The Ugandan communities a border away from Ebola

Kasese in Uganda is one of the communities near the border of Ebola-hit DRC. Photo by: hribisko / CC BY-NC-SA

MANILA — The Ebola outbreak in the Democratic Republic of the Congo will persist for at least another six months, World Health Organization emergency chief Peter Salama said recently.

As an Ebola outbreak in DRC gathers pace, neighboring countries are preparing for the risk that the highly-infectious virus could hit them too. This story explores preparations in Uganda. Read more about the situation in South Sudan and Rwanda.

While the virus has so far remained within DRC’s borders, that raises concerns for surrounding countries including Uganda, the closest of DRC’s neighbors to the epicenter of the outbreak in the northeastern town of Beni.

High levels of traffic at the Uganda-DRC border raise the risk of an Ebola spillover, while continuing insecurity in Beni is also a source of concern. Just last Friday, armed clashes led the DRC health minister to suspend operations for two days. Several peacekeepers were killed, and 16 WHO staff evacuated to Goma for psychological care after an unexploded shell hit their residence.

“I think we’ve done our best [to prepare for Ebola], but of course we cannot say for sure that our best is the best until it is tested.”

— Jane Aceng, minister of health, Uganda

Still, public health professionals on the ground in Uganda say the situation remains calm.

“You’ll be surprised, the people are very calm, and they are going about their business,” Benjamin Sensasi, WHO health promotion adviser in Uganda, told Devex. “They know we’re doing everything we can to protect them. We are giving all kinds of messaging via mass media to [advise] people what to do, and people are following,” he said.

The Ugandan Ministry of Health and its partners, including WHO, have set up isolation centers and currently require health worker screening on a daily basis. Surveillance is ongoing at the border crossing and in nearby communities. Uganda’s Minister of Health Jane Aceng told Devex that health workers have been given “adequate” personal protective gear and training in case the epidemic reaches its borders. In early November, the Ugandan government has also started vaccinating its frontline health workers as a preventative measure, reaching more than 300 of them to date.

The health minister believes the country has everything it needs for now, with partners filling in where there are gaps. The United Nations Children's Fund and the Ugandan Red Cross Society, for example, are supplying handwashing facilities to schools, local communities, and churches to promote good hygiene and sanitation.

URCS is also currently in discussion with the Ugandan Ministry of Health on supplementing safe and dignified burial teams, with technical support from the International Federation of the Red Cross and Red Crescent Societies.

The country’s national appeal has also received financial contributions from a number of donors, including CDC, the United Kingdom Department for International Development, and the United States Agency for International Development, although URCS argued that funding remains a challenge, especially as they deal with multiple emergencies in addition to Ebola.

Aceng worried about the impact of violence in DRC. “I don’t see the outbreak going down because of the rebel activities. It is difficult for the teams on the side of the DRC [border] to handle this Ebola outbreak effectively. And that keeps me worried because when they are not doing it effectively, then Uganda is at the risk of having Ebola imported into the country,” she said.

She told Devex Uganda and DRC will hold a joint meeting early next month to share updates on the situation and discuss how they can work together.

They are also working on setting up a laboratory station for screening at the border. At present, test samples have to be taken to the capital Kampala, which is time-consuming and expensive. “We have over 10 vehicles deployed to bring samples on a daily basis, and they keep on running to and fro,” she explained, estimating that at least 10 samples are delivered daily from the border alone.

“I think we’ve done our best [to prepare for Ebola], but of course we cannot say for sure that our best is the best until it is tested,” she said.

Risk communication

While there have been no confirmed cases of Ebola in Uganda to date, organizations are continuously sharing information and engaging with communities, both as part of their preparedness response and to quell any misconceptions.

A recent death from Crimean-Congo hemorrhagic fever in western Uganda, for example, sparked fear among residents of an Ebola outbreak, said Irene Nakasiita, URCS public relations and communications coordinator — so when the test results came in, they were relayed to the community immediately. “We try to answer any FAQs with high sensitivity and also as quick as possible,” Nakasiita added.

WHO’s Sensasi said risk communication is handled in two ways — first, through mass media, in particular radio, to inform communities on how to protect themselves from infection and what symptoms to watch for; and second, direct engagement in high-risk communities with groups or individuals.

“We’re also using the local leaders that people know. We give them necessary information and ask them to help us to directly engage. So in schools, churches, communities, they ask us questions and we try to clarify,” he said, adding that people are responding well to their advice.

Some of the most common questions raised are on protection and survival, reflecting people’s anxiety over Ebola, a disease with an average fatality rate of 50 percent, according to WHO. People want to know what treatment is available, and if Ebola centers really help.

As of Nov. 19, the death toll in DRC had surpassed 200, with 326 confirmed cases, and the case fatality rate is at 65 percent.

There is no cure for Ebola, although there are several experimental drugs being tested. Médecins Sans Frontières currently offers five of these in their arsenal of treatment options for patients in DRC.

Given these realities, how do responders address sensitive questions from communities about treatment and survival?

“We tell them that something is better than nothing … [Once] somebody has got the disease there’s nothing much you can do [about that], but it’s better that person is put on supportive care. And there have been cases where people have survived. Even in DRC, there are people who’ve survived on supportive care … Should something happen, we take care of people there and we do our best to save their lives,” Sensasi said.

Update, Nov. 23, 2018: This article has been updated to clarify the URCS is currently in discussion with the Ugandan Ministry of Health on supplementing safe and dignified burial teams, with technical support from IFRC.

About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.