pathogens. Three years later in the (Democratic Republic of the Congo) DRC, many of the lessons learned were in vain as the second-deadliest outbreak of the Ebola virus was declared an international public health emergency in early July as the White House recently barred US officials from entering affected zones. This is only further complicated by a strict and inaccurate interpretation of the Trafficking Victims Protection Act resulting in the withholding of non-humanitarian assistance.
The current outbreak, according to a July WHO report, has killed more than 1,500 people while infecting over 2,300 individuals. Ethnic- conflict has hindered the response to the current outbreak, but pales in comparison to the role of distrust. As the virus spreads to Goma, a city bordering Rwanda, the global health community anticipates little international support despite increasing public panic
Despite dire potential consequences and new challenges facing the current outbreak, international funding does not compare to the epidemic of 2014 due to Trump’s proposed global health budget cut and significant reductions in the CDC global health security initiative. Thus, the role of non-governmental organizations (NGO) is crucial to containing the infection and preventing further spread. Humanitarian organizations tend to garner a more positive response from local communities due to their established relationships within the community and their ability to provide messaging tailored to the society.
I recently spoke with Kirk Prichard from one such NGO, Concern Worldwide, an organization that is on the ground in the DRC and over 20 other countries protecting the health, education, and livelihood of the poorest and most vulnerable. Prichard, Concern Worldwide’s US Director of Humanitarian Programs, characterized Ebola as “stubbornly persistent and stigmatized.” Typically, the endemic nature of this virus will cause it to flare up and burn out. However, its stubborn nature confused health officials when they mistakenly thought the virus was under control in February. The current outbreak presents far more challenges and hurdles for those on the ground than the previous, but larger outbreak, from 2014 to 2016. Prichard paints a complex picture of the community lacking faith in health officials while high levels of violence prevent aid and messaging from arriving to the ill.
Concern prioritizes messaging as its most important mission in the fight again Ebola due its highly contagious nature. Ebola is easily transmitted through bodily fluids. Thus, the careful handling of an infected body postmortem is crucial to preventing further spread to family and friends. Many ritual burials and practices, such as the washing of bodies and public funerals, remain the norm in the DRC even after the vast impact of the 2014 outbreak. Hand washing and general sanitation is also vital part of Concern’s messaging campaign in terms of preventing transmission and maintaining good hygiene, but the lack of safe drinking water greatly complicates this need. Better information saves lives and is vital in combatting Ebola, but the lack of faith in health centers and officials has prevented these messages from reaching locals and causing lasting change.
Many in the DRC believe that health care workers may have brought Ebola with them, while others believe it is a means to financial gain or a strategy to eradicate the local population. These narratives prevent the international global health community from gaining insight into the outbreak since individuals may refuse to take the ill to health care facilities. The idea that an arrival at such facilities causes death may be more dangerous than the virus itself. Prichard believes that the relationships between NGOs and community elders is imperative to changing this narrative within the local population.
Ebola is stigmatized and associated with death, panic, and the unknown. This false association should not stop the international community from caring for the vulnerable and infected with compassion and dignity. This stigma is unfounded as two vaccines are on the horizon and transmission is known. This is why messaging regarding Ebola is just as important internationally, as it is within the local affected communities.
Militia violence directed at health care officials, as well as civilians in the epicenter of the outbreak is hindering support and containment. In April, an attack on a hospital in Butembo killed a Cameroonian epidemiologist working for the World Health Organization. This type of violence has caused a variety of relief organizations, such as Doctors Without Borders, to leave. “Before this attack on Wednesday, leaflets of May-Mai militia were circulating to tell the teams of foreign doctors to leave the region as soon as possible before the worst happens,” Butembo Mayor Sylvain Kanyamanda told The Associated Press.
The current Ebola outbreak response is not only about the DRC, but about the world’s security and welfare. If international funding reflected this belief, the current outbreak would have been contained months ago. All is not yet lost, as Concern Worldwide and many other NGOs work tirelessly despite the numerous obstacles. “…there may be a lot of problems and people think they have been forgotten,” Prichard said. “And then I see Concern’s little green sticker on a pickup truck, or our sign on a tent, and I think there are still a lot people out there who care about humanity and helping those in need…”