In DR Congo, health workers pioneer new Ebola isolation 'CUBE'

The World
A doctor visits a patient in the cube isolation booth

The Ebola outbreak in the Democratic Republic of Congo has spread relentlessly since August 2018, infecting more than 2,000 people and killing at least 1,500. Recently, it reached Uganda, where several cases have been recorded, all in people who had come across the border from DR Congo.

Doctors at a medical center in Beni in the North Kivu province are using a new design for treatment rooms called the CUBE, which allows doctors more hands-on care and allows family members to visit. 

A typical Ebola treatment unit isolates patients in rooms where doctors and nurses only briefly enter wearing "PPEs" or heavy protective gear. By comparison, the CUBE is a Biosecure Emergency Care Unit for outbreaks of highly infectious diseases, which allows health care workers to monitor the patient, check their vital signs and administer certain treatments and care from the exterior, without having to wear full Personal Protective Equipment (PPE) suits.

A row of transparent tents are set up on a gravel clearing

A row of CUBEs are set up. There are 14 in Beni and 11 in Katwa in DR Congo. 


Couresty of Jennifer Lazuta/ALIMA

Family members can also safely talk with and see the patient throughout the course of treatment, thanks to the CUBE's transparent walls.

Dr. Richard Kojan, president of the Alliance for International Medical Action (ALIMA), works at the center with the CUBEs.

Kojan says staff right now are managing several suspected Ebola patients, plus 19 confirmed ones in semi-stable condition, and six more who are quite sick. For six patients, they have one doctor available. 

The World's Marco Werman talked with Kojan about the unique CUBE design and what it has meant for treating Ebola patients with dignity and efficiency, while also reducing the risk of contamination for health care workers. 

Marco Werman: How are you treating [patients] if somebody is unstable? What do you have to do? What can you do?

Dr. Richard Kojan: We have to follow the kidney function. We have to follow the liver function. We have to follow the lungs function so we have to follow all the little functions. But we have to continue to give them strong care. 

Related: Kenya responded fast to Ebola scare, but cross-border risk remains high

Tell me about the last person you treated. Were they panicked or scared?

The last patient for today? I saw a child, 14 months, who is in septic shock and very unstable. So, he receives blood, he receives the drugs to protect his stomach, to protect his lung function, to protect the liver function. 

And how is the child's family coping with his illness? 

One of the good things in this outbreak is that our design facilitates contact between the patient and their family, between the family and us, the health workers. So, the family, they are there. They see their children and we discuss with them, we explain to them the situation, the evaluation of their children. They sit around the CUBE, they are near their children all the time they need.

Related: DR Congo Ebola outbreak spreads to neighboring Uganda, activating rapid preparedness response

Dr. Kojan, before we talk about this innovation, the CUBE, — remind us how Ebola is spread and how do you as health care workers and doctors keep from getting infected? 

Yeah, that's a good question. This is a problem for this outbreak. Until now, we don't know the index case, because, with the index case, we will understand well how this outbreak starts. But the contamination is the same for all Ebola outbreaks. The contamination is by fluids — when you touch the dead body and when you touch all biologic liquids. 

We received some health workers contaminated in some health centers from Beni, from many villages. Their contamination, it starts by an examination of the patients to confirm the case, and we failed to know all the information about the suspected case and after that, they start [to get] sick [with] Ebola. But we have not yet registered the contamination in our team.

So far, the health care workers at your center have not been contaminated. Perhaps that's because of this innovation that ALIMA, your organization, has come up with. We were talking about it earlier — the CUBE. I'm checking out a photo of one of them. It's totally transparent. The doctors and patients can see each other through them. What makes the CUBE different than the kind of isolation that was used in the big Ebola outbreak in 2014 in West Africa? 

Before this outbreak, I worked in a traditional situation with big, strong isolation for the patients. It was very hard to work in this condition. With a strong PPE, with a heavy PPE, you can't stay with the patient [a] long time. Many things change, you know. Now, I don't have a PPE. So I see the patient, I meet with the patient. I can stay every time with the patient. With the CUBE, we have a possibility to touch the patient without full PPE. I can examine the patient outside the CUBE. 

Related: In DR Congo, Ebola rumors may spread faster than the virus

You've actually got latex gloves that go inside the CUBE from the outside, correct? 

Yeah. I can help the patient to eat without contamination or risk of contamination. 

A health worker shows how the gloves work in the CUBE

A health worker shows the gloves that are part of the CUBE's walls.


Courtesy of Jennifer Lazuta/ALIMA

It sounds like big progress from 2014. Have you found that it's increased trust? Are people more willing to come to the Ebola treatment center because of these CUBEs? 

Exactly. In the last design with strong isolation, the family can't come and health workers can't stay longer in the red zone. I'm a specialist in ICU and you know, it was a big, big problem for us because you can't stay with your patient, you can't meet all the time your patient. But today, with the CUBE, I breathe well because I'm not in the full PPE. I breathe well, I can stay longer with my patient and there is no risk for my contamination. When I finish, I don't need to wash. I don't need to disinfect my body because we have good biosecurity today when compared with the old [way].  

It certainly makes the work much more efficient if you don't have to disinfect every single time. Dr. Kojan, the numbers of deaths continues to climb from this Ebola outbreak. What are your concerns right now? 

That is our big problem. The important thing we need in the village areas of Beni — we need to support those health centers, to increase the biosecurity in those area health centers and establish the confidence between the community, the population and the old health care system. ... when we receive the patient early, I'm sure we have all the standards of care. We have all the drugs. We have a vaccine, we have many ways we can help the patient and we can decrease significantly the number of dead patients under Ebola. 

This interview has been condensed and edited for clarity.

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