Overwhelmed health workers in Congo are struggling to keep up with an Ebola virus that is outpacing contact tracing

Nizi, Congo: Every day, community health worker Gideon Banga Ngbabi and his team walk through communities in eastern Congo looking for people who may have crossed the paths of the country’s fastest-growing Ebola outbreak in history.
Workers are investigating dozens of alerts, looking for people who have been exposed to suspected or confirmed cases, and trying to get anyone with symptoms into care before the virus spreads further.
But the surveillance system is increasingly failing to keep up with the virus. Between 60% and 70% of new Ebola cases are discovered among people who have not already been detected as contacts, meaning health workers may not discover infections until after patients are sick and have had a chance to expose others.
“If monitoring does not work well, the entire response will suffer,” Ngbabi said. “Monitoring is the engine of response.”
The outbreak has killed more than 2,200 people out of more than 4,700 cases, according to the latest government figures. This number of deaths was reached almost three times faster than the 2014-2016 Ebola outbreak in West Africa – the worst in history. This outbreak has claimed the lives of more than 11,000 people.
“We are chasing the virus, the virus is in front of us,” WHO Regional Director for Africa, Dr. Mohamed Yaqoub Al-Janabi, said this week.
UN Humanitarian Coordinator Tom Fletcher on Friday announced $30.5 million in additional funding to help tackle the Ebola outbreak.
Response teams work long hours, often without pay
In Nizi, Ngbabi’s monitoring teams say they receive an average of 60 to 70 alerts a day. They move across communities to investigate suspected cases of infection, follow up on people who have been in contact with suspected or confirmed cases and direct people with possible symptoms to health facilities.
The action can extend deep into the night.
“I leave in the morning at eight o’clock and come back around 11 p.m., sometimes at midnight,” Ngbabi said. “I still have to follow up and plan upcoming activities. I feel very tired, but what matters to me is to always be of service to the community.”
He did not say how many days a week he works or how many times he can take leave.
Community health workers who go door-to-door face their own risks. Anna Ndroi Ghasemi, a community health worker in Nizi, said she visits homes to educate residents about Ebola and reports suspected cases to health officials. But she said workers like her lack basic protective supplies.
“When we go door to door, we do not have protective equipment, such as shoes, disinfectants and other supplies, even though we are at risk,” Ghasemi said. “We buy disinfectants with our own money.”
The current outbreak, caused by the rare Bundibugyo Ebola virus, is unfolding in some of the most difficult circumstances imaginable. There are no approved vaccines or treatments for Bundibugyo virus, although trials are ongoing. Unpaid strikes by some health workers, threats by rebel groups, anger from long-traumatized communities and misinformation that Ebola is not real have all significantly hampered the response.
These gaps are particularly important in Nizi, one of the most affected health zones in Ituri Province, which accounts for about 90 percent of Congo’s Ebola cases and 80 percent of deaths.
“We started monitoring with a smaller number of workers,” Ngbabi said. “The challenges are enormous,” he added.
On Thursday, health workers at the Nizi Treatment Center went on strike and the facility was temporarily closed. Ngbabi said that health workers have not received their salaries for more than three months.
The head of the Africa Centers for Disease Control and Prevention, Jean Cassia, on Thursday called on the Congolese government to pay outstanding salaries, saying funds were available and paying workers’ wages was the government’s responsibility.
The government says the payments were delayed because it was checking workers’ payrolls after finding irrelevant names had been added, while converting payments from cash to mobile money.
Qasim said community health workers like her have received their payments, but at about $50 a month, she considers the amount insufficient for the work and risks involved. She said other Ebola response workers should get paid quickly.
“They make sacrifices and take risks,” Ghasemi said. “If these workers decide to stop working, the epidemic will spread further through the population.”
Insecurity and displacement make communications elusive
Ngbabi said monitoring workers in Nizi often struggle to move around, making it more difficult to investigate alerts and follow up on communications across the health region. Frequent population movements associated with mining and people fleeing armed conflict add another complication, as people can move before surveillance teams can follow them.
Poor and sometimes impassable roads can also make access to remote areas difficult, while insecurity limits the places where health workers can work safely. It remains unclear how many communities in the province are currently inaccessible to monitoring teams.
Dozens of rebel groups and militias are active in eastern Congo. The ISIS-linked Allied Democratic Forces are among the groups active in Ituri. Insecurity has forced some health and aid workers to leave remote areas where the Ebola virus is spreading, in search of the relative safety of the regional capital, Bunia.
The violence affecting the Ebola response also comes from the population. At least a dozen attacks on health facilities and staff had been recorded as of mid-July, according to local health authorities. In one incident, residents attacked a hospital in Nyakundi and entered a nearby Ebola treatment centre, forcing patients and staff to flee before resuming operations the next day.
Many residents are angered by misinformation about the virus and a ban on traditional burials – when families prepare bodies and people gather for the funeral, which can lead to further infections.
But Ngbabi said his surveillance teams in Nizi were not attacked.
He said cooperation improved as residents became more familiar with the monitoring teams and their work. Ngbabi also said he did not believe people in Nizi were hiding suspected infections on a large scale, although population movements and limited means of transportation may make it difficult to follow up on contacts.
For Ngbabi, maintaining this surveillance is crucial to prevent individual infections from developing into broader chains of transmission. He said the long hours and limited resources have left him exhausted, but he is not ready to stop.
He added: “I am here to save the lives of residents.”