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Violent Ebola Zone Calls For Creative Strategies


Ebola has broken out again in the Democratic Republic of Congo. So far the number of confirmed cases more than 75 since the start of this month is in line with previous flare ups in that country. There are positive signs for an experimental treatment being used there. But this outbreak comes with a dangerous twist. It is in an eastern region where a violent conflict is also raging. That's requiring health workers to come up with some creative strategies for reaching people in need. NPR's Nurith Aizenman reports.

NURITH AIZENMAN, BYLINE: To get a sense of just how insecure this part of the DRC can be, consider the experience of a top official in the World Health Organization, Dr. Peter Salama. Just over a week ago, he stopped in at a town called Beni that's near the epicenter of the outbreak.

PETER SALAMA: And the night we were there, there was an attack on civilians about 20 kilometers from where we were staying.

AIZENMAN: That's about 12 miles away.

SALAMA: And at least four or five people were murdered.

AIZENMAN: There are at least 20 armed rebel groups active in the area, and they've also kidnapped and killed humanitarian workers. So far, says Salama, nearly all Ebola cases in this outbreak have been in towns and villages that health workers can get to relatively safely. As soon as they confirm a case, they've been rushing in to find and vaccinate everyone that the sick person has had contact with and anyone who's had close contact with those contacts. The vaccine is experimental, and the strategy is called ring vaccination.

SALAMA: You form, in a sense, a protective ring around that confirmed case.

AIZENMAN: But last week, officials got the kind of news they'd been dreading. There was a confirmed case in a town called Oicha, which is surrounded by violent insurgent forces. A health team was able to travel there but only by getting an armed escort of U.N. Peacekeepers. That's not ideal, says Salama.

SALAMA: There certainly is risk with being too closely associated with any fighting force.

AIZENMAN: And Salama says the WHO already decided they'll have to suspend ring vaccination if a case surfaces in a village or town that's too dangerous to visit long enough to meticulously trace the sick person's contacts. Instead, they'll move to a less effective strategy, basically making a much briefer visit during which they'll just vaccinate anyone and everyone they come across before it's time to leave.

SALAMA: Because we may only have access for a couple of hours with armed vehicles and armed escorts.

AIZENMAN: Another group that's having to tweak its usual Ebola-fighting approach is Doctors Without Borders. The organization has opened an Ebola treatment facility in a town called Mangina. Karin Huster is an emergency coordinator.

KARIN HUSTER: We have 70 beds.

AIZENMAN: Huster says if this were a typical Ebola outbreak, for every patient that comes in, she'd be sending a team back to their house to decontaminate it, a specially trained group wearing protective suits who would spray down every single surface with chlorine.

HUSTER: To make sure that then that family can be reassured that it's safe for them to live in this place.

AIZENMAN: But many of these families live in areas that are too dangerous for Doctors Without Borders to travel to, especially since it's against the group's policy to go in with armed guards.

HUSTER: And so one of the things we've been thinking about is having sort of a mock, you know, little house.

AIZENMAN: And then use it to teach families how they can decontaminate their homes themselves with a take-home kit.

HUSTER: It might not be, you know, professionally done the way we would do it. But it would be much better than having nothing done to the house.

AIZENMAN: Doctors Without Borders is also considering training patients who recover from Ebola to become ambassadors of a sort, educating their communities about the disease when they go home. But when it comes to responding to an Ebola outbreak in a conflict zone, she says, if we don't find creative ways to deal with it, we'll never control it. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.