From the Photographer: Covering Ebola in DR Congo

- Kate Holt

For several months I had been discussing a potential trip with the humanitarian organisation Medair to visit their projects in Eastern Democratic Republic of Congo and their response to the ongoing Ebola outbreak. My initial plan was to travel to Goma in December, but the upcoming elections in Congo posed security concerns that may have impeded my ability to visit the projects I wanted to see.

A view shows the top of the Nyragonga Volcano that towers over the city of Goma and the surrounding Virunga National Park, in North Kivu, Democratic Republic of Congo. Photo: Kate Holt/Medair

I witnessed first-hand the devastation Ebola had caused in West Africa; having worked throughout eastern DRC between 2004–2005 I was keen to see how communities there were coping with the outbreak. The region had been riddled with violence an ineffective government for years and massive displacement had caused traditional coping mechanisms to be reduced.

The latest Ebola outbreak in eastern Congo, the second deadliest in history, has entered its seventh month, with 807 confirmed cases, of which 483 have resulted in death. The disease is moving toward the major border city of Goma; a city of nearly 1.5 million people. This development would greatly complicate any hope of stopping the virus’ spread in the unstable region.

By the end of January the election results were finalised and tensions were starting to calm. The Ebola outbreak still raged, however, with between 3–14 new cases being reported every day. Medair had been working in Beni and Butembo — the regions affected by the outbreak — for the last six years, so had existing programmes that could be expanded to meet the challenges of containing the outbreak.

An aerial view shows the close proximity of houses in which a population of 1.5 million people live in the city of Goma, North Kivu, in the Democratic Republic of Congo. Photo: Kate Holt / Medair

One of the reasons I love working with Medair is the warm welcome their staff always give you. I have visited their projects working with Syrian refugees in Lebanon, in Somalia, and have undertaken photography trainings with their communication staff. At the first morning meeting I attended in Goma, I was invited to join the morning prayers — The Congolese love to sing and are incredibly musical. They were all so positive, despite the challenges they faced every day in combating the outbreak.

I was accompanied on my visit by Pete Harrison from the Communications and Fundraising team. We flew together on the daily UN flight, landing on the UN military base just outside of Beni. There have been ongoing security issues in Beni; one of the Medair-supported health centres was attacked and burnt to the ground in December. Seven Medair-supported health centres have been attacked and burnt or looted in North Kivu since November, along with several others supported by other organisations.

Two Congolese Government soldiers ride a motorbike in front of a sign warning about the dangers of Ebola on the road between Beni and Oicha in the Democratic Republic of Congo. Photo: Kate Holt / Medair

Everywhere along our journey there were handwashing stations: at the entrance and exit to the airports; entrance to offices; and at every UN and government building. It was very reminiscent of the outbreak in West Africa. Small amounts of bleach are diluted in the water to ensure that any trace of the Ebola virus is killed should you have it on your hands. After five days of washing my hands and nails were spotlessly clean!

It’s also interesting to note that one of the upsides of the Ebola outbreak in West Africa, was that the cases of diarrhoea decreased in communities where handwashing was implemented. It is thought that this was because of the improved hygiene standards as a result of frequent handwashing.

Children wash their hands at a handwashing station supported by Medair in Goma, Democratic Republic of Congo. Photo: Kate Holt / Medair

As we arrived Beni as the number of cases continued to rise . A case had just been confirmed in Bunia and several had been confirmed further south, on the road to Goma. The outbreak had first been declared on 01 August, and I was in Beni for the six-month anniversary. By this point, over 500 peopled had died and nearly 800 infected, and there were fears that the outbreak was getting out of control.

I was told that the WHO was currently engaging its sixth strategy in the outbreak. The methodology employed in the western DRC outbreak hadn’t been effective in the east; the context was too different and security problems with rebel groups had hindered the ability of vaccinators to reach communities, and safe burial teams to carry out funerals.

