H5N1

Ebola survivors in DR Congo face stigma and mental health issues

An excellent article in The New Humanitarian: Ebola survivors in Congo face stigma and mental health issues. Excerpt:

Anselme Kambale Mungwayitheka thought he was going to die of Ebola a year ago. After contracting the virus and being admitted to an isolation ward, the 40-year-old nurse didn’t think he would make it out alive. Now cured, he says he also feels cursed. 

The father of three, who still works at an Ebola treatment centre during the day, lies awake at night questioning why even those closest to him have been reluctant to come near him: “I thought, why am I alive? Even my wife and my friends don’t like me. I should have been killed from Ebola.” 

The Democratic Republic of Congo’s deadliest ever Ebola outbreak has shown signs of slowing in recent weeks despite a spike in cases reported yesterday. But stigma against survivors – who can be shunned by loved ones, colleagues, and neighbours – and a lack of mental health support mean the virus will haunt many of them long after the epidemic is officially declared over.  

This outbreak has been raging for more than a year now and has cost more than 2,200 lives. Although treatment advances have contributed to a higher than ever proportion of survivors – more than 1,000 – there is growing concern that the stigma of the disease has not been adequately addressed as part of the response.  

Although the 2014-2016 West African outbreak killed more people, the latest outbreak has posed unique challenges. 

It is the first to occur in an active conflict zone, compounding existing trauma with the distress of Ebola.  

Eastern Congo is home to more than 100 armed groups. Attacks against health workers – amid rumours that the virus isn’t real or that it’s a money-making venture for some – have led several times to the suspension of Ebola response operations.  

However, according to survivors and aid officials involved in operations in Congo, there is also a lack of trained mental health staff in the country and an insufficient mental health component within the response.  

For example, in Beni, one of the major towns in the outbreak zone, the government’s psychosocial commission, which works with Ebola survivors and their families, has 115 employees, including 15 trained psychologists. The employees receive three days of training from the commission before they start, followed by monthly information sessions.  

But the Ministry of Health estimates it needs at least another 50 trained psychologists between Beni and nearby Butembo to properly cover the area. 

“It’s not sufficient,” said Justin Kakule Kasai, president of the psychosocial commission.  

Health workers visit survivors on average once a month for 30 minutes. Ebola orphans – of which there are almost 2,500 at risk of being stigmatised, isolated, or abandoned according to UNICEF – get more frequent check-ins: once a week for 15 to 25 minutes. 

International aid groups are trying to fill the gap, with UNICEF training more than 1,000 psychologists and psychosocial workers since the beginning of the epidemic – but reaching affected communities has proved challenging amid bouts of violence.

Ebola survivors battle grief and stigma in eastern Congo

Via Reuters: Ebola survivors battle grief and stigma in eastern Congo. Excerpt:

BUTEMBO, Democratic Republic of Congo (Reuters) - Arlette Kavugho was discharged from an Ebola ward in eastern Congo in March, but her troubles did not end there.

When the mother of six tried to return to work as a seamstress in her hometown of Butembo, her customers were too scared of catching the disease, despite doctors’ assurances that she was no longer contagious. 

Instead she found work as a caregiver to children suspected of having Ebola only to be accused by neighbors of faking her illness to get the job.  

To this day, Kavugho has not been able to find the graves of her 19-year-old daughter and two-month-old granddaughter, who died of Ebola while she was receiving treatment and were hastily buried to avoid any further contamination.  

“I try to find the dates on the crosses that may coincide with their deaths but I always come back empty-handed,” the 40-year old said softly as she clung to a picture of her daughter with the word “adieu” written alongside.  

As of this month, more than 1,000 people have survived the 14-month Ebola outbreak in Democratic Republic of Congo, the world’s second deadliest, helped by new medicines that have proven effective against the virus when administered early. 

More than 3,200 people are known to have been infected with the virus, of whom more than 2,100 have died since the outbreak was declared in the eastern region. 

The survivors, who call themselves “les vainqueurs” - French for “the victorious” - however struggle to return to their former lives as they deal with the fear of relapse, long-term health issues like blurry vision and headaches and stigmatization by their families and neighbors. 

Vianey Kombi, 31, was a maths teacher when he contracted Ebola last November. Like Kavugho, he found it impossible to return to his former job and now cares for Ebola patients.  

“It hurts when I walk past the school where I was teaching, and the children who recognize me start screaming in my direction: Ebola, Ebola,” Kombi said. 

“We have all been accused of receiving money to say that we had Ebola,” he said. “It hurts a lot when your community treats you as corrupt after you’ve been at your sickest.”     

