Ebola: Letter from Biakato

Oussama blogs from the Democratic Republic of the Congo, where he shares the "vortex of emotion" experienced on the frontline of the fight against Ebola.

Last year, as I said goodbye to my Congolese colleagues before returning home at the end of my assignment, I said to them, “People always end up coming back to DRC”.

And, here I am again in the immense Democratic Republic of Congo, the country of a thousand shades. 

This time, however, my assignment is different because the situation is different. A very delicate situation, indeed much too delicate... This time it is Ebola, a deadly disease that leaves no way out.

Fighting Ebola feels like a war of nerves, a war where the two belligerents study each other waiting for each other's moves

I know Ebola through articles I've read and through the stories of colleagues, but I have never been on the frontline myself. 

Honestly, I felt fear at first. But, once I started the journey, that feeling went away, giving way to so adrenaline, a desire for discovery and an awareness that you're going to do something right.

I am now in Biakato, in the south of Ituri Province, where MSF has an emergency project. My job here is to manage the health promotion team, consisting of 16 health promotors plus two supervisors.

A war of nerves

The Congo is a country of many contradictions: wealth and poverty; paradise and hell; and especially epidemics to no end.

Ebola has been scourging the country for more than a year; it seems to be in a war of nerves, a war where the two belligerents study each other waiting for the next move.

[Read next: Ebola - Staying safe in the "red zone"]

Sometimes this damn virus gains ground, sometimes it is defeated. It is induced to disappear from one village, only to return, even stronger, in another.

For a humanitarian worker, the watchword is to have a firm nerve, a cool head and, above all, a lot of focus and determination.

"No touch policy"

The basis for success in this type of situation is the cohesion of the team.

There are eight international staff members. We live and work in our base in completely different living conditions from those to which we are accustomed: the dominant rule here is the "No Touch Policy".

This is exactly what it sounds like - Ebola can be transmitted through human touch, so we avoid physical contact like handshakes and hugs.

Our space is very limited, and yet despite this, we feel strong and united.

Number-one enemy

We currently support four health centres: Alima, Biakato May, Biakato Mine and Katanga.

We offer free primary healthcare (the kind of community-based healthcare you often receive from family doctors or nurses), but also free secondary health care (the kind of healthcare provided in hospitals) for children.

Ignorance generates fear, and fear provokes anger and hatred - then hatred ends in violence

We treat diseases such as malaria, sexual infections and anaemia. We provide services for survivors of sexual violence, care before and after childbirth and, above all, we advise the community on the importance of hygiene.

Maybe you are wondering why all is this being done when the number-one enemy is Ebola?

It is true, our enemy remains Ebola, but the situation here requires a step-by-step strategy...

Fear, paranoia and distrust

Imagine yourself serene and calm in your city. Then suddenly you wake up to a disease that, on the one hand, is advancing and killing everyone. However, on the other hand, has brought many strangers, cars, ambulances, people movements to no end. And you are in the middle of this!

What feelings would you experiences if not fear, paranoia, and distrust?

These three feelings are the gasoline on the burning fire over which the rumours and gossip cook...

Most people here know Ebola, but don't know much about it. They try to ignore it. However, this ignorance generates fear, and fear provokes anger and hatred - then hatred ends in violence.

This cycle has happened and still happens - directed against the very response teams working to fight Ebola!

Roots and respect

We know that people need to be listened to and to be engaged and informed. For this reason, we have established a step-by-step strategy to ensure that MSF teams are well accepted by communities here.

Among the first things we achieved was constructing water points for communities that didn't have reliable access to safe drinking water. For example, in Biakato Mine we established or renovated four water points and three more in Alima.

Obviously, with each water point, we have worked with the local people. They have formed committees whose main task is to maintain the water point: it is their jewel, their child that they must protect.

In addition to the water, we have met people from all the little hamlets that make up the local communities, starting with the village leaders and through to the ordinary people.  

We have listened, discussed, proposed and received advice and ideas. Together we have touched at the roots of that tree whose trunk is formed by problems and the branches by consequences.

In return, people welcomed us with open arms. A few weeks ago, one of Alima's community leaders to me:

"Oussama, we love MSF. Now you are really part of our family because you arrived, you knocked on the door, you asked for permission and you entered... You earned all our respect. You deserve it," 

Health promotion

There are many organisations active in the area. Each of them does their job, but we all work together. We are like a coalition that fights the same enemy, perhaps with different means but the goal is the same: to annihilate Ebola and give people access to treatment.

In the different neighbourhoods where our health promotion team is deployed, we carry out individual and group sessions that deal with different topics, such as the relevance of condoms.

However, our biggest challenge is to convince people to go to the Ebola treatment centres and clinics as soon as they spot the symptoms. Waiting until the last moments means the situation for the patient could be irremediable.


An MSF Health Promotion Outreach team visits a local community
The health promotion team is vital in the fight against Ebola

One of the important activities of our team is supporting patients and their loved ones within the different centres.

Every opportunity is good to raise awareness and give advice, explaining, for example, why and how washing your hands at the entrance of the healthcare facility is so important, but also the route to follow through the facility to avoid spreading infection.

The vortex

You know, hearing the cries of a mother whose child has just died is the worst feeling you can experience. I have experienced this before on our ships in the Mediterranean and as well in my previous assignment in Congo.

On this assignment, there have been a couple of times, in the centres of Katanga and Biakato Mine, when I have heard this sound. Seeing a child just a few months old die - a little "angel" flying away - it blocks you. Hearing the screams of mothers makes you stay still like a rock. 

Stop thinking, stop walking, stop looking, you're just immersed in a vortex of emotion that slams you right and left.

Observe in silence because you don't have the strength to say a word; weep inside yourself because you don't even have the strength to do it with real tears...

Your strength is sapped, you feel small, powerless, with your hands tied. And, as if that wasn't enough, this vortex is mixed with another feeling that's even stronger: the frustration! 

You are frustrated because you can't console, you can't approach, you can't hug, you can't talk. Instead, you stay there, dumb; observeing in silence because you don't have the strength to say a word; weeping inside yourself because you don't even have the strength to shed real tears.

This vortex lasts only a few moments, but they are infinite moments. You feel like you are in a Dantean journey of eternal duration.

Once you get your strength and your lucidity back you have only one desire: to resume your work immediately with more power, more strength, more determination and more will.

You get back to work because that's a legitimate response. Because you don't want to be transported and slapped, against your will, in swirls of feeling like these. But, in the end, we are vulnerable, we are human, we love our neighbour and we must always treasure our humanity and our emotions.

Protection from fear

You ask yourself: "How? How can a person cope with these emotions?"

I have learnt that you have to face stress with your heart wide open. That you have to know how to manage your emotions, otherwise you will be the victim of circumstances.

If you think too much about this disease and you allow yourself to be afraid, all the things that you should do to protect yourself will fail to work. Thoughtfulness and vigilance, which should protect you, will not be possible. You will stop thinking, you will not think wisely, you will not think at all, and when fear consumes you, then the disease consumes you!

Unfortunately, this is only the raw truth, the ordinary normality that the local people live with and with which we have been living for months.

Perhaps it is these misfortunes that feed our strength to always keep moving forward. One hand never applauds, but two hands can. In the work we are doing here, MSF is one hand and the community is the other.

I know that together we can work miracles; we can eradicate Ebola and all the other diseases that have plagued this great country and its good people for years.


Read more: Powerful stories about fighting Ebola

The giant

F**k you, Ebola