Curbing an Epidemic on the Move, Stopping Ebola in its Tracks

Travellers line up to cross into Rwanda at Goma’s busiest border point. Before crossing, every traveller is screened for symptoms of Ebola by IOM and partners.
Photo: Muse Mohammed/IOM

Goma – Everyday Bernadette Bita assumes her position at Goma’s border crossing point between the Democratic Republic of the Congo and Rwanda. With a thermometer and clipboard in hand, she diligently checks travellers for symptoms of Ebola before allowing them to travel onward.

“It is everyone’s responsibility to protect themselves and communities from Ebola until the disease is eradicated…I’m not only helping my own country but also our neighbour,” said Bernadette.

Bita Bernadette checks travellers for symptoms of Ebola before they travel from Goma in DRC to neighbouring Rwanda. Photo: Muse Mohammed/IOM

She works at the Grande Barrière Point of Entry (POE) screening point where she and other frontline workers check approximately 15,000 people for symptoms of Ebola daily.  A few kilometres away, an additional 65,000 people per day are screened at the second border crossing in eastern Congo’s most populous city.

More than 80,000 people cross the two border points between Rwanda and DRC every day to buy and sell goods in the market. Photo: Muse Mohammed/IOM

Throughout eastern Congo, hundreds of thousands of people earn their income from trading goods – ranging from timber to charcoal to pineapples – in neighbouring countries and between cities. Ongoing conflict throughout the country has displaced more than five million people.

Ease and freedom of movement within the DRC and across borders allows people to keep food on the table, put children in school, engage in the local economy, and seek refuge from violence.

It also adds an extra challenge to curbing the spread of a highly infectious epidemic.

Ebola has taken the lives of more than 2,000 people since the outbreak was declared one year ago.

According to the World Health Organization, cases have emerged throughout North Kivu, Ituri and South Kivu provinces, spanning a geographical spread of more than one thousand kilometres.  

Health screening points established at borders of Rwanda, Uganda and South Sudan and at busy transit hubs inside DRC, like markets or entrances to major cities, keep communities on the move safe from the spread of disease. 

“It is important that people can continue to move, trade and seek refuge freely. As long as borders remain open, people won’t cross informally and Ebola won’t go undetected,” said Dr. Patrick Kaliika while serving as IOM Uganda EVD Health Coordinator, at a POE on the border of Uganda where IOM screens travellers.

Thousands of people cross the Uganda/DRC border every day to engage in economic opportunities despite the threat of the disease crossing the border. IOM works with partners to screen travellers at 20 official Points of Entry screening points along the border of Uganda.

The International Organization for Migration (IOM) manages more than 100 POE and Point of Control (POC) screening points in Ebola-affected North Kivu and Ituri provinces.

Frontline workers employed by the Congolese Ministry of Health instruct travellers to wash their hands with chlorinated water to prevent transmission before checking each person’s temperature and other symptoms at POEs and POCs.

Frontline workers use thermal imaging on the border of Rwanda to check travellers for fever. Photo: Muse Mohammed/IOM
Travellers are encouraged to wash their hands with chlorinated water at health screening points in Ebola-affected areas. Hand washing is an effective way to kill the virus and prevent transmission. Photo: Muse Mohammed/IOM
The OPRP Point of Control screening point is located at a busy transit point along the road from Butembo, a hotspot of the disease,  to Goma where approximately 20,000 travellers are screened for symptoms of Ebola every day.  Photo: Angela Wells/IOM

“If anyone has a fever, I pick that up. As soon as I see anyone with symptoms (of Ebola), I pull them aside to get them to go through more checks with a medical professional,” said Bernadette.

Travellers are also cross-checked with a list of people who have been in contact with anyone infected with Ebola in the past 21 days. IOM recently installed 70 tablets at some points, allowing the Organization to share contact tracing lists faster.

