Outbreak: Ebola surfaces in Uganda

In October 2000, the Ebola virus surfaced in Gulu, a district in northwestern Uganda. The outbreak hit in three waves from October 2000 through January 2001. First identified in Zaire in 1976, the last known outbreak before the one in Uganda was in Gabon, in 1996. The virus has no known source, and no known cure. Ebola is a mythic disease in part because it is brutal, swift, frightening - and rife with paradox. Infected patients are highly contagious, but care must be hands-on, intensive, contact-driven. Medical personnel experienced with the disease are needed, but the virus is so rare that people who have dealt with it are few. Hospital care is essential, but medical staff can be the first to die, with infections in the hospital often high. And a disease so adept at bringing death upsets the rituals and rhythms of death itself. Swift international response MSF was part of a team of international organizations and agencies, including the World Health Organization and the Centers for Disease Control in the U.S., that responded immediately after Dr. Matthew Lukwiya, a Ugandan doctor, suspected Ebola in some of his patients in Gulu in early October. MSF was on the ground with a team of 20 doctors, nurses, epidemiologists, and logisticians by October 15th. For four months, MSF focused on case management, which encompassed active case searching, contact tracing, medical care, proper burial of bodies, and reintegration of survivors into the community. No cure, only care Ebola patients suffer initially from symptoms that can include fever, headache, vomiting, diarrhea, and rash. As the disease progresses it is often accompanied by liver damage, kidney failure, and massive internal bleeding. Some patients bleed to death from all body orifices. Others go into shock. The disease is spread through bodily fluids, passed through contact as simple as a handshake, a hug, or a shared cigarette. The principal medical care given to Ebola victims is oral rehydration, mostly in the form of salt. Sometimes intravenous drips are used, or, occasionally, other medication. But there is no cure for Ebola, only care. Severe progressive weakness in Ebola patients is a sign that the concentration of the virus is building up in their bodies; the people most in need of attention become the most hazardous to care for. One of MSF's activities was training local health staff on how to attend to Ebola patients while protecting themselves. A method called "barrier nursing" is necessary in the Ebola isolation ward. Hospital personnel wear individual non-reusable gowns, two pairs of gloves, masks, goggles, and rubber boots. They wash constantly and are periodically sprayed with bleach, and equipment is continually sterilized. Patients are isolated from all contact with unprotected people. In Uganda, MSF supervised one of the two isolation wards set up during the outbreak. The key caregiver for each patient was often not part of the medical staff at all, but a member of the family. This is common in many African hospitals, a result of a lack of nursing staff, or because nursing duties do not extend to cooking, cleaning, and attending to bodily functions. Of the utmost importance during the outbreak was making this personal caregiver as safe as possible from infection, through protective clothing and close monitoring by the medical staff. People who survived Ebola in Uganda often pointed to two conditions that really helped them: fluids when they wanted them, and encouragement from staff and caregivers, sometimes in the form of spiritual support or music playing by their bed. Information campaign Mobile teams worked in tandem with the medical care efforts. Small groups fanned out in Gulu district, and later in Masindi and Mbarara, tracing contacts of confirmed patients. They identified suspected cases and brought them to the hospital. About 10% of the cases in the outbreak were identified this way. Because of the frightening nature of the disease, many people were at first afraid to report it - but later swamped the hospitals with any small complaint, fearful that they had contracted the virus. An important part of MSF's work was providing information to try and lessen the stigma. Health workers and recovered patients were shunned because of their association with the disease and their contact with the hospital. Psychological support was also given to local medical staff and international volunteers. Deadly disease upsets the rhythm of death In Uganda, as elsewhere, the rituals of death are an intimate part of the rituals of life. Bodies are washed carefully. People watch over a body on the eve of burial, and mourners dip their unwashed hands into a common bowl. The emergence of Ebola changed this. In a time of so much death, a ban was put on traditional funerals in an effort to stem the spread of the disease. The bodies of Ebola victims were sealed in special bags and taken by protected workers and drivers to be buried immediately. People handling the bodies and trucks transporting them were thoroughly disinfected after each trip. Grim tally When the outbreak was officially declared over on February 28, 2001, and the virus had slipped away once again, it had infected 425 people and taken the lives of 224, including 21 health workers, among them the doctor who had first sounded the alarm.