Health workers told him he had Ebola but his first thought was for
his sister who had been battling the virus.
"How is my big sister doing?" he asked health workers again and
again at an Ebola treatment center on the outskirts of Butembo, a
major trading hub set amid volcanic hills in eastern Democratic
Republic of Congo.
Staff said they didn't have the heart to tell him that 9-year-old
Lareine had died.
"His sister was his best friend," said Desy Shabani, who provides
psycho-social support to the patients. "To have lost the dearest
person in his life... I asked myself, 'What will this child do?'"
The Ebola outbreak in Congo - the second-largest on record - has
inflicted an unusually heavy toll on children. More than a quarter
of the confirmed and probable cases identified as of early April
were children under 15, compared to 18% in the last major outbreak
in West Africa in 2013-2016, according to figures compiled by the
World Health Organization.
The disease can progress rapidly, crippling the immune system and
shutting down vital organs.
Young children and babies are especially vulnerable. Their small
bodies are less well equipped to cope with extreme fluid loss
brought on by common symptoms such as diarrhea, vomiting, fever and
bleeding, said Daniel Bausch, an infectious disease specialist at
the London School of Hygiene and Tropical Medicine.
More than two out of every three children infected in this outbreak
have died compared with just over half the adults, the WHO said. As
of May 26, the death toll stood at 1,281 people, including at least
541 who were under 18.
Fatality rates are highest for children under 4 who died at a rate
of around 80% in West Africa, according to a study published in the
New England Journal of Medicine in 2015.
https://www.nejm.org/doi/
full/10.1056/NEJMc1415318
More than 11,000 people in all died in that outbreak.
The contents of the storage room at the Butembo treatment center
attest to the age of many of the patients. Alongside blankets and
spare clothes stand shelves full of baby formula and neon-colored
plastic rattles in the shape of little bears.
In the city center, small coffins wrapped in flowery plastic were
stacked outside a carpenter's shop. An employee lamented the
frequency of orders.
GLOVES AND BODILY FLUIDS
Ebola cases would typically be divided more or less equally between
male and female patients. But in this outbreak, women and girls
account for 58% of cases, down from a peak of 62% in December, the
WHO said.
The reason more women and children have fallen sick remains a bit of
a mystery. But experts suspect it may be because the Beni area,
where the outbreak began in August, was also battling malaria at the
time.
Malaria can cause severe complications in pregnant women and
children, requiring treatment at medical facilities where they risk
exposure to undiagnosed Ebola patients, said Mike Ryan, who heads
the WHO's health emergencies program.
"Transmission within the healthcare setting has been a major factor
driving this outbreak," Ryan said. "Unfortunately, women and
children have been the unwitting victims of that reality."
Healthcare standards in Congo vary widely due to lack of oversight
over a system that includes many unregistered private clinics and
traditional healers operating out of their homes.
The virus is transmitted through contact with infected bodily
fluids. But health workers operating outside of government hospitals
do not always follow guidelines to prevent cross-contamination,
according to Congo's health ministry.
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"It means at times they don't change gloves or don't use single-use
ones or simply they don't use gloves at all," said Jessica Ilunga, a
ministry spokeswoman. "They don't sterilize their equipment, and
they don't decontaminate beds, and they don't change sheets."
Anselme Mungwayitheka said he and two other health workers at a
private clinic in Beni caught Ebola from a woman and her newborn who
were infected while in the care of a traditional healer.
"We didn't have much equipment in this facility," said Mungwayitheka,
who now works at an Ebola treatment center in Beni he credits with
saving his life. "When we received patients, we just had to put on
protective gloves. After caring for them, we had to remove the
gloves, but the patient had touched almost all the doors."
A key part of the Ebola response effort involves decontaminating
health facilities, educating health workers on how to protect
themselves and their patients, and persuading residents to seek
treatment at specialized centers. But these efforts have been
hindered by outbreaks of violence and a deep mistrust of outsiders.
This is Congo's tenth Ebola outbreak, but it is the first in the
densely populated provinces of North Kivu and Ituri, where militias
carry out sporadic raids from hidden strongholds in the tropical
forest. Women and children are often the first to be displaced by
the bloodshed.
"ALL OF THEM COULD HAVE DIED"
At the Ebola treatment center in Beni, a city of several hundred
thousand with close ties to neighboring Uganda, five members of the
same family of farmers were being treated for Ebola in late March.
Three were children.
Marcela Kaswera, 45, said she had sent her children to their older
brother in the village of Biakatu after their hometown of Oicha was
attacked by members of an Islamist militia.
"On March 20, it was a Wednesday, my son called me," Kaswera
recalled. "He said, 'Mama, I'm coming back to Oicha because Ebola
has touched Biakatu, and many people are dying.'"
When they returned, her 7-year-old son was feverish. He died in her
arms at a hospital, where he posthumously tested positive for Ebola.
In quick succession, Kaswera's 13-year-old son, 2-year-old daughter,
grown-up son, daughter-in-law and grandson all developed symptoms of
the virus and were transferred to the treatment center run by the
Alliance for International Medical Action.
"Now I can thank God because they are stable," said Kaswera, who had
traveled 30 kilometers (19 miles) on the back of a motorbike taxi
with her husband to visit their sick family members. "If it was just
me without doctors I think all of them could have died."
On the evening of Feb. 27, unknown assailants attacked the center in
Butembo where Kennedy was being treated, setting fire to some
structures and vehicles. Hearing gunshots, one of the other patients
took the boy and fled through open fields into the city. They spent
the night at the man's home and returned the next day.
"He was really scared," recalled Shabani, standing on a walkway
outside a line of tented cubicles, where people with suspected Ebola
waited for test results.
Kennedy was discharged less than a week later. He is now back at
school and plays football with a gaggle of children on the steep,
muddy streets near his home, bordering lush farmland.
(Additional reporting by Djaffar Al Katanty in Butembo and Beni,
Stephanie Nebehay in Geneva, Kate Kelland in London and Giulia
Paravicini in Brussels; Editing by Alexandra Zavis and Anna Willard)
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