Ebola in DRC – Take Nine

May 24, 2018

In the world of disease outbreaks, knowing that there’s a problem, and finding the source of it, are two important components to helping governments and global health institutions know what to respond to, and how to do so.

The DRC is a country where finding diseases is particularly difficult—and especially important. It is home to 80 million people who live in an area the size of Spain, France, Germany, Sweden, and Norway combined, and shares highly porous borders with nine countries.

This May, a spark was lit. The Congolese Ministry of Health announced that another Ebola outbreak had occurred, its ninth, this time in Équateur province in the northeast of the country. By May 8, there were 21 patients with reported symptoms and 17 people had died; of five cases that had been tested, two were positive for Ebola. The Ministry declared that the outbreak constitutes a “public health emergency of international concern.”

But tracking diseases in DRC can be hard. Weak or non-existent cell phone and internet coverage can make it difficult for a far-flung health center to alert the Ministry of Health in Kinshasa of potential issues. Even if suspected disease outbreaks occur, the country has only one centralized laboratory, also in Kinshasa. Due to poor roads, transporting samples to the lab for testing can take days or more.

The DRC needs health workers who can spread throughout the country to detect and report on diseases early, before they become large-scale outbreaks. The Ministry of Health, through the Kinshasa School of Public Health and with the support of partners such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC), is training clinicians and public health specialists as disease detectives able to find, stop, and prevent disease outbreaks in even the most remote parts of the country.

The country’s Field Epidemiology and Laboratory Training Program (FELTP) began in 2013, with 77 associates completing the two-year program and another 50 currently enrolled. They are trained to identify, report on, and respond to some of the key threats to the country, such as yellow fever, cholera, Ebola, polio, and measles.

Graduates of the FELTP program were instrumental in responding to the 2017 Ebola outbreak in Likati health zone, Bas Uélé province, a remote region in the far north of the country. Three graduates were part of the first team of ten epidemiologists deployed to the site. They were tasked with sending patient samples back to Kinshasa, identifying others who may have been infected and observing them to see if they developed symptoms, and helping to coordinate the response on the ground. “They were responsible for very fast detection, and therefore very fast response,” explains Trad Hatton, the DRC country director for PATH, a global health NGO.

There were only five confirmed (and three probable) cases, four of whom died, in comparison with the country’s 2014 Ebola outbreak, which saw 38 cases (with another 28 probable cases) and 49 deaths. Both outbreaks took place during the 2013-2016 West African Ebola outbreak, which caused a reported 11,310 deaths in total. The country’s ability to identify the virus quickly, and respond quickly, was hailed by the WHO. The DRC also sent dozens of trained epidemiologists to Guinea during the 2014-2016 Ebola epidemic. These epidemiologists joined the US CDC team as equal members, and were invaluable in the disease control efforts.

Graduates are now working on responding to the current cholera and Ebola outbreaks. Although the disease has spread quickly, detection of cholera in 2017 was much faster than before, compared to the detection of the 2016 yellow fever outbreak, which went undiscovered for nearly two months.

The DRC has set up its first Emergency Operations Center (EOC) in Kinshasa, an arm of the Ministry of Health tasked with overseeing all emergency response in the country, from health threats to natural disasters. In order to function, it requires the expertise of FELTP graduates and similarly trained disease detectives to inform the EOC of potential outbreaks. “They identify potential events on the ground and communicate to the national MoH,” explains Hatton, who supports the EOC. “We need this information in order to move forward.” However, continued funding for the DRC’s FELTP program is threatened by proposed cuts to CDC’s budget.

Hatton sees efforts such as the EOC and the FELTP as stepping stones towards building a disease readiness system in the country, noting that this is not only important for the DRC, but also for its nine neighboring countries as well as the entire African region.

“We’ve built the fire station, but we haven’t yet trained all the firefighters,” says Hatton. “How can you shut down the operation when this is the site of potentially the biggest inferno?”

Photo credit: REUTERS / KENNY KATOMBE – stock.adobe.com