Celebrating Epidemiologists Anta and Ayumuna
June 25 marked the end of the 10th outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC), according to a statement issued that day by the World Health Organisation. The WHO noted in the statement that key to this success the leadership and commitment of the DR Congo Government, “supported by the World Health Organization (WHO), a multitude of partners, donors, and above all, the efforts of the communities affected by the virus.”
Dubbed the second largest, the 22-month long outbreak that was declared in North Kivu on August 1, 2018, registered 3470 cases, 2287 deaths and 1171 survivors. In other statistics, 250 000 contacts were recorded, 220 000 samples tested, and over 303 000 people were vaccinated with “the highly effective rVSV-ZEBOV-GP vaccine.”
Under the stewardship of the DR Congo Government through the Ministry of Health and supported by WHO and partners, this outbreak involved thousands of champions ranging from the patients, communities, and healthcare workers, among others. In Part 1 of the “Champions of the DR Congo Ebola Response” series, we showcase some of the champions that have benefited from our support especially through our field epidemiology training initiatives, starting off with two epidemiologists.
Mr Anta Mongosha Yvon
Yvon attended the field epidemiology training in Kinshasa from March 19 to September 25, 2018 with support from the African Field Epidemiology Network and the US Centers for Disease Control.
My contribution has largely been to support surveillance in the response to help break the chain of transmission of Ebola Virus Drive. I have done this largely through active search for suspected EVD cases in the health care centers and the Community (family home, traditional healers, prayer house, etc.); investigation of rumors and alerts; referral of suspected cases to the Ebola treatment center; as well as listing and following up of contacts of confirmed cases of EVD
However, we faced some serious challenges. We faced resistance in the community which lacked sufficient information on the disease. There was poor record keeping and poor filling of consultation registers in the FOSA. Some health workers were not adhering to some protocols. And the biggest of them all, the insecurity in the city did not allow the smooth running of activities.
Amidst these challenges, we could not just resign to fate. We had to think of a way out through intensifying the awareness of health personnel and the community, briefing healthcare providers on EVD, and building the capacity of providers. We also established an alert threshold to be raised in each health area, and in case of security we involved the local police to offer security though this proved difficult on some occasions.
What led to success?
I owe to the eventual massive support from the community and healthcare providers following the strong awareness which eased to ground for us. The frequent phone calls to my family and the rest days kept me sane during this time.
Dr Ayumuna Malasi Belinda
Dr Ayumuna was part of the 6th cohort of the Field Epidemiology and Laboratory Training Programme at the Kinshasa School of Public Health from 2018 to 2020.
During the duration of the outbreak, Belinda was based in Katwa health zone working in five health areas that included Sayo, Malepe, Ngongolio, and Mandrandele. In all these areas, Belinda was involved in active research, investigations, training and capacity building, community awareness, contact follow-up, and data analysis among other things.
She also had time at the Beni Ebola Treatment Center as a support epidemiologist and was involved in training of community relays in community-based surveillance. While at Beni, Belinda was as well involved in the briefing of health area personnel outside epidemics for their immersion.
Ably serving in all these places, you would easily assume that Belinda never faced any challenging moments as the virus ravaged North Kivu. On the contrary, language barrier, insecurity, a reluctant population, aloof partners, and non-favorable working conditions, were among the challenges that Belinda and colleagues faced.
None-the-less, Belinda says they had to find a way around their challenges to work towards achieving their goals:
“Learning the basics of the Nandé language and an effort to speak more Swahili than French or, if necessary, to be interpreted.
Regarding the security challenge, it was a question of strictly complying with the guidelines of the security committee, of limiting movement after certain hours.
Concerning the reluctance of the population, we engaged them in more dialogue and awareness-raising with the help of the political and administrative authorities, community leaders, leaders of religious denominations.
Regarding working conditions, we endeavored to take the necessary precautions not to expose ourselves and just to find our space.”
Belinda categorises these into two – “Training and prerequisites” and “Personal qualities.” Under the first category she lists “physician departure training, on-the-job training for emergency physicians, FELTP training, and some rudimentary knowledge of Swahili.” In the latter category, she underscores “empathy, ability to work under stress and pressure, ability to learn from failures and improve, strong collaboration with the locals, predisposition to work in a team, and great ability to communicate and maintain human relationships.”
Keeping sane away from family
Belinda shares some survival tactics that she employed and hopes others can learn a thing or two from her experience. According to her, despite the sacrifices, family lives have been affected regardless of the measures and precautions taken. However, to strike a balance she says “it is important to:
- Properly prepare and anticipate the family's needs before departure (provisions, need for a coach for children, needs for an additional nanny, etc.).
- Maintain communication with the family twice a day as much as possible, we have tried to encourage video calls.
- Always show signs of life in strong moments, of insecurity, unrest on the ground but also family illnesses, and mourning.
- Talk to the spouse and the children about the benefits of our presence in the field but also share some of the difficulties experienced.
- In short, keep spiritual, fraternal, and parental communion.”