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Dedicated to the cause

By Didier Revol

Local Red Cross volunteers in northern Congo are risking their lives to contain the second outbreak in two years of the deadly Ebola virus.

"I see corpses everywhere. I go back to the hospital every day, but I know I have no reason to be there any more. I don't recognize myself anymore. Here, there is no medicine to cure bad thoughts," explains Adele. Deeply traumatized, she was one of only three to survive an outbreak of the Ebola virus in the hospital in Kéllé. Since the first death was recorded on 7 January 2003 in a remote village in the forest, more than 115 people from the districts of Kéllé and Etoumbi in Congo have succumbed to the Ebola virus amidst a climate of deep-rooted fear and superstition.

It began in November 2002 when hundreds of primates were found dead in a neighbouring nature reserve. The alarm was sounded, but three hunters from the village of Yembelangoye, unaware of the dangers, set off in search of gorilla meat. They were returning empty-handed when they stumbled across a dead chimpanzee, which they ate after briefly cooking bits of it wrapped in banana leaves. They died in early January. The people infected through contact with them unknowingly spread the disease to other surrounding villages. When the health authorities officially recognized the epidemic at the beginning of February, Congolese Red Cross volunteers were burying up to nine people a day in Kéllé.

Kéllé is situated in the heart of the equatorial forest, 850 kilometres north of the Congolese capital, Brazzaville. The army encircled the region, allowing only the movement of humanitarian and medical personnel. Churches and schools were closed. At all costs, the disease had to be prevented from spreading southwards to the capital.

"The epidemic would trigger anarchy and murder in an urban setting," says Paul Foreman, head of mission of Médecins sans Frontières-Holland. "How would you react to the presence of a disease whose origin is unknown, for which there is no treatment and for which the mortality rate is higher than 90 per cent?" The symptoms of Ebola give reason for fear: bloody diarrhoea, internal and external haemorrhaging and tearing of the skin on the slightest contact. Death occurs within days.

Deeply traumatized be her experience, Adele is one of the rare survivors of the Ebola virus outbreak in northern Congo.

Fabienne Ekere, a 29-year-old volunteer with the Congolese Red Cross, is burning beds
recently used by victims of Ebola.

Fighting local fears

The contrast between the richness of the region and the lack of schools and health centres is striking. "Clearly, these deaths are also the result of illiteracy and lack of infrastructure," asserts Dr. Virginot Kounkou, head of the Kéllé hospital. "Most people believe that Ebola is not a disease, but the curse of people who want to take possession of souls in order to acquire supernatural powers. Needless to say, messages of prevention are largely ignored," adds Kounkou.

The doctor admitted that even the hospital staff thought at first that they were dealing with malaria. Disbelieving and with little means of self-protection, two nurses and a midwife died in January. Red Cross volunteers, trained in 2001 in disaster management and epidemic control by the International Federation, worked hard to persuade the population to take simple measures to contain the spread of Ebola. "We owe a huge debt of gratitude to the 19 local Red Cross volunteers," says Gérard Eon, a World Health Organization (WHO) logistics officer who arrived in mid-February. "I would never have achieved as much as I have without their experience and dedication." For health organizations, which met with open hostility from the population during a previous outbreak in 2001, being able to rely on the volunteers was key. "As neighbours or relations, they were able to get close to the patients, speak to the families, handle and bury the bodies, and disinfect houses. They took unbelievable risks."

The 19 volunteers say they are lucky to be alive today. Lucky, yes, tired, undoubtedly. They buried more than 60 people under the scorching equatorial sun, without a word of thanks. The opposition they encountered from many of their fellow citizens also saddens them. When, at the beginning of February, a local witchdoctor accused four teachers of belonging to a sect called the "Pink Cross" and of practising witchcraft leading to the deaths of dozens of people, Kéllé was gripped by frenzy. The teachers were seized by the crowd and publicly executed with iron bars and machetes.

People confused the Red Cross with the "Pink Cross", a confusion further exacerbated by the fact that in Lingala, the local language, there is only one word for red and for pink. Shortly after the lynching, 70 per cent of the 6,000 inhabitants of Kéllé took refuge in the forest seeking protection against the epidemic and believing that the volunteers were spreading rather than combating the virus.

The hard task of containment

During the week of 17-24 March, only two people died of Ebola, showing that the painstaking work of the volunteers had succeeded. "Some people have realized that a curse cannot kill so many people all in one go," says Fabienne, a 29-year-old volunteer. "If someone is sick, the family informs us immediately and the person is put in quarantine to avoid contagion." Sadly, one man who died on 24 March had failed to heed the volunteers.

Dr. Steven Callens of WHO, who was at the patient's bedside before he died, instantly recognized the symptoms of Ebola. The young man, against all advice, had dragged himself outside where he collapsed in a coma and died a few minutes later. The volunteers promptly returned dressed in protective clothing, collected the deceased's body, burned his personal belongings and disinfected the house.

Each team is made up of five volunteers, four to carry the sick or dead person, a fifth to spray a chlorine solution over his or her colleagues and anything that might be infected. The protective clothing intensifies the heat: in no time the volunteers are bathed in sweat under their suits, their plastic goggles fogged up. Nerves are strained.

"This man had always denied he had been in contact with the disease," says Fabienne. "Yet he had carried one of his sick parents back from the forest on his back. He concealed his illness until the last moment for fear of being driven out of the community. And his relatives all say that they have not touched him. We know they're lying. This incident proves that many people still need to be converted. I can assure you that the outbreak is not over yet."

The traditions that have prevailed for centuries in this part of Africa have turned overnight into lethal habits. As Gaston Mbela, assistant to Dr. Kounkou, explains, "the family of the deceased washes the body and the mourners throw themselves upon it, kissing and hugging it in their grief. After the burial, people often wash their hands in the same bucket of water." Mbela believes that all these behaviours greatly facilitate the spread of Ebola. "The volunteers are always pointing out to the people of Kéllé the risks of such attitudes. And what of the people hiding in the forest? I am sure that they continue to eat gorilla meat and you know that this is how the Ebola virus was transmitted to man."

The International Federation is in the process of recruiting and training new volunteers, including in the zones that are as yet unaffected. "We are all delighted by the current lull," declares Yuma Twahiru, International Federation medical coordinator in Kéllé. "But we must remain vigilant and prepare for the future. A huge task of persuasion lies ahead if we are to change behaviour. I hope that in the days to come the volunteers will receive the recognition from their community they so richly deserve."

Didier Revol

Didier Revol travelled to Congo on assignment for the International Federation.

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