Harrowing scenes are unfolding at health facilities at the epicenter of an Ebola outbreak in the Democratic Republic of Congo.<\/p>\n
A 25-year-old midwife and a doctor in his early 30s are sick with Ebola symptoms, including fevers and severe joint pain, said their colleague Elisabeth Furaha, the medical director at SOFEPADI\u2019s Karibuni Wa Mama Medical Center<\/a> in the northeastern province of Ituri.<\/p>\n They had cared for patients with similar symptoms in early May, before the outbreak was detected. One of the patients is now dead, Furaha said, and none of them has been tested for Ebola, even though samples were taken. The hospital still lacks access to tests, and an adequate supply of protective gowns and plastic masks to keep doctors and nurses safe.<\/p>\n \u201cWe live with fear in our stomachs,\u201d Furaha said, speaking in French. \u201cEvery day, there are healthcare providers and patients dying.\u201d<\/p>\n The outbreak took the world by surprise, with nearly 250 suspected Ebola cases and 80 deaths by the time Ebola was confirmed in Congo. Disturbed by the extent of silent transmission, and by cases in neighboring Uganda, the head of the World Health Organization sounded the group\u2019s highest alarm on May 17, declaring the outbreak a \u201cpublic health emergency of international concern.\u201d That triggered donations from around the globe, including a pledge<\/a> of more than $162 million from the U.S. State Department to \u201cstop the outbreak at its source and ensure Ebola does not reach the United States.\u201d<\/p>\n But despite international attention, doctors in northeastern Congo say that many clinics lack even rudimentary supplies: gloves, protective gowns, masks, Ebola tests, and even clean water. Without rapid action to bolster those on the front line, researchers say, the outbreak will grow exponentially, costing even more money and risking lives far beyond Congo.<\/p>\n \u201cAll signs point to this becoming the biggest outbreak we\u2019ve ever seen in the DRC,\u201d said Nahid Bhadelia, the director of Boston University\u2019s Center on Emerging Infectious Diseases. \u201cThat could lead to regional instability, and that has repercussions for the world.\u201d<\/p>\n Some supplies from the country\u2019s Ministry of Health, the WHO, and other United Nations agencies have landed in northeastern Congo, but not nearly enough to stock hundreds of health facilities where Ebola patients may seek care. Furaha has spent her own money on gloves, masks, and a tarp to build a makeshift tent to isolate patients with Ebola symptoms from the rest of the hospital. But she said it\u2019s \u201cinhumane\u201d to put patients there before she can afford a mattress for them to rest on, or reliable access to tests.<\/p>\n Without testing, patients who turn out to have Ebola can infect those who don\u2019t. Malaria and other diseases have initial symptoms similar to Ebola, causing fevers, soreness, and gastrointestinal problems.<\/p>\n Aid workers say shipments of medical supplies have been delayed by logistical hurdles, such as suspended flights within Congo and between Congo and neighboring countries.<\/p>\n \u201cWe need flights to move a lot of things, so this is a big challenge,\u201d said Chikwe Ihekweazu, executive director of the WHO Health Emergencies Program. Small planes used in humanitarian crises have been permitted to move, but Ihekweazu said those are insufficient, expensive, and unsustainable.<\/p>\n Moving between remote clinics can be an impossible task because roads are often badly eroded or blocked by armed groups, said Rafaramalala Volanarisoa, a doctor with Catholic Relief Services in Kinshasa, Congo\u2019s capital. Conflict, combined with the Trump administration\u2019s abrupt withdrawal of funds from the U.S. Agency for International Development, has made Congo\u2019s already ailing health system dysfunctional, Volanarisoa said.<\/p>\n \u201cIt\u2019s very dangerous,\u201d she said. \u201cThere is no medicine, no equipment, no surveillance.\u201d<\/p>\n Dilapidated Labs<\/strong><\/p>\n Researchers at Congo\u2019s National Institute of Biomedical Research had built a sophisticated molecular biology laboratory for surveillance in Goma, the country\u2019s eastern economic hub. But the lab stopped functioning last year after the Rwandan-backed armed group M23<\/a> violently seized control<\/a> of Goma and shuttered its airport<\/a>, stunting the flow of international aid.<\/p>\n Other cities in Congo lack well-stocked molecular biology labs, so they have instead relied on simple, automated tests that detect only one type of Ebola virus, said Eddy Kinganda-Lusamaki, a microbiologist at the biomedical institute. The shortcomings of these simple tests became obvious when the first samples tested in early May were negative for Ebola. Doctors were still worried, so they collected more samples, packed them in an icebox, and sent them to the institute\u2019s main lab, in Kinshasa.<\/p>\n It took the samples six days to get there, traveling over bumpy roads and between storage facilities, Kinganda-Lusamaki said, and many were degraded by the time they reached the institute on May 14. Still, researchers identified an unusual variety of Ebola caused by the Bundibugyo virus, with a fatality rate of up to 50% and with no vaccines or drugs existing to treat it. They alerted authorities.<\/p>\n Later, investigators traced the first confirmed cases back to several deaths from unknown causes in a gold-mining town in Ituri. The Red Cross suggests<\/a> Ebola was spreading there as early as March, with three of the group\u2019s volunteers dying of unknown causes after burying bodies as part of their humanitarian work.