The recent explosion of Ebola virus cases in a Ugandan rural community began when defiant residents exhumed a body at night, undoing the work of a safe burial team in order to give the deceased man a proper Islamic funeral.
Within days, at least 23 of the mourners had contracted
Ebola and three were dead, prompting Uganda’s health minister to say she hoped
the members of the farming community in the district of Kassanda had learnt
their lesson.
But it seems not everyone had.
In a recent community discussion of the challenges health
teams face in combating the current outbreak of a strain of Ebola with no
proven vaccine, the district’s Ebola incident commander cited pockets of
resistance to health measures.
Another official spoke of people who hide in the shrines of
traditional healers — who are temporarily banned from working amid the outbreak
— and another complained about youths unhappy with restrictions on movement who
throw stones at patrol vehicles.
Ebola, which can sometimes manifest as a hemorrhagic fever,
arrived here from Uganda’s neighboring district of Mubende in October, as
patients crossed valleys and hills to seek treatment. Others didn’t even know
they were infected. The early symptoms — including fever, fatigue and muscle
pain — can often be mistaken for those of malaria or measles. But failing to
isolate infectious patients can have fatal consequences.
When Ebola patients or their contacts are highly mobile,
it’s harder to trace them and new clusters can emerge. At least two people sick
with Ebola traveled 150 kilometers (93) miles from this central Ugandan region
to Kampala, the capital, where authorities have voiced serious concern after 15
people there — including six schoolchildren — were infected.
Ebola has infected 130 people and killed 43 in this East
African country of 45 million since Sept. 20, when the outbreak was confirmed
in Mubende days after local officials first noted a “strange illness.” Official
figures don’t include those who died with probable Ebola before the outbreak
was confirmed.
There are at least 40 active Ebola cases in Uganda, which
has had multiple outbreaks in the past. One in 2000 killed more than 200
people.
Ebola spreads through contact with the bodily fluids of an
infected person or contaminated materials. During the current outbreak, the
World Health Organization has said the fatality rate is nearly 30%.
Last week, the U.N. health agency revised its formal risk
assessment, saying the risk to Uganda had been raised to “very high” and the
risk of regional spillover was “high.” Scientists suspect that bats are the
natural reservoir of Ebola and say outbreaks are often triggered when people
come into contact with infected wildlife including bats, monkeys or antelopes.
Ugandan health officials say most Ebola contacts have been
documented by tracers, hoping to reassure people who are worried that further
spread of the disease could cause a nationwide lockdown. The Africa Centers for
Disease Control and Prevention says the outbreak is under control because of
the contact tracers’ efficient work.
But without effective vaccines or medicines, unless everyone
cooperates an Ebola outbreak can be hard to end. This is especially so in a
remote community with high levels of illiteracy, where some still link Ebola to
witchcraft and choose to address it at home rather than call an ambulance.
Ugandan health officials have achieved “a tenuous degree of
control” in the outbreak, said Dr. Atul Gawande, a U.S. official responsible
for global health at USAID. Just a few errant individuals can cause the
outbreak to change rapidly, he said during a visit to Kassanda Tuesday.
Scientists do not consider outbreaks to be over until 42 days — twice the
maximum incubation period — have passed without new cases detected.
Speaking to the community, Health Minister Jane Ruth Aceng
warned that if contacts continue to run away, “there will be an explosion where
they run.” She said sometimes villagers “are like children. You tell them,
‘Don’t touch the fire.’ They touch it.”
On Wednesday, the national Ebola incident commander, Dr.
Henry Kyobe Bosa, said the outbreak “is entering a phase of potentially
sporadic cases” as contacts keep running as was recently seen in Masaka, along
the busy highway to western Uganda.
Some residents of Kassanda and Mubende said movement
restrictions in place since mid-October seem worse than Ebola itself.
Traditional healers complained they had no income. A food vendor who waits on
passenger buses said he lost business. Others said even food is hard to come
by.
“It has affected us too much because we don’t have customers
for buying our booze. We lock ourselves inside at 7 (p,m.) exactly,” said Miria
Twijukye, bitter that after two days she was still waiting to get her package
of government-supplied food rations. “We are suffering so much.”
Even if the measures are necessary, “we need food,” she
said, drawing cheers from others in a crowd waiting for free food in Mubende
town.
Some in Mubende are concerned about the risk of new
contamination from neighboring Kassanda amid the reports of community
resistance.
“This disease escalated from here and it went to the
neighboring district. And today I want to report that Kassanda is the one
that’s having very many numbers,” said Rosemary Byabasaija, who heads Mubende’s
Ebola task force.
In a sign of the shifting epicenter of the outbreak, most of
the 24 Ebola patients admitted at Mubende’s regional referral hospital are from
Kassanda. Only three are Mubende residents.
“That’s a big problem,” said Byabasaija, talking about the
jump in cases from Kassanda after the infected body was exhumed. “I want to
appeal to religious ... and cultural leaders that this is not the time to go by
our (normal) rules and procedures, because Ebola kills.”
She spoke worriedly of a trail that some people are following
to dodge restrictions, creating unwanted traffic from Kassanda that could hurt
efforts to eliminate active cases in Mubende.
“For us, we had fought our war and we are succeeding,” she
said, “but now we are getting challenges (from) people who are coming from
Kassanda.”
0 comments:
Post a Comment