Uganda Ebola Outbreak: Health promotion is key

Doctors Without Borders (MSF) started an Ebola emergency mission in Uganda after the outbreak was declared on September 20th. The teams are involved in supporting the Ministry of Health (MOH) in case management and are doing health promotion, a major pillar in fighting the disease. Outreach activities take place in Mubende and Kasanda, where the first cases were identified in September and have now started in Kampala and Masaka.

Health promotion is a vital part of fighting an epidemic. In an Ebola response, it is one of the main pillars of tackling the outbreak. Since the beginning, MSF has been working closely with the Ugandan Ministry of Health.

MSF has been constructing Ebola Treatment Centres (ETCs) and smaller Ebola treatment Units (ETUs) and has been conducting outreach activities in areas where the virus appears. The health promotion teams go into the community and share information on infection prevention and control with health workers, community members and local leaders, as well as traditional healers.

As it is the case in many epidemics, rumours are spreading rapidly. Regina Kasule Nakabuye is one of the health promoters in Tom’s team. She experiences every day how hard it can be to fight fake news and to pass on correct health messages to the community: “Some people are scared, but others also do not believe that Ebola is there. Especially the youth around Mubende, for example, do not trust the information they hear.”

The community in the area are mainly farmers, and people depend on petty jobs. They suffered during the lockdown due to COVID-19 since they had no income. “There is a big link between COVID-19 and Ebola because people still remember how it was back then, and now they are afraid it will happen again”, explains Regina. “But we are very patient with them, and we try to be as down to earth as possible. We present the messages in a way that people understand. And we repeat ourselves if needed.”

MSF is focusing its intervention on the prevention of the spread of the outbreak and tries to reduce the time between the onset of the symptoms and admission to a health facility. The outreach project in Mubende entails health promotion, infection prevention and control, investigation, and contact tracing and gives social support to contacts who have to self-isolate if necessary.
 

Tom Alunga explains: “Every day, my team is dispatched in different groups. Some work closely with the contact tracers and try to prevent resistance by the communities. If they have the right information, we reduce fear, and people are more transparent about potential contacts. The second team is attached to the field investigators by the MOH. If there is an alert about a potential case in the communities, they visit the place to gather the details.”

There is a big need for information, especially if a person shows Ebola symptoms and needs to be evacuated: to reassure the family of the patient, to avoid rumours and also to prepare contact tracing straight away. Additionally, a third team called “flying health promoters” are deployed if special needs are identified during the outreach activities. These needs could either be psychosocial support or social support in case basic food items are required in a household, for example, if people are self-isolating after having been identified as contacts.

Information is needed to prevent Ebola but even beyond that. Survivors face strong stigmatisation once they leave the ETCs or ETUs. People fear them and keep their distance which can create tensions and often also leads to the marginalisation of the survivors. Regina is convinced there is still a long way to go: “We are working really hard and will continue to do so to reach as many people as possible. A lot of sensitisation is needed. We continue to go to the villages, we follow up on issues, and we go where the survivors are and give the right information about Ebola and its transmission.”