By Solange Gasanganirwa and Mumbere E.Lubula
The measures taken by most nations of the world to limit the spread of the Corona virus disease (hereafter Covid-19) were drastic and abrupt. The closure of borders, physical and social distancing, or hand washing, were all measures that shocked populations, because they limited interpersonal exchanges. The adaptation of these measures was in many ways difficult, especially during the first wave of the pandemic. In some circumstances, this shock led to the decision to take actions or act in ways that could increase the risk of spreading the disease. This is shown by the case of Titi (this is a pseudonym), a young unemployed man living in Goma away from his parents in Bukavu, to whom we spoke on October 10, 2021. In February 2022, we approached his paternal uncle to validate the data we had been drawing from the interview. The collection of data in two stages allows us to show that during the pandemic, the conflict between emotions and rules established to fight the pandemic is a central factor of spreading the disease.
The journey of risks in the name of familial belonging
Titi is the oldest son of a large family. During the first wave of the pandemic, he experienced the confinement as a nightmare. When his parents, living in Bukavu, had just contracted Covid-19, without him being informed that it was Covid-19, he could not travel to assist them, except by a mode of transportation that exposed him to more and greater risks. As Titi told us:
„Dad had called me to say that he wasn't feeling well and that he was already in the hospital. He had not told me exactly what he was suffering from. So I decided to go back to Bukavu as soon as possible to help him, as I am the eldest son in my family,“
There are four ways to reach Bukavu from Goma. The first is the lake route, which consists of crossing Lake Kivu from north to south in nearly five hours, where the two cities of Goma in the north and Bukavu in the south are built. The second route is by land. It is longer (more or less 8 hours) and exhausting as the road is not, in many places, good and safe. The third route, also overland, consists of crossing Rwanda by its western strip along Lake Kivu, over Gisenyi, a town next to Goma, to Kamembe, a town next to Bukavu. This route is paved and well secured and takes about 4 hours. The last one is by airplane.
„During the first wave, traffic between Goma and Bukavu was suspended, whether by lake, by Rwanda or by air. Even on the national land route, only motorcycle cabs operated, exposing themselves to various risks: kidnapping, traffic accidents, or even contamination. Moreover, even the traffic on this road was suspended; we had given Titi a little bit more money so that he could bribe the police and thus get past the ‚opportunistic barriers‘ (« barrières opportunistes ») that the latter had erected here and there on this road,“
revealed the paternal uncle of Titi whom we met in Goma.
Titi was distraught when he learned of his parents' illness during the pandemic, as he could not easily travel to be at their bedside. Torn between a strong need to assist his sick parents and the severe difficulty to be mobile, he decided, four days after receiving the news of the illness of his parents, to ignore the health regulations. He travelled by motorcycle taxi, constituting the unsafest route, both, in terms of security and health. It was the only choice he had. For this trip, neither the taximan nor the traveler had to take a Covid-19 test. This test is not mandatory for users of this mode of transport. It is as if the state is unaware that Covid-19 concerns motorcycle transport users as much as boat, plane, and car users; as if the state is afraid to subject motorcycle-taximen to restrictions out of their fear of their tendency to revolt against measures to regulate their activity.
It may be true that Titi arrived well in Bukavu, but it is not certain that he could not have contracted Covid-19 along the way. In fact, he said said:
„because the trip is so long, at one point the cab driver and I had to take off our face masks and free our noses to breathe properly. I was aware of the risk of infection that I was facing, but I could not do otherwise given the pressing need to breathe normally after about three hours of travel.“
When he arrived in Bukavu, Titi was not tested. This is normal, as there is no provision to force him to do so. Hence, he could have been also at the root of a chain of transmission of other members of his family, if he had contracted the disease during his trip. „How could I go get tested before I came in contact with my family members? I didn't have the will, I didn't have the money for it; I just washed my hands with soap!“
It should be noted that at the time, the INRB alone, based in Kinshasa, was responsible for testing. The analysis of samples was centralized. Samples taken in the provinces had to be sent to Kinshasa for analysis. The results would arrive in Goma after two weeks. Enough time for a person to die before the results arrive. Nevertheless, the disease itself instilled fear. People were afraid to come forward. Anyone with even a simple cough had to hide so as not to be isolated and then die. „Some patients died before the helpless eyes of doctors, before they could even receive test results.“ Later, he contacts both parents, without knowing anything about their infection, as if Covid-19 is just a banal story or a taboo subject.