A frontline worker cross checks a traveller’s identity with a list of people who have come in contact with people infected by Ebola in the last 21 days. Photo: Muse Mohammed/IOM

If a passer-by shows Ebola-like symptoms or is recognized as a contact, or a contact of a contact, they are asked to stay in an isolation room for onsite secondary assessment and counselling. If the alert is validated, they are transported to the closest health facility or transit center with capacity to handle suspected cases for vaccination and care.

A frontline worker at a Point of Control in Beni spreads messages about Ebola prevention techniques to people traveling through the endemic area. Photo: Muse Mohammed/IOM

As with most infectious diseases, early detection and proper health seeking behaviours are critical in eradication efforts for Ebola. The more access at-risk communities have to vaccines and treatment, the higher likelihood persons who contract the disease will survive.

 “When I meet people who have contracted Ebola, I tell them not to fear, because it is possible to survive, especially if they get treatment early. I cannot imagine that some people are suffering from Ebola and do not understand how they can get help. I tell my story to the community so that people will follow good practices to protect themselves and get treatment,” said Kavugho Ngitsi Giresse, an Ebola survivor who now works at a Point of Control in Beni, the epicentre of the outbreak.

Kavugho Ngitsi Giresse registers travellers at a Point of Control in Beni, the epicentre of the outbreak. Photo: Angela Wells/IOM

In addition to curbing the spread of the disease, humanitarian and health organizations grapple with constant insecurity. Throughout the country, violence often disrupts screening activities and compromises community engagement efforts.

“There are times we hear gun fire while we screen passengers and we have to vacate the premises which means passengers go unchecked,” added Fazili Abdurazaka, who manages a POC on the outskirts of Beni.

 “There is skepticism in the community about the reality of Ebola. Some people believe myths that it’s something created in a lab to make people sick intentionally. Armed ideological groups tell people Ebola is not real. If no one addresses the insecurity, we’ll stay here working with patients for a long time,” added Audrey.

Regine and Audrey are Ebola survivors and health workers at an Ebola Treatment Centre in Beni where they use their experiences to debunk misconceptions about the disease in the community.
Photo: Muse Mohammed/IOM

The disease has also emerged in areas with increasingly high levels of displacement. Ituri Province has seen 900,000 people internally displaced, many to areas where humanitarian and health organizations are unable to reach due to insecurity.

Veve Tosi fled to this displacement site in Ituri province in June after her village in Djugu territory was attacked.  Photo: Muse Mohammed/IOM

“We know there are confirmed cases in inaccessible areas. Luckily, as far as we know, Ebola has not yet reached any of the displacement sites, but if it does, infection rates would be higher because everyone is in close spaces. This would create a domino effect and complicate things much further,” said Dr. Eddy Tuyinama, an IOM doctor based in Komanda, a remote area of Ituri.

IOM’s Doctor Eddy Tuyinama monitors the health status of people traversing through a remote area of Ituri Province that has had little contact with outside humanitarian actors before the Ebola intervention began last year.

As the outbreak progresses into its second year, humanitarian organizations like IOM continue to work hand in hand with the government to intensify their efforts to stop the epidemic and address mass displacement.

IOM also helps partner organizations better understand movement trends in the area to guide the response to the spread of the disease. The Organization is also restructuring some displacement sites to meet minimum standards and constructing more Water, Sanitation and Hygiene (WASH) facilities, including water points in sites with geographic proximity to Ebola affected health zones.

Traffic flows on the road leading out of Komanda town west towards remote areas of Mambasa Territory in Ebola-affected Ituri Province. Photo: Muse Mohammed/OIM.

Even as the number of confirmed Ebola cases gradually decreases, the risk of the disease spreading to more populous areas in the region remains.

A more concerted international investment in preparedness and prevention efforts – and broader humanitarian response – is crucial if governments and humanitarian organizations are to effectively save more lives and ensure that the outbreak does not impact further the citizens of DRC and it’s neighbours.

This article was written by Angela Wells, IOM Public Information Officer for the Department of Operations and Emergencies