Congo: The second largest Ebola outbreak in the world is unveiled

On the last Monday morning of February, three days before the fight against Ebola in eastern Congo escalated into a real war, Dr. Jean-Christophe Shako stood in the scorching sun of the Equatorial at Katwa, between eucalyptus and cornfields, in the smoking ruins of the Doctors Without Borders (MSF) treatment center.

Shako, the director of Ebola operations in Butembo, was appalled. The expression on his face reflected a mixture of anger and fatigue. Two deep wrinkles were formed on his forehead. He spoke softly. "People here simply do not want to accept that this disease exists," he said. "They think we are killing them with this vaccine, that our clinics are places of death, that the government wants to eradicate their tribe, the Nande".

In the night, about thirty men came out of the bush and attacked the MSF clinic with machetes, bows and arrows. The patients were evacuated. The attackers left behind them leaflets that said: "We have more surprises."

The clinic was about the size of a football field. Shako watched the devastation of the night before. Now she was littered with carved wooden skeletons, destroyed generators and a burning car. Three days later, Shako received a WhatsApp message informing him that it was time for him to die.

So close, and yet so far

Nobody knew where exactly the assailants had been in the clinic – nor what they had touched. Did they come in contact with a highly infectious cadaver? Were they now carrying the virus, passing it on to other people?

It was a disaster.

Shako is one of the most respected epidemiologists in the Democratic Republic of Congo. Since August 18, he fights the Ebola virus in North Kivu province on behalf of the Ministry of Health, heading operations in Butembo, the current epicenter of the epidemic. Under his leadership, employees of the Ministry of Health, the World Health Organization (WHO) and MSF fought the second largest Ebola epidemic in history. The only period during which the number of Ebola infections and deaths increased in West Africa was recorded between 2013 and 2016. It is also the largest epidemic never recorded in Congo, where the virus became a human host in 1976.

To date, 980 people have contracted the virus; of those, 610 people died. Unnecessarily. Because modern medicine has everything it needs to defeat the virus.

In 2015, towards the end of the outbreak in West Africa, a new vaccine was used for the first time in humans, with good results. Virologists were very optimistic. The vaccine, they said, was going to change the way the world sees the virus. In eastern Congo, where it is used for the first time on a large scale, it is considered extremely effective. To date, 87,390 people have been vaccinated.

The idea is to contain the virus using what is called ring vaccines. Anyone who may have been in contact with a patient with Ebola will be vaccinated. In this way, the virus is deprived of potential hosts – it has nowhere to go; he dies and dies of hunger. With the new vaccine, the victory would have been easy.

If only.

Epidemics are not natural disasters

Ebola doctors and nurses always wear protective clothing and gloves. The Ebola virus is very contagious. It is transmissible by blood, saliva, urine or vomit from an infected person. It can not be transmitted by air. As soon as the first symptoms appear, a sick person is contagious. more than half of the infected people die in agony.

Epidemics, as shown by North Kivu, are not natural disasters. These are products of human error. And there are few areas of the world where human failure is as marked as in eastern Congo. The "Great African War", which began in 1998 and has claimed more than 3 million lives, never really ended here – a conflict between the government and various rebel militias.

This is the first time that Ebola claims to be in a conflict zone of this type, making the fight against the epidemic so difficult. The virus has found allies in the region, neglected for decades. The more than 100 militias who massacre themselves for gold and coltan, money and power, terrorize the local population and rape thousands of women in the dangerous hills of North Kivu, have made it difficult for Eradication of the disease with the help of the vaccine. Ignorance and war became the criminal partners of the virus.

The disease is spreading to neighboring Rwanda or Uganda, transported across borders by people fleeing violence at home. Vaccination programs for endangered groups were launched several months ago in several places.

"Surrender," says Shako, "is not an option." He is one of the most experienced hunters of the Ebola virus. In 2014, during the outbreak of West Africa, he was sent to the most dangerous places. "I am here as a general commanding his troops," he said.

Helping people who do not want to be helped

From a wooden platform that smelled of gasoline, Shako looked at the remains of the warehouse where the vaccine was once stored. It was completely destroyed during the attack of the previous night. Small flames were still blazing here and there. His biggest enemy was no longer the virus, he says, "it's ignorance". The thinking of the people here is too much corrupted by witchcraft, conspiracy theories and political leaders who manipulate the virus for their personal purposes.

