Ebola, Disease Outbreaks, and Inadequate Health Systems

I vividly remember the Kagadi Hospital run by the Ministry of Health. In 2002, I was visiting the communities that would benefit from an ambulance fundraiser project. That evening the need for emergency transportation in the Kagadi-Nakuulabye area of the Kibaale District could not have been made more clear to me. Driving back to our housing one evening, our pickup truck was flagged down to help at the scene of a bicycle accident where two riders had collided head on in the dark. One man was bleeding from his ears and obviously needed advanced medical attention. We drove him, lying in the pickup truck bed, to the Kagadi Hospital only to be turned away because the staff said they didn’t have any supplies to treat the man. I remember looking into the hospital windows and seeing nothing but empty walls.

It came as a shock to read news of the Ebola outbreak in that very same area where I had visited 10 years ago: Kagadi, Kibaale District. My first thought was that the health care system couldn’t possibly respond quickly enough, but hopefully things had improved over the last decade. Reports noted that the Red Cross, Doctors Without Borders, CDC, and the World Health Organization (WHO) were assisting with the response. This was a positive sign since the area is rural, difficult to travel to, and as far as I knew lacking a strong health care system.

“This outbreak is occurring in the same area where the Red Cross is already responding to the growing crisis caused by the influx of Congolese refugees fleeing violence in their country” said Charlie Musoka, Regional Operations Coordinator for the International Federation of the Red Cross.

On top of dealing with the Ebola outbreak, the Ugandan Red Cross was also managing the influx of refugees into the country. My initial thought was that Ebola is easily transmitted by close contact between people and usually kills 90% of those infected. With the regular movement of people across the Uganda/ DRC border it could be just days before an Ebola outbreak occurs in the DRC.

Shortly after the Ebola outbreak, news broke that the Ugandan Ministry of Health needed Sh3 billion to be able to contain and manage the disease and necessary health care facilities. I was also contacted by the local health center in Kagadi and told that were having difficulty responding to the outbreak as well. My fears seemed to have been true and the health system was feeling the pressure of responding to an Ebola outbreak in an area where there was very little health care capacity.

Roughly, two weeks after the request for supporting funds by the Ugandan Ministry of Health, the Ebola outbreak is reported as contained in Uganda and a Ugandan team would be sent to the DRC to help contain the new outbreak there. Reports said that it was a different strain of Ebola, but the first reports were in a Uganda/DRC border town that is a regular crossing point between the two countries. I had worried about the lacking health care system in Uganda, but the health care system in the DRC is in an even more strained. There are limited health care workers and facilities, which are usually filled by casualties from the ongoing violent conflict in the region.

Early this month, the WHO declared Uganda Ebola free after there were no new cases reported after August 3rd (24 confirmed cases, 17 deaths). The facilities in Kibaale District remain on alert, but the larger Ebola crisis is in the DRC. The WHO confirmed the Ebola outbreak is a different strain (see map above) and not connected to the Ugandan outbreak, however there have already been 72 confirmed cases and 32 deaths. Health workers were reported infected in the Ugandan outbreak, but in the DRC so far 23 of the 32 deaths have been health care workers. Representatives of Medicines sans Frontiers note that the death of health care workers at hospitals scares people away from seeking treatment and they are more likely to continue the spread of Ebola. It seems that the DRC has been less equipped to deal with the Ebola outbreak or its just the nature of the area where the outbreak occurred that made it easier to spread.

Both of these examples of Ebola outbreaks in a remote region of Uganda and in a transit town in the DRC demonstrate the critical need for adequate health care systems and health care workers. Before conflict started in the DRC, the health care system was already underfunded and in need of investment. The United Nations reported that militias raided almost all of the health care facilities in rural areas where 70% of the populations lives. The conflict also disrupted transportation and everyone must travel by foot to get treatment. NGOs have tried to invest in the health care system, but Doctors Without Borders report regular attacks on their compounds. In Uganda, there has been similar conflict, but greater investment in the health system. However, a recent report highlighted the inadequate staffing and space in many key hospitals. In some areas there is 1 doctor for every 178,000 people. Due to financial constraints the Ugandan government has banned recruitment of health care workers.

No one can afford to not invest in health care capacity building. In these two countries it seems that health crises need to be managed by outside NGOs with additional funding. How can the international community better work to build the capacity of individual country’s health care systems?

congo is not a country

Recent research and commentary on atrocities in the Democratic Republic of the Congo (DRC) have fueled reference to a “Congo” that seems to include only one country, but “the Congo” is a large, resource rich region made up of many countries.

Traditionally “the Congo” refers to the region of Middle Africa (referred to as “Central Africa” by the UN) comprised of parts of ten (10) different countries, including: Angola, Cameroon, Central African Republic, Democratic Republic of the Congo, Republic of the Congo, Equatorial Guinea, Gabon, Sao Tome and Principe, Burundi and Rwanda.

