INTERNATIONAL – HIV/Aids, Lassa fever, and tuberculosis are just some of the communicable diseases that African health experts are used to dealing with, and many realized the danger of the coronavirus as soon as they saw the case counts rising in China and Europe.
Yet, of all the diseases the continent has grappled with, the worst-ever Ebola epidemic that killed more than 11,300 people in West Africa between 2014-16 was instrumental in changing the response to health emergencies in several African nations.
Lessons from that outbreak were applied to the Democratic Republic of Congo, which has been grappling with an epidemic since 2018.
Ebola prompted the Geneva-based World Health Organization to change its emergency response structure, while experts acknowledged the necessity of immediate research, rapid laboratory testing and changing the design of treatment centers. Many health workers in Africa say they learned valuable insights from Ebola that can be applied to today’s coronavirus pandemic.
Here are some of their stories.
Jules Aly Koundouno, 35 – Head of the coronavirus response at the Donka Epidemiological Treatment Center in Conakry, Guinea
Koundouno contracted Ebola at the height of Guinea’s epidemic in 2014 while working at the infectious diseases department of a state-run hospital. After his recovery, he returned to treating patients and has been at the front line of the country’s coronavirus response based on his experiences with Ebola. His team currently cares for 150 patients.
“I learned a lot when I was sick with Ebola — I suffered and saw how other people were suffering. As soon as I got out of hospital, I decided to make a real commitment to save lives. Earlier this year, when I saw the case counts increasing in China and Europe, I started preparing the health and administrative authorities in my city by giving them information and proposing control strategies.”
Koundouno was then transferred to Donka, where he instructed hospital staff on the use of personal protective equipment. Some nurses, he said, lacked basic training and only used face masks.
“In Guinea, some people trivialize protection, while during Ebola, protection was total. The protective equipment that we used during Ebola is the best protection against all communicable diseases — coveralls, gloves, goggles and masks. In addition, patients must be in individual rooms, but unfortunately that’s not the case at the moment. Ebola also taught me that you have to think about your own safety so as not to expose others. I haven’t lived with my family since I became involved in the coronavirus response and I’ve stopped seeing friends.”
While Koundouno said he can’t comment on the country’s financial resources to deal with the virus, he believes there’s no shortage of capable people to help fight the pandemic.
“We have unemployed graduates and retired doctors who can be called upon, and there are students at the end of their studies who are also able to intervene. But now it’s time to start preparing the towns outside the capital. Community workers are best-placed to raise awareness because people listen to them. If the government trains those intermediaries, the fight against the coronavirus will be a success.”
Dr Petronella Mugoni, 41 – Pretoria-based public health communications specialist who researched the community response during the Ebola epidemic in the Democratic Republic of Congo
“In Congo, women were more affected by Ebola for a variety of reasons: They have traditionally had greater participation in care-giving, child care and burial practices. They were also likely to be more resistant to accept health messages early on in the response. The assumption is always that, if you reach women with health information, you reach the whole household. So you need to find ways to engage creatively with women. In Congo, a lot of work was being done with hairdressers. If you educate them and get their buy-in, they can get that information to a larger public.”
“Covid-19 is an abstraction for many people. In the early stages, when each region in southern Africa got cases, a lot of time was spent debunking myths. ‘Covid-19 does not affect black people, Covid-19 is manufactured to kill black people, you can cure yourself if you drink a lot of alcohol’ — those were some of the things we saw on social media.”
“That’s why a standardized response on a national level is critical and the messaging has to be strong. Citizens need information on how to protect themselves. Prevention is the most important thing, because many African countries won’t be able to cope with a large public health crisis. We need to be able to trust the leadership of our governments in the pandemic response. Without high levels of trust, work at the community level will be very difficult.”
Democratic Republic of Congo
Trish Newport, 44 – Geneva-based deputy program manager for emergency response for Doctors Without Borders who worked in the Democratic Republic of Congo
“One of our local staff said when I asked her why surveillance and contact tracing wasn’t working: ‘If you had Ebola and someone that you didn’t trust came up to you and asked you for a list of everyone close to you so that they could go to their house every day for 21 days, would you do it?’ It was such a great explanation. We had all these tools, but they weren’t as effective as they could have been because we missed the first step.”
“We can’t do anything without having the trust and the engagement of the community from the very start.”
With an average fatality rate of 50%, Ebola absorbed so many resources in the health system that more people ended up dying from non-Ebola related illnesses. Newport had another colleague who previously lost her husband to conflict and two children to malaria.
“We have to ask people what their priorities are. Because if they don’t think it’s the priority, no one is going to support the response. My colleague said, ‘We didn’t have access to treatment, but then Ebola comes and then you all come here with all of your money to focus just on Ebola.’ Many, many more died of measles than of Ebola during the outbreak.”
“One of the things that comes to mind when thinking about Covid-19, is that the health system needs to be supported. It’s going to be overwhelmed. The positive is that there’s a lot of capacity that was built during the Ebola outbreak; doctors, nurses and logisticians who now have incredible experience with experimental treatments, vaccines, surveillance. But we have to make sure that there’s access to care.”
Dr Junior Ikomo, 33 – Referring doctor at the non-government organization Alima in Mambasa, eastern Democratic Republic of Congo
It’s been more than 120 days since his last Ebola case, though the epidemic continues elsewhere in eastern Congo, where it has killed more than 2,200 people.
“One day, they called all the medical staff to ask us about our psychological state. ‘Are there people who are stressed and could use a rest?’ Can you imagine, they asked if there were volunteers, people who were frustrated or stressed, they only had to raise their hand. No one did. We waited five minutes. I felt like we were all determined to save lives and there was this humanism that propelled us. I’ll never forget that.”
Ikomo was born and raised in the province that is home to the Ebola river that gave the virus its name, and he heard stories of the disease as a child. The Ebola epidemic has prepared many local communities for Covid-19, Ikomo says.
“The fact that the population already has the experience surviving the Ebola epidemic means we all know the standards and have the knowledge of preventive measures — using soap to wash your hands, no touching, the social distancing. These are things the community already mastered before Covid-19 arrived. I think this will help us.”
By Pauline Bax, Michael Kavanagh and Ougna Camara