Shako hurried out of the clinic alongside the WHO chief and the mayor of Butembo. People had begun to gather in front of the barriers, watching the destruction with satisfaction. Shako was tired. He is a small, almost delicate man who tends to tilt his head slightly as he walks and has trouble hiding his anger.

He returned to headquarters to prepare for a meeting with leaders with Maji-Maji, the local militia. Maji means water; warriors are drugged with "magic" water before the fight because they believe, with many others, that it makes them invincible.

"I have to protect my people," said Shako.

As he was leaving, MSF employees wearing plastic goggles and rubber boots began decontaminating the treatment center buildings. The anger of the villagers grew.

"Leave already!" shouted a woman, grimacing.

"Ebola is a lie!" shouted another.

Gratia Kalungero, an award-winning young man dressed in a tight shirt and a slim blue pants, stood in the middle of the circular crowd.

Kalungero is one of the people Shako must protect: a so-called "risk communicator" with the WHO who studied psychology. He goes to the villages before the arrival of the ambulances to recover the bodies, before the arrival of the decontamination and vaccination teams. He also accompanies the teams when they go to the villages. He is there to prevent attacks and explain to locals that these people who wear protective clothing are not after their life, they try to prevent their death.

& # 39; This is a warning & # 39;

About 50 people surrounded Kalungero, maybe more. Half of the village seemed to be gathered in front of the clinic. "You can not attack clinics," Kalungero explained. "It will only cause the spread of the virus."

"We do not want your Ebola virus!" a woman shouted.

"You can not hide the sick," said Kalungero. "That's how you are infected."

Behind him was the deserted isolation room of the clinic. Protective suits are hanging from the hooks in empty rooms. The floor was covered with fragments of broken mirror. "They think the government invented everything to prevent them from voting," said Kalungero. In December, residents of Beni and Butembo were not allowed to vote in the presidential elections due to the epidemic. This has made the situation worse. Theories of conspiracy abounded.

According to an estimate from the Ministry of Health, up to 30% of people do not think that the Ebola virus exists. All that is happening is the work of the government, they say, carried out with a mysterious poison or witchcraft. Some accept the existence of the virus, but think medical teams spread it to make money. Others believe that it is a scam to collect their organs.

Kalungero went to his car. He was tired too. he had been working for months and was risking his life. He knew how ruthless the militias are. Kalungero comes from North Kivu. The 29-year-old knows this war since his childhood.

"The resistance against our teams is increasing," he said.

While walking, a choir of voices is raised behind him. "Iyi Mufano, "they called," This is a warning. "

To enrich Ebola

The next morning, just after 10 am, Shako was sitting in his car. Every morning he holds a preliminary meeting with all the NGOs involved. But the main topic discussed at today's meeting was not the three new Ebola cases of the previous day, nor the 12 cases of resistance to vaccination teams, nor the fact that only a small number of teams could leave hospitals. which need military escorts. No, for Shako, the priority was clear: do not let the virus take precedence over us.

"If you do not consider that they are too likely to tear you to pieces, get out of your car and do your job, vaccinate people, negotiate in every way possible, talk to the families, talk to the priests, talk to them. the world."

It's a vicious circle. The stronger the resistance, the more teams need to be concerned about their safety. But the greater the militarization of the operation, the greater the fear and resistance in the villages. Shako is not a fan of the escort. But he does not want to be responsible for the death of a member of his people either. "There is a war going on," he said.

The epidemiologist went to Vuhovi. The village and the surrounding area have been designated "red zone", a high-risk area. Many people who have been in contact with the latest Ebola patients here have been able to be located and vaccinated.

"If we lose those contacts," said Shako, "the virus is spreading and our efforts are in vain." The problem was that there was currently no doctor in Vuhovi's small clinic. It was too dangerous.

Six days earlier, a group of militiamen had claimed $ 1,000 (880 euros) from one of the nurses at the local health center. They accused him of getting rich with the Ebola virus. When the man was unable to produce money, the fighters dragged him into the bush and beheaded him.

Shako convened a meeting with eight Maji-Maji leaders from the region. "Once I've talked to them," he says in the car, "the resistance will decrease.They usually want money and some form of participation.In their eyes, the doctors earn a lot of money. Money now. " Shako's voice was hoarse. Like every night, he telephoned his wife on the phone in the capital, Kinshasa, about 1,600 kilometers away. Sometimes he just wants everything to be finished quickly so he can go back to the zoo with his kids.