The Congo is best understood as a geographic region, with lush tropical rainforests and a wealth of mineral deposits, that benefits from the drainage of the Congo River. As a result, interest in the Congo region has caused violence and atrocities arguably since its “discovery” by Henry Morton Stanley in the name of King Leopold II of Belgium. The King wanted to spread Western civilization and religion to the region, which has led to continually destabilization and conflict.

The geographic region known to us as “the Congo” was home to one of the advanced African civilizations as well as the Baka people (often referred to as pygmies). The Kingdom of the Kongo included parts of the DRC, Republic of Congo and Angola. As recorded by Europeans the Kingdom of Kongo was highly developed with a extensive trading network. As “explorers” and colonizers penetrated further into the interior of the African continent, the Kingdom of Kongo became a major source of slaves. As a result of political in-fighting, resource grabbing, and European invasion, the Congo region’s factions remained in civil war for almost forty years (1700).

Since European arrival, the Congo region has been in a regular flux of conflict either between political factions, against colonizers, or now among local militias fighting for control of areas of resource wealth.

Much like our misunderstandings of various aspects of the African continent, its history, and people fuel monolithic interpretations of Africa, so too do our misunderstandings of the Congo region’s governments, resources, and cultures.

Maybe our misunderstandings and myths of “the Congo” are driven by the Heart of Darkness (supposedly inspired by Henry Morton Stanley) narrative set on the Congo River that details atrocities committed against native peoples? Maybe history shows Western violence has created a culture of violence in the quest for control and resources? Either way Congo is not a country, but a vast region with deep history and amazing possibilities.

history channel perpetuates misperceptions of africa

Reminiscent of the 1800s, a new History Channel show describes a team of explorers, dressed in their colonial khaki, set out to discover the perils of the African continent.

Four modern-day explorers retrace the most famous search in history through 970 miles of hell. They face countless dangers from predators and insects to disease and nature’s own fury. Check out the television event of the summer!

Miles of hell in Africa, oh my! Don’t forget the natural danger!

Between Zanzibar and Ujiji, there are 970 miles of high seas, steep hillsides, scorching plains, fast-moving rivers and mud-filled swamps. Danger lurks around every corner, and any step could be their last.
(Expedition Africa, History Channel)

The webpage for the expedition show describes how the explorers will be following in the footsteps of the great explorers, “heroes” to some of these ‘modern-day’ explorers, Sir Henry Morton Stanley and Dr. David Livingstone.

Stanley a Welsh journalist, who spent a number of years of his life in the US, is best known for finding Dr. Livingstone after he was thought lost in the African bush. Regarded as one of the premier African explorers, a little known fact about Stanley’s African exploration is that he laid the foundation, through his exploration, for the takeover of the Congo (now DRC) by King Leopold II of Belgium. The King was interested in spreading Western civilization and religion to the region as well as claim land. This has led to a still destabilized region where some of the longest running African conflicts are located. Allegedly his expeditions were marked by violence and brutality. He is quoted, “the savage only respects force, power, boldness, and decision.” On a health related note for the central African region, the spread of trypanosomiasis is attributed to the movements of Stanley’s enormous baggage train.

Livingstone’s African exploratory era was marked by the greatest European penetration of the continent. He began his African explorations as a Protestant missionary, but supposedly did not force his preaching on unwilling ears as his main interest was exploring. He was known to travel lightly and was able to negotiate with local chiefs. Livingstone was a man in love with the continent and popularized the search for the source of the Nile. After being ‘found’ by Stanley he refused to return without completing his mission. Just 50 years after his death, colonialism exploded across the continent and was able to penetrate further into the interior due to his work. However, this also allowed missionaries to provide education and health care services to more central Africans. Livingstone was also a staunch abolitionist and made many friends among the African chiefs and populations.

Both men are examples of the Western colonial mindset scarring the African continent. While Livingstone was perhaps a step forward in Western engagement of Africans, Stanley is far from a figure to emulate. The History Channel fails to take note of the important contributions these men made to the destruction of the continent. Instead they focus on the meeting of the two in a popular media tale of discovery in the African wilderness.

Four Westerners with varying experience with the African continent will be followed on their journey that will pit them against the harsh natural environments of Africa. But, this show isn’t about Africa, learning about African peoples, remembering African history or highlighting the difficulties faced in Africa. The show makes generalizations about the continent and perpetuates the myths of Africa as primarily a place of danger. It focuses on Africa as “the unknown, the interior of Tanzania.” If I’m not mistaken people have been living on the African continent longer than any other place on earth. It may be a dangerous, unknown hell full of nature to outsiders, but it is far from a mystery to those who live there. The show seems to be all about these four privileged individuals and the story of their personal journeys. The explorers are worried about mosquitos, disease, death, and surviving. Rightly so in some regards, but what if the story included the people that actually live there?

When will Africa cease to be represented solely by its nature, its dangers and its forgotten history?

Written for the SCOUT BANANA blog.