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In the Democratic Republic of the Congo (DRC), there have been 682 confirmed cases of the new coronavirus disease, known as COVID-19, and 34 deaths reported by the World Health Organization as of May 4. Doctors Without Borders / Doctors Without Borders (MSF) teams are responding to new challenges presented by COVID-19 while addressing other urgent and ongoing health needs. David Walubila Mwinyi works with MSF as a medical data supervisor in South Kivu, an area affected by violent conflict and other epidemics. Here, he explains why many people are skeptical of the new measures to curb the spread of the coronavirus, and why the spread of misinformation is so dangerous.
When the first confirmed case of COVID-19 was reported here in the Democratic Republic of the Congo (DRC) in early March, I immediately wondered how people found out and if it really was the first case. Were there other unannounced cases?
While there is a low number of confirmed cases [of COVID-19] in the DRC, this is more likely due to the fact that very few tests have so far been conducted in the country. There is currently only one laboratory that can analyze samples, and it is in Kinshasa. This laboratory can run around 100 tests per day for a country of 80 million people. However, even if people manage access to a health center for testing, there are still huge logistical challenges in obtaining these tests from rural areas in South Kivu, where I work, to Kinshasa. Right now, the current average wait time for results is around a week.
One of my main concerns when it comes to a pandemic of such proportions affecting the DRC is misinformation or lack of information. Too often, people lack reliable sources of information, such as renowned medical experts working on this new virus or the Ministry of Health. Instead, they receive their news from uncontrolled and often unreliable sources through social media, especially WhatsApp. These sources, in most cases, spread rumors rather than truth. Without clear official communications it is difficult for anyone, including me, to discern the truth.
Misinformation makes already vulnerable people even more vulnerable
Across the country, especially in the east, where it is still volatile after decades of instability, war and conflict, we have several groups of people who are already very vulnerable. This includes people with diabetes or high blood pressure, and those already affected by some of the region’s top killers, such as malaria and acute respiratory infections, or other diseases such as measles, cholera, HIV / AIDS. , tuberculosis (TB), malnutrition or even Ebola. As a doctor, these are the people that worry me a lot, as we don’t yet know how coronavirus will behave with these pre-existing conditions.
Many of these vulnerable groups already face stigma within their communities. My concern is that if they become infected with COVID-19, at a time when people hear so much myth and misinformation, they will face additional stigma, which will make their lives even more difficult.
Not enough food, much less fans
To make matters worse, now that all borders are closed, it is very difficult to bring not only daily supplies, but also humanitarian personnel and medical supplies to help combat COVID-19. Medical equipment such as ventilators is desperately needed. There are only around 40 fans here in South Kivu, and they are all here [provincial] Bukavu capital. These 40 fans will have to settle for a population of several million. In short, it is not enough.
One might ask, have we thought of establishing intensive care units (ICUs) in the past? It is a difficult question when people here in the DRC are still starving. Hunger makes ICUs seem like a bit of a distant problem. We don’t even have the money to guarantee enough food for everyone, let alone fans.
Much skepticism
This is one of the reasons why comparisons between health systems here in the DRC with those of China or Western countries seem inappropriate in our context. Even when it comes to preventive measures, if you want people to wash their hands with soap and water, you must provide soap and water. The reality here is that many simply do not have access to either. If they don’t even have food to eat, why would they have soap?
It is especially difficult to explain to a community that behaves in a certain way that generations change customs to avoid negative health consequences. The introduction of measures such as social distancing is very difficult not only to explain but also to implement. People are used to shaking hands when they meet, especially with the elderly. Failure to do so could be seen as a sign of disrespect, something contrary to tradition, and that can cause problems, especially in rural communities.
There is a lot of skepticism from a large part of the population. Many people ask me how many people have died from COVID-19 here, compared to malaria, measles, and diarrhea. The answers often exacerbate the confusion, as the reality is that they are very few in comparison. Even the Ebola outbreak did not provoke movement restrictions or measures such as social distancing and the mandatory use of masks, such as those caused by COVID-19, and without a clear explanation.
Learning from other epidemics
People are used to epidemics, unfortunately they are common here. There is something we can and should learn from them. The most important thing is to listen to communities, speak to community leaders, and recognize the traditions they hold so dear. We have to recognize that COVID-19 is just one of the many medical or humanitarian emergencies they face on a daily basis. During the Ebola outbreak, many people with other illnesses, such as malaria or women seeking prenatal care, were told that they could not be cared for because there was no money for it. The money was only for Ebola. Many people began to believe that Ebola was just a business, that people only came to earn money, and that doctors ignored the real needs of the population.
We need to meet people’s needs by continuing to provide general health care across the country, earn their trust, and work together toward the end of the outbreak. We must include the community every step of the way, not only by listening to them, but also by employing as many local staff as possible to ensure that we actively contribute to the general well-being and prosperity of the entire community.
