Front Burner - How mistrust and fear make fighting Ebola more difficult

Episode Date: April 23, 2019

An Ebola outbreak in the Democratic Republic of Congo has killed more than 800 people, and infected hundreds more. The crisis has worsened due to a local mistrust of the government and aid workers. Ebola treatment centres have been burned to the ground and many people are reluctant to see a doctor. Canadian doctor Vinh-Kim Nguyen tells us what he saw on a recent mission to the DRC for Doctors Without Borders.

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ignited a real-life culture of space exploration, and a lot more. You can listen to TED Talks Daily wherever you get FrontBurner. Hello, I'm Jamie Poisson. There's an Ebola epidemic going on right now in the Democratic Republic of Congo. There's been over 1,200 cases and 800 deaths. It's the second largest Ebola epidemic ever. The last one was in 2014. The hemorrhagic fever causes severe vomiting, diarrhea and bleeding.

More than half of those infected die. Experts are concerned about the outbreak spreading to major urban areas. And doctors on the ground in the DRC are not only fighting the disease, they're facing a second battle against widespread rumours and fear. There's been attacks on Ebola treatment centres around the country. This past weekend, there were two attacks. An attack at a hospital left a WHO worker dead. In another, attackers armed with machetes

tried to burn down a different treatment centre. And in March, a police officer was shot and killed and a medical worker injured. So, why is this happening? My guest today is Vin Kim Nguyen. He's a family physician from Montreal and recently got back from a mission in the DRC with Doctors Without Borders, who are on the ground there working with patients.

That's today on FrontBurner. Vin Kim, thank you so much for joining us today. You're welcome. My pleasure. So you've worked on a mission in North Kivu, which is in the eastern region of the DRC along the Uganda border. Can you tell me what it's like there? So I think, Jamie, the first thing I have to say is that it is – I've traveled a lot. And it is the most beautiful part of the world I've ever been to. It's incredibly lush, very mountainous, rolling countryside. It's temperate.

It's got all these kind of postcard African villages with thatched huts. So it's a little bizarre when you get there because you know that this is a place that has been the scene of really horrific violence and now this epidemic. Can you tell me a little bit more about the conflict that this area has seen? Yeah, I mean, I'm not a regional expert, but really there's been endemic conflict there, at least since the Rwandan genocide. And what you have and what's very difficult to get a grasp on is you have literally hundreds of different armed groups. And these are groups that basically use violence as a survival strategy. So they kidnap people, they take over villages when it's harvest time. And of course, there's also, you know, this is an area

that's very rich in resources, in cobalt and tungsten and things that we use in our cell phones and computers. Sort of low-grade armed violence is basically an economic strategy to capture some of those resources. Between 1998 and 2003, a brutal civil war and the starvation and disease that came with it tore the country apart, killing between one and five million people. And how is that affecting your work? What it means is that people are frightened, right? They're afraid. They know violence intimately.

They've seen it. They've fled from it. They've returned home. And they are afraid of anybody with guns. And they're afraid of anybody who looks like they might have guns. They see somebody who might have guns, they run away. They've learned that this is the best thing to do. Now at MSF, we don't look like we have guns or we might have guns. There have been very extraordinary circumstances, but we never have armed escorts. If they're armed convoys, we don't travel with them. We

negotiate our entry onto the field beforehand with armed parties. So for us, it hasn't been a problem, but it's been a problem in general for the Ebola response because in some cases, the Ebola responders or the teams actually do have armed escorts. And you mentioned that you negotiate with the armed groups. Is that safe for you? Well, you know, it's interesting. Yeah. I mean, basically what we do is we say, look, we're here to treat people. Do you guarantee our safety? And then they say yes or no. So these armed groups are really part of the community. So it's very easy to get into contact with them. It's a small world.

Everybody's related. So everybody knows what's going on. I was never concerned at all in the town where I was. It was a bit different, though, in the bigger city. Right. I understand there were treatment centers that have been targeted, one in Beni by protesters and another in February. Two treatment centers were set on fire. So I think that, you know, there's two kinds of violence that I saw.

