MANILA — The availability of an experimental vaccine is seen as a game changer in the ongoing Ebola outbreak in the Democratic Republic of the Congo. But some residents in the North Kivu province capital city of Goma, in particular women over 35 years old, aren’t so sure.
For starters, they don’t know what “vaccine” is, nor its equivalent in Swahili, “chanjo.” They only know of “ndui,” a Congolese Swahili term that refers to prenatal vaccines, Ellie Kemp, head of crisis response at Translators without Borders, told Devex.
“Women and older people [in Goma], the majority of them told us that they didn't have the information they needed to keep their family safe. That's a terrifying situation to be in.”— Ellie Kemp, head of crisis response, Translators without Borders
“That's the word they understand for vaccination, while men were more likely to understand the formal Swahili word for vaccination. But unless you know that and test the comprehension of some of these keywords ... then you could miss out [a significant part of] the population,” she said.
The findings are part of a new report by the NGO that surveyed 216 residents of Goma and engaged 75 others in a group discussion to assess whether the information provided by aid organizations on Ebola prevention is understood. The assessment was made in support of the ministry of health’s campaign to ensure the effectiveness of Ebola prevention and preparedness in Goma.
There are fears the virus might reach the city of more than 1 million people near the Rwandan border, making it even more challenging to contain the outbreak.
Kemp said insights on the language people use and in what format they most effectively receive information is crucial for the Ebola response.
“This is in Goma, which is a relatively well-educated, well-connected part of eastern Congo. Once you get into more deprived rural areas, you're going to find more people and more linguistically diverse areas [where] people struggle to understand communications in Swahili, written communication, and the formal kind of Swahili that is taught in schools,” she said.
“The risk communication needs to adapt to the local area if it's to be understood locally.”
What’s the French word for gums?
While the report only surveyed residents in Goma, it gave aid organizations insights into what works in Ebola prevention communication. This includes understanding that while French is considered to be the country’s official language, not everyone speaks it fluently.
During the focus group discussions, Translators without Borders found that most people didn’t understand some terms in a French-language poster that shows the different Ebola-related symptoms. This included words such as “sanglant” (bloody) and “gencives” (gums), which, in the poster, were referring to bloody diarrhea, vomiting blood, and bleeding nose and gums.
When asked how they refer to gums, participants used the Congolese Swahili phrase “nyama za mumeno,” which means “meat of the teeth,” or “bihanga.”
Some participants also did not fully grasp the meaning of some of the illustrations in the information poster. For example, an image of a man’s torso with reddish spots in the stomach area was mistaken by some to mean hot, or an upset stomach, when it was meant to show skin rashes.
This helped the NGO understand how drawings can be misunderstood, Kemp said, adding that some participants encouraged the use of photos instead of drawings. For some respondents, it may be a way to convince them that Ebola is real.
Another poster using Congolese Swahili and endorsed by the ministry of health and several aid agencies “was very widely understood” by focus group participants, Kemp said.
“So there are good things in place. It's about learning what's working and what's not, and then adjusting,” she said.
International Rescue Committee Country Director Sarah Terlouw told Devex the report will help inform the organization’s programs, especially as IRC prepares its teams in case the outbreak reaches Goma.
While the reason behind two attacks on MSF treatment centers in five days is still unclear, an MSF official argues Ebola response actors need to do better in gaining the trust of Ebola-affected communities.
“Knowing linguistic preferences will aid us to work better in North Kivu and may also prove useful to offer insights to improve IRC’s wider response beyond Ebola in the DRC. It is important to note that the key to resolving the epidemic will be through community engagement,” she said.
The report found disparities in language between demographics, reiterating the importance of targeted communication.
In the individual surveys for example, 21 percent of respondents prefer information spoken in French. However, only 48 percent of women understand spoken French. Many of them prefer Congolese Swahili, or their mother tongues, such as Nande, Rwanda, Shi, and Hunde. Only 48 percent of youth participants ages 18-34 can understand French.
“Women and older people [in Goma], the majority of them told us that they didn't have the information they needed to keep their family safe. That's a terrifying situation to be in,” Kemp said.
Why only now?
The report provides new insights that could aid in the Ebola response, but it also raises some critical questions. Kemp said this is the first language assessment they have done in Congo in relation to the current response. And they were only able to carry it out after receiving some support from a small group of organizations, such as IRC.
“To be honest, we've struggled to get the attention to the issue to enable us to carry out that initial research,” she said, explaining that they’ve tried to raise the issue of language since the outbreak was declared in August.
Words such as "gender" and "chlorine tablets" may be familiar to aid actors, but not to the communities they serve. Translators without Borders is on a mission to help aid groups find the right words to assist the Rohingya in Cox's Bazar.
Looking at the importance of language for effective risk communication is still quite new in the humanitarian sector. Kemp, who has worked in the sector for 20 years, said the aid community tends to disregard language as a factor of communication. Most of the time, aid agencies leave that to their national staff, assuming they “can handle the burden of communication in multilingual settings.”
But that needs to change, she said. During the Ebola outbreak in West Africa, the language used was mostly in English and French across Liberia, Sierra Leone, and Guinea. But only 13 percent of women in Sierra Leone spoke English, and literacy rates were below 50 percent across the region. In addition, there were over 90 languages spoken across the three countries, she said.
“So we need to make a starting point in a new major disease outbreak or in any humanitarian emergency, … to say, ‘OK, is language an issue here? Let's get the data and find out,’” Kemp said.