A health care worker fills in a patient’s form in in the Ebola Treatment Centre in run by ALIMA in Beni, in the Democratic Republic of Congo. Photo: Kate Holt / Medair

The Ebola vaccine is transforming the way NGOs are able to respond to the outbreak. It has been a massive development since the outbreak in West Africa — when no vaccine was available — meaning frontline health workers were in danger of catching Ebola from patients. Nearly all of the Medair staff in Beni had volunteered to have the vaccine, which gave them a sense of security against contracting Ebola when going about their daily work.

Micheline, who worked in the Medair procurement department, told me that she felt much more confident and able to do her job since she’d had the vaccine. She pointed out that when the staff were all vaccinated, it was only the men who complained of feeling ill afterwards and took time off work — whereas the women were able to keep on doing their jobs!

Vaccinators dispense the vaccine in Goma, Democratic Republic of Congo. Photo: Kate Holt / Medair

It was fascinating to see first-hand the challenges being faced by the NGOs and UN agencies trying to stop the spread of Ebola. Sara Philips, the Medair Ebola response coordinator, was adamant that security wasn’t the only reason that it was proving difficult to get on top of the outbreak, and that much more engagement with local communities was needed. She explained how Medair was dong this through engaging with communities and providing education to traditional healers and community groups who were are the forefront of the outbreak.

Sarah Philips speaks to a health worker at a clinic in Mbau, Beni, in the Democratic Republic of Congo. Photo: Kate Holt / Medair

I was taken to Mbau, one of the epicentres of the outbreak where Medair was working in the local health centres. They had helped the centre to set up a screening unit and establish infection, prevention and control measures through handwashing stations and hygiene promotion.

Gédéon Mafungula , Hygiene Promoter with Medair, uses a handwashing station supported by Medair to clean his hands in Mbau, Beni, in the Democratic Republic of Congo. Photo: Kate Holt / Medair

To get there we had to pass through a checkpoint on the road out of Beni, where we all had to get out of the vehicles, wash our hands and have our temperatures taken. These checkpoints exist all along the road down Eastern Congo at the moment, in the hope that anyone infected with Ebola will be screened in an attempt to stop the spread.

Two Congolese soldiers have their feet and tires sprayed with bleach on the road between Beni and Oicha in the Democratic Republic of Congo. Photo: Kate Holt /Medair

Nothing can prepare you for meeting a parent who has lost their child to Ebola. We met Papa Kambala in Mbau. His daughter, a school teacher who lived with him, had contracted Ebola before Christmas and died shortly afterwards. He told me “My daughter was the one who supported me but now she is gone I am alone to care for my three grandchildren. Life has been hard. All I want to do now is dig my own grave and die.”

Papa Kambale poses for a photograph in his house in Mbau, Beni, in the Democratic Republic of Congo. Photo: Kate Holt/Medair

His daughter had lived with him and helped to look after his three orphaned grandchildren, as well as supporting him financially. After her death, the house was sterilised and all mattresses and cushions were destroyed; he was given a new mattress by the Ministry of Health, but no new cushions.

I also met 65-year-old Agwandia Jermanine, who had survived Ebola at Christmas time. She was determined to teach others about the importance of early detection and treatment, through speaking at community meetings organised by Medair.

Agwandia talks to a group of traditional healers about the importance of alerting health authorities early if they suspect a case of Ebola in patients in Mbau, Democratic Republic of Congo. Photo: Kate Holt / Medair

It was evident from my visit to Mbau that Ebola wasn’t the only challenge facing this community. I met Marie, sitting on a bed with her baby, who was suffering from a convulsions.

Marie sits next to her daughter in a health centre that is supported by Medair, in Mbau, Democratic Republic of Congo. Photo: Kate Holt / Medair

Marie had been forced to flee her village in a village 25 kilometres away after it was repeatedly attacked in September. During one of the attacks, her husband was killed by rebel soldiers, and she lost everything. She is now living with her eight children in rented accommodation, and has little money to buy food or pay for any of her children to go to school. She is frightened of catching Ebola and this prevented her accessing treatment earlier with her daughter.

The international response to the Ebola outbreak has been huge. Millions of dollars-worth of help has flooded into the region to try to curb the Ebola outbreak since last August. Yet it struck me that for years, people like Marie have suffered displacement, poverty and violence. Thousands of people have died because of the war and lack of access to quality healthcare, before this outbreak began.

