Marburg epidemic spreads fear in the north Angola

For many Uige inhabitants, the provincial hospital remains synonymous of death. Not only because almost none of the confirmed cases have survived, but also because the hospital has been one of the main focal points of the outbreak. At first children in the pediatric ward died; then their mothers died; health staff followed - 16 lost their lives; and the disease spread on to the staff's relatives.
Feeling hopeless against the Marburg Epidemic that has gripped their region, inhabitants of the Angolan city of Uige are either suffering in silence, expressing their anger, or fleeing their homes. Marburg - the hemorrhagic fever that resembles Ebola - has already claimed the lives of more than 280 people in the province, and new cases are surfacing almost every day. Faced with a disease that can be transmitted by the simplest contact with an infected and symptomatic person, the 200,000 or so city-dwellers of Uige want to know who is responsible, and sometimes their fears turn into wrath. Stones have been thrown at international teams who are fighting against the epidemic but cannot treat patients, as no cure exists; the only measure they can take is to isolate infected persons to avoid further transmission. As patients who enter the hospital very rarely come out alive, families are refusing to abandon their sick and prefer to keep them hidden at home, exposing themselves to the risk of being the next victims. Day after day Zita visited her husband Horacio at the Marburg treatment center of the Uige Provincial Hospital. But back in the barrio (or neighborhood) of Camdombe Velho, she did not dare tell her neighbors why her husband was sick. "If I told them what he has, they would not approach my house," said Zita. After spending 13 days in the center, Horacio no longer had symptoms and he recently returned home He is one of the first isolated patients who appears to have won the battle against the disease. Yet for many Uige inhabitants, the provincial hospital remains synonymous of death. Not only because almost none of the confirmed cases have survived, but also because the hospital has been one of the main focal points of the outbreak. At first children in the pediatric ward died; then their mothers died; health staff followed - 16 lost their lives; and the disease spread on to the staff's relatives. "People always look for someone to blame for such deaths," said Pastor Alberto Moisés, while watching team members from Médecins Sans Frontières (MSF) and the World Health Organization collecting a body in the barrio of Pedreira. "They say that Marburg is in the hospital; that there is a large reservoir of blood there; and that anyone who approaches it dies," he explained. "Many people have fled to Luanda (the capital) or to the villages." In one of the rudimentary buildings on the hospital grounds, an MSF team has set up a treatment center for Marburg patients. Covered from head to toe in bio-security suits, the team members are working in extreme conditions. In addition to the inevitable fear and the intense heat they must endure, their role is limited to accompanying patients to their near-certain death. "It's very frustrating," said Diana Pou, an MSF doctor. "We can only wash the patients, give them food and drinks, and treat their symptoms." "We have to tell ourselves that we are here to deal with a public health problem, and we have to get away from a personal approach. The primary goal is to isolate infected persons so that they don't infect others," adds Luis Encinas, the medical coordinator. Convincing the population that isolation is necessary is a Herculean task. An MSF team recently organized a meeting with representatives of the Pedreira barrio. The importance of having cases come to the hospital - even though no treatment is yet available - was discussed for hours. Then a traditional healer spoke up: "I have a cure. And I have cured five people" he claimed, without being able to name any of the five. Suddenly all the participants at the meeting - including those who had seemed most convinced of the need to isolate cases - began demanding that the traditional healer's cure be applied. Two short sentences had reversed the meeting's progress. Beyond such setbacks, local traditions and customs can become lethal weapons. In preparation for a burial ceremony in the barrio of Ngana Camana on April 10th, the body of a woman named Madalena was washed by her sister Ana, her sister-in-law Lisa, and her godchild Elisabeth. All three women subsequently died of Marburg. "If we prove that Madalena was infected, it is clear that the virus may have been passed on when her body was washed," said Evelyn Depoortere, an epidemiologist at Epicentre. Evelyn is also looking into the possibility that Madalena belongs to a cluster of five people, all from Ngana Camana, who may have contracted Marburg at the local health center. A WHO team noted that needles in this center were being re-used after soaking for only a few minutes in warm water. "If you compare it to AIDS," said Josefa Rodríguez, an MSF psychologist, "in Europe, after years of awareness-raising, we have managed to change some behaviors. Here we need people to change their customs in two weeks. And no matter how hard we try, it's very hard to succeed in doing that." In the meantime - and despite the fact that new cases are registered almost every day - the inhabitants of Uige are returning little by little to a semblance of normality. The streets, virtually deserted some weeks ago, have gradually filled up again. People no longer cover their mouths with horror when teams collecting bodies pass by. Accustomed to many other hardships, the population is showing signs of stoicism. "In Angola we have known war," said Ligia María Costa Pedro, head of the pediatric ward in the Uige hospital, "and we have come out of it and moved on. Even though Marburg is killing a lot of people, there will always be a few survivors." She lost seven of her colleagues to Marburg.