GIVING BACK 

Accusations like this are common in eastern Congo, where many residents see the outbreak as a money-making scheme made up by the government and outside organizations. 

“I was even accused of having received money to bring people from my community to the treatment center, to kill them with the virus and then sell their organs abroad,” said Moise Vaghemi, 33, who survived Ebola in August.

Butembo: Civil society pleads for serious coaching of Ebola winners

Via Radio Moto Butembo-Beni: Butembo: Civil society pleads for serious coaching of Ebola winners. The Google translation:

Butembo's civil society pleads for serious supervision of Ebola cures. His Vice-President said so during an interview with the Canadian Ambassador on Tuesday, September 24, during his visit to CTE Katwa. 

Edgard MATESO is worried about the transmission of Ebola which was on the track to be eradicated. He then seeks the support of the Canadian Embassy in this type of initiative.  

"Recovering patients also require special guidance because it is possible, according to experts, that they are still the basis of a contamination of the community. We think that we should put an end to Ebola if we can find mechanisms to formalize a structure that will take care precisely of their supervision so that they are not at the root of the stigma in the community," pleaded EDGARD MATESO. 

Present at this meeting, some survivors are committed to raising awareness about the Ebola virus disease. 

"I am president of Mukuna's Mom's Solidarity. We were resistant. It is we who incite the young people to learn the teams of response. We could take care of our bodies at night before the riposte knew. But when we realized that it was women and children who were more victims of Ebola, we decided to collaborate with the response teams," said the woman. 

Note that the cure rate of Ebola virus disease in CTE Katwa is increasing according to Dr. MUYISA SKODA, the director of this structure.

Ebola: Ituri records nearly 200 deaths and 385 confirmed cases since the beginning of the epidemic (Provincial Minister of Health)

Via mediacongo.net: Ebola: Ituri records nearly 200 deaths and 385 confirmed cases since the beginning of the epidemic (Provincial Minister of Health). The Google translation:

Ebola virus disease remains a concern in Ituri province, where it has been rife since August 2018 in the Mandima health zone in Mambasa territory before spreading to other parts of the province.  

According to the provincial health minister, the 200 deaths and 385 confirmed cases of this disease have already been recorded while only more than 15 patients have been cured. 

The health zones of Mandima, Mambasa and Komanda remain the most affected by the epidemic.  

"We have just put new strategies in place to try to stop this epidemic in our province," Dr. Patrick Karamura Mwira told buniaactualite.  

The same source believes that the stigmatization of patients in some villages would favor the strong spread of this disease especially in Mambasa territory. 

"In some parts of the country, the population still does not believe in the existence of the epidemic and it remains a great danger. I call the population to respect the rules of hygiene," he concludes. 

Ebola, which has been successfully controlled in the city of Bunia, the provincial capital of Ituri where no new cases have been reported for more than two months, as well as in the city of Ariwara in the far north of the province, However, it is difficult to do so in the territory of Mambasa, bordering Beni in North Kivu. 

Here, the population sometimes offers a fierce resistance against the teams of response, which it often criticizes for the disrespect of the local customs, concerning in particular the isolation of the patients and the safe burial of the victims.

Number of children orphaned or left unaccompanied by Ebola in the DR Congo rising fast

A UNICEF news release: Number of children orphaned or left unaccompanied by Ebola in the Democratic Republic of the Congo rising fast.

KINSHASA/DAKAR/GENEVA/NEW YORK, 13 August 2019 – The number of children in the Democratic Republic of the Congo (DRC) who have been orphaned or left unaccompanied due to the Ebola epidemic has more than doubled since April, requiring a rapid ramp-up of specialized care in the Ebola-hit provinces of Ituri and North Kivu.  

UNICEF and partners have registered 1,380 orphans, meaning children who have lost one or both parents to Ebola, since the start of the outbreak just over a year ago.   

In this same period, 2,469 children have been separated from their parents or caregivers — either left alone while adults undergo screening and treatment, or isolated because they’ve been in contact with someone infected.  

“This disease has been especially harrowing for children,” says Pierre Ferry, UNICEF’s head of child protection programmes in the DRC. "Children are watching parents die in front of them or seeing loved ones taken to Ebola treatment centers, uncertain of when or if they will return. They are struggling with grief and anxiety, while having to comfort and care for younger siblings. Many face discrimination, stigmatization and isolation."  

UNICEF is working closely with partners and communities to rapidly identify affected children and tailor support to address their extensive physical, psychological and social needs.  

