l’heure du spectacle: Film-based monkeypox outreach in the Democratic Republic of Congo

By Benjamin Monroe

The glow of the dell projector was the only source of light for miles except the blanket of stars in the African sky.  In a life without lights, the chance to watch a movie can be a really big deal.  So it shouldn’t come as a surprise when an entire village shows up to an educational film screening.  What was amazing was the audience frozen in rapt attention, the simultaneous gasps and laughter from the audience as if on cue, and the hour-long discussion that occurred afterwards.   This was no ordinary PSA, but something meticulously developed by a group with vast working knowledge of conservation, health, and behavioral education.

We had come to the town on Bokungu in a remote area of the Congolese rainforest to investigate a recent epidemic of human monkeypox.  The often-neglected disease is a relative of smallpox, and can cause widespread rash over much of the body and be fatal in some severe cases.  The virus hides in an undiscovered animal reservoir and spills over to humans after contact with infected wildlife.  Once infected, it is possible for a patient to infect other close contacts like family members and playmates.  An important goal of this investigation was to educate the local population about ways to prevent monkeypox.

One of the keys to producing useful and effective health videos is to make them relevant and relatable to the population you are trying to reach. Luckily, the International Conservation and Education Fund, a conversation organization working in the Congo basin, graciously agreed to lend us their monkeypox films and equipment to aid in this effort. InCEF takes great care to incorporate African film makers, regional subject matter experts, and local residents in all their films.  To an outsider, watching and InCEF film is like a 10-minute trip to one of the most remote regions of earth.  You hear the songs of village children, see a level of poverty that is almost unimaginable to those from developed countries, and begin to grasp the resiliency of a people largely overlooked by even their own government.  To the residents of these communities, there is an undeniable excitement of seeing people just like them living their lives and sharing their stories on screen.

A particular vignette that resonated with these audiences was a tale of two boys who fell ill after they disobeyed their father and decided to eat a squirrel they had found dead in the forest.  Based on audience reaction, this situation was as common in this area as breaking mom’s vase on a Western TV sitcom. Thanks to these common storylines, and relatable characters, these films sparked animated discussions among the audiences and gave health educators a chance to impart valuable information on how to avoid contracting and spreading this deadly disease.

All the effort involved in bringing these films to affected populations starts to pay off when InCEF educators can lead a community discussion.  People began to line up to share their thoughts with neighbors while the credits rolled.   Amplified by a megaphone in the local dialect, Lingala, several themes seemed to constantly reoccur as the audience took the floor.  What animals have monkeypox and how can you tell if it is sick?  That meat available in the market often comes from untrustworthy sources.  Are there methods of preparing these types of meat that prevent monkeypox?  Why are there no medications available to treat the disease?

A great deal of tact is necessary to put misconceptions about this disease to rest and address the risks associated with wildlife consumption.   It’s easy to sit in an office somewhere with a full stomach and make the recommendation to not eat dead animals you find in the forest.  But when standing in front of chronically malnourished crowd the words can get stuck in your throat.  These communities are some of the most marginalized in the world.  Agriculture is difficult in a landscape covered in dense tree cover and flooded lowlands, there is minimal infrastructure to transport goods, and no social safety nets available if crops fail.  Subsistence is based almost entirely on what you collect from the forest.  The choice is often between letting your family eat the dead squirrel you found collecting wood, or not eat at all. This issue is complex to the heart, and is unlikely to be solved by campaigns developed worlds away.   There is no substitute for the ground-level effort groups like InCEF put into bringing information like this to forgotten places.    Over a seven-day period we were able to reach more than 2,300 people with the light from one small projector.  That could mean an untold number of future monkeypox cases prevented.