Prof. Pierre Akilimali does not think the numbers matter, even though he is the person most responsible for producing them. "The statistics are meaningless," he told the Guardian in an interview published Friday, describing the milestones this paper has spent the past week reporting — the largest outbreak in the Democratic Republic of Congo's history, the second-largest Ebola outbreak ever recorded globally. "It is behind those numbers that matters; it is the father, the child, the loved relative." [1]

Those two milestones were the subject of this paper's August 26 account of the outbreak surpassing the country's own historical record and its August 27 report on the outbreak becoming the second-largest ever, the same day Uganda's linked outbreak formally closed. Both pieces treated the Democratic Republic of Congo primarily as a case-count ledger, tracking discrepancies between WHO's, the CDC's, and BBC's competing tallies. As of August 24, the Bundibugyo-strain outbreak stood at 5,656 confirmed cases and 2,715 deaths, per Akilimali's own national institute — a figure that itself sits between the other agencies' counts this paper has already flagged as unreconciled. [2] Akilimali, who heads the Department of Research at the DRC's National Public Health Institute and now serves as incident manager for the country's multi-agency response, offers something the ledgers cannot: an account of what building that response actually requires, one household at a time.

He is honest that the trajectory remains unknown. "Let's say in two months we will reach the peak and start seeing a decrease, but this is guesswork," he said. "The honest thing is that we do not yet know." [1] He spoke to the Guardian on his first day off in months, delaying the interview repeatedly to take work calls. "Rest is not an easy thing for the Ebola workers to find," he said, describing colleagues who have been away from their own families for long stretches of a response now in its fourth month.

The outbreak is the 17th recorded in the Democratic Republic of Congo since Ebola was first identified there in 1976, in a region — eastern DRC — already exhausted by war, displacement, and decades of institutions that have repeatedly failed to arrive when needed. Akilimali argues that the community suspicion field teams encounter is not ignorance but memory. "It would be wrong of us to be surprised that some people hesitated at the start," he said. "That is not ignorance; in most cases it is the understandable fruit of hard experience, including experience of institutions letting them down." [1] He described attacks on clinics fueled partly by rumors that health workers profit from deaths, rumors he traces to confusion over how international funding is actually managed: foreign organizations announce large sums, he said, but "it's not true when people say this. Their money is not managed by local government or regional centers, it is managed by the NGOs" — a distinction lost on communities who hear only the total. [1]

What Akilimali describes as the actual work bears little resemblance to a spreadsheet: finding every case and contact, ensuring dignified burials, maintaining infection control, and building trust patiently enough that a frightened family chooses to walk through a treatment center's door rather than hide a sick relative at home. He recalled one mother who brought her child in for care "against a current of fear," after others in her neighborhood had waited too long to survive. "That she could decide to step through that door and trust us with the life of her child says everything about what the work is," he said. "We are not only fighting a virus, we are building enough trust that people will cross their own fear to reach help." [1]

Case-fatality percentages and health-zone counts are the vocabulary of the outbreak this paper has used all week to track its scale. Akilimali's vocabulary is different — families, doors, and the specific, unglamorous work of being believed. Neither replaces the other. But a reader who has followed only the numbers has not yet met the response those numbers are meant to describe.

-- KENJI NAKAMURA, Tokyo