Deo Bakulu washed his hands every opportunity he receives since Ebola entered the town of Goma last month in the Democratic Republic of Congo.
But the local authorities close to his home set up the washing station is only accessible from 8 a.m. From Monday to Saturday at 6 p.m. and he has no running water.
“Does Ebola only spread during the day?” he asked as a health official at a different station aimed an infrared thermometer at his temple. “What about on Sundays?”
Goma, a town of almost 2 million persons, is on high alert following confirmation last week of the first transmission of the virus within it. That raised concerns that the epidemic could spread through its boundary with Rwanda and the international airport in the densely populated town and beyond.
A gold miner brought the virus to the north from the epicenter of the epidemic. He and his wife and 10 kids spent a week at home ill before being transferred to a hospital where he died the next day. Then his wife and daughter tested the disease positively.
Goma had time to prepare for Ebola, given an almost year-long head start as the disease spread close Beni and Butembo towns. Most citizens seem to have taken the recent developments in step, queuing up at the government and private companies ‘ dozens of washing stations set up on sidewalks. They do not shake hands.
Nevertheless, there are deficiencies in the preparations, and some of the same suspicion and hostility doctors encounter in other hot places of outbreaks. More than 1,800 persons have been killed by the virus in the present epidemic, the second highest toll ever. West Africa’s 2014-16 Ebola epidemic recorded a grim record of more than 11,300 fatalities.
Whether health officials can effectively apply lessons from these hot spots is going to go a long way to determining whether they can claim a major win in Goma.
“The system was there before, which is good, so that we’re not starting from scratch,” said Kate White, medical emergency manager for French medical charity Médecins Sans Frontières (Doctors Without Borders). “But it definitely needs to be reinforced and scaled up.”
Ebola, a hemorrhagic fever first discovered in Congo in 1976, spreads through direct contact with body fluids and typically kills roughly half of those it infects, although the mortality rate is closer to two-thirds during the current outbreak because many people are not seeking treatment.
The three cases in Goma set off a scramble to find and vaccinate more than 800 direct and indirect contacts. As of Tuesday, all but five had been vaccinated, said Tresor Amiri, the World Health Organization’s vaccination chief in Goma.
Officials were cautiously optimistic about their chances of containing the virus in Goma. No additional cases have been identified, and the miner’s wife and daughter are recovering.
“We hope they will become the first people cured in Goma,” said Jean-Jacques Muyembe, the head of the Ebola response across Congo, saying their survival would show people that “if you show up for treatment early, the chances of survival are relatively good.”
The one previous case in Goma led the WHO to declare the outbreak an international health emergency three weeks ago, but it did not result in any further transmission inside Goma.
Authorities chalk up those successes to elaborate preparations since the outbreak was declared last August.
Ferdinand Tangenyi, 23, is one of scores of volunteers going door to door with illustrated flipbooks warning against handling bloodied clothes or cleaning up vomit. Public service announcements also run repeatedly on the radio.
At the border with Rwanda, crossed by an estimated 45,000 people each day, travelers have their temperatures taken twice on either side. Rwanda briefly closed the border last week but re-opened it as experts warned the move would encourage illicit crossings.
Officials established protocols to handle cases, which they isolated in a special ward at the main hospital. After two months of construction, a 72-bed center built by MSF exclusively for Ebola received its first suspected cases on Friday.
MSF says it is taking additional steps to reassure the population in Goma and to avoid the conspiracy theories that have undermined the response near Beni and Butembo. The Goma center, for example, was built with see-through fencing to pre-empt rumors that anything nefarious is happening inside, said Alexis Touchais, the construction manager.
Francine Mulangala, who goes door to door informing people about Ebola in the Goma neighborhood where the gold miner lived, said she was also threatened last Friday by more than a dozen people demanding to see his body.
“If anyone gets sick, we are going to kill you,” she recalled them saying.
The local government has limited ability to deliver crucial services. Only about 10% of the population has access to running water and many rely on communal latrines. The population is also highly mobile, with many traders crossing into Rwanda every day, some outside the official checkpoint.
One driver of a special Ebola ambulance in Goma, who asked not to be named, said drivers had not been paid in six months. The provincial health ministry, which employs the drivers, could not be reached for comment.
Many residents said they were eager to be vaccinated, but could not be because only those exposed to Ebola patients or their contacts are currently eligible. A decision on whether to deploy a second vaccine that would cover a wider population has been bogged down by wrangling inside the Congolese government.
“The population accepts that Ebola is real,” said Joseph Mumbere, a money changer. “But it is very hard to get the vaccine.”