<\/p>\n As of June 3, 363 Ebola cases and 62 deaths had been confirmed in the country, according to Congo\u2019s National Institute of Public Health<\/a>. Tallies of suspected cases have fluctuated dramatically, a reflection of gaps in surveillance.<\/p>\n Researchers at the biomedical institute urgently want to improve labs in eastern Congo so they can test for Bundibugyo.<\/p>\n \u201cWe need support for local staff, training, equipment, consumables, and fuel,\u201d for cars and backup generators, Kinganda-Lusamaki said. He also worries that expensive lab equipment could be stolen or destroyed by roving militias if war is permitted to continue in the east. \u201cMy brothers and sisters are perishing,\u201d he said.<\/p>\n Conflict Aids Ebola\u2019s Spread<\/strong><\/p>\n Violence abets Ebola in other ways. As the outbreak was silently spreading in Ituri in late April, nearly 200 people<\/a> caught in the crossfire of armed groups fled, potentially carrying the virus with them. South of Ituri, Maurice Kakule Mutsunga, a doctor at a large general hospital, said he\u2019s seen a surge of people injured or killed<\/a> by members of the Allied Democratic Forces, an armed group<\/a> linked to the Islamic State. \u201cEvery day this week we\u2019ve received patients massacred by the ADF,\u201d Kakule Mutsunga said in French, adding that bodies carried into the hospital have been decapitated by machetes.<\/p>\n People displaced by attacks are living in dense quarters that provide perfect conditions for a virus that spreads through touch. A person sick with Ebola, or recently killed by it, excretes sweat, blood, and other liquids packed with viruses that cause the disease.<\/p>\n Unpredictable attacks have also prevented health workers from tracking down people who may be infected in remote villages, to offer them care and keep the virus from spreading to others, Kakule Mutsunga said. Less than a quarter of contacts that Ebola responders identified had been monitored for signs of infection, the WHO reported on May 21.<\/p>\n Contact tracing and isolation \u2014 the cornerstones of an Ebola response \u2014 are also fraught because of the slow turnaround time on tests. Kakule Mutsunga said samples from his hospital in the town of Oicha are shipped to Kinshasa on humanitarian flights that take off only once they are at capacity. Many patients can\u2019t or won\u2019t isolate themselves for a week while they wait on results, he said, so they may pass the deadly virus to those closest to them.<\/p>\n Congolese researcher Gang Karume said that scientific information about Ebola isn\u2019t reaching many communities, partly because of the trauma of daily life. On top of years of conflict, more than 220,000 young children are severely malnourished<\/a> in provinces where Ebola is spreading. He wasn\u2019t surprised to learn that angry youths have set fire to Ebola treatment centers and stolen corpses from morgues.<\/p>\n \u201cAn empty stomach does not have ears to listen,\u201d he said.<\/p>\n To reach people, the Catholic humanitarian group Caritas<\/a> is relying on its network of some 250 priests in Ituri. \u201cThey\u2019re deeply rooted,\u201d said Volanarisoa, with Catholic Relief Services, which partners with Caritas. \u201cThey understand how to approach communities who refuse to seek treatment.\u201d<\/p>\n Through this network, Volanarisoa and her colleagues have gotten in touch with health workers seeking medical advice and protective equipment. With private donations, the Catholic charities have transferred money to priests in the northeast who arrange for jeeps to carry cash and supplies to clinics.<\/p>\n \u201cWhat we\u2019ve provided will only last for a few weeks,\u201d Volanarisoa said. \u201cThe need is really immense.\u201d<\/p>\n Another crippling factor is that the United States is far less involved than in the past, aid workers said. The Trump administration left the WHO, dissolved USAID, and downsized the Centers for Disease Control and Prevention.<\/p>\n \u201cThe U.S. is just not the player it used to be,\u201d said Jeremy Konyndyk, a former USAID official who led the agency\u2019s response to the world\u2019s largest Ebola outbreak, in West Africa from 2013 to 2016. \u201cWe used to have a stockpile of gear for an Ebola response that we could throw on an airplane and get it to where it needs to go,\u201d he said.<\/p>\n The U.S. used to give hundreds of millions of dollars to the WHO and nongovernmental organizations with experience fighting outbreaks. Under President Donald Trump, the State Department has announced that it will give $350 million to a pooled fund maintained by the U.N. Office for the Coordination of Humanitarian Affairs, which will then distribute funds to aid groups.<\/p>\n \u201cThis adds steps,\u201d Konyndyk said. \u201cThe organizations that are ready to roll now are not confident that they will get money, so they\u2019re kind of frozen.\u201d<\/p>\n Even then, aid can take weeks to materialize on the front line. During the West Africa outbreak, more than two months passed between the WHO\u2019s declaration of an international emergency and significant help arriving. In the interim, the Ebola death count more than quadrupled. Nurses, doctors, and ambulance drivers lost their lives<\/a>.<\/p>\n Front-line workers in Congo face a similar fate if help doesn\u2019t arrive soon. Furaha said her hospital is running out of clean water. \u201cAll of this accumulates,\u201d she said. \u201cHealthcare workers will reach a breaking point.\u201d\u00a0<\/p>\n![\"Newsletter](\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\"){kind=icon}
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