Dying by empathy or by ignorance: the fate of Titi's mother
It was known that Titi’s mother suffered from a chronic heart disease (Titi was unable to specify the name of his mother's chronic illness). She did not complain of any other health problem. When her husband fell sick, she naturally decided to accompany him to the hospital and stay at his bedside. She thus remained in direct contact with her husband, who was already showing signs of Covid-19, although she did not, unsurprisingly, realized this. In general, especially at the beginning of the pandemic, doubt about the existence of this pandemic was the rule in the collective opinion of the population of Bukavu.
Two days after her husband's hospitalization, Titi’s mother experienced unusual discomfort. But she and her husband decided that she should return home, because her fragile health situation made her unable to cope with the difficult conditions at the hospital at this particular time. Neither the husband nor the wife paid any attention to the new type of illness. Only the chronic disease concerned them. For this disease, they knew its history, they were almost blinded by it to the point of ignoring the new disease and its severity. Titi explained:
„Without any opposition or counter-proposals from the doctors, Mom returned home to her children. But two days later, she showed other signs, including difficulty in breathing. Like many people, Mom was suspicious of Covid-19. My parents called it a white man's disease.”
Obviously, Titi would have liked the doctors to prevent his mother from returning home, but he had lost sight of the fact that this is not the role of the caregiver, especially for a nurse. Moreover, in a context of generalized denial of the existence of the disease, Titi’s mother was unable to think about the possibility of going for a Covid-19 test before leaving the hospital. Because Titi's mother was at her husband’s bedside, she was a contact, who had not protecting herself, the health care staff could have prevented her from returning home, and taken care of her directly. „But how could they think of that, if it is true that the results of the test could be delayed for many days in this public hospital?“ wondered Titi.
Out of empathy for her husband, she contracted Covid-19, and focusing on her chronic disease, she ignored her vulnerability to Covid-19. She developed severe symptoms and died of it. Thus, empathy and ignorance contributed to the rejection of the serious reality of Covid-19.
Caregivers' indifference: expression of ignorance or fear of the unknown
In relation to the story of Titi's mother's infection, one can rightly wonder why the health care staff could not have kept her in the hospital, as she had been constantly at the bedside of a highly suspect case, her husband. She should have been tested and, if necessary, counseled by the health care staff on what to do. During a pandemic, everyone is on alert, especially the health care staff, especially for awareness.
„I felt that even the doctors were afraid; that they had trouble making even the simplest decisions about patients vulnerable to the pandemic,“ notes Titi. The fear of the caregivers was all the more justified because the test results took a long time. „Doctors were faced with a new pandemic, after ebola, without having enough information or experience. They didn't know how to deal with it,“ explained Titi's paternal uncle. In addition, the controversy that had built up about the treatment protocol and the lack of test kits in hospitals were additional reasons for the fear among health care workers.
Unaware of her Covid-19 status, Titi's mother had returned home, unknowingly exposing her household to risk. She could not imagine that she herself not being tested was a risk to many, notably to her children.
The hospital: source of hope or crucible of trauma for patients and their families?
Upon her return to the hospital, Titi‘s mother was immediately admitted to the intensive care unit. Meanwhile, his father was dying in the emergency room. He told us that “There (in the emergency room), Dad was sharing an oxygen tank with another patient and I wondered how convenient that was for a patient, like my father, whose blood oxygen level was fluctuating all the time,“ and added “Meanwhile, the results of the Covid-19 test were being delayed for hours, while mute bodies were crossing the emergency room to the morgue every five minutes. It was traumatic, it remains traumatic for me”,” he concluded, his face between his two hands, as if to hide his tears.