Battling with mistrust and poor working conditions, health workers face a difficult fight against Ebola in DRC

The handwashing and temperature reading stations set up in the most widely frequented places in Goma and on the roads leading to other urban centres in North Kivu seem pitiful in the light of the threat that the Ebola virus represents. “I’m not sure it’s enough to protect me,” admits Guillaume Bisimwa, from Goma, as he crosses the Grande Barrière border post between the Democratic Republic of Congo (DRC) and Rwanda. He scrubs away, nonetheless. “Ebola is frightening, really frightening. We have experienced wars here, uprisings, armed groups… We know how to react to such threats. But when it comes to Ebola, we don’t know what to do. We don’t know who to turn to anymore.”

And understandably so: the Congolese government, first in line, is struggling to offer an adequate response of its own. The epidemic that hit west Africa in 2014 (killing over 11,000 people) demonstrated the importance of a strong, massive and rapid response. In DRC, however, the ‘reaction’ has been anything but fast. Checkpoints have been set up on roads to take the temperatures of those travelling. Their names are registered, so that anyone who has come into contact with someone diagnosed with the virus can be tracked down. But for those living in the heart of the infected area, in the rural parts of North Kivu, health workers are a rare sight.

NGOs specialising in healthcare, which are in no short supply in DRC, have been quick to try and fill the gap. But they are still struggling to make inroads. “Insecurity in the region is still a significant challenge for the Ebola response, as north-east DRC has been an area of active conflict for the past quarter-century and is rife with armed groups,” points out a report published by Doctors Without Borders (MSF). Medical teams are unable to access certain rural parts of the region, tyrannised by armed groups. The NGO, however, concedes that this is not the only obstacle to the response effort.

Locals caught between fear and anger

The local health authorities’ failure to act fast when the first cases were detected meant that a few dozen cases soon gave way to hundreds of deaths. According to the latest figures, from 13 October, there have been 2,150 fatal cases out of the 3,600 registered. Health workers on the ground point to the tough working conditions. “I have to make do with a salary of US$250. It’s nothing, given that I could be infected and die. I keep on treating people, out of a sense of duty. But I am not happy about working under these conditions,” says a local doctor from Beni, a town with over 230,000 inhabitants, in North Kivu. The poorly equipped health workers have paid dearly in the fight against the virus. At least 35 members of the field staff have been infected and died.

Between two consultations, the doctor insists that he should not be named. Ebola fieldworkers live in fear. In April 2019, Richard Valery Mouzoko Kiboung, a doctor from Cameroon, was killed during an attack on a hospital in Butembo. He had been sent by the World Health Organization (WHO), within the framework of the response to the outbreak. Ebola treatment centres (ETC) have been attacked, some with guns, others with stones.

That local communities should turn against those coming to their aid may seem surprising. But in a region that has been ravaged by war for the last 25 years as the international community stood by, practically indifferent, anything that comes from the West is viewed with suspicion.

The term “Ebola business” is often heard on the streets. And the concept is thriving as the number of foreign healthcare workers grows. In Beni, their brand-new four-wheel drives contrast sharply with the pain and suffering experienced by the local population since 2014. A mysterious rebel group from Uganda, the ADF (Allied Democratic Forces), has been conducting regular, deadly incursions. Each time, dozens of civilians are killed, either with guns or machetes, and yet no support has ever come from the international community.

It is against this tense backdrop that the sheer scale of the resources allocated to the fight against Ebola offends. “The international community is not coming to help us for our sake. They know that the virus spreads, and there’s a risk it will reach Europe and the United States. That’s why they’re moving in. But there’s no real will to help us,” says Etienne Kambale, deputy general rapporteur of a civil society umbrella group bringing together various associations from the region. “There is a strong reaction among the locals, who don’t understand how so much can be invested in fighting Ebola whilst complete indifference is shown to the machete massacres of the ADF,” adds Sylvain Kanyamanda, mayor of the city of Butembo (population one million), to explain the critical response to the arrival of ‘aid’.

The lack of a decent healthcare system fuels the spread of rumours

The contempt for the international community is feeding the spread of rumours. “Many don’t understand why people with malaria-like symptoms are being placed in Ebola treatment centres before dying a few days later. The conclusion they draw is that they caught the virus there. There are posts circulating on social media saying the virus is part of a money-making scheme for businesses in the West,” explains Charlie Mathekis, a teacher from Katwa, a town near Butembo.

The lack of a decent and recognised healthcare system has fuelled the spread of the virus and the rumours.

The fight against the epidemic is not helped by the fact that the local medical teams are treated differently to those from abroad. Local doctors are paid US$300 a month, on average, whilst foreign doctors receive between US$5,000 and US$10,000 a month, plus a per diem of US$150 for every day worked. The situation of other local medical staff also raises questions, with the average monthly pay for public health workers ranging between just 91,000 (US$55) and 115,000 (US$70) Congolese francs. “People are recruited to join the response effort and expect to earn a generous wage, like those working for certain NGOs. When they see their first pay, they’re outraged and they show it,” says Tchernozem Kambale, president of Congo’s largest national union, the UNTC. “And to make matters worse, their pay is sometimes late.” Wage arrears are commonplace in the public sector.

The far-reaching consequences of unpaid wages

The poor working conditions and the unequal treatment have been known to fire up an explosive response, such as a stoppage staged by frontline staff. In June 2019, provincial workers posted to Mangina, to the west of Beni, went on strike to demand the payment of substantial wage arrears. “We want our three months of unpaid wages. It’s our right,” protested the health workers. It took an outburst of rage from Freddy Mbayahi, vice president of the network of civil society groups in North Kivu, and a call to the WHO, to release the funds. His fear was that the virus would spread more rapidly if the prevention and diagnosis effort was not urgently resumed.

The late payments were all the less comprehensible given the announcements made by the WHO indicating that the funds were already available. The United Nations secretary general, Antonio Guterres, said as much during his ‘solidarity visit’ to Goma on 31 August 2019, when he stressed the importance of combatting the virus. For trade union boss Kambale, greater transparency is needed to answer for the gap between the amounts promised and the amounts received by most of the field staff, who often work for NGOs.

“We must end the secrecy behind the amounts paid out. Transparency will help to lessen the misunderstandings.”

In recent weeks, the spread of the virus seems to have been slowing a little. The Congolese president, Etienne Tshisekedi, has entrusted the task of coordinating the response to Dr Jean-Jacques Muyembe, the doctor who first discovered Ebola in 1976 and the current general director of the Congo National Institute for Biomedical Research. The fact that several cases were discovered in a major city like Goma also probably helped to shock the authorities into action, given the havoc that would be wrought by an Ebola outbreak in a major urban centre. Caution, however, is being exercised by all.

“Exemplary management of the funds allocated to the response is essential, and the workers must be treated fairly,” adds civil society representative Kambale. And above all, he concludes, a solution must be brought to the pay arrears problem. “It impacts terribly on the workings of our health system and the fight against the epidemic. Such dysfunctionality is totally unacceptable when Ebola has been declared a global emergency.”