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Ebola crosses a porous border



Medical staff at the Ugandan border

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Health workers assigned to the borders of DR Congo and Uganda

This week, the Ebola virus has moved from the Democratic Republic of Congo to Uganda, but there is reason to hope that it can be controlled on this side of the border, reports Olivia Acland.

On Monday morning, a family was traveling from the Democratic Republic of Congo to Uganda after the funeral. The grandfather had died of the Ebola virus and his daughter had left a few weeks earlier in the country to try to cure him.

By the time the family approached the Ugandan border, most of them were suffering from high fever and diarrhea. They stopped at a clinic and were put in isolation while waiting for tests. But after dark, six family members, including a five-year-old boy, escaped from the clinic and began a desolate and poorly monitored road crossing in Uganda. A few days later, the boy and his grandmother had died.

Health officials have long been concerned that the Ebola outbreak could cross the porous border in Uganda. The border is over 500 miles long and many crossings are informal – sometimes just a few boards laid on a shallow river. An incessant stream of traders, baskets of eggs on their heads or chickens swaying on the ground, moves every day across the border.

The Ebola outbreak in five graphics

One of the main reasons why it has been so difficult to contain the disease in DR Congo is because it spreads in a conflict zone. Some 120 armed groups are hiding in the jungle-covered hills in the east of the country and regularly go out of the bush to abduct or rape civilians. They make money by smuggling minerals like gold and coltan, used in cell phone batteries, or by looting villages and stealing cattle.

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Bury the dead in Butembo

To further complicate matters, the local population has little confidence in the authorities and their ability to respond. Health workers often travel with armed escorts, which gives rise to suspicion. And when impoverished villagers see fleets of four-on-four demolish their roads, they talk about Ebola business and are jealous of the money poured into the response.


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Last month, I visited Butembo, in northeastern DR Congo. This ravaged region is known as the "Ebola Zone". People there said they thought the disease had been deliberately bought in the area so foreigners could benefit from it.

Since the beginning of the epidemic, there have been more than 100 attacks against health workers and Ebola treatment centers. Some were spontaneous, fueled by mistrust and jealousy. Others, such as the fire treatment centers, were premeditated and organized by rebel groups. Their purpose and agenda are unknown.

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Olivia Acland

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A burnt treatment center in Katwa, near Butembo

When I was in Butembo, I visited an Ebola treatment center and spoke to a patient on the other side of a plastic window. She told me that she was there, clinging to the drip, when the rebels attacked but were too weak to flee. She said that she had heard them shout "Get the matches!" and then felt the heat of the fire. She was lying there, thinking that she would die until a nurse, who had run away, came to rescue her 40 minutes later. Fortunately, the tents where patients stay have been spared and most of the center has since been saved.

At present, one in four people with Ebola in DR Congo do not show up in treatment centers. This is partly due to mistrust and partly to fear – both disease and rebel attacks.

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Olivia Acland

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Health workers in DR Congo dressed in protective clothing

DR Congo may be struggling to manage the spread of the disease, but when the dreaded announcement of the spread of the virus at the border was announced, Uganda did not delay in act: 4,700 health workers in 165 hospitals have already been vaccinated. Markets close to the border have been closed. Religious gatherings have been suspended. People make an effort not to touch each other and handshakes are turned into elbows or waves.

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Olivia Acland

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The sterilized boots are put to dry in the sun

In reality, it takes more than a clammy handshake for the disease to spread. A patient infected with the Ebola virus can only transmit the virus if its liquids enter another person's body through broken skin, mouth, nose, eyes or other holes. As the disease causes diarrhea and makes you sweat, bleed and vomit, those most at risk – by far – are those who take care of the sick.

In Uganda, the fight against Ebola will be determined by the government's ability to win the trust of the people. The country is not torn by conflict, like its unstable neighbor, and has a more robust health system. For the moment, at least, it is hoped that the disease will be contained in Uganda.

Olivia Acland is the correspondent of the economist in DR Congo

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