About the photographer

Kate Holt is the founder and director of Arete. For the last twenty years she has photographed regularly for numerous NGOs — including UNICEF, Care International, Jhpiego, the International Red Cross, MSF and OXFAM. She is a regular contributor to the Guardian and the BBC.

From the Photographer: Covering Ebola in DR Congo was originally published in Arete Stories on Medium, where people are continuing the conversation by highlighting and responding to this story.

From the Photographer: working in SE Asia as a documentary photographer

- Lewis Inman, Arete photographer

Language, heat, moisture and more moisture.

Can I take your photo?

Across Indonesia, over 300 different languages are spoken. As a photographer, you will almost certainly need a translator who can speak the language of the ethnic group that you will be working with. But finding someone with professional translation experience outside of a big city can be difficult.

Photo: Lewis Inman

Translator or not, a critical sentence to learn in the local language is “Can I take your photo?” as this helps to build a relationship and can help to spark a conversation. Just make sure not to say the sentence too well, as people sometimes assume you are fluent, which can be quite embarrassing when it turns out you most certainly aren’t!

You may pick up the local language quite quickly, but then find yourself on another assignment in a different area, with an entirely different dialect. This has been the case with all the cities and villages that I have worked in or visited across South-East Asia. The key is to remain adaptable — try to pick up a few key phrases wherever you are and build up your base of translation contacts.

Culture vulture

Having spent the majority of the last four years in South-East Asia, I have developed a good understanding of the culture and the way things work. For instance, it is critical to understand prayer times in Muslim countries. You need to be aware that the people you are working with might need to stop what they are doing to pray, and to be able to time interviews and travel around this.

Photo: Lewis Inman

One of the things I have found helpful is my love of food! Having a passion for food somehow gives me a good understanding of local culture when I first arrive somewhere. All you need to do is visit a local market or a local street food hotspot when you first arrive — this can give you a good understanding of how the place works, which can come in very handy in the long run when you are out and about taking photos.

Heat and humidity

As expected, South East Asia is, in general, very hot. Shooting will make you tired and achy, and in between shoots you will most likely be travelling, most of the time on dangerous and uncomfortable roads. So it goes without saying that keeping hydrated and out of the sun is essential.

Photo: Lewis Inman

But those new to this type of environment might not realise the problems of extremely high humidity, which can be incredibly dangerous for cameras and laptops, and before you know it, that expensive laptop starts failing, the metal starts to corrode, and the whole thing eventually dies. It is always essential to have spares, backups and workarounds in case of emergencies. Use silica gel and waterproof cases to keep your equipment as dry as possible (and bring plenty of the former — it’s not often you come across an obliging oven in which to dry out your silica packages!).

Of course, it’s all very well telling you to pack two of everything, but bear in mind that an assignment begins before you start pointing your camera at things — it starts in your suitcase. Plan ahead, travel as light as possible and make sure that everything you have is functional and necessary. As if worst comes to worst — know if and where you can get a quick replacement to mitigate against any equipment failure.

Photo: Lewis Inman

Working as a freelance photographer in South East Asia — or any new region — will always present its own set of challenges. Some problems are universal, some specific to the place you will be working in: the key is research, research, research. And then, be flexible!

Yes, South East Asia can be a daunting place to work in sometimes, but there’s a reason I keep coming back, both as a photographer and in a personal capacity. It’s an extraordinary area with so much life, culture (and food) to see that I can’t imagine I’ll ever feel ‘done’.

Lewis Inman is an award-winning documentary photographer and filmmaker born in London and now based in the Philippines, covering social issues and commercial commissions worldwide. Lewis received a 1st class honours in Photojournalism & Documentary Photography from University of the Arts London (LCC). Lewis has won many awards including first place prize of the Symons-Hatton Award, recognising his “commitment and dedication to Lens Based Media”. He has been working in South-East Asia with a range of clients including Team Rubicon UK and the DEC on behalf of Arete.

From the Photographer: working in SE Asia as a documentary photographer was originally published in Arete Stories on Medium, where people are continuing the conversation by highlighting and responding to this story.