Meeting with the rebels

The convoy passed Butembo. The city extends deep into the bush, extending for miles and on both sides of a wide asphalt road. Here, everything is pastel and seems to break down. Homes along the main road are often painted with advertisements for beer, soft drinks or mobile phone providers. Unlike Liberia, Sierra Leone or Guinea during the outbreak of West Africa, there is no banner or posters warning against the disease.

"It will not help me," says Shako. "People would demolish them immediately, it provoked them." He did not have an escort with him. Maji-Maji would attack them immediately.

Shortly after, he was sitting in a community center in Vuhovi, next to eight militia leaders. One of them was wearing a leopard-skin hat like the dictator Mobutu. Another was wearing an orange suit.

Outside, near a flagpole, the old policeman of the village bellowed a few notes on a trumpet, always the same. The most important thing, Shako told his people before the meeting, was respect. Maji-Maji does not like to be criticized. "Then they become violent, then they kill, or they will take us away," he said.

About 60 people gathered in the room, occupying wooden benches and plastic chairs. "Why can not you explain to your people how dangerous the disease is, I can not do it, you have the power here, more power than the president, I want you to use it."

The men nodded.

"Your weapons are useless in this battle, and with Ebola everything will get worse here," said Shako. Then the militia leaders spoke. One of them told him that doctors had come to his village and told people that the Ebola virus did not exist. These doctors were jealous of the salaries of the Ebola teams, he said, and were seeking revenge.

Another complained that people without Ebola are being brought to clinics. The man in the leopard-skin hat said that maybe they should let people die, so they might think the disease was real. Everyone laughed.

This lasted for a while, until almost all of them ask for money or jobs from their people. Then they would report new cases of Ebola. Then the situation could be controlled. Shako promised to return the following Monday. The Maji-Maji had to bring their men with them. Shako wanted to see how he could recruit those who can read and write.

"I think things will improve after this meeting," he said at the return. He is mistaken.

The pariah of the village: a father in mourning

But Shako must believe. Without faith, he could not continue. He used to be a priest, but he could not stand the sight of dying cholera children because no one in their villages was helping them out of fear of the militias who controlled the area. That's why he studied epidemiology.

On the way home, in a car different from the convoy, a WHO employee said, "It will not work."

The next morning, Kalungero, the man responsible for appeasing people, went down a narrow valley trail to the village of Makangala. The day before, a 21-year-old nurse died of Ebola here.

Kalungero had almost passed the fenced hole when the drums started. The villagers had started shouting menacingly on their corrugated iron fences. The arrival of the WHO team was punctuated by a strident rhythm. By the time Kalungero reached the two homes of the victim's family, more than 30 people had gathered on the black cliffs overlooking the heights. They silently stared the attendants into their protective clothing as they spread the dead man's business in the dust in front of the houses and sprayed a chlorine solution on the walls.

"Stop spraying poison," shouts a person from the top of the cliff. The father of the deceased was standing on the wall of the house. A sturdy man dressed in a red polo, he was tired and worried.

"Go away!" people shouted from above.

The father said that they had not recognized the virus in the hospital. That's why they thought the son had been poisoned. The mother had treated him with medicinal plants. The mother was now probably infected too. She sat apathetically under a tree. At one point, she got up, grabbed one of the pictures of her son lying on the floor and looked at her. Tears filled his eyes.

"It was only at his death that we recognized that it was Ebola.Now, I am the enemy of the village because I am in the middle of the day. have brought the Ebola teams here, "said the father.

Beside him, a blue plastic chair broke. He flinched. At first, he could not see the stones flying on him. Then Kalungero's hand rushed through the air and grabbed a piece of flying rock. Kalungero ran to the top of the cliffs and tried to calm the crowd. He told them that the government was not there to kill them, that there could be no government without the people. Then another punch was thrown at one of his colleagues. "Do not react," he says. He continued to talk to the enraged crowd. In the end, his team dared to leave. A fire burned behind the house. It was the last belonging of the victim. His mattress.