To date, UNICEF has trained 906 psychosocial assistants and psychologists who provide a range of individualized assistance for orphaned and separated children.   

"Coming from the affected communities, psychosocial workers are among the most trusted actors in the response,” says Ferry. “As a result, they've been able to reduce harmful discrimination and misinformation and boost community acceptance and engagement, which is crucial to stopping the outbreak." 

For unaccompanied children, psychosocial teams provide dedicated care that includes food, psychological support and material assistance.  UNICEF runs three nurseries next to Ebola treatment centers in the epidemic's hotspots, where Ebola survivors, who are immune to the disease, care for and closely monitor infants and very young children until their parents or caregivers have completed treatment. 

For children with no surviving parents, the needs are longer-term. Psychosocial assistants work to place children with nurturing relatives or foster families — no easy task given the economic burden of raising extra children and the pervasive fear of catching the disease or being associated with it. It often requires delicate mediation as well as financial support for food, school fees and other basic necessities. The nature of the support is determined by the most pressing needs of each child or family.  

All the children require psychosocial assistance to mitigate the debilitating effects of loss, stigma and isolation, which is why UNICEF is working to quickly scale up child protection programs in Ebola-affected areas.  

“The number of children orphaned to Ebola or left unaccompanied is growing as fast as the outbreak itself,” says Edouard Beigbeder, UNICEF Representative in the DRC. “Care, specialized assistance and resources for these vulnerable children must keep pace.” 

Number of children orphaned or left unaccompanied by Ebola in the DR Congo rising fast

© UNICEF/UN0264160/Hubbard

The photograph above should be emblematic of the Ebola response and its aftermath: A survivor caring for the child of an Ebola case. Like all public health disasters, Ebola isn't over when it's over. We're all survivors. It lasts for the rest of our lives.

Via ReliefWeb, UNICEF has published Number of children orphaned or left unaccompanied by Ebola in the Democratic Republic of the Congo rising fast.

KINSHASA/DAKAR/GENEVA/NEW YORK, 13 August 2019 – The number of children in the Democratic Republic of the Congo (DRC) who have been orphaned or left unaccompanied due to the Ebola epidemic has more than doubled since April, requiring a rapid ramp-up of specialized care in the Ebola-hit provinces of Ituri and North Kivu.  

UNICEF and partners have registered 1,380 orphans, meaning children who have lost one or both parents to Ebola, since the start of the outbreak just over a year ago. 

In this same period, 2,469 children have been separated from their parents or caregivers — either left alone while adults undergo screening and treatment, or isolated because they’ve been in contact with someone infected.  

“This disease has been especially harrowing for children,” says Pierre Ferry, UNICEF’s head of child protection programmes in the DRC. "Children are watching parents die in front of them or seeing loved ones taken to Ebola treatment centers, uncertain of when or if they will return. They are struggling with grief and anxiety, while having to comfort and care for younger siblings. Many face discrimination, stigmatization and isolation."  

UNICEF is working closely with partners and communities to rapidly identify affected children and tailor support to address their extensive physical, psychological and social needs.  

To date, UNICEF has trained 906 psychosocial assistants and psychologists who provide a range of individualized assistance for orphaned and separated children. 

"Coming from the affected communities, psychosocial workers are among the most trusted actors in the response,” says Ferry. “As a result, they've been able to reduce harmful discrimination and misinformation and boost community acceptance and engagement, which is crucial to stopping the outbreak." 

For unaccompanied children, psychosocial teams provide dedicated care that includes food, psychological support and material assistance. UNICEF runs three nurseries next to Ebola treatment centers in the epidemic's hotspots, where Ebola survivors, who are immune to the disease, care for and closely monitor infants and very young children until their parents or caregivers have completed treatment. 

For children with no surviving parents, the needs are longer-term. Psychosocial assistants work to place children with nurturing relatives or foster families — no easy task given the economic burden of raising extra children and the pervasive fear of catching the disease or being associated with it. It often requires delicate mediation as well as financial support for food, school fees and other basic necessities. The nature of the support is determined by the most pressing needs of each child or family.  

All the children require psychosocial assistance to mitigate the debilitating effects of loss, stigma and isolation, which is why UNICEF is working to quickly scale up child protection programs in Ebola-affected areas.  

“The number of children orphaned to Ebola or left unaccompanied is growing as fast as the outbreak itself,” says Edouard Beigbeder, UNICEF Representative in the DRC. “Care, specialized assistance and resources for these vulnerable children must keep pace.”

