August 10, 2012

Disease not a death sentence

Although Ebola has only killed around 1,500 people since it first was recognized in 1976, the virus remains inextricably linked in some minds to sci-fi horror stories told in movies and books. A 42-year-old Ugandan nurse, Kiiza Isaac, seems determined to end the stereotypes and give an image of normality to this hemorrhagic fever with no cure but survived by many people. In 2007, he contracted Ebola in his home district, Bundibugyo, in Western Uganda. But he not only lived to tell the tale – these days he is in the neighbouring district of Kibaale, where another outbreak of Ebola was declared at the end of July, to help others in the same situation he suffered.

Sometimes it takes a while to identify outbreaks of Ebola, because the symptoms can be very similar to those of other diseases. How was the beginning of the Bundibugyo outbreak? 

In August 2007, a strange disease was identified in Bundibugyo. Deaths within the community became rampant and people were going to the health centres with high temperatures, abdominal pain, vomiting, diarrhea and fatigue. They were not responding to malaria treatment.

What were you doing at that time?

I was working as a nurse at Kikyo health centre, in Bundibugyo district. So the Ministry of Health was informed about a strange disease in the area. Their epidemiologists came and advised us to send patients to hospitals. 


Uganda 2012 © Agus Morales/MSF
Kiiza Isaac, a 42-year-old Ugandan nurse who contracted Ebola and survived in 2007. He is pictured at Kagadi hospital in August 2012, where patients are being treated after an Ebola outbreak was declared at the end of July 2012.

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What was the reaction of the people?

The community did not know what was happening – they thought that the affected were being bewitched. This continued until October, when we had 18 people admitted in Kikyo health centre.

And you were in contact with the patients?

I was collecting blood samples from them. I contracted Ebola because we did not have enough protective equipment to use. But at that time I did not know. I developed the same symptoms as the patients. Blood samples were taken from me but the malaria test proved negative. I had a persistent fever. I was ill for three weeks. On Nov. 19, I received the laboratory confirmation – I had contracted Ebola. It was a new strain, not Sudan, not Zaire… They named it Bundibugyo Ebola.

How were those difficult weeks?

MSF came to Bundibugyo and they were running a treatment centre like the one here in Kagadi. Many patients were cared for in their treatment centre. Thank God, I survived. After my recovery, I joined MSF and the Ministry of Health in the case management of Ebola patients until Feb. 2, 2008, when Bundibugyo was declared Ebola free.

What about your family? Since the virus is transmitted through close contact (body fluids) and you didn’t know at the beginning that you had contracted it, they were in danger of catching it…

I was the head of the household and my infection was not yet confirmed. Three of my children and I contracted Ebola. We all survived. But a cousin who was also a nurse at Kikyo and was taking care of me also contracted the virus. He was rushed to the hospital and died on Nov. 3, before my results were confirmed.

How did your life change after this experience?

When I recovered, I continued treating others and doing psychosocial support until the district was declared free of Ebola. Currently I am working at Bundibugyo hospital as a nurse. When the outbreak was declared in Kibaale at the end of July, the World Health Organization (WHO) requested the district to send a team of seven people who had worked in the isolation centre in 2007. So now I am giving my help to the Ministry of Health and the WHO.

What can patients learn from your story? Isn’t it difficult to avoid the stigmatization?

We tell patients that this is a disease. It has nothing to do with witchery. They should not fear. When there is an outbreak, people just need to avoid contact with their body fluids. But if they recover – after 21 days they are not patients any more – they are free of Ebola. People should not fear them. They can have a normal life.

 

The first outbreak of Ebola was discovered in Zaire (now Democratic Republic of Congo) in 1976. The disease is named after a river near the initial outbreak epicentre.. The Zaire virus had a case fatality ratio of 80 to 90 per cent. The current outbreak in Uganda is caused by the Sudan Ebola virus, which is usually associated with a 40 65 per cent fatality ratio, but in the present case has been much lower, closer to 30 per cent. While health workers in sub-Saharan Africa are the group most at risk for contagion, educational efforts as well as recent successes in laboratory research are aimed at making their jobs safer.

 

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