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Michel Yao says his work is very much like a detective's job.
Yao leads the World Health Organization's response on the ground to the ongoing Ebola outbreak in the Democratic Republic of Congo. And whenever a new person gets sick, his team has to fight to understand how she's been infected.
So, says Yao, "we ask the person a series of questions".
Step 1: Have you been in contact with a sick person with symptoms such as bleeding or fever? Maybe a parent you were caring for?
No? OK, did you attend a funeral? (At traditional funerals, people in mourning often wash the body, which is another way of transmitting the Ebola virus.)
Not yet? Well, have you recently touched dead animals?
But a few weeks ago, as cases began to appear around two cities, Katwa and Butembo, the investigators discovered that one patient at a time had something else in common: they had all recently visited a clinic for the treatment of another disease, such as a respiratory infection or respiratory infection. malaria.
"They said:" I went to the hospital and they treated me. [of that illness]. And then, a few days later, I start having a fever. "The fevers that were the first signs of Ebola.
The influx of confirmed cases in Katwa and Butembo – 307 and on the rise – is now the biggest push during this outbreak, which has infected nearly 900 people since the month of August. And WHO officials estimate that in about a fifth of recent cases, the person has contracted the Ebola virus in health facilities.
When Yao started visiting the clinics, the way this was going on was pretty obvious: even government-run facilities, such as large hospitals, had not set up tents to separate potential Ebola patients of all others.
"This disease is not well known in this part of the country. This is the first time, "says Yao, although the Ebola virus has erupted repeatedly in other parts of the DRC.
According to Yao, hundreds of unofficial private health facilities in the region are even more problematic. Some are big operations. In many other cases, says Yao, "it is only a house, a very old house".
And often a crowd to that. "In a bed with two children."
These facilities also lack supplies. "You can see people using the same gloves or the same equipment several times," including syringes, Yao said.
In addition to modern medicine, many institutions also offer traditional treatments. (Indeed, health officials generally describe these facilities as "traditional-modern.") And this also creates risks of infection, Yao said.
Indeed, traditional medicines are often diluted in water and placed in a cup that the patient can drink. Then he noticed during his visits, that the cup is often not cleaned before being passed on to the next patient.
In response to all these findings, the Government of Congo and the WHO are trying to contact each of these health facilities in Katwa and Butembo. In collaboration with various nonprofit support organizations, they train the staff in the fight against infections and provide them with the necessary protective equipment.
But it is a daunting task. It is difficult to find all private clinics because there is no official list, says Yao. Officials only know those reported by patients with Ebola.
Dr. Cimanuka Germain, of the International Medical Corps, who helps with the effort, explains that private clinics sometimes resist help.
For example, when he told staff at a clinic that he should report suspected cases to an assistance line rather than treating them, his response was, "This is not we are not possible. "
This facility treats about 65 patients a day, says Germain. They did not want to lose business.
Then there is the installation where Germain spent several days training nurses to set up and operate a sorting tent. Two weeks ago, he went for a surprise visit.
"One of them was there without wearing gloves," Germain said sighing with disbelief.
For Germain, the conclusion was clear: "Changing the behavior of someone is not [a matter of] a day or two days – you need time. "
He came every week – but from then on, he charged two people from his organization to look after the clinic all day. And he did the same for the 11 other facilities working with International Medical Corps.
Officials are optimistic about the effectiveness of the monitoring mechanism due to the success of similar efforts in the city of Beni, about 40 km from Katwa. Last fall, Beni was the epicenter of the epidemic, with cases finally reaching 200. However, in the last three weeks, the number of cases has fallen to almost zero.
Yao, of the World Health Organization, said that improving infection control in Beni clinics had played an important role in the change. However, Yao notes, "it took us more than two months to achieve these results."
Laurent Sabard, health coordinator at the International Committee of the Red Cross, who collaborates with health facilities in Beni, said they could not afford to give up anytime soon.
"We need to follow up continuously," he says. If only to make sure they did not run out of supplies. The thermometers donated by the Red Cross are of the thermoflash type that allows you to take the temperature of someone by touching it, Sabard notes. "But they have to change the batteries regularly – so we have to provide them with batteries regularly."
The insecurity reigning in the region is another problem. Many armed groups often face government forces.
Paul Lopodo of Save the Children – who works with 39 health centers in the epidemic area – recalls how much violence had prevented the group in December from enrolling in a public clinic for two weeks.
Upon their return, the staff was so untrained, says Lopodo, that "we had to resume training again."
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