In an Ebola response, information needs to move quickly. But so does trust.
When people are afraid, uncertain, or convinced that a disease does not exist, simply giving them more information is not enough. Health workers need to understand the fears and concerns that shape how people respond to an outbreak. The first step toward stopping an outbreak is giving people the opportunity to speak and to listen to what they have to say.
Maurice Muhito, a community health worker (CHW) in the Democratic Republic of Congo (DRC) knows this from experience. When he first approached a woman whose husband had tested positive for Ebola, the woman wanted nothing to do with him. Her husband had contracted the disease and she and her children were considered high-risk. But the woman refused follow-up from CHWs and repeatedly chased them away from her home.
Maurice works in Nyankunde health zone, Ituri Province, as a CHW (known as Relais Communautaire (RECOs) in DRC). The health zone is about 45 kilometres from Bunia, the capital of Ituri Province.
“I let her speak without interrupting,” Maurice recalls. “Then, I explained the disease to her, its signs and the risks of transmission. I explained that what we are doing is primarily for her well-being and that of her children.”
After nearly two hours of conversation, the woman agreed to allow CHWs to begin monitoring her family.
In DRC, the response to Ebola is not only taking place in health facilities and laboratories. It is also unfolding in homes and communities, where fear and rumors can spread quickly. Yet, in these places, trust and dialogue can make all the difference.
RECO Bainga Muhito conducting an Ebola awareness session in a village in Nyankunde, Photo credit: Kaseraka Mulimbwe Michel
Listening before responding
In DRC, CHWs play a critical role in detecting health alerts early, raising awareness among families and monitoring people who may have been exposed to Ebola.
VillageReach is working closely with the DRC Ministry of Health to support the government’s response. One way we are helping is by training CHWs in community-based surveillance to identify and report suspected cases, while engaging communities to address concerns, fears, and misinformation about the disease.
For Maurice, the training changed how he approaches these conversations.
“During the training, we learned how to communicate with communities, follow up on cases, conduct community-based surveillance and use various monitoring tools to quickly escalate alerts,” he says.
But one lesson has been particularly important: listen first.
“To gain the families’ trust, we always begin by listening,” Maurice said. “We allow people to freely express their fears and concerns, without interrupting or judging them. Then, we respond calmly and precisely.”
That approach matters in a setting where rumors about Ebola can undermine trust in health workers and discourage people from seeking care or cooperating with response teams.
“Many say that Ebola is a fabrication designed to make money,” Maurice said
For Maurice, the response to such beliefs is not argument, but conversation. His experience with the family shows why.
Nyankunde Evangelical Medical Center, Photo credit: Kaseraka Mulimbwe Michel
Building on trust to improve outbreak response
For Dr. Désiré Duabo, Chief Medical Officer of the Nyankunde health zone, listening to communities and building trust has changed how RECOs interact with the population.
“The RECOs are now better equipped to communicate with communities, respond appropriately to concerns and transmit reliable information,” Dr. Duabo said. “They use an approach based on listening and dialogue, which has strengthened public trust and facilitated faster reporting of health alerts.”
This trust has consequences beyond addressing rumors. Dr. Duabo recalls a case in which a RECO identified a person with symptoms consistent with Ebola during a visit to the community. The alert was quickly communicated, allowing the investigation team to mobilize, provide care to the patient and begin contact tracing.
“Building trust likely prevented wider transmission of the disease,” he said. “This example demonstrates the importance of the RECOs’ daily commitment.”
The lesson here is that an effective Ebola response depends on whether community members trust the people delivering the response. When community members are willing to share their concerns, report symptoms and cooperate with health workers, outbreak response is more effective.
Stronger systems for faster outbreak response
VillageReach is supporting the training of RECOs in health zones across Ituri and in other provinces affected by the outbreak, including Tshopo and Haut-Uélé.
The goal is not only to counter rumors about Ebola, but also to strengthen the community-level systems that allow health threats to be detected, reported and addressed earlier.
In an Ebola outbreak, information must move quickly. But trust must also keep pace. When community health workers and communities work together, health threats can be identified and reported earlier, enabling response teams to act faster.