The ebola-virus: ... and the Challenges to Health Research in Africa.

• Author: Bausch, Daniel

Sometimes, it seems that much of Africa almost courts misery, reading like the script of a bad action movie, everything happening at once -- disease, natural disasters; war, epidemics -- a Hollywood producer would likely throw it out as too unbelievable. As the Ebola epidemic started to wane, I finally had a few minutes to get to know some of my co-workers -- the human beings behind the surgical masks. One day, in between screening patients, a young nurse named Christine told me her story -- the story of Africa's other epidemic. Her father, mother and brothers, all dead from AIDS; she and her sisters are left behind, trying to make the best of things. She recounted the tale almost casually, not because it wasn't tragic but because, tragically, it wasn't unusual. What's more, suffering caused by malaria and tuberculosis is so common that people generally fail to recount stories about it at all.

To survive to old age in muck of sub-Saharan Africa, it seems you have to run the gauntlet. Only a strong disposition, and perhaps a good dose of luck, buys you longevity. Children survive the respiratory and diarrhoeal illnesses of childhood, only to face new threats of AIDS and Ebola, wars and automobile accidents. Too often if one thing doesn't get you, another will.

Lest we become overly pessimistic, it should be noted that there is cause for hope. Africa has many resources upon which to draw--incredible cultural diversity, a tradition of creativity and perseverance, wealth in the form of minerals and natural resources. Most notably, I have always been impressed with the civility, liveliness and depth of the social structure in many African countries, the respect for elders, the strength of the family unit, the sense of duty. Answers may take time, perhaps generations, but we have to start looking now. Even the continents that we presently consider more "developed" emerged out of complex periods with similarities to present-day Africa.

African success stories exist. Public health initiatives have recently scaled back the AIDS epidemic in Uganda. Even Ebola can have its happy ending Like Onenchan Jones. The day before I left Gulu, he came back to the hospital to visit me, along with his eleven children. Feeling good, with a huge smile on his face, he offered to give me a chicken. Say what you want about tragedies in Africa, but you've never seen someone so happy to be alive.

This is the main road in Gulu, Uganda.

Onenchan Jones looked at me through sunken fearful eyes, Doctor. I'm dying," he said simply. It wasn't a declaration but a plea. Weak, whispered, far away a voice already half dead. Given his condition and that he had seen friends and family die of Ebola. I silently supposed he was right. It was just a matter of time until his motionless body would have to be counted as another corpse. Thus started my first day of work on the Ebola ward at Gulu Regional Hospital in northern Uganda.

As it always seems to go. I had returned from a long trip to West Africa just a week before, working on an outbreak of a related viral disease. I was planning on settling back into Atlanta, catching up on e-mail, plugging away on some manuscripts, and getting some rest and execise. But late on a Friday afternoon last October in came my boss. Pieire Rollin, pulling up a chair and sitting down on it backwards, his arms folded across the backrest, the way he does when he has something definitive to say. "This thing in Uganda is Ebola. We got the results from South Africa today." After a frenzied few days of packing equipment and arranging travel details, we were off to Gulu, a team of six from the Centers for Disease Control and Prevention (CDC), United States.

I must confess, despite having spent a lot of time in developing countries over the past decade, I wasn't quite prepared for what was about to come. I had seen more cases of viral haemorrhagic fevers than your average doctor. I had not yet seen Ebola, but how different could it be? I had scoffed at a lot of the exaggerated popular literature about it, describing melting eyeballs and all.

So, as much as anybody can be I figured I was prepared for these things. I think most of us going in fel that way. But that was before Onenchan. Before so much upheaval. And before Dr. Lukwiya's death.

Dr. Matthew Lukwiya known to his colleagues simply as "Dr. Matthew", "upped the ante" on the scale of tragedy of the Culu Ebola outbreak. His death was the sort of thing you thought could never happen, misfortune that existed only in books or films. As the Medical Director of one of the primary hospitals affected by the outbreak, he was an the heart of the matter in vitually every way possible. But his involvement wasn't just circumstantial. He was a talented, dedicated man, the first to put together the pieces of the puzzle and suspect that Ebola was the culprit killing his patients. Those who knew him are not stingy with words of praise--healer, scientist, gentleman, leader, friend.

Two thirds of the way through the epidemic. Dr. Matthew suddenly developed a fever. A week later, his name was added to the registry of Ebola deaths at the very hospital where he worked. Those of us "experts" visiting Uganda knew the havoc that Ebola could cause having seen so many deaths and the total upheaval the epidemic caused in the Guhu community. But until Dr. Matthew's death, we managed to somehow look on as outsiders observing the chaos, peering in through wat we took to be the protective cloak of our scientific training. We were watching a battle from a faraway hilltop, recognizing the horror but not feeling personally threatened. Dr. Matthew wasn't the only hero nor the only health care worker to die, but when he went down, everything changed.

We then realized the chaos could come even to our door. This is not to say that we had no concern, no fear, prior to Dr. Matthew's death. Every day the slightest hint of a headache or fever would cause health care workers and citizens alike to seek...