Additional Coverage:
- Exhausted health workers in Congo struggle to keep up as Ebola outpaces contact tracing (apnews.com)
NIZI, Congo – In eastern Congo, community health worker Gédéon Banga Ngbape and his team tirelessly comb through local neighborhoods each day, searching for individuals who may have been exposed to the country’s rapidly escalating Ebola outbreak-the fastest-growing in its history.
Their mission involves investigating numerous alerts, identifying those who have come into contact with confirmed or suspected cases, and ensuring symptomatic individuals receive timely care to curb further transmission. However, the outbreak is outpacing surveillance efforts. Currently, between 60% and 70% of new Ebola cases are detected only after patients exhibit symptoms, indicating many infections go unnoticed until after potential spread has occurred.
“If surveillance does not work well, the entire response suffers,” Ngbape emphasized. “Surveillance is the engine of a response.”
The epidemic has claimed over 2,200 lives among more than 4,700 reported cases, according to government data. This death toll has been reached nearly three times faster than during the devastating 2014-16 West African Ebola outbreak, which ultimately caused over 11,000 fatalities.
“We are chasing the virus; the virus is ahead of us,” noted Dr. Mohamed Yakub Janabi, WHO’s regional director for Africa.
In a move to bolster efforts, U.N. humanitarian chief Tom Fletcher announced an additional $30.5 million in emergency funding on Friday to help combat the outbreak.
Long Hours and Limited Resources for Response Teams
In Nizi, Ngbape’s teams receive between 60 and 70 daily alerts. They navigate communities to verify suspected cases, trace contacts, and direct those exhibiting symptoms to health facilities-a demanding job that often extends late into the night.
“I leave in the morning at 8 and return around 11 p.m., sometimes midnight,” said Ngbape. “I still have to follow up and plan the next activities. I feel really tired, but what matters to me is always being of service to the community.”
Despite their dedication, many community health workers face considerable challenges. Ana Ndroy Kasime, also a health worker in Nizi, highlighted the lack of essential protective equipment such as boots and disinfectants, which they often purchase out of pocket.
The outbreak is caused by the rare Bundibugyo Ebola virus, for which no approved vaccines or treatments currently exist, though trials are ongoing. The response faces further obstacles from unpaid health workers’ strikes, threats from rebel groups, community distrust, and misinformation denying the virus’s existence.
Nizi, part of Ituri province, bears the brunt of the epidemic-accounting for about 90% of the country’s Ebola cases and 80% of deaths. “We started surveillance with fewer workers,” said Ngbape. “The challenges are enormous.”
On Thursday, health workers at Nizi Treatment Center went on strike due to unpaid salaries, leading to a temporary closure. Africa CDC head Jean Kaseya urged the Congolese government to release overdue payments, stating funds are available and emphasizing the government’s responsibility.
The government explained delays stem from verifying payroll lists and transitioning from cash to mobile payments. Kasime mentioned that while community health workers receive approximately $50 monthly, this compensation is insufficient given the risks and workload. She stressed the importance of timely payments to all response workers to prevent further spread.
Security and Access Issues Hamper Surveillance
Surveillance efforts are further complicated by insecurity and displacement in the region. Ngbape described challenges in reaching remote areas due to poor roads and ongoing conflict. Frequent population movements related to mining and armed violence make contact tracing difficult, as people often relocate before follow-up can occur.
Eastern Congo is home to numerous rebel and militia groups, including the Allied Democratic Forces linked to the Islamic State. Violence and threats have forced some health workers to withdraw from high-risk areas to safer locations like the provincial capital, Bunia.
Hostility toward the Ebola response has also emerged from local communities, fueled by misinformation and restrictions on traditional burial practices, which have historically been a source of new infections. Several attacks on health facilities and workers were reported as of mid-July, including an incident in Nyakunde where a hospital and adjacent Ebola treatment center were briefly overrun.
Despite these challenges, Ngbape noted that his teams in Nizi have not experienced attacks and that cooperation has improved as community members grow more familiar with their work. He does not believe widespread concealment of cases is occurring, though movement and transport limitations remain obstacles.
For Ngbape, effective surveillance is crucial to stopping isolated cases from evolving into larger outbreaks. Despite exhaustion and scarce resources, his commitment remains unwavering.
“I am here to save the lives of the population,” he affirmed.