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Ebola Inevitably Reaches Uganda: ‘Everybody Was Waiting for the Outbreak to Arrive’

GULU and KAMPALA, Uganda—Earlier this month, a family with a five-year-old boy left the Democratic Republic of the Congo and entered Uganda. They skirted the official crossing point, using an unmarked footpath. The family had attended the burial of a relative in Congo, who had died of Ebola.

Since the Ebola epidemic in Congo began in August 2018, more than 1,500 people have perished, making it the largest Ebola outbreak ever in Congo and the second-largest on record. The virus has been notoriously difficult to treat and contain, due to Congo’s instability and its porous borders. Unrest in Congo has sent more than 37,000 refugees streaming into Uganda since the beginning of last year, while other Congolese nationals regularly cross the border to trade.

Given these conditions, Uganda’s Ministry of Health sprang into action. It coordinated a national task force to prepare for Ebola’s inevitable spread, uniting national and international partners, and investing some $18 million in various protection measures, with financial support from major international donors.

“Everybody was waiting for the outbreak to arrive,” says Isabel Amoros, a former medical coordinator for Medecins Sans Frontieres in Uganda.

A positive test result, confirming that the five-year-old had Ebola, was almost a foregone conclusion. The latest Ebola outbreak had arrived in Uganda. The boy’s brother and grandmother were soon infected as well. In mid-June, all three of them died.

The current outbreak is by no means the only time Ugandan doctors and authorities have had to contend with Ebola. The virus first appeared in northern Uganda in 2000, during the height of the insurgency by the Lord’s Resistance Army.

At St. Mary’s Hospital, just outside the town of Gulu, Matthew Lukwiya led a small team of doctors and nurses who set up an isolation ward and cared for the sick, laboring to contain the outbreak at the time. The risks were enormous. Ebola, which has treatments but no cure, is spread via infected bodily fluids, and corpses are also highly contagious.

During the 2000 outbreak, Lukwiya contracted the virus himself, a devastating blow for everyone who worked with him. “It was like being hit on the head with a hammer,” wrote missionary Elio Croce, who kept a detailed journal of that epidemic. Lukwiya had led the charge in Uganda against Ebola; he died just nine days after falling ill.

According to Cyprian Opira, the current executive director of St. Mary’s Hospital, many health workers remain inspired by Lukwiya’s sacrifice. “Ugandan health workers are easier to convince to work on the isolation ward because of his example,” Opira says, adding that advanced protection systems give them additional confidence.

Uganda suffered four more Ebola outbreaks after Lukwiya’s death, each allowing the country to bolster its prevention measures.

“When we heard of this outbreak in Congo, it was yet another opportunity to strengthen our systems even further,” Minister of Health Jane Aceng told WPR in an interview. In order to curtail the spread of Ebola in the country, the national task force has engaged in numerous preparedness activities over the past 10 months.

So far, Ebola has been contained to one district in Uganda. But the ongoing outbreak in Congo means the virus could cross the border once more.

Among other initiatives, experts identified a total of 22 high-risk districts, and pre-positioned supplies so they could quickly reach areas where an Ebola outbreak was most likely. An experimental vaccine was also administered to health workers long before Ebola reached Uganda, making it the first country to preemptively employ the vaccine.

Community participation is another crucial aspect of Uganda’s Ebola preparedness, with people living in high-risk districts taught to identify the symptoms of the virus.

“We realized that without involving communities, we can’t fight Ebola,” says Irene Nakasiita, the communications and public relations coordinator for the Uganda Red Cross Society. “People with the virus stay in the community. It is easier for a neighbor to see the signs of Ebola,” she says, “and then call the Red Cross.”

Anyone entering Uganda via an official border point is also screened for Ebola. Yet there are many unpatrolled areas along the border with Congo, like the footpath the five-year-old’s family took in early June, potentially allowing infected people to enter the country without detection. These unmarked entry points make grassroots involvement particularly crucial, as community members can ideally identify cases that bypass official screening.

“Screening at border points is our first defense, but community surveillance is our second and major defense,” says Alexander Chimburu, a health security adviser for the World Health Organization.

Despite various prevention efforts and Uganda’s track record, Ebola remains a public health threat. Doctors and nurses working in Bwera Hospital in western Uganda, just a few miles from the Congolese border, and where the young boy and his family were treated, say they do not have necessary medical supplies. The isolation unit for sick patients is apparently just a tent. There aren’t even enough protective gloves.

The Ministry of Health, however, denied that there is any shortage of resources there. “All these districts have adequate supplies and personal protective gear,” Aceng, the minister of health, insisted in an interview with WPR.

On June 14, the WHO convened an International Health Regulations Emergency Committee meeting, consisting of a team of independent technical advisers, to discuss whether or not the Ebola outbreak in Congo and Uganda constituted a public health emergency of international concern, like the Ebola outbreak in West Africa in 2014, the worst in history. They decided it did not.

The declaration of a public health emergency of international concern would have resulted in an increase in attention and commitment from the international community. The WHO maintains that the lack of such a declaration should not prevent mobilizing the necessary resources to respond to this latest outbreak.

So far, Ebola has been contained to one district in Uganda. Following the deaths of the three family members from Congo earlier this month, there are currently no known cases of Ebola in Uganda. Health workers administered the vaccine to everyone who came into contact with the infected family and they continue to monitor them, relying on prevention systems already in place.

According to Lisa Nelson, country director of the Centers for Disease Control and Prevention in Uganda, health workers will observe these individuals for two cycles of the Ebola incubation period, totaling 42 days. “After this point, we will be out of the woods for the current cases that were diagnosed,” she says.

Still, the ongoing outbreak in Congo means the virus could cross the border once more. “As long as the outbreak in DRC continues, we do believe that Uganda will continue to be at risk for Ebola,” Nelson says. “The best way to reduce the risk here in Uganda is for the DRC to be able to contain the outbreak as quickly as possible.”

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