Letters from the Uganda ebola outbreak

December 8 Uganda/Ebola - No one shakes hands because of ebola, the 'serial killer' virus

December 8 2007 - It's been less than a week since I arrived in Bundibugyo from Geneva via Kampala, the capital of Uganda. We're a stone's throw from Congo at the foot of the Mountains of the Moon and the setting is magnificent. The great forest is nearby. Bundibugyo is more of a big village than a real town. No paved road and few permanent structures. Everything is green, everything is alive. The impression is that, normally, life should be easy here. But life is anything but normal in Bundibugyo right now. Ebola, the serial killer virus, made its appearance here several weeks ago and fear is all around, accentuated by the increasing number of victims. Exactly 29 as of today. No one shakes hands here. People avoid each other at all costs, even if it isn't very easy or very natural. The smell of chlorine that precedes the team's arrival causes unpleasant tingling in your eyes. There are no fewer than twenty-some expatriate doctors, nurses, and logisticians who come and go between the base and the hospital, where 16 patients are currently in complete isolation. The weekend was especially difficult for the team. Six people died between Friday evening and Sunday morning, including another Ugandan health worker. He was infected while treating other patients. Ugandan health workers have paid a heavy toll with five deaths already. Fear is out there. We all feel it even if we shield ourselves against it. Yesterday morning, Anya, the German nurse who is working in the ebola ward, arrived back from the hospital with a broad smile. Outfitted like a cosmonaut, she even began to dance in the courtyard of the guest house. "No one died last night." Everyone applauded, relieved. Then she added, "There are three tough cases in the ward..." December 12 Uganda: In ebola's the high risk zone

December 12, 2007 - Today 'Doc Esther', the MSF doctor, took me inside the ebola ward. She patiently helped me put on the various layers of protective clothing. The synthetic, ultra-light material is as impermeable and strong as it is suffocating. She carefully checked that no amount of skin went uncovered by gaps in the protective glasses. Then she double-checked that the second pair of latex gloves securely covered the sleeves of the jumpsuit before allowing me to enter the at-risk zone. It's a really strange feeling for a passing visitor to enter the fighting ring this way. It's a contradiction, a combination of fear in the face of invisible viruses that loom and the calm of a protective envelope. While following 'Doc' I can't stop thinking what a daily challenge it is for health workers to provide care to these patients hour after hour, day after day under these conditions! Doc Esther is very young and so calm. Does her calm come from her very recent experience with Ebola in Kasa in neighboring Congo? She impresses me with her control, and I feel completely at ease threading my way through patients in my synthetic armor since, to my great surprise, some of them are wandering the enclosed space of the isolation ward, going for walks, and taking in the fresh air rolling off the nearby mountain while we melt inside our nylon shells. The 15 patients in isolation here today are spread between two pavilions. In the first are the patients suspected of having been infected. They have just arrived at the hospital. One of them is on an IV. "He's not doing well," Esther whispers to me. "We're hoping to have the results from the Entebbe lab as quickly as possible. Positive! Negative! We're all pulling for him." She leans over him to cheer him on. In the other pavilion, about ten meters away, are the confirmed cases. These are the survivors. Eight patients who continue to fight. Among them is a nurse who is bedridden and not doing well. I let Esther get ready for a small event: four patients are being discharged. "They have made it through the critical phase, and today they have recovered," says the Doc, her eyes glistening behind her protective glasses. The war against Ebola is also fought with hope. December 14 Uganda/Ebola - The pastor is gone

