BMJ: Ebola in Sierra Leone and DRC

27 August, 2019

Below are the citation and selected extracts of an article in this week's print BMJ (24 August)

CITATION: Ebola in Sierra Leone and DRC: lessons learnt

BMJ 2019; 366 doi: (Published 05 August 2019)

Cite this as: BMJ 2019;366:l5012

Mara Kardas-Nelson, journalist

MKN: In West Africa many ill people stayed in the community, and many did not seek treatment at all. Do you see the same in DRC?

Eugene Richardson: In Sierra Leone patients didn’t go to health facilities in part because there wasn’t enough staff to treat them. That’s not necessarily the case in DRC, which has four times the number of doctors per capita. But patients are still showing up to treatment units late and sometimes dying two or three days later. Or they’re not coming at all.

A Lancet Infectious Disease paper said this was due to mistrust, claiming that only 25% of people in the DRC believe that Ebola is real.4 The paper suggests that “conspiracy theories” are driving the epidemic, but that discounts a very real history of colonial exploitation: the brutal rule of Leopold II of Belgium in the 19th century, the fact that the country’s first democratically elected president was killed with the support of the US CIA in 1961.5

There’s a theme of people coming in a way that doesn’t benefit people in the Congo. So of course they don’t want to comply with outside forces. Rejecting intervention—it’s almost like a habitual reaction now.

People have been dying from malaria, measles, and armed conflicts for years, and there’s a sense that no one’s come to help. And then all of a sudden they see people from abroad with SUVs and money. They feel like all of this is being foisted on them. They feel like we’re the ones spreading Ebola...

MKN: The DRC outbreak has continued for a year. Why isn’t there an end in sight?

ER: I worry that a vertical, hypertechnical approach, with a focus on vaccinations and new drugs, is backfiring. It may be causing a lot of people to recoil. To access these new interventions people have to go through an ordeal of consent and paperwork. That does not normally accompany medical interventions, raising suspicion of ulterior motives.

I’ve been surprised to see how much refusal there is. In one village I visited, of a couple of hundred people, only eight people took the vaccine. I think this has to do with a habitual rejection that communities have as a reaction to depredation from Kinshasa and foreign entities over many decades.

Maybe we have to approach things differently. For example, we could consider paying people cash to get the vaccine, rather than assuming they’ll trust an outside force. We also need to provide high quality care across the board, not just for Ebola but for malaria, obstetrics, surgical services—things that people need every day.


Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: