A woman and her daughter, both suffering from Ebola, became the example of the difficulties faced by the government teams in the Democratic Republic of Congo, the NGOs who were working there and the World Health Organisation (WHO) to contain the epidemic which was affecting the east of this gigantic central African country. The mother, who was 24, died on Tuesday 13 July; the little girl is still having treatment. The woman was a high-risk case because people in her village had caught Ebola, and she fled from there. She travelled 700 kilometres to the south, where she died. The WHO says she changed her identity four times during her journey. Why? Because she didn't want to be identified, due to her lack of trust about medicine and her false beliefs which are rife, especially in rural areas which are the majority in this part of the African country.
They were registered as the first two cases of the virus in the South Kivu region, thereby expanding the number of regions which are fighting against Ebola. So far, it has only been detected in neighbouring Ituri and North Kivu.
This is one more problem for the health teams, who are also having to deal with the instability in the region, where there are battles between the Congolese army and different militia which operate in the area. Many of the medical teams have to have bodyguards," says Dr Marta Mora-Rillo, a specialist in infectious diseases at La Paz-Carlos III hospital in Madrid. "There is no single large outbreak, but there are a lot of small ones," she says.
"You also have to bear in mind that it hasn't massively arrived in the big cities," points out Dr Diana Pou, who is a specialist in these types of illnesses at the Vall d'Hebron hospital in Barcelona and is the spokeswoman for the Spanish Society of Tropical Medicine and International Health (Semtsi).
This is precisely the major difference with the outbreak five years ago which caused more than 13,000 deaths in Sierra Leone, Guinea and Liberia. "It reached the big cities and spread rapidly," explains Dr Pou. So far, that has not happened in DRC: only four cases have been detected in Goma, the biggest city, a few weeks ago.
Nobody must drop their guard to prevent Ebola crossing the border with Uganda. "It's a tourist country, and if a tourist returns to Europe with a fever...." says Dr Pou. "We are much more prepared now, though," adds Dr Mora-Rillo.
During these past years there have been numerous training courses, says Dr Pou. "The protocols have been greatly improved compared with five years ago".
She was part of the team who treated three Spanish people who caught the disease: missionaries Miguel Pajares and Manuel García Viejo, both of whom died, and nurse Teresa Romero.
"It is true that at that time it was a bit crazy, but we learned a great deal from it. The National Health School ( at the Carlos III Health Institute) carried out a major training campaign and now we need to refresh that knowledge," she says.
Checking materials to ensure that they are not past their expiry date - they normally have a useful life of four years -, informative talks and simulations are some of the measures being taken by the seven hospitals designated by the Interterritorial Council of the National Health System to deal with this type of case: Virgen del Rocío (Seville), Royo Villanova (Zaragoza), Nuestra Señora de la Candelaria (Tenerife), Clínic (Barcelona), La Fe (Valencia), La Paz-Carlos III (Madrid) and Donostia (San Sebastián). The Gómez Ulla military hospital in Madrid also has an isolation unit.
"We learned a lot, but this isn't just about Ebola. There are other illnesses, like zika, dengue, chikunguña... we have to respond properly to them as well," says the doctor.
Something that has changed everything in the fight against this illness, however, is the vaccines. At the moment, the rVSV-EBOV which is in experimental phase is being applied in the Congo. The WHO has already recommended the use of a second one, and a scientific team in the USA has tested two others -REGN-EB3 and mAb114- with good results.