Beni: 19 people cured of Ebola have left the Treatment Center

Via 7sur7.cd, some very good news: Beni: 19 people cured of Ebola have left the Treatment Center. The Google translation ad then a comment:

19 people healed from the Ebola virus this Saturday, August 10, left the treatment center in the city of Beni in North Kivu.  

According to the figures given on Friday, August 09 by the technical secretariat of the multi-sectoral response committee headed by Dr. Jean Jacques Muyembe, 810 people have already been treated for this epidemic, whereas it has made up to 1,873 deaths of confirmed cases and likely to be 2,793 people infected.  

According to the same data, 333 suspected cases are under investigation. 

While staying in Beni, the current epicenter of the epidemic, Dr. Muyembe said he noted a drop in cases in all areas for a few weeks now and assured that the city of Goma that has recorded 4 cases, is now under control.  

Two Goma patients could also be released on Monday, August 12th.

The Congolese haven't said as much as they should about how they follow up with their recovered patients. We know from West Africa that survivors often suffer long-term effects, including damage to their sight and hearing—and the virus often survives in men long enough for them to infect their sexual partners. As well, survivors' communities are likely to stigmatize them. These are all issues deserving of a prompt and sustained government effort to deal with the post-recovery damage Ebola can do.

Psychological support for life after Ebola

WHO AFRO has published Psychological support for life after Ebola. Excerpt:

It is a bittersweet day for Kennedy, 8 years old, who is about to be released from the Ebola Treatment Centre (ETC) in Butembo, in the Democratic Republic of the Congo. 

 On the one hand, he is cured. On the other, he has lost two family members to the disease - and he does not know it yet.  

Ebola has a fatality rate of about 50%, so explaining the loss of family members and helping patients through the grieving process is a daily task for psychologists who work alongside doctors, nurses and caregivers.   

There are five psychologists and 11 psychosocial assistants, trained by the Danish Refugee Council and financed by UNICEF, working at the Butembo ETC. Kennedy’s psychosocial assistant, Shabani Dezy, sits down with him for his session. First, he asks Kennedy some questions. Is he aware his sister and grandfather were also sick? When was the last time he saw them?  

Then he explains how they too were admitted to the ETC as suspect cases and transferred to the confirmed cases ward. He talks about the time he and other health workers spent with them and the care they were given. 

Finally, he asks about which religious background Kennedy belongs to and he explains they have gone to heaven for their second life.  

"Kennedy, if today we call you a hero, it’s because God wanted you to stay alive because there is something you will accomplish in your life.”  

Mental Health after Ebola 

Outside the treatment centre, Kennedy’s family is waiting to receive him. His mother is still mourning the loss of her father and daughter. She too has been working with psychologist Dezy to move forward. He reminds her anytime she or Kennedy need help to come see him.   

Dezy explains the people in the area are already traumatised by the ongoing conflict, and Ebola exacerbates the situation. 

“Ebola is a new threat in this community. It has affected everyone's mental health. It’s a disease that kills so many, and everyone is afraid of death. It also affects the economy because decontamination efforts require mattresses and other personal effects to be destroyed."  

Then there is the stigmatisation. Some households have had multiple deaths in the family. The surviving family members tend to be stigmatised by the community who stop doing business with them or coming to visit.  

“They say, 'there’s the family that brought us Ebola. We don’t want anything to do with them.' My colleagues and I have worked hard to understand the environment surrounding families and to work to reintegrate them." 

Survival lessons for Congo in the aftershock of West Africa’s Ebola crisis

Via The New Humanitarian: Survival lessons for Congo in the aftershock of West Africa’s Ebola crisis. Excerpt:

When he was sick in the treatment centre, [Alsény] Touré’s family kept calling him, warning him to refuse the food and medicines provided. They said it was tainted with the disease – a common rumour during the epidemic as people tried to rationalise the death toll. It took courage, but Touré said: “I entrusted myself to God; I accepted to take the medicines; I accepted to eat.” And he ensured his children did as well.

The extreme mortality rate of Ebola – from 60 to 70 percent – is terrifying. In responding to the outbreak, culture matters – how the dynamics of the disease are understood by the local population can be crucial.  

West African communities often distrusted the response effort, partly because the initial interventions were inadequate, and also because they upended the most intimate aspects of life – from touching loved ones to the mourning of the dead. 

It got worse for Touré. After his ordeal, he decided to return to Forécariah to tend to his father’s land, but on his way, riding on the back of a motorbike taxi, he received a call from a friend who warned him that his wife’s family was plotting to kill him. 

