Dr. Pablo Lwanzo is the head doctor of the Butembo Health Zone in North Kivu, Democratic Republic of the Congo (DRC). This zone, home to more than 200,000 people, was recently the site of the tenth Ebola epidemic in the DRC. Dr. Lwanzo spoke to PHR about how the lessons of combatting Ebola can inform the way his country addresses the COVID-19 pandemic.
I first encountered the Ebola virus in 2018, when I was overseeing the health zone of Butembo in North Kivu. It was chaotic in the beginning, with the threat of the virus looming over other provinces in the DRC and even the African Great Lakes region, more generally. Considerable efforts undertaken by the community and the government to sensitize populations and build the capacity of health professionals made it possible to overcome initial difficulties and fully eradicate the disease in the eastern part of the country. Now, as the Ebola epidemic nears its final stages in the DRC, North Kivu faces a new threat – the coronavirus. Thanks to the lessons learned in its fight against Ebola, the DRC is now better prepared to take on this new epidemic. However, many of the same structural challenges persist, impeding the DRC’s response.
Among the many issues my colleagues and I face is the limited availability of labs and tests. Currently, the only testing center in North Kivu is in the city of Goma, several hundred kilometers from Butembo. It takes far too long to ship the patient samples and wait for the results. Results for Ebola tests took only a few hours, and the rapid tests made all the difference in the fight against the disease, as they allowed the patient to isolate and begin treatment immediately, in turn reducing spread. For the coronavirus, test results take a few days. Reports indicate that, in the current pandemic, some patients are abandoning isolation centers because they are not receiving their COVID-19 status quickly enough. On top of issues with testing, we face a serious shortage of protective equipment, and health care workers aren’t adequately trained in how to treat COVID-19 patients.
“Thanks to the lessons learned in its fight against Ebola, the DRC is now better prepared to take on this new epidemic. However, many of the same structural challenges persist, impeding the DRC’s response.”
Another obstacle is the population’s resistance to following the necessary safety measures, including social distancing and wearing a mask. I believe this stems from a lack of accurate information about the pandemic. The misappropriation and abuse of aid and resources that took place during the Ebola crisis (which became known as “Ebola business”) further reinforces false beliefs about the existence or transmission of the coronavirus. My colleagues and I find it highly concerning that most of the patients that we see either express skepticism about the seriousness of COVID-19 or share suspicions that the virus was introduced in the community to advance certain political or financial interests. This widespread misinformation increases mistrust and at times leads to reckless behavior, both of which can increase the spread of the virus.
“Despite the challenges of providing care in such precarious circumstances, my colleagues and I remain committed to our oath as doctors to make every possible effort to save lives and heal people.”
Yet, faced with all of these difficulties, I believe it is still possible for the DRC to build on the successes of its Ebola response and set up an effective intervention model to fight the coronavirus. Due to the Ebola crisis, the DRC now has the professionals needed to respond to COVID-19 using a multisectoral approach. There are health structures that can ensure community sensitization, grassroots organizations that have the capacity to support affected communities, and response teams made up of local expert epidemiologists that are able to intervene early on in an epidemic. As was the case during the Ebola epidemic, the response to COVID-19 must be multisectoral. It must involve professionals from different fields who, when working in coordination, multiply their impact. This is why the Ebola response strategy implemented by the Congolese government involved not only health care staff (doctors, nurses, clinical psychologists, etc.) but also community leaders, political and administrative authorities and humanitarian workers, as well as members of civil society. This is far from the case in the current coronavirus interventions. Even more concerning to me is that contingency plans established by the health facilities in my own zone will be extremely difficult to operationalize due to a lack of material means and partnerships.
To effectively respond to this crisis, the following actions should be prioritized: 1) targeted trainings on COVID-19 for medical personnel and community awareness; 2) the provision of personal protective equipment (PPE) to prevent and control spread and to operationalize contingency plans (this includes rapid diagnostic tests, making the raw materials needed to produce PPE more widely available, strengthening contract tracing, and making health check points operational across all modes of transport); 3) the coordination of response teams that are pre-positioned in every health zone. Implementing these steps would allow for stakeholders from multiple sectors to work in concert under the leadership of the country’s health authorities, together strengthening the DRC’s fight against COVID-19.
It is an especially difficult time for health workers like me, as we witness the coronavirus spread in high-risk areas already confronting other dire health threats such as measles, cholera, and polio. Despite the challenges of providing care in such precarious circumstances, my colleagues and I remain committed to our oath as doctors to make every possible effort to save lives and heal people. I sincerely hope that the authorities incorporate lessons learned from the Ebola response as they tackle COVID-19, so that we don’t repeat our past mistakes and can prevent more loss of life during this pandemic. I also call on the international community to provide technical and material support to aid the DRC’s training efforts, increase access to lab equipment and PPE, and strengthen the country’s capacity to treat the most severe cases. This partnership will be crucial in ensuring the Congolese state provides a robust response to this pandemic.