On the border of the Democratic Republic of Congo (DRC) and Uganda, separated only by the River Lhubhiriha, people share cultural, social, political and economic activities. Their lives flow across the border, for example, Congolese women constitute the highest proportion of women who give birth at Karambi health centre in Uganda. Ugandan women cross to DRC every day to go dig, harvest crops and buy items like palm oil.
This area has suffered from 11 Ebola epidemic outbreaks, and since December 2018 Ebola checkpoints were erected at several DRC – Uganda border crossings. For Ugandan women carrying babies on their backs, whose farms are on the DRC side of the border, crossing the border is a normal part of daily life, but at the Ebola checkpoints, they are viewed and treated as returning travellers. As such, they must set aside all the luggage, including water fetched at River Lhubhiriha, babies wrapped on their backs, bunches of bananas, firewood and other harvested crops to first wash their hands and feet in 0.05 per cent chlorine and 0.5 per cent chlorine respectively.
The team at the Ebola checkpoint, including armed soldiers, argue at length about how all travellers must disinfect themselves of any risk, particularly of the Ebola virus they might have picked up from the DRC. This is despite the fact that no risk case has been identified at this checkpoint over a ten-month period. During our research when we observed the checkpoint, the women appear to comply. Some only let the chlorinated water drip on their fingertips before proceeding for a temperature check and traveller registration.
‘Stubborn’ border women
One Red Cross volunteer and another officer deployed by the International Organization for Migration (IOM) called some of the women stubborn travellers. They told me:
“In spite of constantly telling them about the dangers of the Ebola virus and how to wash hands properly, some of them refuse to comply. One day, one of the stubborn women was so frustrated and told everyone that she does not want to wash. she bit and severely injured one of the soldiers’ hands. These days, many women travellers do not want to wash hands, they say it is a waste of their time. They say they are already tired and overburdened.”
So far we have not seen any women with a high temperature amongst these women who go and dig across in DRC, but we have to be vigilant.
“Ebola is still in DRC and anytime a sick person can cross over to Uganda. It is because we do not know exactly what they have been doing there and that is why we subject them to all Ebola control measures including temperature taking when they are sweating profusely under their heavy weights”, argued one Ebola control volunteer.
Only one man for every ten women cross the Ebola checkpoint
On 9 October 2019, having observed the checkpoint for over an hour, it struck me that there were no male travellers crossing to or from DRC. Also, traveller records for July 2019 showed that on average, for every ten women, only one man crossed through the Ebola checkpoint. This is unusual since it is usually men from African villages that travel the most. So, we asked several men in the village why there are so few men crossing the border.
One told me that “I would like to go to Congo to help my wife, but there is ekihambohambo [unnecessary arrests] there. So many soldiers and people posed as soldiers, asking for this, asking for that, beating you if you show them your Ugandan national identity card. There are many unnecessary arrests. I used to go there, but because of those behaviours, I stopped.”
Even the Ugandan soldiers only add to the problem. They arrest mostly men, particularly if you do not move with your identity card, added another elderly man.
Only one man mentioned that he goes to DRC, but he uses a DRC national ID while there and his Ugandan ID when in Uganda. He prefers to use informal border paths to avoid the Ebola checkpoints and describes at length how he behaves and talks like a Congolese while in DRC, but upon returning he lives like a Ugandan.
Ebola controls have many unintended and negative consequences
Ebola control activities have had many unintended repercussions. For women regularly crossing the border carrying heavy loads, this includes the increased burden of being viewed as potential disease carriers and complying with all Ebola border checks, including thorough washing of herself and her children. She does this in spite of the exhaustion, the heat and her mind is fixed on her immediate and everyday threats including hunger, the health of her child, poverty and increasing workload.
The men, being tired of these monotonous procedures decide to stay away from the border preferring to discuss political matters, washing and re-washing their motorcycles.
In sum, after the index case of the 11th Ebola epidemic was confirmed in neighbouring DRC, Uganda implemented pandemic preparedness activities in a bid to protect its citizens. Pandemic preparedness activities can facilitate disinfection, identification, management and treatment of common febrile conditions, the benefits of which cannot be underestimated. However, it’s these very activities which have had negative social, economic, political consequences. If women who cross the border twice every day are defined as travellers, their constant movements monitored and subjected to hand and feet washing, it adds an extra burden to their tiring everyday tasks. It also results in the men’s reluctance to cross the border, leaving even more of the work to the women. Men in effect have been reduced to idle and sedentary lives because of fear of being subjected to Ebola control activities, including the fear of arrests.
In in an earlier blog (Akello et al. 2019), we show how social dynamics in the village were affected for people whose land was occupied by an Ebola surveillance team, with one neighbour blaming the other for having brought the Ebola Control Centre to their small piece of land. Additionally, Ebola control activities were politically divisive whereby the various authorities responded differently to the demand by one old man that the Ebola team vacates his land. The district health authorities threatened to arrest him for interfering with government activities, while the village leaders supported his need for land to grow food crops. In the next blog, we will highlight key economic aspects including a reduction in the number of tourists to Kasese district.
More focus needed on everyday heath threats
While there is a major focus on Ebola and indeed its virulence, little attention has been paid on people’s everyday threats and priorities. To pay attention to people’s everyday health threats may call for a totally different focus – for instance to the provision of clean water instead of subjecting the individual fetching and intending to use dirty river water to disinfection. Additionally, villagers will be happy when preventive approaches are put in place for high priority diseases like childhood diarrhoea, cholera, malaria. All these activities need to be implemented in tandem with Ebola preventive activities in order to garner people’s trust in health promotion activities. Frequent travellers, going back and forth across the border every day could also be exempted from Ebola checks.
Grace Akello, PhD, is an Associate Professor and Medical Anthropologist based in Gulu University, Faculty of Medicine. She is also a visiting Professor at the London School of Economics and Political Science.
This blog is written as part of the Pandemic Preparedness Project. A key aim of the project is to examine ‘preparedness from below’ – the understandings and practices of communities through which they anticipate and manage threats on a daily basis. This research will highlight the importance of local perspectives to disease response which have not been fully recognised and supported in global discourses so far. As part of this work we are conducting ethnographic fieldwork and this blog is part of a series of notes from the field, so you can keep updated with our work.