No government likes a disease outbreak, least of all one that draws international attention. The US and Canada (and other countries) are currently embarrassed by resurgent measles, and governments fear embarrassment more than any mere plague.
This is even truer of poor countries run by insecure authoritarians who consider public health an afterthought. When Ebola spread from Guinea to Liberia and Sierra Leone, I was appalled but not surprised to see that Guinea had no functional website for its ministry of health, and the sites for Liberia and Sierra Leone took months to improve. The media in such countries are not much better; they publish government news releases and visits by the health minister to the hot zone, and avoid anything investigative. Investigation can lead to good stories and bad beatings.
Considering the century and a half of misery that the DR Congo endured, first under the Belgians and then under its own thugs, its health ministry has done a pretty good job of informing its people and the world about ten separate Ebola outbreaks since 1976. The Congolese, like their Ugandan neighbours, have hard-earned experience in fighting this and other diseases, and they deserve our thanks and respect.
Nevertheless, both the Congolese and we also deserve much more information about the current outbreak.
Like most poor black African countries, the DR Congo is of little or no interest to Europe, North America, and Japan. As long as its mines keep delivering, no one in the West cares what happens to the almost 100 millions who live in this enormous and tormented country. The Ebola hot zone involves parts of two provinces with 17 million people, half the population of Canada, who have lost five million people over the past 25 years to vicious civil violence. No one in the West knows, or cares.
Almost no one. The internet can bring scattered individuals and groups together, whether for good or evil, and a few people around the world actually care about Zika in northeast Brazil, West Nile virus in Hungary, encephalitis in Bihar, and Ebola in North Kivu and Ituri. Apart from people in the agencies dealing with such outbreaks, these people include virologists, epidemiologists, science writers, health bureaucrats, and health journalists. Their expertise enables them to exert a surprising amount of leverage on public opinion and their governments.
The more such people know, the more leverage they can exert. But with few exceptions, all they know about Ebola is what the Ministry of Health and WHO choose to tell them. And that is frustratingly little.
For example, why don't we learn daily about the children infected and killed by Ebola? Why don't we know about their families? Why don't we know about how those families were exposed to the disease, and what they did about it, and how the response actually responded? Too many healthcare workers, even vaccinated, have contracted Ebola; why, and why are any of them still working unvaccinated?
The world that can help fight Ebola is wretchedly ignorant about the DR Congo in general and North Kivu and Ituri in particular. Where are the towns and villages where people are getting sick? How many people live there, and how do they make their livings? If over 73 million people have been screened at the border of the DRC and its neighbours, how do they travel, and why?
Just this afternoon, I downloaded a new report from the UN Development Programme on the Multidimensional Poverty Index. It tells me that 76.6% of Congolese live on less than US$1.90 a day, and 44% of its 92 million people live in severe multidimensional poverty—of which violence is just one of the dimensions. These numbers certainly help to explain the persistence of the outbreak and the resistance of the people to the response. Why should they cooperate with the government of a country of incredible wealth, which has left them in poverty through 60 years of independence?
And for that matter, why should the healthcare workers of North Kivu and Ituri get themselves vaccinated, and reassure their patients, when the same government can't protect them from the dozens of armed groups that periodically emerge from the forests to kill and kidnap people?
If the well-tailored bureaucrats in Kinshasa had the guts to describe the situation on the ground, and admit their own culpability in that situation, the global health community would at least know what it was getting itself into. If the Congolese media honestly reported the situation on the ground, their readers around the world would be able to offer more effective help—especially by twisting their governments' arms to provide that help.
Long ago I learned a simple rule of crisis communications: When things go horribly wrong, tell the truth, tell it often, and tell it well. Never mind if it might make you look bad for a day or two. By day 3 the world will respect your candour and come to your aid.
If governments like Kinshasa, and agencies like WHO, would only master that rule as well, we might be in sight of the end of this wretched outbreak—and bracing for the next one.
