On-Scene at the Ebola Outbreak

There's just one road to Bundibugyo. A nameless dirt track, it winds through dense forest flanked by the verdant Semliki Valley below and crags known as Mountains of the Moon hovering above. Even in the best of times it's a dangerous route. Trucks speed around narrow switchbacks, baboon packs block the way, and Islamic rebels encamped in the surrounding bush have mounted roadside attacks. But these aren't the best of times, and travelers here face a new risk: a mutated strain of the dreaded Ebola virus that has killed at least 28 people and is spreading panic—and allegations of a government cover-up—far beyond this remote region of Uganda.

Bundibugyo is at the epicenter of the outbreak, which began in August. Doctors in the town are monitoring more than 360 sick people believed to be incubating the virus and have recorded 18 local fatalities, including four medical staffers at Bundibugyo Hospital. Townspeople are terrified by the outbreak. Bundibugyo's usually bustling central market is quiet, and residents of nearby villages are anxiously reading newly distributed Ebola information posters. Hawkers sell the antibiotic Cipro at inflated prices on the street, falsely promising that it can prevent infection; local healers and herbalists are offering their own versions of a cure.

Ugandans are no strangers to Ebola; some 225 patients died of the disease in 2000—at a 70 percent mortality rate. But while the new strain seems to be less virulent, it also raises the possibility that the infected are now more likely to survive long enough to spread it elsewhere. Already there have been Ebola cases in eight districts across Uganda, with confirmed cases as far away as Mbale, a village some 600 miles from the outbreak zone. On Uganda's borders, neighboring Kenya, Rwanda, Tanzania, and Sudan are screening all Ugandans for symptoms and travel patterns in an attempt to halt the disease from spreading into their countries.

For Bundibugyo, this is just the latest ill fortune. Isolated and poor even by Ugandan standards, the region is one of the few in this East African country of 30 million that doesn't have electricity. Its overstretched hospital treats 65,000 patients with a budget of less than $250,000 in government funding per year. Those services are now at risk after the Ugandan Medical Workers Union, alarmed by the deaths of the medical personnel, advised its members who are dealing Ebola patients to vacate their hospital jobs until they were provided better protection and sanitary measures. At Bundibugyo Hospital, where two nurseries are now being used as isolation wards, patients aren't isolated from each other, leading the sick to regard being sent to the quarantine ward as a death sentence. Instead, they either refuse treatment or look for help elsewhere. So great is the fear that locals in the nearby Kabarole district attacked and vandalized an isolation ward, forcing its closure.

At Bundibugyo, where red tape—the physical rather than the bureaucratic kind—and staffers in teal and white biohazard suits cordon off the isolation wards, foreign health officials and epidemiologists have begun surveillance of a suspected source of the outbreak: fruit bats living in nearby caves. The scientists believe that the source of this outbreak—a wild monkey eaten by a Ugandan man and his family in the village of Kikyo in late August—was probably bitten or exposed to Ebola by a bat. Ugandan President Yoweri Museveni has since appealed to his people to stop eating monkey meat and has also urged them to stop shaking hands and to practice basic hygiene to help contain the outbreak.

Some Ugandans, however, are questioning whether Museveni's government deliberately covered up news of the outbreak ahead of the recent meeting of the Commonwealth Heads of Government meeting in the capital city, Kampala. The government did not announce the outbreak until just after the conclusion of the high-profile meeting, even though government reports acknowledge that blood samples from infected patients were sent to South Africa for Ebola testing on Sept. 29. These samples were reportedly found negative for Ebola but were subsequently shown to carry a new strain of the virus at the Centers for Disease Control (CDC) in Atlanta on Nov. 24—the second day of the Commonwealth meeting. The initial false negative may have been due to the difficulties of identifying the new strain—even the CDC tests took a day longer than usual—but that hasn't stopped public outrage over whether the government could have acted faster to stop the spread of the virus. "It looks quite strange, from a public health perspective, that blood samples were not taken [to the CDC] earlier," said Dr. George Pariyo, dean of the public health school at Kampala's well-respected Makerere University in a front-page Uganda Monitor feature investigating the suggestions of a government cover-up.

Behind the statistics and the politics there are poignant tales of loss. Among Bundibugyo's dead are three staffers working with Scott Myhre, a Johns Hopkins-trained American missionary doctor who has provided medical services in the Bundibugyo region for more than 14 years. One of the fatalities was Dr. Jonah Kule, a Bundibugyo man put through medical school by Myhre's World Harvest Mission. Kule was especially beloved by his community for turning down lucrative city jobs to help his own people. Myhre tries to console himself over Kule's loss with thoughts of faith and religion. "A seed has to die to produce food," says Myhre, repeating an axiom that comforted him at Kule's burial. If the outbreak isn't contained, it's a line he may find himself using again in the weeks ahead.