An inclusive response: reaching Batwa communities to combat Ebola
Dr Bijoux Sambu Fiti is part of the surveillance team working in Itipo, a small community in the Democratic Republic of the Congo (DRC) that has been battling Ebola since May. Her job is to go deep into the forest around Itipo to seek out sick people in Batwa villages potentially suffering from undiagnosed cases of Ebola. The Batwa, which is the plural term for Twa people, are hunter-gatherers living primarily off the forest. Dr Sambu Fiti, who is from DRC herself, was keenly aware of the challenges she would face in engaging with a population so culturally different from the rest of the country.
In Itipo, 60% of the population is Batwa and 40% is Bantu.
“The Bantu have the same kind of culture so it’s very easy for another Congolese person to communicate with them,” says Dr Sambu Fiti. “The Twa have a completely different culture. They shut off when they meet someone they don’t know. There’s a good chance they will just melt into the forest.”
The Batwa people are often less inclined to visit state health centres, saying the cost of care is too high and that they sometimes do not feel welcome by the staff. This puts them at increased risk in the midst of an Ebola outbreak, where accessing care is one of the most important ways to prevent the spread and increase chances of surviving the virus.
Dr Sambu Fiti was able to locate Batwa villages by asking nurses at local health posts to identify the locations they knew traditional healers to be present. Next, she teamed up with a Bantu acquaintance whom the Batwa villagers had previously met. By going with someone they trusted, she hoped this would encourage them to talk to her and listen to her messages about protecting their health.
On entering each village, Dr Sambu Fiti introduced herself, explaining that was a doctor and part of the Ebola response. She discovered that many people in the communities either did not know about Ebola or had only the slightest understanding of the disease.
For Dr Sambu Fiti, a key issue was whether the Batwa community would agree that any sick person she found could go to a clinic rather than stay in the community to be treated by a traditional healer using medicinal plants.
“They understood that Ebola is a disease that kills,” she explains. “For them, there are certain times it’s acceptable go to a hospital and Ebola is one of those times.” Healthcare was provided free-of-charge by the government in Ebola-affected areas, which has also helped people access care.
When Dr Sambu Fiti did come across a sick Batwa lady, she learned that she had previously given birth in a clinic and was comfortable with being admitted for tests. (She subsequently tested negative for Ebola).
Jose Maria Masanga is an anthropologist and WHO consultant, who is also from DRC. He works with the surveillance and risk communication teams in Itipo. As an anthropologist, he has played an important role in the response by analyzing the Batwa community’s attitudes to the Ebola outbreak.