Deo Bakulu washes his hands at every opportunity since Ebola reached eastern Democratic Republic of Congo city Goma last month.
The washing station set up by local authorities near his home is open from 8 am to 6 pm Monday through Saturday and he has no running water.
“Does Ebola only spread during the day?” he asked as a health official at a different station aimed an infrared thermometer at his temple. “What about Sundays?”
Goma, a city of nearly two million, is on high alert after the first transmission of the virus there was confirmed last week. That raised fears the outbreak could spread in the city and beyond via its border with Rwanda and the international airport.
A gold miner carried the virus from the epicentre of the epidemic, several hundred kilometres north. He spent a week at home ill with his wife and 10 children before being transferred to hospital, where he died. His wife and daughter tested positive for the disease.
Goma has had time to get ready for Ebola, given a nearly year-long head start as the disease raged near Beni and Butembo. Most residents appear to have taken the latest developments in their stride, queuing up at washing stations set up by government and private businesses and avoiding shaking hands.
There are shortcomings in preparations and medics encounter some of the same suspicion and hostility they faced in other outbreak hotspots. In the current epidemic, the virus killed more than 1 800 people, the second-highest toll ever.
Whether health authorities can apply lessons from those hotspots will determine if they claim victory in Goma or if the epidemic will hurtle toward the grim record of more than 11 300 deaths registered by West Africa’s 2014-16 Ebola outbreak.
“The system was there before, which is good, so we’re not starting from scratch,” said Kate White, medical emergency manager for French medical charity Medecins Sans Frontieres (MSF). “It definitely needs to be reinforced and scaled up.”
The three cases in Goma set off a scramble to find and vaccinate more than 800 direct and indirect contacts. As of Tuesday, all but five were vaccinated, said Tresor Amiri, the World Health Organisation’s (WHO) vaccination chief in Goma.
Officials are cautiously optimistic about containing the virus in Goma. No additional cases have been identified and the miner’s wife and daughter are recovering.
“We hope they will bethe first people cured in Goma,” said Jean-Jacques Muyembe, head of the Ebola response across Congo, adding their survival would show people “if you show up for treatment early chances of survival are relatively good.”
A previous case in Goma led the WHO to declare the outbreak an international health emergency three weeks ago, but it did not result in further transmission in Goma.
Authorities chalk up those successes to elaborate preparations since the outbreak was declared last August.
Ferdinand Tangenyi (23) is a volunteer going door-to-door with illustrated flipbooks warning against handling bloodied clothes or cleaning up vomit. Public service announcements run repeatedly on radio.
At the Rwanda border, crossed by an estimated 45 000 people daily, travellers have temperatures taken twice each side. Rwanda briefly closed the border last week but re-opened it when experts warned the move would encourage illicit crossings.
Officials established protocols to handle cases, isolated in a special ward at the main hospital. After two months of construction, a 72-bed centre built by MSF exclusively for Ebola received its first suspected cases last week.
Steep challenges remain. On Saturday, relatives of a boy referred to the MSF centre from a local hospital with fever and diarrhoea showed up to demand his release.
A male relative threatened to burn the facility down. “They were right in Butembo,” he said, referring to unidentified assailants who torched MSF’s treatment centre there in February, leading the charity to suspend activities.
“We had fevers and diarrhoea since I was a child,” said a female relative. “Why does a fever now equal Ebola?”
An MSF official was able to defuse the situation and the relatives left.
MSF is taking additional steps to reassure the population in Goma and avoid conspiracy theories that undermined response near Beni and Butembo. The Goma centre, for example, was built with see-through fencing to pre-empt rumours of anything nefarious happening inside, said Alexis Touchais, construction manager.
Francine Mulangala, who goes door-to-door informing people about Ebola in the Goma neighbourhood where the gold miner lived, was threatened by more than a dozen people demanding to see his body.
“If anyone gets sick, we are going to kill you,” she recalled them saying.
The local government has limited ability to deliver crucial services. Only 10% of the population has access to running water and many rely on communal latrines. The population is mobile with traders crossing into Rwanda daily, some outside official checkpoints.
The driver of a special Ebola ambulance in Goma, who asked not to be named, said drivers had not been paid in six months. The provincial health ministry could not be reached for comment.
Residents were eager to be vaccinated, but could not be because only those exposed to Ebola patients or their contacts are currently eligible. A decision on whether to deploy a second vaccine to cover a more people is bogged down by wrangling in the Congolese government.
“The population accepts Ebola is real,” said Joseph Mumbere, a money changer. “But it is hard to get the vaccine.”