Moving target: Congo's North Kivu province becomes new Ebola hotspot
BUTEMBO, Democratic Republic of Congo, Sept 25 - All 29 beds were full this week at the Kitatumba Ebola treatment centre in Congos North Kivu province, where surging cases have overwhelmed health facilities even as the deadly virus shows signs of easing elsewhere.
asserted
virus → move → signs
In one room, a critically ill patient lay on oxygen support, crying out as medical staff in masks, gloves and plastic aprons rushed past him at the centre in Butembo, a city of 2 million people.
"Over the past two weeks, we've seen a very sharp increase," said Stephanie Hoffmann, project coordinator for the international medical charity Medecins Sans Frontieres (MSF) in the city.
asserted
Hoffmann → lie → city
"There are sometimes patients who know they have Ebola but cannot find a bed."
asserted
they → be → bed
City authorities announced the opening of two new treatment centres this week to deal with the demand, bringing the total to four.
But some patients arrive so unwell, there is nothing doctors can do, said Hoffmann, speaking at the Kitatumba centre.
asserted
Hoffmann → announce → centre
She described the case of a 10-year-old boy who died in triage before doctors could admit him to the facility on Tuesday.
uncertain
doctors → describe → Tuesday
The scenes underscore the difficulty of containing Ebola across a stretch of eastern Congo that is bigger than France – one where medical resources are stretched thin.
asserted
resources → underscore → France
Researchers believe the rare Bundibugyo species of the virus was spreading for months before the first cases were confirmed in Ituri, a province that neighbours North Kivu, in May.
uncertain
that → believe → May
Aid cuts, surveillance system gaps and the absence of approved vaccines and treatments hampered the response, along with armed conflict in the region.
asserted
cuts → approve → region
As of Tuesday, Congo had confirmed 7,820 cases and 3,779 deaths, according to government data.
uncertain
Congo → confirm → data
While Ituri remains the worst-affected province, North Kivu's share of new infections increased sharply this month, the data shows.
asserted
data → remain → infections
The province now accounts for around a third of newly confirmed cases and deaths, the World Health Organization (WHO) said in a report on Sunday.
asserted
province → account → Sunday
Last week, South Ubangi became the seventh province affected, another sign of what WHO described as a "pronounced geographic redistribution of transmission."
United Nations and Congolese government officials said last week there were signs transmission is slowing in some of the worst-affected parts of Ituri, where responders have been racing to set up treatment facilities, identify victims, trace contacts and educate people on how to protect themselves.
asserted
responders → become → themselves
But it remains a "massive" outbreak, UN Special Ebola Coordinator Julien Harneis told reporters in Geneva.
asserted
Harneis → remain → Geneva
Frontline workers say cases continue to emerge in new and underprepared areas.
asserted
cases → say → areas
"Assuming the outbreak is under control because some Ebola treatment centres are admitting fewer patients would be a mistake," Anthony Kergosien, MSF's emergency coordinator in Congo, said in a September 18 statement.
asserted
Kergosien → assume → statement
"The outbreak is not shrinking; it is moving."
asserted
it → shrink → ?
DEEP MISTRUST
Interviews with residents, health workers and local leaders suggest shortages of funding and skilled personnel, together with deep-seated mistrust of Ebola responders, are making the virus difficult to contain in North Kivu.
asserted
virus → suggest → Kivu
Just over 60% of people diagnosed there are dying, significantly higher than the national average of 48%, the data shows.
asserted
data → diagnose → %
Medical staff say there has not yet been enough education about the virus, and patients are avoiding health facilities.
asserted
patients → say → facilities
That complicates efforts to identify cases and start treatment before the disease reaches its most dangerous stages.
asserted
disease → complicate → stages
By the time Ebola patients reach Dr Michel Paluku Mukuloli's hospital in Butembo, it is often too late.
asserted
it → reach → Butembo
"Patients think that if they arrive at the hospital, they will be immediately sent to the treatment centre to die," he said.
asserted
he → think → centre
In Butembo, one of the region's largest cities and a major trading hub, there are few signs that mitigation measures are being widely adopted.
asserted
measures → be → cities
Overcrowded minibuses criss-cross the city.
asserted
minibuses → criss → city
Markets remain packed.
asserted
Markets → remain → ?
Some residents refuse to have their temperature checked or wash their hands at entry points to the city and outside public buildings, according to the head doctor in the Butembo health zone, Pablo Paluku Lwanzo.
uncertain
temperature → refuse → zone
Only two of the zone's nine health checkpoints are operating due to staffing constraints, he added.
asserted
he → operate → constraints
Other residents question whether Ebola is real.
asserted
Ebola → question → ?
One local welder said his 12-year-old son, who suffered from respiratory problems, died the day he was transferred to an Ebola treatment centre.
asserted
he → say → centre
Because none of the relatives and neighbours who accompanied the boy became sick, he became convinced doctors had wrongly diagnosed the case
asserted
doctors → accompany → case
"For me, Ebola does not exist," the man told Reuters on condition of anonymity.
asserted
man → exist → anonymity
Frightened and angry residents have attacked teams sent to decontaminate their homes and safely bury people suspected of having died of Ebola.
asserted
residents → attack → Ebola
One person "came at me with a machete," said Lambert Maboko, a member of a burial team, as he recovered at home from the attack, which fractured his knee.
asserted
which → come → knee
Ahead of each deployment, members of the team hold a prayer session for their safety.
asserted
members → hold → safety
Earlier this month, residents set fire to a health post they accused of collaborating with Ebola responders, sending patients fleeing into the community, staff said.
asserted
staff → set → community
Microscopes and solar panels were lost in the attack.
asserted
Microscopes → lose → attack
"I'm at a loss for words," Kakule Mahamba, head of the Hope health post, said as he surveyed the charred wreckage.
asserted
he → say → wreckage
"Even the hospital beds were burned, as well as the medicines."
asserted
beds → burn → ?
Congolese authorities and WHO say they are working on building trust through awareness campaigns, household visits and engagement with religious and local leaders.
asserted
they → say → leaders
Speaking after meeting with the North Kivu governor and WHO representatives on Wednesday, Congo's incident manager for the Ebola outbreak, Steve Ahuka, said authorities had gained more access over the past four weeks.
"While pockets of resistance remain, we believe that with the involvement of traditional, religious and neighbourhood leaders … we can make progress."
asserted
we → speak → progress
…and 17 more, not listed.
The Aporia
