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
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
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
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 travelled to Congo on assignment for the International
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