Lessons still to be learned from recent Ebola outbreaks in DRC

This post is also available in: Français (French)

Ebola continues to threaten communities in the Democratic Republic of Congo (DRC). In order to be prepared for future outbreaks, responders need to learn from previous responses and adapt their community engagement approaches to local circumstances. They need to do this with an understanding of specific language and communication needs in affected communities. For any future response to be most effective, this needs to happen early. 

Responding to the 2020 Ebola outbreak in Equateur

During health crises, it is especially important to get communication right. This means carefully considering the preferred languages, channels, and formats of information in communication with communities. Ebola is endemic in the region and it is unlikely to disappear any time soon. Unfortunately, both communicators and responders in DRC have a lot of experience with Ebola outbreaks. After the 2018-2020 Ebola response in North Kivu, responders acknowledged the importance of considering communication and language in preparedness planning for future responses. Unfortunately, the 2020 response to the Ebola outbreak in Equateur highlighted that there are still lessons to be learned about centering language and communication in crisis responses.

Lessons to be learned - Ebola, DRC
Mbandaka, DRC.

Context in Equateur

Equateur was the location of the 9th Ebola outbreak in DRC in 2018. After the 2018-2020 10th Ebola outbreak in North Kivu, Equateur was once again affected by Ebola in the 11th outbreak in 2020. The threat of Ebola is not new to communities in Equateur. Unlike the location of the previous Ebola outbreak in eastern DRC, Equateur is not the location of any active armed conflict. However, the province faces its own humanitarian challenges, including critical malnutrition, flooding, and difficulty of access to remote areas. Like most of DRC, Equateur is incredibly linguistically diverse. An important dynamic to consider in Equateur when communicating with communities is access to information, services, and rights for indigenous communities

Quality information on languages spoken by people experiencing health crises

To fully support communities and health workers, it is important to take language into account when planning activities. Our research and work with our NGO partners found that many of the recommendations for responders in eastern DRC apply also to the response in Equateur. TWB’s research and language team conducted a study in Bikoro and Mbandaka on language and communication barriers for the Ebola response. The team conducted focus group discussions and individual interviews with health communicators, members of the community, and humanitarians. Our research focused especially on access to information for different groups, including indigenous communities, women, youth, and older members of the community. To inform and reinforce our qualitative research, TWB works with partners to collect quantitative language data to map languages spoken locally. This up-to-date language data collected with communities and partners helps TWB to deliver evidence-based language support. For Equateur, TWB has mapped spoken languages in Equateur and neighboring provinces by health zone to support responders.

Lessons to be learned - Ebola, DRC
Mbandaka, DRC.

Local languages matter

In DRC, responders are learning to go beyond French in risk communication and community engagement, and are starting to consider national languages such as Lingala in regional responses. With more than 200 languages spoken in DRC however it is important to look at more local languages such as Mongo or Ngombe in Equateur. 

Similar to French and Swahili in North Kivu, our research found that most health communication resources in Equateur, including posters and tools for community workers, are provided in French or sometimes Lingala. Communities and health workers need to be equipped with information in other local languages. One research participant in the village of Iyembe Munene told us, “We receive the information in Lingala, but the best way for us to receive the information is in Ntomba (a local language), because if it passes in Ntomba there is understanding of the messages.” Even Lingala, one of the four national languages of DRC, has its variants. The Lingala spoken in Equateur is known as Lingala facile which borrows words from local languages as well as French. 

Indigenous communities in the Lake Tumba area (often referred to as Batwa) told us that they also prefer to receive information in local languages. They prefer to receive that information face-to-face from someone from their community who can navigate the specificities of the variant of local languages spoken in their communities. One research participant in Elanga said, “We prefer to communicate with the health workers in Twa, but they do not understand our dialect.” 

Terminology is key for comprehension and trust

Terminology is important in health communication. In eastern DRC a key lesson was that people didn’t appreciate dehumanizing terms, for example referring to those sick with Ebola as “cases”. Research participants in North Kivu identified the term cas suspect as having criminal connotations. The same issue came up in Equateur where research participants said that “suspect case” had criminal connotations and could also be associated with users of witchcraft. 

Furthermore, as in eastern DRC, in Equateur we found that some concepts are difficult to translate into local languages and some words continue to be communicated in other languages without translation or without consistent translation. One health communicator from Mapeke acknowledged, “There are difficulties, especially if the communicator speaks French, English words and even […] Kinshasa Lingala and Lingala Makanja which is [harder to understand].”

Problematic terminology can endanger communities and undermines communities’ trust in responders. The lack of trust in eastern DRC had serious consequences for communities and responders alike in the 10th Ebola outbreak. 

Lessons to be learned - Ebola, DRC
Mbandaka, DRC.

Language and communication needs must be considered for responders to be accountable to people who need information

After the end of the Ebola outbreak in eastern DRC, reports of sexual exploitation came to light. Survivors reported not knowing how to report abuse or make complaints. Our research participants in Equateur reported a similar lack of information about reporting mechanisms. Alongside improving communication around reporting, it is important to ensure that feedback mechanisms and support offered to survivors are accessible to all, including speakers of marginalized languages. A research participant from Bokaka told us, “We prefer to give our opinions to people who listen to us and who respect us, and we prefer to do the interviews in person to express ourselves clearly.” We have found that offering information and services in people’s preferred languages, channels, and formats can facilitate trust and mutual respect between responders and communities.

Key recommendations for humanitarian responders in the DRC

  • Integrate language data questions into data collection
  • Translate community-facing materials into local languages; field test them to make sure they are understood and acceptable to local people
  • Equip health workers with appropriate tools and training in the relevant languages

During our research and activities in Equateur, health communicators and communities shared their experiences with us. It is important that all responders learn from the mistakes of past health interventions and prioritize communication and language needs to be better prepared to respond to future health crises.

Funded by UNICEF and UK Aid, TWB put in place a local team of researchers and language experts in Equateur to support partners in the 11th Ebola response in Equateur in 2020. 

TWB’s tools for Ebola responses in DRC can be found on our site. Materials and tools are available in English, French, and local languages. To find out more about TWB’s activities in DRC please contact [email protected]

Written by Laure Venier, TWB’s Program Coordinator, DRC.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.