Ebola in the DRC: How Goma’s Wellness Clinic Fights Distrust

The Ebola outbreak has changed daily care at the Wellness Clinic, Jericho Road's clinic in Goma, Democratic Republic of the Congo, even though the clinic has not received a confirmed Ebola case. The clinic provides essential health services for patients in the region, including primary care, a surgery center, and a birthing ward.

The effect of Ebola in the region has been indirect on the clinic, but damaging. Clinic staff reported a roughly 20% decline in patient visits early in the outbreak. Many patients, they said, were afraid to enter the health system because of widespread distrust.

The outbreak, caused by Bundibugyo virus, has led to at least 721 deaths and 1984 cases, according to the DRC and Ugandan Ministries of Health. Cases have been concentrated in the DRC's Ituri, North Kivu, and South Kivu provinces. The CDC reports this is the DRC's 17th Ebola outbreak and the third-largest Ebola outbreak on record.

In Goma, the capital of North Kivu province, the outbreak is unfolding in a city already battered by civil conflict and mass displacement.

In this Q&A, Dr. Prince Mbuzukongira, a physician and public health specialist at the Wellness Clinic, and Chantal Mandro, a nurse and director at the clinic, spoke with Direct Relief about managing patient fears in order to keep infection-control measures in place, and why local trust may be as important to the Ebola response as masks, medicine, testing, and isolation beds.

Their account shows how an outbreak can impact care even before a clinic sees a single suspected case.

This interview has been edited for length and clarity.

How did the outbreak affect patient visits at the clinic?

Dr. Prince Mbuzukongira: At the beginning, patient visits dropped by about 20 percent. When someone was not extremely sick, they often preferred to stay home.

Around mid-May, there was one Ebola case in Goma. The patient was isolated and survived. That had a positive impact in the community. After people heard that someone could survive, they began coming back.

How has routine care been affected by the outbreak?

Chantal Mandro: The biggest impact is on people with diseases that can become more dangerous if care is delayed. Malaria, respiratory infections, and typhoid can become more dangerous when people stay home. If someone has fever and headache, it can be malaria, or it can be Ebola. Chronic-disease patients continued to come, but when an outbreak happens, people with chronic diseases are at higher risk.

We saw a similar problem during coronavirus. Many of the people who died had chronic diseases.

Border closures also limited access to some essential medicines. We have enough in stock for everyday use, but not if there's a local outbreak. The medicines we requested from Direct Relief are very useful for poor patients with chronic illnesses, who are numerous here and who are not able to regularly pay for their medicines. These medicines are a great relief for them.

Why is trust among the population so low when it comes to seeking care during an outbreak?

PM: The response has many branches, but communication with the population is not emphasized enough. When there is an outbreak, people often come from very far away to organize the response. They do not use enough local nurses, local doctors, and local people who have influence in the community. They often come from Kinshasa or other places, and they come with funding.

That is a problem because some people do not trust medical personnel who come from far away. Communication is one of the biggest challenges in this outbreak. You have to use local people with influence to explain things clearly.

For example, people need to understand that Ebola can come from contact with infected animals and that eating certain wild animals can be dangerous. But that is not easy to explain to the community. The same is true with burial ceremonies. Some family members became very angry and took their deceased relatives by force.

CM: Some people think medical personnel are there because there is money in the outbreak. They worry they will be falsely told they have the disease, or that they will be used as an experiment for a new disease.

PM: They are afraid of what may happen to them inside the health system.

CM: At the beginning of an outbreak, there is often no organized response. The first cases die. People see that and think there is no help even if they go to the hospital. In Bunia, at the start of this outbreak, many of the people who went for care were dying. Later, a treatment center was organized with international NGOs.

Beyond communication and trust, what has been missing from this response?

CM: In this new outbreak around Bunia, many things were missing at the beginning: money, setup, medicine, testing, and protective equipment. There was nothing in place.

There is no easy place to buy PPE in Congo. We need partners to send it to us. Testing was also a problem. In Bunia, tests had to be sent to Kinshasa, and they could not do more than a small number of tests per day. That is why an outbreak can spread quickly. It is also why many medical personnel died.

In Goma, the response has been more organized than in some other places. There has been isolation, testing capacity, and a system to control cases. People exposed to cases can be placed in isolation for 21 days.

CM & PM: At the entrance to our clinic, we established a temperature-screening point and several handwashing stations. We also restricted gatherings inside the facility. Whenever a suspected case is identified, an alert is immediately issued, and the patient is taken over by the official outbreak response team. To date, however, our facility has not received any Ebola cases.

CM: Still, at Wellness Clinic, we do not feel fully prepared. We do not have many masks. Some PPE we received was given to the government and to people at the quarantine center. We have medicine, but not enough if a large epidemic comes. The best way is to have stock ready before the epidemic period so people can use it immediately.

Without identifying them, can you tell me about one patient or family you cared for recently who stayed with you?

CM & PM: We remember a family that was afraid to visit the health center because they feared being stigmatized. After several discussions with our team, they agreed to seek medical care.

Fortunately, the test result came back negative for Ebola after the sample was collected. Instead, the patient was diagnosed with another illness that required prompt treatment. This reminded us of the importance of community awareness and of building trust between communities and healthcare professionals.

What do you want people outside the DRC to understand about this outbreak?

CM: Ebola does not come to the same towns every time. This is the DRC's 17th Ebola outbreak, but each outbreak has its own response challenges and its own trust issues.

PM: The response must include local doctors, nurses, and trusted community members from the beginning.

People often hear about crises in eastern Congo. What progress or success do you wish people outside the country knew about?

CM & PM: Despite the many challenges, healthcare professionals and local communities have shown remarkable commitment and, above all, great resilience. Over the years, surveillance, diagnostic, and patient care capacities have improved considerably. Collaboration between health authorities, partners, and communities has made it possible to detect outbreaks earlier and respond more rapidly. These efforts deserve greater recognition.

Direct Relief's response to the current Ebola outbreak continues, including continuous shipments of medical aid to support patient care. Direct Relief sent personal protective equipment, oral rehydration salts, chronic-disease medications, antibiotics, and diagnostics to Jericho Road to strengthen ongoing health services and will continue to support health providers reaching patients in the DRC.