Ebola diaries: Lessons from previous Ebola outbreaks help with the response in Guinea
Marie Claire Mwanza, a social mobilization expert
Marie Claire Therese Fwelo Mwanza, a social mobilization expert with 27 years experience at WHO, helped end 5 of the Democratic Republic of Congo’s (DRC) 7 Ebola outbreaks through effective community engagement. In 2014, Marie Claire played a role in bringing DRC’s latest Ebola outbreak to an end in 3 months. Then, she, and 60 colleagues she trained, went to Guinea to support the outbreak response there.
“In Guinea, there were rumours that blood was being sold. For us, this was déjà-vu. In the 2012 Ebola outbreak in Isiro and Dungu in Oriental Province, DRC, families hid their sick loved ones in the forest because of such rumours. These rumours instilled so much fear, the community revolted and attacked Médecins Sans Frontières.
Nearly 60% of the community believed the rumours, so we had to correct it. This was not easy, as we ourselves had only words to work with, but we knew what we needed to do: understand the rumours, find a way to gain the trust of communities and engage communities in helping to dispel the myths. This was similar to what would be needed in Guinea.
Understanding communities and tailoring messages
This is how we handled it in DRC: first, we had to understand why this was happening, so we trained 50 medical students – nurses – to conduct quick surveys in the communities. They reported that people heard, ‘when you go to an Ebola treatment unit (ETU), your heart is punctured and 20 litres of blood are drawn. Your genitals are cut off and your blood and organs are sold on the international black market.’
Equipped with this information, we redeveloped our messaging to better educate people about what was really taking place in ETUs, but the rumors did not go away. Why? Because people needed to see it with their own eyes.
Then, we invited 3 community leaders to visit an ETC. We dressed them in personal protective equipment (PPE) and took them into the Red Zone where they saw firsthand that patients were being given food, that they were not being killed or having their organs cut. After this, we invited them and Ebola survivors to go door-to-door with us and share their stories. Ebola survivors shared personal advice with their testimonies: ‘If you come quickly, you will have a better chance to survive. I was saved because I went to the ETU earlier.’ These testimonies rebuilt trust with the community, who then not only trusted us but even began bringing in the sick and collaborating to help find contacts. They now understood why it was important to go to an ETU.
It was the same thing for safe burials. Communities refused them. So we dressed a family member in PPE and took him with us to help bury his loved one. He saw for himself that we were not cutting out his loved one’s organs before burying him. This is how we stopped the 2012 Ebola outbreak in DRC in 6 months – through community engagement.
Nearly 40 years later, another outbreak in the birthplace of Ebola
In 2014, DRC faced its seventh Ebola outbreak. This time it was in Boende, in Equateur Province, about 1 000 km from Isiro. This province was the birthplace of DRC’s first Ebola outbreak in 1976. Using our experience, we were able to work together with communities to stop the outbreak in just 3 months. It was very interesting: how the communities themselves helped, how they even showed the surveillance teams where the contacts were and how they engaged with each other and with the authorities in this work.
In Boende, the response emphasized engaging communities in the contact tracing alongside the social mobilization and surveillance teams. We formed partnerships with the communities through dialogue and we gave them both the responsibility and the power from the beginning.
Encouraging active participation yields positive results
During this outbreak, there was a 7-year old with Ebola who was taken to a treatment centre. When he arrived, he saw ‘the cosmonauts,’ health workers dressed in PPE. He was so scared to see them, he always kept his eyes closed. When he survived, he happily returned home, but he still kept his eyes closed. His parents were sad and complained. They thought he had become blind at the ETU. WHO sent a psychologist and a social mobilization team to visit the family. The psychologist talked with the boy, who said he was scared to open his eyes. In the end, he finally opened his eyes and he could see.
In Guinea, we used a similar approach and took it even further. Not only did we engage communities to help with educating their neighbors about Ebola, we also encouraged them to actively participate in community surveillance and contact tracing. We trained 250 community members as surveillance officers and 25 supervisors for the active surveillance of Ebola in their communities.
We spoke with the community to help them understand the risks and to obtain their help in searching for and notifying us of suspected illnesses and contacts, visitors and deaths at the community level. First, we talked with affected families. We told them, ‘You have this sick (or deceased) family member. You do not want another one. To avoid this, we must list and find all contacts. Here are the dangers of Ebola that can happen to your family members if we do not find all contacts....’
It is very important to be compassionate during these conversations. Our conversations were careful and effective. Afterwards, families themselves created contact lists and helped contact tracers find contacts, even those located 50 km away. This made all the difference.”