What Happens To A Country When An Outbreak Of Ebola Ends?

Hair salons and bicycles are abundant in Bumba, a town in the Democratic Republic of Congo. (Courteys of Dr. Heidi Larson)
Hair salons and bicycles are abundant in Bumba, a town in the Democratic Republic of Congo. (Courteys of Dr. Heidi Larson)

Liberia is nearing a milestone. On May 9, its Ebola outbreak will be officially declared over, assuming no new cases between now and then.

But what happens when an outbreak of Ebola ends?

Dr. Peter Piot, the director of the London School of Hygiene and Tropical Medicine and the co-discoverer of Ebola, visited the Democratic Republic of Congo last year. He wanted to show his wife the region where the first known outbreak of the virus took place. They went to Yambuku, a remote village in the north where Ebola killed almost 300 people in 1976.

He says Yambuku hasn't changed much since then.

When Ebola first struck the village, it took a toll on the region's already weak health infrastructure and economy. There was only one hospital in Yambuku, opened by Catholic missionaries, and when that closed, "regular health care became impossible because Ebola kills, in the first place, the caregivers," Piot recalls. "There was no place [for residents] to go because there are no other health facilities."

Dr. Peter Piot (right) meets with Sukato Mandzomba, a nurse who contracted Ebola during the 1976 outbreak. Mandzomba now runs a makeshift hospital lab in Yambuku.
Dr. Peter Piot (right) meets with Sukato Mandzomba, a nurse who contracted Ebola during the 1976 outbreak. Mandzomba now runs a makeshift hospital lab in Yambuku.

And as nearby villages came under quarantine during the harvest season, people weren't able to sell crops. That, he says, exacerbated the poverty.

Nearly 40 years later, Piot says it was hard to find signs of improvement during his visit. His first stop was Bumba, a city near the Congo River, about two hours away from Yambuku. There's neither electricity nor running water; women and girls still go down to the river to fetch water in jugs. And there are no cars, except for the jeep Piot was in. "We went 120 km [about 75 miles] from Bumba to Yambuku and we saw maybe three trucks," he says.

Most residents traveled on foot or by bike. "People were incredibly resourceful with their bicycles," says Heidi Larson, an anthropologist who, like her husband Piot, works at London School of Hygiene and Tropical Medicine. "Many times they were just pushing their bicycles, which were more of a vehicle to put all heavy things on as they were going to and from the markets."

Some have managed to find an innovative business around equipment that clinics threw away. "There were a lot of syringes that you would use for a vaccine, except without the needle, and filled with oil for your bicycle or to fix a squeaky lock" Heidi says. "[The merchants] basically made doses of oil so people would bring their bicycle and get a syringe full of oil."

As Piot and Larson took the dirt road into the forest, up toward Yambuku, they came across abandoned plantations that once produced cash crops like palm oil, cocoa, coffee and rice. The crops were once traded for essential goods like cloth and utensils, and the plantations employed hundreds of thousands of villagers.

Old syringes are filled with oil to grease squeaky locks and bikes.
Old syringes are filled with oil to grease squeaky locks and bikes.

But years of civil war, poor governance and a string of disease outbreaks have left people with no jobs. Many now depend on subsistence farming and foraging in the forest for meat. "People are living on a 24-hour cycle to survive," he says. "Although we didn't see malnutrition. It's quite easy to grow things and there are fish and bush meat."

At the hospital in Yambuku, the conditions are worse than what they had been nearly 40 years ago. The hospital is rudimentary at best, with only a few mattresses and tables but barely any medicine. There are no ambulances, radio or phone; the hospital's only connection to the outside world is a bike messenger.

"In order to send a message, we had to send someone on a motorcycle to go 100 km [62 miles] and come back," Piot says.

At the hospital's makeshift lab, Piot met up with Sukato Mandzomba, who was a 24-year-old nurse back in 1976. Like several other health care workers at the hospital, he contracted the Ebola virus. But Mandzomba survived and today, he runs the lab by himself, identifying infectious diseases with just one microscope, a tiny hand-cranked centrifuge and a notebook.

He earns $20 a month — barely enough to send his kids to school. "It's incredible that he's still there," says Piot. "I find him a real hero."

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Women wait in a maternal ward in Bumba. Dr. Heidi Larson says women there always dress elegantly even when going to the doctors.
Women wait in a maternal ward in Bumba. Dr. Heidi Larson says women there always dress elegantly even when going to the doctors.

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