As in Congo now, the authorities were deeply distrusted during the West African epidemic, with some believing Ebola was a source of profit for the government and aid agencies. “They said I was negotiating to sell my family, to sell the village,” Touré said of his in-laws. They were accusing him, as a suspicious survivor, of somehow cashing in on his wife’s death. Alarmed, he forced the motorbike to crash and ran away.  

Surviving Ebola often means a social death, with some communities fearful that returning individuals may not be fully cured. In a survey in Guinea in 2014, 78 percent of respondents said they would not welcome an Ebola survivor back. Nowadays, this discrimination might not be as severe, but it still endures. 

‘Even if I wanted to sleep, I couldn’t’ 

Shunned by his family, Touré was forced to abandon a promising fishing business. The boat he had bought before the crisis was beached; it slowly filled with silt and the engine rusted away. He ended up working with the Red Cross, helping Ebola patients in a treatment centre, convincing them to take their medicines, and tasting their food first to prove it was safe.  

Touré is still traumatised by the events of the last few years. “I started to have depression,” he said. “Even if I wanted to sleep, I couldn’t. So if I didn’t go to a maquis (unlicensed bar) to drink to beyond, then I couldn’t sleep.” 

Towards the end of 2015 he attempted to hang himself but was saved by a friend. “I had no desire to live,” he admitted. “If it wasn’t for my two children, nobody could have talked me out of it.” 

His friend took him to a psychiatric hospital – another social mark against him. “People treated me as if I was crazy,” said Touré. “I had no more voice in my community.”

NEJM: Facing opioids in the shadow of the HIV epidemic

Via NEJM: Facing Opioids in the Shadow of the HIV Epidemic. Excerpt:

The United States is in the midst of an opioid crisis. An estimated 2.1 million Americans had an opioid use disorder in 2016. The rate of opioid overdose deaths has increased by 500% since 1999, and each day an estimated 115 Americans die from opioid overdose. Despite the proven effectiveness of medication-assisted treatment (MAT) for opioid use disorders, the opioid mortality rate has now surpassed that of the AIDS epidemic during its peak in the early 1990s — a time when there was no effective treatment for HIV/AIDS.  

Given that U.S. HIV incidence and AIDS mortality declined dramatically after the advent of antiretroviral therapy in the mid-1990s, it is not surprising that the AIDS response is often celebrated not just as an unqualified success, but also as a blueprint for the response to other emerging threats to population health. However, there are vital lessons to be learned from failures in the response to HIV as well as from the successes. Learning these lessons will require a less celebratory accounting of where we stand with the current HIV epidemic than we have seen so far.  

Effective treatment for HIV has been available in the United States for more than two decades, and the majority of people living with HIV in this country (86%) have now received that diagnosis. Still, less than two thirds of people living with HIV remain in care (62%), and viral suppression has been achieved in less than half the cases (49%). The benefits of scientific progress have been unequally distributed, with growing ethnic and sexuality-related disparities in new infections, dual diagnoses, and overall mortality. If current HIV diagnosis rates persist, one in two black men who have sex with men in the United States will contract HIV during their lifetime. 

This failure of equity should draw our attention to the importance of social factors in shaping who benefits from effective biomedical therapies. Each of the following lessons has the potential to improve the population health impact of MAT for opioid use disorder in the United States. 

First, the existence of effective medical treatment does not mean that people who need treatment can and will obtain it. Even as efforts are under way to scale up access to MAT, it is vital not to assume a position of “if we build it, they will come.” Though MAT scale-up is a necessary step for increasing access, engaging the 80% of people with opioid use disorders who currently receive no treatment also requires identifying cultural, social, economic, and structural barriers to access to care. In areas where MAT is available, studies already reveal age-based, racial, and ethnic disparities in treatment engagement and completion. If we fail to address the contextual barriers that shape engagement with MAT, biomedical advances may actually exacerbate health disparities by benefiting people who are more socially advantaged rather than the population as a whole. 

Second, we need to stop considering only one person at a time and address the structural drivers of the crisis. Since the 1990s, HIV researchers have recognized that the virus’s spread is driven by structural factors such as economic inequality, sexual oppression, gender inequality, and racism. 

A key lesson for the opioid epidemic is that without achieving long-term changes in the structural inequalities that render some populations vulnerable to opioid addiction, we will not be able to slow the epidemic. Structural drivers of the opioid epidemic include eroding economic opportunity, market-driven health care, insufficient regulation of pharmaceutical markets, evolving approaches to pain treatment, and limited access to effective drug treatment. Combating the epidemic will require addressing these drivers.