Ebola wins again

When Shako returned to the old Belgian hotel – his seat and his makeshift residence – after an early dinner on the same day, he was still convinced that the meeting with the militia leaders the day before had made the difference. At 5:30 pm, the muffled sound of the gunshots is heard: at first, there are only a few shots, then two turns at sunset. Shortly after, Shako stood in front of the wooden door of his residence and looked at his three cell phones.

"I need an armored car," he said. But the car was not found. The driver was getting drunk in a bar. "I can not wait!" He shouted. "I'm leaving now!"

He climbed into a silver Land Cruiser, still holding his three phones. The minister called. Shako spoke with a phone in each ear. His operation was in danger of collapsing. Then another phone rang. "They always shoot, I'm going now." He hung up. The car climbs the dark road lined with eucalyptus. Nobody said a word.

Dark blue police vans were parked in front of the MSF treatment center. The officers were still waiting on the beds, the outlines of their dark uniforms barely visible in the dark night. They stood there watching the center as if they were petrified. A policeman had just been beheaded behind the clinic. No one dared cross the destroyed grounds for fear of being infected.

Shako passed in front of the men. The fighting had calmed down, said someone. The attackers had disappeared. They unfortunately could not catch any. Later, it would appear that most of the police had fled when the attack began.

"Do not touch anything," Shako said. He passed in front of a charred MSF Land Cruiser, whose radio was inside. Sometimes he would beep. The warehouse had been almost completely burned. The air was filled with hot smoke from burning plastic. Voices could be heard in a stone villa with broken windows. Two men were removing the iron plates that had been placed in front of the door. Shako entered and saw the fear of death on the faces of the doctors and nurses who had barricaded themselves inside.

They remember how a machete passed the head of a Congolese nurse and crushed against a tree trunk. They hid, while dying patients fled panicked. Highly infectious people carried the virus from the center to the surrounding darkness; they ran home and brought Ebola back to their villages. A patient would be found the next morning in a nearby tree.

Shako snuck into the crowd. "What happened to the patients?" he asked an MSF doctor. Nobody knew. Shako went out, walked past the rooms with their open plastic windows. They looked inside with flashlights, calling the names of people, but almost no one answered.

There was a child lying in room 26. The doctor looked at his list. "Anita," he shouted. The child has not moved. Shako has stopped. He looked in disbelief. "Anita?" No answer. Shako's eyes filled with tears. For the first time, he lost control. "I'm going in. I can not leave this child here like that." His people could barely prevent him from bursting into the room.

A little later, Shako was standing in front of the isolation wing, looking at his phone. He opened WhatsApp and clicked on his wife's profile picture. He has long looked at the woman in a smiling orange dress. Then he wrote a message to his leader in Kinshasa. "Of the 38 suspected cases, 32 have fled.Of the 12 confirmed cases, four have fled.A dead."

The virus had won another battle.

"The dead can not save lives"

That evening, the MSF team decided to evacuate its white staff. There was rumor that whites would be kidnapped. At 10 am the next morning, they were on the track, west of the city, a small strip of red earth, waiting for the Russian helicopters from the United Nations World Food Program to fly away.

That day, one of the WHO's security officials said that protective measures needed to be significantly strengthened. There had to be more escorts, 180 men would keep the hotel from the WHO. United Nations peacekeepers would protect the headquarters and the army would look after the clinics. "The dead can not save lives," he said.

Shako told his superiors that they should give more to the local communities: wells, hospitals and schools. It was like that. They had to bribe the locals to prevent them from sabotaging their fight against the virus.

Three days later, the treatment center was reopened under the Congolese authority. In a statement, Doctors Without Borders criticized the deployment of police and armed forces. According to MSF, it only serves to alienate the surrounding communities, adding that this is counterproductive because the epidemic is not under control.

On the night of the attack in Butembo, Shako was standing in front of the isolation ward. A laborious coughing sound could be heard from the inside. A dying baby was evacuated. Then Shako's phone vibrated. A colleague in Kinshasa warned Shako that the rebels had threatened to burn his hotel tonight. The rebels had threatened to kill him too.

He went back to his hotel. As he remembered later, he spent the night talking to his wife. Neither United Nations peacekeepers from Tanzania who promised to guarantee his safety, nor the Maji Maji, came that night.

Early in the morning of March 9, the Butembo clinic was again attacked. On Thursday, another clinic near Lubero was also.

Shako perseveres. He meets rebel leaders. He negotiates.

He tries to explain it.