When he opened the fourth seal, I heard the voice of the fourth living creature say, “Come!” 8 And I looked, and behold, a pale horse! And its rider's name was Death, and Hades followed him. And they were given authority over a fourth of the earth, to kill with sword and with famine and with pestilence and by wild beasts of the earth. (Revelation 6:1-8, ESV)
http://observer.guardian.co.uk/world/story/0,,2228284,00.html
Inside Ebola's zone of death
Uganda is gripped by fear of an epidemic 'explosion' as the killer virus develops a slower and potentially more lethal version
Anushka Asthana in Kampala
Sunday December 16, 2007
The Observer
It is a country where the President has asked people to stop shaking hands, where MPs have called for an end to public gatherings, market vendors wear gloves and Roman Catholic priests no longer give the communion wafers and wine by hand. Uganda is gripped by terror over a new strain of one of the world's most deadly diseases. Ebola haemorrhagic fever, which is spread by touch, kills between 50 and 90 per cent of victims.
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Thirty-two people have died and 120 people have the virus - in a nation where malaria kills 300 people a day - but it is the nature of the illness that has caused such panic. After an incubation period of up to 21 days, Ebola patients develop terrible symptoms: high fever, headache and joint pains, then vomiting and diarrhoea, and in some cases bleeding from the mouth, nose, eyes and ears. In most cases, multiple organ failure, haemorrhaging or shock brings death.
This new strain is feared to kill more slowly than previously, leaving more time for the disease to spread. There is no vaccine and no cure. The only hope is to contain the lethal virus, but Ebola moves fast and is hard to track. If just one infected person boards a plane, this could become a global outbreak.
Buses heading west from the capital, Kampala, to the affected region of Bundibugyo normally have standing room only. Now they leave half empty, and anyone crossing into neighbouring Rwanda and Kenya is screened. 'For the time being people should resort to jambo [waving]. If I don't shake your hand, it doesn't mean I don't like you,' President Yoweri Museveni told his people.
'One of the fears with Ebola is that it can move very quickly to different parts of the world,' said Dave Daigle, of America's Centres for Disease Control and Prevention (CDC) in Atlanta, Georgia, where the virus was confirmed as Ebola last month. The date of the announcement, three months after the first deaths had been reported, aroused suspicion, falling just after the Commonwealth heads of government meeting, attended by the Queen, ended in Kampala. Ugandan newspapers accused ministers of suppressing the news to ensure the meeting went ahead, and claimed the delay may have cost lives.
A team of CDC scientists has travelled to the epicentre of the outbreak. The focus, said Daigle, is on containment. He described how experts mapped out the movements of sufferers and tracked those they came into contact with. Hundreds have been confined to their homes over fears that they may have come into contact with infectious people or corpses.
The most senior politician in the affected area, Jackson Bambalira, the Bundibugyo district chairman, fears the worst: 'I am greatly worried that a bigger Ebola bomb could explode, claiming many more lives.'
Among those most at risk are doctors and nurses. The first time Ebola came to Uganda, in 2000, 14 nurses and one doctor died. This time eight medical workers have died and many doctors and nurses are in isolation units after testing positive for the virus. Nurses have threatened to strike, angry about the lack of protective clothing and any risk allowance, and the Uganda Medical Workers' Union has instructed health workers without proper protection to flee the Ebola zone after reports of medics treating patients with bare hands.
It began in late summer in Kikyo, a village hidden away on a mountainside of western Uganda. At the edge of a beautiful game reserve, villagers who spend their lives farming the cocoa crop began to fall ill. There were headaches, fevers, vomiting, diarrhoea and the painful bleeding. Relatives washed the bodies of their loved ones before burying them, unaware of a deadly disease at its most contagious. Although news spread of a strange sickness in the west, the word Ebola was not mentioned.
Local doctor Jonah Kule decided he wanted to help. He drove his motorbike to the district's government offices to see his friend, Elias Byamungu, the region's chief administrative officer. It was a warm day and sunlight was streaming through the windows of Byamungu's office when Kule walked in. 'He told me he was going to find out what the disease was that was infecting his people,' said Byamungu. 'I questioned him; I said it could be deadly.' But Kule insisted he was prepared to die to help Ugandans. 'He was the first person who dared to go and see,' said Byamungu. A few weeks afterwards Kule left Bundibugyo to pick up his children from school in Kampala. While there he fell sick and was admitted to the isolation ward at the city's largest hospital. Eight days later he died. A matron, Rose Bulimpikya, died within 24 hours of Kule.
Dr William Sikyewunda, director of health services in Bundibugyo, said health workers were petrified. 'We are trying to reassure them,' he said. 'It was Rose Bulimpikya's kindness and diligence that put her at risk,' he said.
Bulimpikya was the most senior nurse in the district and next year would have celebrated her 60th birthday. Her devastated family were in disbelief as she was buried. She had fallen ill less than a week earlier.
'She has left a very large family with six children,' said her husband, Hassan Bhatungi Kabho, 60. 'I have lost a beloved wife. We have been working hand in hand to look after the family. I don't know how I will manage. I am very afraid.' Her son Francis said Rose died a heroine. 'She wanted to help people. I feel proud because she died doing her job and she behaved with professionalism.'
Now officials are focusing on who Bulimpikya and the other victims have come into contact with. The early symptoms of Ebola are similar to those of malaria, said Dr Susan Wandera, head of programmes for the African Medical and Research Foundation. 'Ebola is a very big risk for doctors and nurses. Usually sweat is taken as harmless, but it is not in this case.'
Ebola first appeared in two simultaneous outbreaks in Zaire and Sudan in 1976, killing 90 per cent and 50 per cent of sufferers respectively. It was believed to have come from monkeys, perhaps through eating 'bush meat', but scientists remain at a loss. Kule died a day before the anniversary of the death of Dr Matthew Lukwiya, the first doctor to die of Ebola in the last outbreak here, in 2000, which killed 224 people.
Lukwiya has become an international hero, described in the New York Times as a 'fearless commander at the centre of a biological war that threatened everyone in the country'. Called to his hospital in Gulu, northern Uganda, after a mystery virus began to kill student nurses, he suspected Ebola and set up restrictive safety measures that prevented the further spread of the virus.
For his widow, Margaret, this month has been difficult. 'I started recalling how I felt when Matthew was sick and died,' she said. 'I am imagining that poor widow now,' she said of Kule's wife.
Then, as now, the nurses threatened to strike. Lukwiya brought them together and told them: 'Whoever wants to leave can leave. As for me, I will not betray my profession. Even if I am on the ward alone, I will continue.'
More than a month after he returned to the hospital, Margaret gathered her five children around the phone to sing him happy birthday. Six days later she received the call she had dreaded. Margaret rushed to the hospital. She wore protective gear, including six gloves, but was still told not to touch him. In those final days she ignored his own rules, taking his hand and bathing him.
She has not celebrated Christmas since and fought for six years to persuade the government to give families of health workers compensation.
'He went too fast,' she said. 'At first I was bitter. But then I think, suppose it was me that was sick and needed a doctor - if a doctor refused to come to my aid, how would I feel? He died for the right cause.'
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