LONDON — The night before her deployment to the northeast region of the Democratic Republic of the Congo, where an Ebola outbreak has killed 25 people and threatens the populous city of Mbandaka, epidemiologist Hilary Bower’s living room floor is organized chaos. Toiletries of all shapes and sizes, swollen first-aid kits, a pop-up mosquito net, a laptop, and pairs of well-battered footgear form an odd topography in the otherwise tidy room, all of it ready to be packed into a small rucksack and hauled to the airport at a moment’s notice.
“The preparation tends to be a lot of ‘hurry up and wait,’” she told Devex last week. Visa and logistics had just delayed departure for Bower and two of her colleagues — three of the 11-member UK Public Health Rapid Support Team, jointly run by the London School of Hygiene & Tropical Medicine and Public Health England, and funded by the U.K. government. Bower and her team finally departed Sunday, May 27, arriving in DRC about 24 hours later.
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Bower is no stranger to the deployment scramble. Since 2017, she’s been deployed five times, most recently to Madagascar and Ethiopia. She was also on the ground in Sierra Leone in 2014, during the deadliest Ebola outbreak, which in only 21 months spread across six countries, killing some 11,500 people.
“Ebola, regardless of whether it’s this size now or massive, it’s always worrying and therefore you need extra hands, and quickly,” she said.
Bower spoke to Devex about the logistics and preparation of a rapid deployment — she and her team are only given 48 hours to prepare — and gave her take on the humanitarian response in DRC, where she will support local and regional health teams as they track and contain the disease.
The conversation has been edited for length and clarity.
How common are these delays, and where exactly are you going?
The logistics of moving people in DRC is really challenging. Obviously with bases and helicopters and figuring out where people can be accommodated.
We’re guided by what the ministry of health in DRC wants us to do. The point of arranging the logistics now is because you can’t just deluge an area like that [with aid workers] or you end up with less assistance and more chaos. So we’re waiting on the visas and we’re also waiting to make sure we go in an organized fashion.
What are you expecting in terms of accommodation or sleeping arrangements?
One of the conditions you accept when you agree to work with the Rapid Response Team is a certain degree of “we’ll find out when we get there.” That’s partly because you don’t want to burden the people there — who are working very hard — with lots and lots of questions. You know when you get there things will be worked out, but you may not know in advance.
I know in Mbandaka, there will be little hotels or maybe larger hotels, in Bakoro and Mpenge, these are villages. I was talking to a colleague from the [World Health Organization], and they were saying that at the moment, people are bedding down in school rooms, so that’s why the pop-up mosquito net and the sleeping pad are important, because school floors are hard. [Laughs]. I’m fine as long as I have something between me and the concrete.
How else do you prepare for something like this?
We’re really there to support those people who fight this disease every time, and to give them this surge of moral and technical support to manage it.
Obviously, all of us have been watching, looking at all the background, re-familiarizing ourselves with the guidelines for Ebola, the preparations, the personal safety, but also the community messages. I actually worked in Sierra Leone during the West Africa outbreak, and another one of my colleagues worked in that field, so we’re fairly familiar, but these diseases depend on context and you want to be as well informed as possible. There are some anthropological reviews being put online for example that we’re looking at, because you need to know how the community feels about certain things.
I’m an epidemiologist, but all these things can affect how you go about your work, they can affect the people you work with, remembering that we’re not there as some standalone superheroes, that we’re there to support.
What makes a good team, in these deployments, and how do you quickly get to know the needs of the teams on the ground once you arrive?
We are 11 people [in the UK-PHRST], including epidemiologists, microbiologists, social scientists, clinical researchers, data scientists, and as a team we all know each other, though we haven’t deployed as a full team. Supporting each other and communicating is very important.
Again, in these situations, we work closely with ministry of health staff and their partners, so it’s really important in terms of teamwork to understand exactly what they need from us; to understand what they’ve been doing. They’ve been working on this since it was announced, so you have to understand that you’re not just coming into something completely fresh, and to be as flexible as possible to support them in that, so not to go in with a fixed idea of, “OK my job is x.” That flexibility is really important. You can’t just go in and join and say, “this is what I’m going to do.”