Thursday, 09 August 2012 23:21
Written by Shifa Mwesigye
Coming face to face with death
Dr Samuel Ssemanda Kazibwe sits outside an isolation unit deeply engrossed in his newspaper.
About ten grey tents have been set up and cordoned off as the isolation camp for suspected Ebola patients at Mulago hospital.
From where I and other people are standing, Dr Ssemanda could as well be sitting in a recreation park enjoying a best seller. When some people learn it’s the Ebola isolation camp, they run as fast as their legs can carry them. Before letting ourselves in, we ask if it’s okay to proceed. Where can we step or not? Do they have any protective gear we can wear?
“Do you see him wearing anything?” the askari asks, pointing at Dr Ssemanda who is wearing no more than a blue stripped shirt, black stripped trousers and black shoes.
“One can say knowledge is power. So, the main thing that protects us as medical workers is precautionary measures,” Dr Ssemanda says.
“We fear but we are brave. Some medical workers agreed to work with the team and others refused.”
But Ssemanda’s colleague, Dr Baterana Byarugaba, the executive director at Mulago hospital who has worked on Ebola cases and continues with this outbreak, is more reticent.
“Why don’t you ask why policemen go into riots and demonstrations? You go and ask the soldiers why they go to war even when there are flying bullets. Isn’t it their work? Then why ask me?” Byarugaba responds.
Just over the fence and outside from where Ssemanda is sitting, the public is in panic. No shaking hands, no touching, no kissing. Last week, President Yoweri Museveni advised people to avoid handshakes and casual sex.
He himself does not shake hands anymore. At Parliament, disinfectants are provided at the entrance and people must sanitise their hands before walking in least they carry the virus and put the lives of MPs and Parliament staff at risk.
Anyone entering or exiting the country must also wash with water and bleach or chlorine at the airport. While Ebola may not be as contagious as some other deadly diseases like Marburg, people live in fear of it. And you can understand why.
The disease kills in less than a week and the deaths are painful - severe fever, non-stop bleeding from all openings, diarrhoea and vomiting. Even more scary, there is no treatment and no vaccine. One has to rely on their immune response to fight off the disease.
But even with this frightening scenario, doctors, the most at risk group for secondary infection, know how to navigate the risks because they have the facts: transmission requires direct contact with infected bodily fluids, including blood, sweat or saliva.
When a case is announced, doctors know what to do; wear protective gear like gloves, gowns, boots, face masks, goggles. Do not touch anything that has come in contact with an infected person, keep a distance from the patient, and disinfect using chlorine.
“Whenever you are exposed to something for a long time, you lose fear. For me I have worked on several outbreaks like the Marburg, Ebola in Bundibugyo, and cholera,” Ssemanda says.
But Ssemanda concedes that medical workers are subjected to psychological torture at times. For instance, some of their colleagues tend to avoid them, often referring to them with the viral name. However, as professionals, they have to simply carry on with the work.
Ssemanda’s observations bring back memories of Dr Mathew Lukwiya who braved the Ebola outbreak at Lacor hospital in Gulu district where some 425 cases were reported and 224 people died.
But Lukwiya’s bravery cost him; a patient spat blood in his face as he coughed and the doctor caught the virus. He died shortly after. When the disease reoccurred in Bundibugyo, Dr Jonah Kule and other medical workers were caught unawares.
Ebola presented itself as a typical infection and the medical workers handled it as a mysterious disease. By the time it was identified, it was too late. Kule was moved to Mulago but his fate had been sealed - he died. In the recent outbreak, 13 doctors were isolated and monitored for possible infection.
Perhaps what is keeping Ssemanda calm is because all the 29 patients who were quarantined at the Mulago isolation camp were discharged because the laboratory tests done at the Uganda Virus Research Institute in Entebbe returned negative for the hemorrhagic fever. So far, 18 people have died and scores are being monitored in Kibaale district, where the disease is mostly concentrated.
“I work because I like helping people, I like challenges. I fear death but this is my profession. I am also a brave man,” Ssemanda says.
What is Ebola?
Dr Joseph Wamala, a senior epidemiologist at the ministry of Health, explains that Ebola is a Zonotic disease primarily found in bats and monkeys. It affects humans when a person gets in contact with an infected bat or something contaminated, like a fruit. This partly explains why it usually starts in the countryside.
The disease was first detected in 1976 when it broke out in the DRC and South Sudan. It is named after a river in the Congolese village where cases were first reported.
The first time Ebola was heard in Uganda was in 2000 when there was an outbreak in Gulu. Many people suspected that Ugandan soldiers returning from DRC had carried it over, but that link was never proven.
Cases were also reported in Masindi and Mbarara. By the time the disease came to light last week, it had killed 15 people in Kibaale district. Worldwide, some 1,800 people have been diagnosed with the disease, 1,200 of whom died.
When doctors receive a patient, they look out for symptoms such as high fever, weakness, nose bleeding, vomiting and diarrhoea. But the same symptoms can also manifest in many other ailments. Mulago hospital recently received a 32-year-old patient from Kyebando with these symptoms but on closer scrutiny, it wasn’t the dreaded Ebola.
“A picture [of Ebola infection] can come but we have to evaluate before we can tell it is indeed Ebola,” says Dr Ssemanda, who is heading the Ebola team at Mulago.
“Anybody from an area with Ebola is an alert case ... we only got Ebola suspects whom we were treating as Ebola patients basing on clinical diagnosis. But when we got viral lab results from Entebbe, we discharged them. The Ebola cases are now in Kibaale.”
