New Vision (Kampala)

12 August 2012

Uganda: How the Deadly Ebola Came Back

Photo: New Vision
Medical workers in protective gear leave an Ebola isolation camp during the 2007 outbreak (file photo).

Fifty two days after the first patient died of Ebola in Kibaale district, the outbreak is still shrouded in mystery. A mother left her two-month-old baby sleeping in a mud and wattle hut and went to her crop garden.

On return, she found the baby dead. The baby's left palm had the sign of an animal bite. Neighbours who spoke to Sunday Vision suspected that it could have been a monkey, but no one really saw it.

About 300 metres away from the family is a 10-acre forest and there are bushes in between, so it would be possible for a monkey or any other small animal to move unnoticed.

Two days later, a 15-year-old girl, Winnie Mbabazi, who touched the baby's wound, became sick and died on June 21. Eventually, nine members of the family died but the baby's mother did not become sick. Then the baby's father, Fred Bahemuka and a paternal uncle fell sick.

According to the national Ebola task force, Mbabazi was the first patient.

However, the locals insist she got the disease from the baby. Medical theory indicates that an Ebola outbreak starts when an infected animal, most likely a monkey or a bat, infects a human being. Through direct contact, she/he then infects other people.

However, it is not clear how animals become infected and where the virus hides in the environment before infecting animals.

Critics have blamed the Ministry of Health for taking long to diagnose Ebola.

By the time the ministry announced it was Ebola on July 24, the epidemic had gone on for 37 days, killing 14 people including a clinical officer.

The ministry, on the other hand, says the outbreak was confusing because it did not show the typical symptoms. Tests have shown that the current epidemic has been caused by a strain of the virus known as Ebola Sudan. However, its signs are different from the previously known Ebola Sudan outbreaks.

According to a press statement released by the health ministry last week, the number of people contracting Ebola had reduced significantly due to increased public awareness. No case has been reported outside Kibaale, says the statement signed by Dr. Denis Lwamafa on behalf of the Director General of Health Services.

By Thursday, 190 out of the 408 people being observed after coming in contact with ebola patients had been declared free of the disease after they did not become sick within 21 days, the maximum incubation period. The ward had only three Ebola patients, of whom one was recovering.

WHAT NEXT?

But the campaign has not been without challenges and, as Dr. Mbonye argues, the Kibaale outbreak should be a lesson.

"The Government should have an emergency fund for epidemics because every time we are faced with outbreaks, the ministry has to run to Cabinet and Parliament to ask for funds. This consumes a lot of time as people are dying. At least sh2b should be earmarked for epidemics annually," said Mbonye.

Nearly half the budget for the campaign against Ebola (about sh800m) has come from donors, and offi cials argue it is disastrous to depend on donors for epidemics response.

Mbonye also says that Uganda needs permanent structures for isolation centres and standby equipment.

HEALTH MINISTRY'S TAKE

According to Dr. Anthony Mbonye, the commissioner for health service and head of community health, it is unusual for an Ebola patient to bleed after, rather than before death as was the case in Kibaale. The patients had high fever, vomiting, diarrhoea and stomach aches. Most of them were not bleeding until after death. It was initially mistaken for malaria.

Mbonye says the health ministry is preparing to conduct ecological studies in the area to investigate the cause of the outbreak. It might involve catching monkey, rodents, bats and other wild animals and testing them for the virus.

"We infer that Ebola spreads from primates, rodents and birds and the index case would be living near forests where such animals are.

But we have never understood the exact animal reservoir. In Luweero we slaughtered monkeys and birds in pursuit of the cause but the results were negative," says Mbonye. "What we know is that Ebola is highly infectious.

If an infected monkey, for instance, ate part of a fruit, you don't need to eat it to catch the virus; you can get infected if you touch it and don't disinfect your hands."

EFFECT ON TOURISM NOT AS BAD AS EARLIER FEARED

Although the current outbreak is small, it has a big impact on the economy. Already the tourism sector, which fetches about $800m to the national GDP annually, has begun feeling the pinch as some tourists cancel trips for fear of catching the deadly contagious virus.

The Associated Press last week quoted British businessman John Hunwick saying his clients were "absolutely petrified" and wanted to go home, and that he lost $6,000 in cancelled tours on July 31.

But Amos Wekesa, a private tour operator, commends the Government's openness in combating the outbreak. Wekesa said tourists had started making bookings again after they were assured that the situation was under control.

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