Ebola Preparedness in Burundi: Rumonge & Cibitoke

UNICEF evaluates progress and needs in WASH in Rumonge & Cibitoke

By Zineb Boujrada
At the Rumonge Port, a health worker prepares the hand-washing device for incoming travelers from DRC.
UNICEF Burundi/2019/Zineb Boujrada
15 January 2020

The Ebola outbreak in the Democratic Republic of Congo (DRC) is the second largest known outbreak in history, with over 700 cases so far. The outbreak is currently taking place in two provinces affected by conflict, and there is a constant risk of spread beyond that, including to large cities and neighboring countries, such as Burundi.

Among the 10 provinces in Burundi that are at risk of the Ebola epidemic spread, Rumonge and Cibitoke are the mostvulnerable due to their geographical position. These provinces are located in the Imbo Plain and along the Tanganyika Lake. The movement of goods and people between these districts and the DRC's South Kivu region is intense, via several official, unofficial and uncontrolled entry points. Rumonge port and the Rwanda- Burundi land border are hence strategic and sensitive points in terms of Ebola preparedness in the country.

As a co-lead of the Ebola communication committee, in co-ordination with WHO and in collaboration with key partners such as the Red Cross and WFP, UNICEF and its partners are supporting the Ministry of Public Health of Burundi to assess and respond to the Water, Sanitation and Hygiene (WASH) needs in screening centers at entry points, schools and health centers through a comprehensive Ebola preparedness plan.

This plan is vital and critical to keep Burundi Ebola-free. The Ebola Virus Disease (EVD) is a serious acute illness, often fatal for humans if left untreated. According to the World Health Organization (WHO), the average case fatality rate is about 50% but has ranged from 25 per cent  to 90 per cent in previous outbreaks. The virus is transmitted to humans from wild animals and spreads to populations via human-to-human transmission through body fluids and blood. As such, a simple contact with a sick person can be fatal in the absence of key preventative measures.

In order to respond to a potential epidemic, partners are putting in place key infrastructure in close collaboration with the Burundian government in Cibitoke and Rumonge, critical screening points have been established to closely examine incoming travelers from DRC via the Tanganyika Lake or inland via Rwanda. This infrastructure also includes basic personal protection for health technicians and WASH facilities such as hand-washing devices, chlorine and latrines.

Travelers arrive from DRC at the Rumonge Port.
UNICEF Burundi/2019/Zineb Boujrada
Travelers arrive from DRC at the Rumonge Port.

o Rumonge

Between 100 and 250 people cross the lake from DRC on market days into Rumonge Port. With UNICEF’s support, health centers deploy health technicians at screening centers at such entry points where arrivals are directed for Ebola screening. 

At Rumonge Port, UNICEF visited one of the screening centers where two health workers screen the arriving travelers.

They have access to water, chlorine and an isolation tent. As the boat docks on the shore of Lake Tanganyika, one of the health workers has already started cleaning the hand-washing device and gets ready to set it up just few meters away from the quickly forming line of travelers getting off the boat. Her colleague is getting ready inside the center: We see her putting on the gown and disposable gloves. Each traveler is greeted as he or she gets off the boat and directed to the screening point where hand-washing is mandatory, followed by a precautionary temperature reading. Today, all goes smoothly, and the travelers move into town to undertake their trade.

The two health workers that we spoke to are entirely invested and devoted to their mission: keeping Burundi Ebola-free. They are performing their tasks in the best way possible: helping travelers pass through the screening center, registering entries and reporting suspect cases.

At Rumonge Port, a health worker prepares the hand-washing device for travelers.
UNICEF Burundi/2019/Zineb Boujrada
At Rumonge Port, a health worker prepares the hand-washing device for travelers, who are lining up behind her.

o Cibitoke

On the Rwandese- Burundian border, a trained health worker screens in incoming travelers and provides sterilized water. However, he affirms that he faces times when water is scarce. The hand-washing device that is put on the border by UNICEF is operational, but in the absence of water, it remains critical and the screening center is not fully efficient without regular water supply. Indeed, in the words of Jacques Ndiysaba, the health worker who screens arrivals from Rwanda: ‘’There is an urgent need to make water available at the border and to respond to the extremely frequent water shortage''

‘’Having a hand-washing device is good, but without water, it is useless’’. UNICEF water engineers are working tirelessly with authorities to repair the supply pipeline of safe water to ensure that each screening center including this one in Cibitoke has water sufficiency at all times.

‘’There is an urgent need to make water available at the border and to respond to the extremely frequent water shortage. Having a hand-washing device is good, but without water, it is useless’’.

Jacques Ndiysaba, health worker, Burundi-Rwanda border in Cibitoke
Jacques Ndiysaba, a health worker in charge of screening arrivals from Rwanda.
UNICEF Burundi/2019/Zineb Boujrada
Jacques Ndiysaba, a health worker in charge of screening arrivals from Rwanda.

Equally important, UNICEF’s water engineers are currently overseeing the construction of latrines at the Burundi- Rwanda border. The WASH program has also provided much needed water bladders to ensure a steady supply of water and is working with extension workers to promote hygiene as part of the Ebola prevention measures in schools, and health centers.

In Cibitoke, the regional health center has the largest accommodation capacity in the region. The hospital receives an average of 100 patients on a daily basis. According to Mrs. Nakirumana Beatrice, the hospital’s manager, they have been facing some critical needs in WASH. The center has a hand-washing device, but it is only available for health personnel. There is a hand-washing device in the backyard of the hospital near the latrines, but water is unavailable. 

 

Talking about basic hygiene practices, Mrs. Ntakirumana sadly explains that soap is a luxury item in the hospital. Indeed, ‘’when we provide it for patients, it disappears within the next 5 minutes. So we stopped doing so’’.

Aware of the urgency to address the needs in WASH but also in risk communication and behavioral change, Mrs. Ntakirumana points out that health personnel require further training with access to basic protection equipment and response tools, to avoid the worst-case scenario: an Ebola Outbreak.

Hygiene club at a school in Cibitoke.
UNICEF Burundi/2019/Zineb Boujrada
Hygiene club at a school in Cibitoke.

UNICEF provides Ebola kits, tents and ready-to-use Intravenous Fluids. UNICEF has also trained 600 social workers and 400 school management committees in the basics of prevention and response – all crucial in containing a possible outbreak in Burundi.

Although some screening centers are fully operational, it is important to continue to expand the preparedness activities to reach all the 10 districts as a matter of urgency.

UNICEF engineers and specialists are on the ground working with partners to address these urgent needs, provide critical support where required, and build capacity for a more sustainable response over time.

This is possible thanks to the generous support from a number of donors who have stepped forward to help protect children at such a critical time.

 

A health worker at the Rumonge port in charge of screening travelers.
UNICEF Burundi/2019/Zineb Boujrada
A health worker at the Rumonge port in charge of screening travelers.