The recent Ebola outbreak in the Democratic Republic of Congo (DRC) is not without its challenges. A country already overwhelmed by diseases in the context of war, coupled with a weak healthcare system and poor access to basic necessities of life suddenly face an epidemic crisis. This session examined how different actors dealt with ensuring the health and security both of the community and the humanitarian aides, while at the same time kept armed conflict at bay.

The session outlined five major points of interests. The first one was an overview of the latest situation of the Ebola outbreak in DRC. Second, they tackled the major challenges faced by the healthcare workers and the military forces alike while extending out their aide. Third, they examined the action plan of the country of Uganda should an epidemic of similar gravity takes place. Furthermore, a discussion about the prominent roles of major NGO’s and military forces in the field was brought up. Lastly, each of the panellist shared a lesson they have learned in the aftermath of this outbreak.

The session opened by citing figures of confirmed Ebola cases. According to the panellists, this outbreak has been so far the biggest one with a total of 3250 confirmed cases. Moreover, this outbreak in DRC has been troubling because it erupted on a war-zone, thereby gaining access remains a challenge. Although this outbreak has been by far the biggest of its kind, Health Minister Aceng verified that the number of deaths are now dropping and new cases are reduced. She commended it to good leadership, preparedness and financing. In addition to that, the World Health Organization has been recognized in its effectiveness in vaccinating the responders and the communities- both in the target community and its surrounding areas

Ms Susanna outlined major challenges the responders are facing- The first one being the dealing of an outbreak in a war-zone where threats of violence both to patients and health-workers alike are perennial. Another two challenges she mentioned are in connection with the demographics. They are dealing with an outbreak in a population that is highly mobile and the outbreak is located in the border, thereby spill-over is a possibility. Another challenge that was brought up was the issue of mistrust harboured by the communities- among the government and the foreign workers. Last but not the least, the spread of fake news about Ebola virus as biological warfare directed against the population worsens the already tarnished relationship between the aides and the community.

The moderator then examined what other African countries can learn from Uganda’s disaster management plan. Health Minister Aceng emphasized the need for the government to set aside resources for preparation and to invest in communities. Good political leadership in touch with its people; capacity building among healthcare workers; improving health infrastructures and obtaining data real-time from the field epidemiologist, among others are necessary steps to be undertaken by the government.   When it comes to strengthening the communities, she stressed the importance of educating the people and to let them do the surveillance of their own area.

Ms Ruxandra from Merck Sharp and Dohme briefly mentioned how the advent of the Ebola vaccine paved the way to better health outcomes and humanitarian workers being more equipped to render treatment while not having to worry to get infected of the virus. She then explained how lengthy and laborious the process was-from discovering a potential vaccine to the actual distribution, and that it entails collaboration between the pharmaceutical company, the international organizations and most importantly the host country.

The session then shifted its focus on the actions undertaken by the NGO’s (World Health Organization and Medecins Sans Frontiers) while working alongside military forces. Questions about who plays a major role and who plays the subsidiary role in this complex emergency surfaced.  WHO’s representative mentioned that while the situation has a remarkable improvement over the last couple of months, this recent outbreak exposed a lack of preparedness coupled with weak planning and systems. Another factor worth considering is the reaction elicited by the presence of the military and the foreign workers- communities become reluctant to accept treatment. Ms Mercedes Tatay from MSF mentioned how uniforms brought about the stigma of fear and tension. Moreover, the process of transporting people infected by the virus to the isolation camps further aggravated mistrust.  With the aforementioned statement, Ms Mercedes acknowledged the effectiveness of decentralized treatments (that is bringing isolation camps proximal to the affected community) which resulted in increased engagement of the people to seek treatment. She also highlighted that the community must be the starting point of any action and that we must bear in mind that the community is struggling to control the outbreak while dealing with all other problems. General Hans Ulrich emphasized that one problem must not be solved after the other. Rather, this crisis must be given a comprehensive approach. He then added that while the military plays a minor role in the outbreak, a couple of their efforts cannot be undermined.  Safeguarding the humanitarian workers, transporting mobile laboratories and diagnostics and utilizing military aircraft in order for the workers to reach out to far-flung areas, among others, were steps undertaken by the military force for early virus detection and prevention of its transmission.

To close the session, each of the panellist shared the lesson that they learned in having to deal with this crisis. Three main ideas emerged: community in the centre, improved multisectoral collaboration and concrete preemptive measures should a similar situation occur. The community’s interests must be the driving force to which all interventions work. An improved collaboration means to set aside our own ideologies and take time to what other actors have to say. Lastly, the panellists highlighted the importance of being proactive, rather than reactive both in the national and international level. All actors should get the habit of how to be prepared than how to react.

Conclusion

Combating an Epidemic Crisis is a monumental Global Health problem that requires combined efforts. It is never a one-man show. Equally challenging is when the crisis occurs in a war-torn area. In this context, several factors have to be considered: treating the population affected by the virus that has already been traumatized by ongoing conflict, while at the same time safeguarding the health and security of the responders. Difficulties notwithstanding, such disasters can also be an arena for the learning experience.  In such emergencies, good dialogue between the different actors is paramount to be able to work effectively. The organizations must lay-out clearly- defined roles even before their neutrality is put into question. These roles must serve the best interests of the affected population and not someone else’s.  This collaboration and communication must take place both in the national and international level. Lastly, as what Health Minister Aceng emphasized all throughout, investment in preparedness and not in response is one of the keys for better management of such a health crisis

Relevance to the nursing profession

As the group of healthcare professionals that have the most patient contact, nurses doing fieldwork are in a vulnerable position(both foreign and locals). Hence, they must also be trained and equipped on how they can protect themselves (and not merely relying on security) in the event an attack directed towards them happens. Much has been said about safeguarding provided by the military but nothing about how these people can protect themselves when these forces are nowhere in sight. As with the rise of false advertisements, especially directed against immunization, nurses must use their influence to propagate the benefits vaccines can bring about.