The first has to do with when people are frightened or angry because of something that we are doing in the context of the fight against Ebola. So an example, one of the things that the Ministry of Health does, what they call community agents who go out into neighborhoods and villages, and they look for people who have fever or who are sick. I'm trying to be diplomatic here, but some of these workers were quite aggressive in testing cadavers or bringing in people for testing and treatment. Okay. And that, I would imagine, broke, there was a breakdown of trust.

So that's right. So people got beaten up. People got, the workers, people got told not to come back. And the next time they came back, they came in with military escorts. So that's when trust broke down, right? Okay. But what we saw in Butembo and Catua and earlier in Beni was these were organized attacks. This wasn't a bunch of angry people, you know, of a neighborhood saying, you know, leave us alone.

of a neighborhood saying, you know, leave us alone. These were organized attacks, submachine guns, petrol to set the centers on fire and people killed. So here I think we're dealing with a very different kind of violence. These are orchestrated attacks. Since February this year, five Ebola centers have been attacked and the medical charity Médecins Sans Frontières has suspended its activities at the epicenter of the outbreak.

Why are we seeing these orchestrated attacks? That's the million-dollar question. But I think what we can imagine is that in a setting where trust has broken down and where there is widespread kind of fear and anger directed towards people who hold positions of authority, whether those be government or elsewhere, the treatment centers became symbols of what was bad. What we think is the attacks were used to sort of rally public opinion and to get people fired up. That's sort of our feeling. They set fire to areas that were not for treatment,

like the changing and utility rooms which were burned down. But in any case, the treatment centre is no longer operational whatsoever. What are they angry about? What are these treatment centres becoming symbols of? What people are angry about was the lack of transparency in the Ebola response. And let me make that very clear. This is a part of the world that's desperately poor. Most people live off of a few dollars a month. Malnutrition is endemic. So this is the level of poverty we're talking about. Now, when the Ebola response came in, the epidemic triggered this international response, a very kind of organized, visible

response, which employs thousands of people and pays them quite a lot of money. That ranged from 10 to hundreds of dollars a day. So if we were in Canada, this would be paying some people 10 or $20,000 a day relative to the purchasing power. And their neighbor has nothing. That's right. So the question is, who is getting all this money? And of course, I think we have to be honest here. It creates a perverse incentive to keep the epidemic going, right? Because a lot of people are literally- Making money.

Yes. I think we have to be honest about this. We've created this kind of therapeutic economy. The Ebola business, as people say, is the best thing going, you know, in terms of making money. So it's conceivable that there are people on the ground there that believe that these aid organizations are playing a role in perpetuating the Ebola crisis. It's not conceivable. That is what people believe. That is. Wow.

That is what. Because they see all this money and they say, look, this is a business. Thank you. its books in a whole new way, where stories are brought to life by powerful performances from renowned actors and narrators. With the free Audible app, you can listen anytime, anywhere, whether you're at home, in the car, or out on a jog. The first 30 days of the Audible membership are free, including a free book. Go to www.audible.ca slash cbc to learn more. So just to recap, you're trying to deal with this on two fronts. The first front is how Ebola is treated in the first place. And the second front is trying to deal with this larger political and social context. Dealing with the kind of perceptions and understanding that the perceptions are based in stuff that we at MSF have no control over,

which is this long history of predation and betrayal and fear, right? And that, you know, all the kind of goody-goody two-shoes public health messages about, you have to wash your hands, they don't cut it, right? Because people are very cynical and they're very frightened and they're always reading between the lines stuff that you don't see. And so then, Kim, what are the next steps here? that you don't see. And so then, Kim, what are the next steps here? Do you think the fight against Ebola can be improved on both of these fronts? We've been having a lot of discussions internally at Médecins Sans Frontières, at MSF. And a number of us who are heretics are saying, we have to kind of let go of the paranoid, you know, this is really

infectious. We have to wear cosmonaut suits kind of biosecurity paradigm here. And we have to sort of be a little bit more pragmatic and willing to take some risks here. What we learned and what I learned by working with communities is that people are smart and they remember. They see things and they remember. It's not an Ebola test. It's you guys were back here and you treated malnutrition 10 years ago. We remember that. We remember that you had an ICU and you treated people and we saw people who were going to die, you know, live. So you have to start with what is true and real to people to rebuild trust.

