Anne ran for her life when she saw the nurses in their white uniforms searching for patients of Ebola. Anna was sick, but thought it was malaria, common in the Congo. Symptoms of Ebola and malaria can be similar at first – high fever, headache, sweating and vomiting. In her village of Ilanga, 5 miles from Bikoro, the Word Health Organization had installed a treatment center for Ebola.
Because of her illness, she had previously been held in quarantine in an isolated room, frightened and alone. Raised in a culture where food is prepared communally and eaten communally, she was fed by people entirely covered with plastic to protect themselves. They distanced themselves from her – fearful for their own lives. Behind the clinical eyes lurked a human fear of attachment to a victim who may die.
The doctors and nurses shielded themselves with more than plastic. She longed for the camaraderie of her sisters – the women of the village – who would care for her when she was sick, bringing food and offer comfort, even in death. The isolation was alien to Anne. One night she opened the window of her isolation room and escaped the treatment center to return to her circle of huts – where the doors opened onto the people she knew and recognized. She resumed her normal life in the village, although she did not recover quickly. Seeing the nurses from the Bikoro treatment center reminded her of the nightmare of separation and loneliness.[i] Actually Ann did not suffer from Ebola, but the fact that she escaped from the treatment center made her a threat to her community.
The history of Ebola in Bikoro has many versions, as histories do – each coloured by the voice in which they are told and the experience that person has had with the virus. Few voices remain untouched by the virus; the tenor of the entire country is affected by the shrill fear of the virus and the background beat of politics. The first narrative I encountered came from a colleague of mine, a fellow researcher who lives in Ilanga, the epicenter of the latest outbreak.
Her story unfolded a tapestry of tragedy. A family was thought to have contracted food poisoning. Three members died. Word traveled quickly. The Congolese doctor, director of Bikoro hospital, was concerned that this might be the start of an Ebola epidemic, informed the Minister of Health in Kinshasa. The minister sent word that if a fourth person of the same family died, the doctor was to send a sample to the CDC in Atlanta to verify the source of the disease. The fourth victim fell; his death knell sounding the alarm that Ebola had been found again in Africa.
The alarm activated a system of support personnel, medical equipment, trucks, cars, and money which started pouring in Bikoro. Doctors Without Borders sent a group from Belgium (Médecins Sans Frontières or MSF). They set up residence in a local boarding school. Young people were hired as drivers – and people unfamiliar with the local economy paid exorbitant rates into the pockets of the locals. Money started flowing in an area of monetary drought.
The tapestry revealed and hid another scene. A young man died when he was quarantined. Unfamiliar with local custom, the medical team offered to buy the dead body from a family who lost their loved one, hoping to prevent further spread of the disease through contact with the body. Rumor was that the young man had been killed to increase the victim count of the virus and further drive the economy of sickness.
Even the most educated in the region of Mbandaka-Bikoro did not fully believe in the truthfulness of the Ebola outbreak in the region. They saw the monetary machinations of the medical teams, attracting funds from WHO and other organizations around the world. It was a common chorus in their history. Africans suffered tragic losses, while others got wealthy because of the outbreak. For them, (MSF or Doctors without Borders from Belgium) it was an opportunity to collect donations from many concerned people throughout the globe. Locally, it was seen as an ‘Ebola Industry’.
The tune changed as I listened to the doctor in charge of Bikoro. He confirmed that the result of the sample tested positive for Ebola, that is why the Minister of Health, Mr. Oli Ilunga, had declared the outbreak in Bikoro. He used science and data to support his story.
Rumor travels faster than reality. The narrative of Ebola industry reached Katwa, a few miles north of Butembo, where a second epicenter had formed. The outbreak of Ebola was the reason the government gave when it declared that people from that region would not vote for the presidential elections on December 30, 2018. However, the backbeat of this decision is the underlying politics of the Nande tribe of Butembo vis a vis those of Kinshasa. It also plays an important part in understanding the attacks on the Ebola treatment centers.
The former president, Mr. Kabila has a farm in Musienene, in northern Butembo. The farm was burned to the ground on Christmas, 2017 and credit for the act was given to the ADF-NALU – the militia in defiance of Kabila. Kablia, in turn, promised the Nande that he would destroy them[ii] when he confided to a dignitary of the Tanzanian regime in Dar-es-Salem, “We have a problem in the DRC with the two tribes, the Baluba and the Nande. But the hardest and the most cunning are the Nande. They are the ones who often block our plans. We will do everything to annihilate them.” Massacres in the region seem to be coordinated by the capital of Kinshasa, or, if not directly involved, Kinshasa turns a blind eye to the killing of those of the Nande tribe by FRDC – the military of the DRC, especially those of Hutu origins.
The Nande people, living close to the borders Uganda and far from Kinshasa, have a reputation as a people who take care of themselves and their own, not depending on the government to help them and in some ways defying the government. Timothy Raeymaekers, in his 2014 book Violent Capitalism and Hybrid Identity in the Eastern Congo describes them thus, “In their tendency to solve an apparently private problem — to generate profit and protect themselves and their property from harm — these businessmen nonetheless generated a fundamental public outcome of changing rules and conventions to determine rights and duties in the domain of cross-border taxation, military security, and the redistribution of economic wealth.”
The decision to forbid those living in Butembo, which are mainly those of the Nande tribe, from voting is seen as part of the retaliation by Kabila against the Nande for the attack of his farm by those living in Butembo. As an extension of the political aura extends to the Ebola outbreak and the efforts to control it. News from Bikoro spread into Eastern Congo. The Nande people perceive that there is money circulating because of Ebola. They visualized Ebola as an industry, a moneymaking machine. As traders, they are looking for ways to enhance their profits.
Leaders, such as National Deputy Crispin Mbindule discredit the existence of Ebola in the Butembo. Mbindule had stated that Ebola had been “created in laboratories to exterminate the population.” (News CD)[iii]. Although Mbindule and his staff have been vaccinated, according to reports, this dissemination of fear enhancing misinformation has fueled the frenzy of violence against Ebola treatment centers.
Then came the outbreak of Ebola, with its influx of outsiders. The problem started, in the words of one individual, “with the first responders. …at the beginning the teams in charge of sensibilization (teaching the people about Ebola and administering the vaccine) misled the local people. Either they did not speak the language or just had poor communication skills.” Added to the miscommunication about the virus, “a huge difference in payroll between local and foreign staff, it made it even harder for local staff to do their job properly.”
Against this backdrop plays the attacks on the Ebola treatment centers, justified by the combination of political motivations, economical reactions and social rejection of MONUSCO (or the International Community in general) which is seen as unfavorable to the region.
In my view, the best way to combat the community of mistrust that has developed in response to the treatment of Ebola is to involve the community directly. The Catholic University of Graben, which enjoys an integration of Nande priests, as well as social acceptance and trust of the Nande community, should be utilized by the Ebola response teams. Close collaboration with the faculty of medicine would establishing a social perception in Butembo of trust. Utilizing members of the community allows them to become part of the industry, feeling they are responsible for and reaping the benefits from fighting the Ebola virus. This would be the first plank in a bridge to be built between foreign health organizations and the community of Butembo, expanding to include other local organizations which could disseminate information to the people in palatable ways.[iv]
There is a distinction between a real person in this story and one that is illustrative of the point. Two of the ‘escapees’ died, and the hospital authorities said, “it is a hospital, not a prison”. The person in the facility feels isolated, but the problem is that upon leaving, she becomes a threat to her community. The new vaccine, which is still considered experimental is being given to all people who may have contact with the patients.