Ebola Experts Say It's Time For A Radical Rethink Of Strategies In Congo : Goats and Soda Threats to health workers are prompting a radical rethink of the Ebola strategy in the Democratic Republic of the Congo.
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Threats By Text, A Mob Outside The Door: What Health Workers Face In The Ebola Zone

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Threats By Text, A Mob Outside The Door: What Health Workers Face In The Ebola Zone

Threats By Text, A Mob Outside The Door: What Health Workers Face In The Ebola Zone

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A text message that says stop or we'll kill you, a knock on the door in the middle of the night, leaflets telling your neighbors that you are the enemy - in the Democratic Republic of Congo, these are the kinds of threats that health workers in the Ebola outbreak zone have been getting for weeks now. Many of those threats have turned into violence, sometimes deadly. And NPR has confirmed another attack on an Ebola treatment center on the outskirts of the city of Butembo just this morning. Here's more from NPR's Nurith Aizenman.

NURITH AIZENMAN, BYLINE: On a recent afternoon in a village called Magherya, Dr. Joyeouse Kivwira was preparing her lunch when she heard a crowd gathering in front of her house. She looked out her window and saw a mob of high school students, many of them carrying rocks.

JOYEOUSE KIVWIRA: (Through interpreter) A horrible, angry crowd - lots and lots of people.

AIZENMAN: Kivwira has been the doctor at the government-run clinic for this village since December. She was shocked to see who was in the crowd.

KIVWIRA: (Through interpreter) They are the people from here, people I have taken care of when they were sick.

AIZENMAN: She grew up in this part of Congo, but she's not from this village. And after years of conflict between dozens of armed rebel groups and the government, people in this region are very suspicious of outsiders. When Ebola hit last August, rumors started swirling that the disease is a hoax invented by the government and foreigners to control the population.

KIVWIRA: (Through interpreter) People say that we - the local health workers - are getting money to refer patients to the Ebola treatment centers, where they are sent to die. The crowd was shouting that they should chase us out - even kill us.

AIZENMAN: Two teachers and an older man rushed over to defend Kivwira. They shouted to her to barricade her door, shut all the windows.

KIVWIRA: (Through interpreter) At that moment, I thought that this would be my death. I've never experienced fear like that.

AIZENMAN: She cowered inside for nearly an hour, listening as the men talked the teenagers down. As soon as the crowd dispersed, Kivwira fled the village - on foot.

KIVWIRA: (Speaking French).

AIZENMAN: Front-line Ebola workers have faced assaults on the job since the start of this outbreak. But the attacks have become more brazen. And increasingly, even regular health workers, like Dr. Kivwira, are targeted, often at home. The head of the area's doctors' association describes multiple incidents to NPR, including, in February, when attackers broke into the house of a government nurse while he was sleeping and made his wife watch as they shot him dead with a bow and arrow.

Karin Huster is an Ebola expert with the aid group Doctors Without Borders.

KARIN HUSTER: We need to really change the way we think about Ebola.

AIZENMAN: Huster was evacuated from the outbreak zone in March after two Ebola treatment centers run by the aid group were burned to the ground. She argues that the extreme distrust of authority in northeastern Congo has made the usual strategy for combating Ebola totally counterproductive.

HUSTER: Biosafety is still in the forefront - you know, biosecurity - you know, bio-everything.

AIZENMAN: As soon as a person shows symptoms, workers in hazmat suits whisk them off to a transit center for testing. If they have the disease, they're sent to a treatment unit that's even more isolated, all of which makes patients and their families understandably resistant.

HUSTER: It would be so much better if we could integrate Ebola inside of the health systems.

AIZENMAN: When someone shows up at the doctor with a fever, says Huster, why not just put them in a special room while they wait for their test results?

HUSTER: Without having the orange netting, you know, the things that scream Ebola.

AIZENMAN: And at the Ebola treatment centers, how about providing family members of the patients with protective gear and a little training?

HUSTER: And bring them in with their kid or with their dying mother.

AIZENMAN: If a patient still doesn't want to go, maybe consider helping their families care for them at home. It's not ideal, she says, but...

HUSTER: Somehow, whatever we're doing now is not working at all.

AIZENMAN: What does the World Health Organization think of these ideas? Dr. Michel Yao is leading the WHO's on-the-ground response to Ebola.

MICHEL YAO: We have a kind of open mind. We have to think out of the box.

AIZENMAN: In fact, he says, the WHO has already started letting some Ebola patients get their care at home.

YAO: It's not too many, but we have few experiences where people resisting to come to the treatment centers remain at home. We train relatives to take care of them.

AIZENMAN: And on Sunday, Congo's government announced they've now met with Doctors Without Borders about this, and they're exploring whether they can do home care on a bigger scale. They're also asking local people to decide who gets to bury the bodies and trace the contacts of Ebola patients instead of leaving the work to outsiders.

But meanwhile, every time there's an attack, health workers have to stop all operations until it's safe to go out again. The efforts to gain the community's trust grind to a halt, and new infections surge. There have now been more than 1,600 cases.

As for Dr. Joyeouse Kivwira, she went back to work for a week then decided it was still too risky.

KIVWIRA: (Speaking French).

AIZENMAN: She says, "I'm worried about the health of my patients, but we can't sacrifice our lives for a population that resists us - that's ready to kill us."

Nurith Aizenman, NPR News.


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