By Megan Klingler
In 1976, along the Ebola River, in what is now the Democratic Republic of the Congo (DRC), a rare and deadly virus was first identified. The Ebola virus, named for the river near its discovery, has since led to multiple outbreaks across several African countries, Europe and even the United States of America. The exact origin of the Ebola virus is unknown; however, it is believed to be an animal-borne disease and harbored in bats. The bats carrying the virus can then transmit to other animals like monkeys, deer and humans. After the transfer to a human, the Ebola virus can easily spread from person to person.
Ebola virus disease, or EVD, is typically spread by love, care and compassion for a sick person. Often healthcare workers, clergy and family members of those that are sick are at the highest risk of being infected. EVD is spread through contact with infected bodily fluids or through contact with objects that are contaminated with infected body fluids. It can be spread from a person who is sick with EVD, from the corpse of a person that died of EVD, contact with an animal with EVD or from breast milk or unprotected sexual contact with a recent EVD survivor.
A public health emergency
On August 1, 2018, the DRC announced a cluster of Ebola cases discovered in the North Kivu province in the East Congo Episcopal Area, marking DRC’s tenth Ebola outbreak since 1976. Unlike previous Ebola outbreaks in the DRC that were contained to remote areas, the spread to urban centers and the increased mobility of people caused this outbreak to easily spread.
On July 17, 2019, almost one full year later, Ebola reached Goma, a busy DRC border city with an estimated two million people and an international airport. The World Health Organization (WHO) announced this outbreak as a “public health emergency of international concern.” The outbreak was not only a threat to the neighboring countries, but to the world, and had grown to be the world’s second largest Ebola epidemic on record with more than 2,400 cases.
Shortly after the WHO announcement, Bishop Unda of the East Congo Episcopal Area requested assistance from the General Board of Global Ministries. Within 24 hours, Dr. Damas Lushima, the East Congo Health Board coordinator, received a protocol from the Global Health unit on actions to reduce exposure to the Ebola virus developed by the WHO, the African Union, the Liberian government and the U.S. Centers for Disease Control and Prevention in 2015. It also contained practical recommendations to screen, isolate and refer potential Ebola cases.
Megan Klingler, Global Ministries’ Global Health unit’s primary health care specialist, volunteered to offer technical assistance and support to the East Congo Health Board’s Ebola response. Klingler, a public health nurse, had previous experience as a team leader for Ebola responses in Nigeria and Sierra Leone and worked for the CDC as a course facilitator for U.S. healthcare workers going to Ebola zones.
Klingler’s trip objectives were to empower the East Congo Health Board’s members with the knowledge and expertise to disseminate information on Ebola prevention among UMC health facilities, communities and churches. The first training was conducted fully by Klingler and for subsequent trainings, the East Congo Health Board slowly took over the curriculum.
Trainings were held for members of the UMC healthcare staff, church clergy and lay leaders. The topics included “Ebola Signs and Symptoms,” “Ebola Myths and Facts,” “Screen, Isolate, Refer”, and “Infection, Prevention and Control.”
For 24 days, the team traveled throughout East Congo by road, boat and plane and worked all day from early morning to late night. Despite the many obstacles like bad roads, a cancelled flight, denied visas, and the car breaking down, the team stayed strong and determined to reach all sites and provide the training promised by Bishop Unda’s team.
The trainings were held in five cities: Goma, Beni, Bukavu, Uvari and Kisangani, and directly reached over 360 participants. The presentations were mostly interactive, with hands on exercises and case studies. Due to working with medical professionals and clergy, the topics were tailored to each attendee’s role and were presented in multiple languages to ensure full understanding. Pre-tests and post-tests were administered at most trainings. The average starting score was less than 30 percent and the average final score after training was at about 90 percent, demonstrating a large gain in knowledge.
The true number of beneficiaries of these trainings is unknown and expanding daily. At a church service in Goma that followed the Clergy and Lay Leaders training, the pastor used his leadership position to speak on the importance of proper hand hygiene and demonstrated how to wash your hands correctly to the congregation, encouraging all to follow him. The bishop’s wife and Maternal Neonatal Child Health Coordinator, Dr. Marie Claire, visited a UMC orphanage in Goma where the orphans were taught how to wash their hands. Examples of the tear down effect were demonstrated multiple times throughout the trip. And even when the team’s car got a flat tire, the Congolese soldiers that surrounded the car were taught about Ebola, the importance of hand hygiene and were encouraged to discuss myths they had heard about Ebola.
As of September 28, 2019, the DRC Ministry of Health reported a total of 3,188 Ebola cases, including 2,129 deaths. Although this is not positive news, there may soon be more relief. A second Ebola vaccine is coming to DRC. The outcome of the first Ebola vaccine has been very positive, but the quantities have been low. The hope is that with this new vaccine, more people can be reached.
Additionally, in early August before the trainings took place, two experimental treatments were found to be up to 90 percent effective in treating Ebola when used early in the sickness. This is an additional reason in why the UMC trainings were so important: the trainings not only demonstrated how to prevent contracting Ebola, but how to identify and educate the community to seek medical help in the face of emerging Ebola symptoms.
Next steps and moving forward
With the Bishop’s support and presence, the East Congo Health Board has conducted additional Ebola prevention trainings in Kindu following Klingler’s departure. This demonstrates the success of the trainings and determination of the East Congo Health Board and church leadership to spread the knowledge of prevention to their community in which they serve.
Megan Klingler is the Global Health unit’s primary health care specialist.