December 14, 2007 - Here in Bundibungyo the local press comes a little at a time. But it does come. There are two or three daily newspapers, including Bukedde, which means 'morning' in Luganda, the language spoken in central Uganda. For news in English, it's the Monitor or New Vision. Then there's The Weekly Observer. With a little organization or a little luck, it's unlikely not to be able to get a copy. They come from the capital via Fort Portal, a name that conjures up dreams. A lot is being written about ebola every day in these papers, and since the Minister came to visit the isolation ward the day before yesterday, people are talking about it even more. Ebola had already made the front page the day I arrived with the photo of a doctor in bed, his eyes vacant, who had come to Mulago Hospital in Kampala to die. It was a doctor from here. Besides blood on the front page, a feature shared by so many newspapers, if you take the time to leaf through the inside pages, you find plenty of articles that cover the epidemic inside and out. There's very little, however, about outside aid. A few words about American researchers who seem to have flushed out a new type of virus here. Nothing about MSF. Ebola is a Ugandan issue. You also find articles that leave you dumbfounded. Those that put the delay in declaring the epidemic on the shoulders of the CHOGM, the meeting of the heads of state of the Commonwealth, send shivers down my spine. I'm not sure that, if the newspapers had revealed the existence of this serial killer virus in time, it would have prevented people from going about their business. However, I can't help but think that the pastor we buried this morning would have perhaps thought before going to the funeral of one of his good friends who died suddenly. Hilde, our Belgian doctor, is a young practitioner, but she already has experience from her time in Kasa She confided her doubts to me when we went to the pastor's home at the request of the Red Cross. It was just a few days ago on Sunday. Before slipping the thermometer under the pastor's sweaty armpit, she asked me for advice, impressed by my gray beard. "Do you think it's better to come with our hands already protected by gloves, or to put gloves on in front of the patients when we take out the thermometer?" I greatly appreciated her concern over not shocking the elderly man, who was already undeniably upset, any further. "I'm afraid there's something behind this fever, which has been going on for a few days," she worried. "We'll have to come back again tomorrow." The next day, Monday, Hilde went back to Belgium. That same day the pastor resigned himself to climbing into the ambulance to be hospitalized. Babu, the clinical officer who was with us, told me that the pastor's faithful waved goodbye as the ambulance took him away. December 16 At the Ugandan ebola outbreak, Swaibu amazed us all

December 16 2007 - Phew! The ebola virus seems to be struggling in Bundibugyo, and this weekend was almost quiet. Rosa, the head of the team, even decided to take a break on Sunday. It must be said that leading this kind of day-to-day intervention with 25 field expatriates from different backgrounds and with various roles to play is no small task. Moreover, with the cellular network working wonders despite the region being surrounded by Lake Albert, the Rwenzori Mountains and the Democratic Republic of Congo, the telephone hasn't stopped ringing with calls from everywhere — Kampala, Geneva, and elsewhere — adding legitimate outside pressure that has to be managed. An unusual atmosphere reigns in Bundibugyo. It combines waiting, the constant movement of MSF 4x4s, their Codan antennas lashing the jacarandas, and multiple daily meetings under huge white tents sponsored by UNICEF. The impression is that of being on the front line. The population watches closely, asks questions, and makes comments. You can sense that hostilities have been declared, and we're counting that the virus realizes it. In the hospital's high risk zone, the doctors and nurses in their cosmonaut suits continue to assist several patients in their fight against death. They are the front line. If you leave town and head towards the first steep slopes covered as far as the eye can see with matoke, vanilla plants, and above all cacao trees, the atmosphere is completely different. It's the middle of the cacao harvest and bulging sacks wait on the side of the road for the collection trucks that have stopped making their rounds. The people whom I meet at a small market don't know much about ebola. How is it transmitted? How can we protect ourselves? What role do monkeys play? I'm baffled by just what is retained from the awareness campaigns organized by the mobilization team. Yet, the 'Facts about Ebola' poster is right there, tacked up at a shop. Nonetheless, they're all afraid. They see the vehicles that come and go, the people with white boots and blue gloves. Hopefully they won't stop in their village. "The ambulance is for chasing down rumors," explains Cristina in her inimitable Catalan accent. She doesn't wear boots or gloves. The rumors are stories about people who might be sick and who might have had contact with ebola patients. "In just over one week, only five out of 25 rumors resulted in hospitalizations. Maybe Ebola isn't going to spread any further." Early in the third week of the intervention, the facts seem to support her. No one has died because of ebola for several days, and the number of discharges greatly exceeds the number of admissions. Swaibu amazed us all. Some 20 years old, he fell ill at the beginning of the month. The lab's verdict: positive for ebola. Doc Esther watched him lose weight very quickly, even while he remained confident. I saw him in isolation. A few days ago, he declared victory in his fight against the disease and phoned his family. He was so happy when we brought him back home. When Esther gave him an open, honest handshake in front of all his wondering family, everyone burst into laughter, relieved. Then they came to slap the hand of the young teacher who beamed with joy. A wonderful lesson in bravery, Swaibu!