Community health workers in eastern Congo are struggling to keep up with the nation's fastest-growing Ebola outbreak, as the virus increasingly outpaces the efforts to trace its spread. Surveillance systems are failing to monitor a significant portion of new cases, with 60% to 70% of infections detected among individuals not previously being tracked.
“If surveillance does not work well, the entire response suffers,” said Gédéon Banga Ngbape, a community health worker in Nizi. “Surveillance is the engine of a response.”
The current outbreak has claimed over 2,200 lives out of more than 4,700 cases, a toll reached nearly three times faster than the 2014-16 West Africa outbreak. "We are chasing the virus; the virus is ahead of us," stated Dr. Mohamed Yakub Janabi, WHO regional director for Africa.
Daily Challenges for Health Workers
Ngbape and his teams investigate dozens of daily alerts, searching for exposed individuals and attempting to isolate symptomatic patients before further transmission. Their work often extends late into the night, with Ngbape reporting daily returns around 11 p.m. or midnight, followed by planning for subsequent activities. Despite the demanding schedule, he remains committed to serving the community.
Workers like Ana Ndroy Kasime, who educates residents and reports suspected cases, face personal risks. Kasime noted a lack of basic protective supplies such as boots and disinfectant, forcing some workers to purchase necessary items with their own money.
Complex Obstacles to Response
The outbreak is complicated by the Bundibugyo Ebola virus, for which no approved vaccines or treatments currently exist, although trials are ongoing. Additional hindrances include strikes by unpaid health workers, threats from rebel groups, community anger stemming from prolonged trauma, and misinformation that denies the virus's existence.
Nizi, a health zone in Ituri province accounting for about 90% of Congo’s Ebola cases and 80% of its deaths, faces particularly severe challenges. Ngbape mentioned that surveillance began with fewer workers and that the overall difficulties are immense.
Unpaid Wages and Funding Gaps
Health workers at the Nizi Treatment Center recently went on strike, temporarily closing the facility due to over three months of unpaid salaries. Jean Kaseya, head of the Africa CDC, called on the Congolese government to expedite payments, stating that funds were available and payment was a government responsibility. The government attributes payment delays to payroll verification and a shift to mobile money transfers.
While community health workers like Kasime have received payments, she considers the approximately $50 monthly stipend inadequate for the risks and effort involved. She stressed the importance of swift payment for all Ebola response personnel, warning that a cessation of work could exacerbate the epidemic.
Logistical and Security Concerns
Mobility issues, including poor road conditions and insecurity, further impede surveillance teams' ability to investigate alerts and follow contacts, especially in remote areas. Frequent population movements driven by mining activities and conflict displacement add another layer of complexity, as people can relocate before teams can respond.
Numerous rebel and militia groups operate in eastern Congo, including the Islamic State-affiliated Allied Democratic Forces, disrupting operations and forcing some aid workers to relocate to safer urban centers. Violence has also erupted from residents, with at least a dozen attacks on health facilities and workers recorded by mid-July. In one instance, an attack on a hospital and an Ebola treatment center led to temporary patient and staff evacuations.
Community anger is often fueled by misinformation and opposition to traditional burial practices, which can facilitate the virus's spread. However, Ngbape reported that his teams in Nizi have not faced attacks, and cooperation has improved as residents have become more familiar with their work. He believes that while population movements and transportation limitations can complicate contact tracing, people in Nizi are not widely concealing suspected infections.
Ngbape emphasized that sustained surveillance is crucial for preventing widespread transmission, and despite exhaustion and resource limitations, he remains dedicated to his mission. "I am here to save the lives of the population," he stated.