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The Democratic Republic of Congo is at the heart of the 10th Ebola outbreak. Since the first case was reported in the city of Beni (north-east) in August 2018, nearly 800 cases have been confirmed in 19 different health zones and more than 500 people have died.
I have worked on four Ebola outbreaks in Africa and I have often found myself in delicate situations with locals who see foreigners with suspicion. During the 2014 Guinea epidemic, for example, my team and I were threatened by villagers who chased us with machetes.
It only took a few days in Butembo before I was surrounded by an angry mob shouting "kill him".
It only took a few days in Butembo, in response to the current epidemic in eastern Congo, before I was surrounded by an angry crowd chanting "Kill it" after refusing to allow our surveillance team to investigate a death in their neighborhood.
These experiences have taught me that keeping calm and talking with respect is the best way to defuse tense and violent situations.
But I was still not prepared for my first experience of direct confrontation with Mai-Mai rebel leaders to negotiate access to the Congo so that our health teams could reach the affected communities.
Since the epidemic that erupted in North Kivu province last August, health teams have realized that they will face great challenges. The virus had resurfaced in a densely populated and heavily populated urban area where about 100 armed groups operated, limiting the response. The risk of rapid geographic spread was very high.
Ebola is a highly infectious virus, and when a person gets sick, all the patients they come into contact with should be screened for symptoms.
As coordinator of the response to Ebola in Butembo, my role was to organize surveillance activities to search for these contacts as quickly as possible, that is, before they started to show symptoms. become contagious and spread the virus.
Very early in this epidemic, we had an idea of the seriousness of the situation. Six days after my arrival in Beni, the epicenter, we learned that 30 confirmed contacts of patients infected with the Ebola virus had fled to Butembo, about sixty kilometers away and where more lived. a million people.
Finding people who do not want to be found is not an easy task.
Finding people who do not want to be found is not an easy task. It is even more difficult when affected people live in inaccessible areas controlled by armed rebel groups, including the Mai-Mai – self-defense militias dreaded by local people due to years of crimes, including acts of torture, kidnappings and indiscriminate killings.
Less than two months after I arrived in Butembo, we learned that the body of an eight-month-old boy who died of Ebola was in the Mai-Mai village of Tinge. Since the risk of spreading the Ebola virus is more serious immediately after the death of a patient, I knew that we needed to have access to the people of Tinge, who were our only way to save lives and lives. avoid disasters.
I told our health teams and our international partners that we had to go to this village to vaccinate people. Everyone thought I was crazy.
Mai-Mai are known for being well armed and not afraid of the authorities. Even our national police and army do not dare to venture into some of these rebel-controlled areas. Only my driver and the owner – the nurse in charge of this health zone – have agreed to join this uncertain and risky mission.
The next morning, I got in the car without knowing if I would come back alive. After a 45-minute drive on windy roads, followed by a 35-minute walk on muddy forest trails, we finally reached Tinge. About fifty people were gathered under large dark green tarpaulins, crying the baby.
We were greeted by a woman who asked what we were doing in their village. I told him that I had to see the village chief because I had something important to tell him. She directed me to her house.
As an epidemiologist specialized in molecular biology, my colleagues jokingly dubbed me "the complete man" because I can perform all the tasks of the surveillance toolbox: investigate and validate alerts, take samples of cases suspects, and even test these samples in the laboratory.
However, in this situation, my skills were not very useful. We still needed to find a way to convince the skeptical local community to work with us and end Ebola.
On entering the house of the village chief, my heart was beating wildly. I had heard so many scary stories about Mai-Mai fighters that I did not know what to expect.
In the house, I saw five men at the dining table, waiting for lunch to be served. They were covered with amulets that the Mai-Mai used to protect themselves. The chief sat on a chair with large banana leaves under his feet.
To my surprise, when they saw me, they invited me to join them at the table. A woman brought me a small stool and hot water to wash my hands, before we used the pondu (cassava leaves), the fufu (cassava flour with l '# 1) 39; water) and a piece of meat.
My hosts remained silent, observing and analyzing my behavior. This is only when I started eating that the atmosphere is lit up. My hosts started to smile and talk. The chef said that they had appreciated my humility in agreeing to eat with them.
It was at this moment that our conversation finally began. They had never heard of Ebola or vaccination. I spent more than 30 minutes explaining to them the virus, how it spread, what preventative measures were taken, and how vaccination worked.
Without saying a word, the village chief came out and gathered the villagers. He said a few words in their local dialect while making big gestures. He then allowed the holder to list all those who had been in contact with the baby so that we could follow the chain of transmission. A total of 75 people came forward.
Before leaving, we agreed to meet the next day in a neutral area where vaccination teams and police officers would be allowed to come. Everyone arrived at 8am and our teams started to vaccinate.
Not a single person in this village has developed the virus.
After contacting the chief of Tinge, I was able to meet other Mai-Mai chiefs, including a group that controls the area between Butembo and the big city of Goma. I visited their village in December, where I spoke to a group of fighters for two hours, to answer all their questions about Ebola.
Later, at a meeting one-on-one with the chief, I called the Minister of Health and invited them to speak. The leader warmly thanked the minister for his commitment to ending the Ebola outbreak, ensuring that his fighters would not harm the intervention teams. A week later, I returned to the village with several boxes of medicine that the minister sent to the Mai-Mai to strengthen this collaboration.
Gaining confidence in such a deadly epidemic is always difficult. This has shown me again that respect, compassion and humility can go a long way, even saving your life and the life of a whole community.
(TOP PHOTO: Dr. Shako with Mai-Mai fighters after Ebola discussion and negotiations with their leader in Rutshuru CREDIT: Dr. Jean-Christophe Shako)
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