Health Officials Chase Clues To Learn Why Ebola Is Spreading In Two Congo Towns : Goats and Soda Responders are zeroing in on an important source of new infections in the towns of Katwa and Butembo.

Why Does Ebola Keep Spreading In Congo? Here's A Major Clue

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Now an update on the Ebola outbreak in the Democratic Republic of Congo. There is a sliver of good news. Infections are down in some of the biggest hot spots, but the disease is flaring up in new areas, bringing the total number of cases since August to nearly 900. And NPR's Nurith Aizenman reports responders are zeroing in on a major source of these new infections.

NURITH AIZENMAN, BYLINE: Michel Yao is leading the on-the-ground response to this outbreak for the World Health Organization. Whenever someone's infected, his team goes through a checklist of questions like...

MICHEL YAO: Were you in contact with any sick person that have some symptoms like bleeding, like fever?

AIZENMAN: Say a relative you are taking care of or maybe...

YAO: Did you attend a funeral?

AIZENMAN: At traditional funerals, mourners often wash the body. But some weeks ago, as cases started erupting around two towns called Katwa and Butembo, the investigators found that patient after patient had something else in common. They had all recently visited a health clinic for treatment for some other disease like a respiratory infection or malaria.

YAO: They say, I went to the hospital that treat me. I got clear. And then a few days after, I start having fevers.

AIZENMAN: That were the first signs of Ebola. WHO officials estimate about one-fifth of the recent cases in Katwa and Butembo were infected at clinics. And when Yao started visiting the clinics, it was pretty obvious how this was happening. Even the government-run facilities, large hospitals, hadn't set up triage tents to separate possible Ebola patients from everyone else.

YAO: This disease is not well-known in this part of the country. It is the first time.

AIZENMAN: Even more problematic, says Yao, are the hundreds of unofficial private health facilities in this area. Some are huge operations, others are in a neighbor's house, and in those...

YAO: Sometimes the patients are crowded, in one bed putting two children.

AIZENMAN: They're also often short on equipment like surgical gloves and syringes.

YAO: You can see people using several time the same gloves or the same equipment.

AIZENMAN: Then there are the traditional medicines a lot of them offer.

YAO: These traditional medicines, they dilute it in water.

AIZENMAN: And put it in a cup, which Yao says often isn't cleaned before it's passed on to the next patient. So Congo's government and the WHO have mounted a massive campaign to reach out to each of these facilities in Katwa and Butembo, train them on infection control, provide them with the equipment to do it.

Dr. Cimanuka Germain is with a group called International Medical Corps that's helping with the effort. He says, at one private clinic, when he told the staff to refer suspected Ebola cases to a hotline instead of treating them...

CIMANUKA GERMAIN: The were saying this is not possible for us because what we are doing is money for our clinic.

AIZENMAN: We're a business. Then there's the facility where Germain spent days training nurses on how to set up and operate a trash tent. Two weeks ago, he showed up for a surprise visit.

GERMAIN: One of them was there without wearing gloves.

AIZENMAN: No gloves. For Germain, the takeaway was clear - even weekly visits were not enough. Since then, he's assigned to people from his organization to keep watch at the clinic all day, every day. And he's done the same thing for the 11 other facilities International Medical Corps is working with. He's confident it will work - eventually.

GERMAIN: To change someone's behavior, it's not one day or two days, but you need time.

AIZENMAN: Unfortunately, he says, in this outbreak, time is one thing we don't really have. Nurith Aizenman, NPR News.

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