In this hospital where I was sent to, this patient came in who was in a coma with a high fever. And he was brought in from a village where a child had died of Ebola. There were serious grounds to think that this guy might have Ebola. What we did, and I remember being a bit nervous about this, we said, look, we're not going to do the whole Ebola, you know, panic drama thing, right? This guy's coming in, he's coming in now in the ambulance, we're just going to wear gowns and gloves, he's not vomiting, and we're going to treat him. And we did. And so we felt, you know, he had come with his brothers. And I thought, why are his three brothers, and they were like teenagers, standing outside of this little hut where we'd isolated him.

They looked kind of scared. And I thought, come on, these kids, they've been with him already. I mean, if he has Ebola, they have Ebola anyway. There's no point in keeping them outside. So I said, look, come in and sit inside. Sit with your brother. And we brought them outside. So I said, look, come in and sit inside, sit with your brother. And we brought them food. And it was very interesting because it just sort of broke down the separation. And then the guy woke up the next day, started to wake up and two days later was eating. And then five days

later, he was home. Can I tell you how much the family and the community loved us after that? They were like, ah, you really treated this guy. Right. Even though he didn't have Ebola. He ended up being negative for Ebola. What about the argument that not all doctors would want to treat Ebola the way that you're suggesting it be treated, you know, for example, not wearing that cosmonaut suit. When we realized there was very low risk of patients with Ebola coming into our transit center, I actually took down the orange, you know, barriers, but there's still the post, so we knew the distance. And I said, look, you can wear either the cosmonaut suits or

standard protection. And some people were comfortable, you can wear either the cosmonaut suits or standard protection. And some people were comfortable. But there's something really important I should tell you, Jamie, here that we haven't discussed, is that everybody is vaccinated. And that Ebola vaccine works. It's not 100%. The risk isn't zero, but it's very low. And caregivers need to make a decision based on that. And I think you can't force caregivers to be at risk, but you can sort of install a culture where it's not about fear. It's about how do I care for these people? And your argument here is that this goes a very long way in building trust. Absolutely. And can I ask you, if this trust isn't improved in the Democratic Republic of Congo,

what does that mean? What happens to this Ebola epidemic? Well, here I'm going to go out on a limb. I think, you know, in a way you want to hear, oh, it's going to be a disaster and everybody's going to die. I actually think this epidemic is going to burn itself out anyway. I'm more worried about trust in general. I see this as part of a global movement where trust in authority and trust in public health is eroding globally. I think you can make an argument that we're seeing that with vaccines right now. The measles epidemic.

This morning, measles concerns are on the rise as the highly contagious virus spreads across the country, according to the center. And we're seeing it with polio. Right. You know, I'm from a global health point of view. I hate to say this. Ebola isn't a really big issue. Doesn't kill a lot of people. I mean, every death needs to be mourned and is tragic. But if we're going to be kind of retail about this, many more people died in the West African epidemic of the increase in malaria deaths. So I'm really worried about trust and reversing advances in public health that we've had for all the other diseases where trust was key to getting people to vaccinate, malaria nets, etc., etc. So I see

Ebola as symptomatic of something that is very worrisome, which is the breakdown of trust in public health. That's the scary part. This is such a complicated subject, and I feel that I could talk to you all day about it. But thank you so much for taking us through all of this. Thanks for having me. Earlier this month, the World Health Organization decided not to declare the Ebola outbreak a global health crisis because it hasn't spread outside of the DRC. The decision was criticized by many health groups, including Doctors Without Borders. In a statement, they said, quote,

It is clear that the outbreak is not under control, and added that a new strategy was desperately needed in the DRC. That's all for today. I'm Jamie Poisson. Thanks for listening to FrontBurner. For more CBC Podcasts, go to cbc.ca slash podcasts. It's 2011 and the Arab Spring is raging. A lesbian activist in Syria starts a blog. She names it Gay Girl in Damascus. Am I crazy? Maybe. As her profile grows, so does the danger.

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