In Bunia, the epicentre of the Democratic Republic of Congo's ongoing Ebola outbreak, surveillance teams face daunting obstacles while working to contain the virus.
Dr Moubarack Kano, one of 27 field investigators in the city, often confronts a shortage of vehicles, with only four cars available to cover 23 health districts serving a population of about one million. On one occasion, he used his personal vehicle to conduct surveillance rounds, carrying emergency alert forms and navigating unpaved roads.
During clinic visits, Kano discovered that health workers frequently fail to report suspected Ebola cases promptly. At a small clinic named "Jesus is Saviour," nurses were unaware of the specific alert numbers to call, despite the presence of patients exhibiting symptoms similar to Ebola, such as typhoid fever. The outbreak, caused by the Bundibugyo strain, lacks a vaccine or treatment and can be difficult to detect early.
At another facility in Nyakasanja, Kano found unreported cases including a teenager whose brother had died of Ebola. The reluctance to report cases partly stems from fears of losing patients—and consequently revenue—if they are transferred to treatment centres. Additionally, the cost of phone calls and insufficient staff to respond to alerts delay critical follow-ups.
Families sometimes refuse testing and isolation, as seen when a mother declined to have her two sick children taken to a treatment centre. Psychologists have been deployed to engage with such families to encourage cooperation.
Kano, who has experience from the 2018-2020 Ebola epidemic in Congo, notes that this outbreak response has been hindered by poor planning, logistical challenges, and the hiring of inexperienced personnel. Furthermore, many frontline workers have not received salaries since the outbreak was declared in May. The Ministry of Public Health and National Public Health Institute have acknowledged operational difficulties, with the Health Minister promising to resolve payment issues.
The surveillance teams continue their work despite these hurdles. At one recent site, officials in protective gear prepared a safe burial for a man who died from Ebola, while Kano compiled contact lists to track potential new infections. Yet, as Kano reflects, the virus often spreads ahead of their efforts to contain it.
