At midnight on my second day home, water poured from the faucet and woke us up.
After thirty minutes, a dry tap again.
I had arrived in my home town of Bukavu in Eastern DRC during the dry season, just days before the Ebola epidemic spread to my province. I travelled from the US, where I live, to prepare my family and community for the imminent threat of Ebola. I had heard about a conflict between the international response to the outbreak and the communities it aims to serve.
What I found was an urban community without running water. We know that people who live in poverty are at higher risk of infection with Ebola. We also know that hand washing is a cheap first line means to protect oneself from Ebola and other pathogens. I am a physician, and in our house we had thirty minutes of running water in two days. How could I help protect my family? Mothers in the neighborhood are resourceful, trekking across ravines of an urban jungle to a water point on a steep hillside to fill jugs of water to carry home to protect their families as best they can for cooking, drinking, bathing, and hand washing.
I went with a team of physicians to a cholera treatment center at the Provincial General Hospital, where I managed an urban cholera outbreak several years ago. Nurses I worked with at that time remain, currently treating patients with cholera as best they can despite not having access to oral rehydration solution. Oral rehydration solution is among the cheapest and most effective life-saving treatments for diarrheal illnesses. We went to the hospital just as patients in our city do: by public bus where passengers were packed like sardines and sweating profusely. We know that Ebola virus is carried in sweat and we cringed because we had no choice but to contact the sweat of others, while we watched Land Cruisers of international agencies driving by with windows closed.
To date, over 2,000 people have died from Ebola in the current outbreak. We have survived 9 others in DRC. US$157 million has been channeled through the World Health Organization for the Ebola response since last year, and the US government has tripled its funding in the past month. Despite these funds, community health workers have held strikes for not being paid. Despite USAID wisely investing in handwashing stations, we do not have water to wash our hands with. Despite UNICEF working for over 50 years in DRC and supporting water and sanitation programs, we do not have water to wash our hands with. Many people in our community ask, as constituents in donor countries should be asking, where is this money going and who is it for? In contrast, we saw a New York senator request from the US federal government $20 million reimbursement for the cost to New York City of a single patient with Ebola in 2014.
This is another kind of resource war, as are other conflicts we have lived through in DRC.
One mother in Congo told me last month, “The strategy of the international response to Ebola is designed to fail.” If we want to contain this epidemic, let us review allocation of resources, ensure that the most cost-effective and evidence-based strategy is used so as to not waste these valuable funds. Without basic resources such as water for hand washing, oral rehydration solution, and safe transport to health centers, we risk ineffective use of funds and remain susceptible to future infectious disease outbreaks. It is time to lift the barriers that limit this mother and others from designing and evaluating humanitarian interventions in their communities.
In Congo we have a saying that if you want to know where a leak in a roof is, you have to live in that house. If you want to know the problems we face in caring for our families and communities, walk with us on our paths. Live in our house with us. Learn what we are able to improvise with. If we can combine the resourcefulness of the poor with the financial resources allocated to this outbreak, together we can successfully conquer diseases such as Ebola and beyond.
1.Fallah, Mosoka et al. “Quantifying Poverty as a Driver of Ebola Transmission.” December 31, 2015. PLOS Neglected Tropical Diseases. Retrieved from: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004260
2. Center for Disease Control. “Handwashing.” 2018. Retrieved from: https://www.cdc.gov/vhf/ebola/prevention/handwashing.html
3. Fontaine, Olivier et al. “Oral rehydration therapy: the simple solution for saving lives.” 2007. British Medical Journal. Retrieved from: https://www.bmj.com/content/334/suppl_1/s14
4.World Health Organization. “Ebola response funding: Democratic Republic of Congo: 2018–2019.” 26 August 2019. Retrieved from: https://www.who.int/emergencies/diseases/ebola/drc-2019/funding
5.Kiro, Merveilles. “Goma/Ebola: des agents des relais communautaires reclament trois mois impayes aupres de l’OMS.” 5 April 2019. Politico.cd. Retrieved from: https://www.politico.cd/encontinu/2019/04/05/goma-ebola-des-agents-des-relais-communautaires-reclament-trois-mois-impayes-aupres-de-loms.html
6. USAID/OFDA. “Five ways USAID is fighting Ebola in Eastern Congo.” August 1, 2019. Peerdiy.com. Retrieved from: https://medium.com/@USAIDOFDA/five-ways-usaid-is-fighting-ebola-in-eastern-congo-c1591460f7f4
7. Schoichet, Catherine E. “Should cities be reimbursed for Ebola costs? One U.S. senator says yes.” 16 November 2014. CNN.com. Retrieved from: https://www.cnn.com/2014/11/16/politics/new-york-ebola-cost/index.html.
8. Unicef. “Water under fire” . March 2019. Retrieved from: https://www.unicef.org/reports/water-under-fire-2019.