In eastern Congo, trust becomes a key tool in addressing Ebola
| Johannesburg
The crowd, gathered at the entrance to the hospital in Rwampara, Congo, was distraught. Family, friends, and teammates of Eli Munongo, a beloved local soccer player, had been told on this day in late May that they could not take him home to bury him. All because hospital officials suspected he had died of Ebola.聽
The crowd鈥檚 grief sharpened into anger. A group of young men stormed the compound. Soon, the large tents pitched in the hospital garden for Ebola patients were aflame.聽
The same day, anthropologist Julienne Anoko was preparing to board a flight to join the Ebola response team in eastern Congo聽organized by the World Health Organization (WHO). But she wasn鈥檛 coming to diagnose and treat the disease that hospital workers said probably killed Mr. Munongo. She was looking, instead, for a cure for the anger that surrounded it.聽
Why We Wrote This
The current Ebola outbreak in eastern Congo has elicited an enormous public health response. Alongside that, anthropologists and community workers are working to build trust between affected communities and outside responders.
鈥淲e can bring in hundreds of the best experts, thousands of brilliant doctors, but all of what we鈥檙e doing will fail if people don鈥檛 trust us,鈥� Dr. Anoko says. 鈥淓verything else we do depends on winning that trust.鈥澛�
Dr. Anoko joins a wider effort to assuage fear and skepticism in the communities at the heart of the Ebola outbreak in eastern Congo鈥檚 Ituri province. Since the disease was first identified there in late April, there have been confirmed cases. The U.S. Centers for Disease Control and Prevention聽 that if the disease is not quickly contained, it could become one of the largest outbreaks of Ebola in recorded history.聽
鈥淢isinformation is almost as dangerous as the virus itself and spreads just as fast,鈥� said WHO Director-General Tedros Adhanom Ghebreyesus last Friday. 鈥淓arning and keeping the trust of communities is at the heart of everything we do.鈥�
For more than a decade, Dr. Anoko has been among the leading proponents of a radical front-line response for Ebola: building trust between communities and those who come in to help them.聽
But trust can be vanishingly hard to come by in this part of Congo.聽
Ituri, the province where the current Ebola outbreak is centered, has spent more than two decades at war with itself. Fighting between the Congolese government and a rotating cast of insurgent groups has turned communities there against each other, displaced nearly a million people, and left the mineral-rich region around them impoverished.聽
Meanwhile, residents have become accustomed to a parade of wealthy outsiders 鈥� United Nations peacekeepers, sweet-talking politicians from the capital, big international nongovernmental organizations 鈥� passing through the region with their own, often inscrutable agendas.聽
In recent weeks, outsiders have begun pouring into Ituri again, this time to quell Ebola, which the WHO calls 鈥渁 public health emergency of international concern.鈥澛�
They might arrive with a crisis plan, but they also come 鈥渨ith significant resources in an area where the population lacks almost everything, and where the economy is devastated by war,鈥� says Kennedy Wema, who studies social responses to Ebola outbreaks at the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany. 鈥淧eople don鈥檛 understand how so many resources can be mobilized just for one disease, when such resources have never been mobilized for their security.鈥澛�
That confusion breeds suspicion and anger, he says, especially when local responders are paid less than those brought in from the outside, as was the case during Congo鈥檚 last major Ebola outbreak from 2018 to 2020.聽
This skepticism also helps fuel rumors that tear through communities fast: that people are dying in treatment centers because the doctors and nurses are poisoning them, for example.聽
And then there is the problem of the approach itself. Responders are often so frantic to stop the spread of the disease, Dr. Anoko says, that they can sometimes lose track of the fact that numbers on their spreadsheets 鈥� cases suspected and confirmed, deaths and recoveries 鈥� are people, too.聽
During the 2018-2020 outbreak, she tried to right this approach by putting herself in the place of the people at the center of the crisis 鈥� at times quite literally.聽
Once, she crawled into a body bag and allowed herself to be carried by a burial team in order to understand a complaint that the dead weren鈥檛 being handled gently.聽
And when communities stoned ambulances or burned treatment centers to the ground, Dr. Anoko tried to crawl inside their grief, too. She imagined being a mother unable to hold her sick child in her arms, or a grieving husband told he could not bury his wife.聽
鈥淲hat I鈥檓 trying to give people is the kind of compassion I have looked for in the difficult moments in my own life,鈥� she told the Monitor at the time.聽
Mr. Wema, who studied that outbreak, says that when responders began to approach communities with this kind of empathy on a wide scale, local acceptance of the response surged.聽
鈥淚n some aspects, the responders have more knowledge,鈥� he says. 鈥淏ut communities are also experts in their own realities and their own cultures. That expertise matters, too.鈥澛�
Still, in the current outbreak, it can feel at times overwhelming. 鈥淭ensions have increased in recent weeks,鈥� wrote Anastassia Chkolenok, humanitarian affairs coordinator for Medecins Sans Frontieres, in an email to the Monitor.聽
In late May, just a day after the attack on the hospital in Rwampar, one of MSF鈥檚 own tented treatment centers in the town of Mongbwalu . Not long after, grieving parishioners at a church in the same town 鈥� some of them armed 鈥� engaged in a five-hour standoff with security forces outside a hospital where their priest had died. 聽
The only way forward, Dr. Anoko says, is to 鈥渟how humility and empathy.鈥� 鈥淭he outbreak started in these communities, and that is where we will end it, too.鈥澛�
