Uganda – Bundibugyo: Part One

Four brothers ascend into the Rwenzori Mountains, crossing orchards of cocoa trees, coffee and kasava to reach the untouched woodlands approaching national park land. The sky is most likely clouded over from their perspective, but through the cold mist, not much ahead is seen other than the dense forest at arm’s reach. Perhaps the monkey was already dead when they found it, or maybe out of hunger or pleasured desire they killed and then consumed the mammal together.
Each brother would tend to his lively duties as normal over the coming days visiting the local markets, socializing with neighbors, seeing to their crops, but after the second or third day, one of the brothers falls mildly ill with a headache and fever. Malaria, he may have thought. Maybe he had a blood smear done at Kikyo Health Unit and found evidence of the parasite, or maybe they simply prescribed the necessary drugs on a clinical diagnosis, but regardless of the treatment his symptoms progress with vomiting and diarrhea. His body is weakening, and by the disease’s fifth or sixth day, the brother’s eyes are turning red, his neck and body is stiff, and his kidneys, liver and respiratory functions are failing. A week has now passed and the one brother falls into sudden shock, maybe bleeds out then dies. The three other brothers follow.
The passing of a community member is followed-up by a series of funeral rites to bring closure to a person’s life. The body is washed and embraced by loved ones before carried then lowered into a grave outside the home. Here the virus is spread and over the next couple months a mystery illness rattles the local countryside.

ONE YEAR LATER…

The Kenya documentary brought me good reason to visit Uganda and South Africa. Proximity is one factor. A round-trip airline ticket is another; and serendipitously timed near perfect. Until a little more than a week before arriving in Kampala, I really had no solid plan for Uganda except I wanted to visit a cave and talk to people. For that reason, I allocated one week’s time in the country before hoping on a one-way flight to Johannesburg before returning to the States. In retrospect, I should have blindly planned for two weeks as I initially felt before the perceived absence anxiety set in.
Through my contact at the Centers for Disease Control and Prevention in Atlanta, I was initially provided with three leads to follow and a link to Scott and Jennifer Myhre’s blog, a pair of doctors living with their family in western Uganda. Through a snail’s paced Internet connection in Kericho, I downloaded and printed 67 pages of entries dating from the end of November last year to early this year chronicling a local’s perspective to the most recent Ebola outbreak in the remote town of Bundibugyo. Admittedly, I had difficulty sleeping one night in Transmara after reading up to the passage, “Grief and Fear”.
With only a couple days of preparation, I met Bob Chedester and family from the World Harvest organization in the city of Fort Portal. I was creating space in the aisle for departing passengers, when a mzungu got the attention of the driver who then directed me to get off the bus. By coincidence, Bob and family were planning to visit the Myhre family in Bundibugyo and offered a seat in their already packed Land Cruiser saving me the adventure of hitchhiking with my equipment and bags over a 100 kilometer stretch of narrow, non-maintained dirt road around and through the Rwenzori Mountains.
“Bundibugyo is about forty kilometers straight that way,” Bob pointed, “but there’s no way to go through the mountains so we have to go around. You could hike it though; it’ll take about six hours—at a good pace.”
Instead, I’ll settle for a three-hour rocking fest squeezed between my luggage in the SUV’s boot seated across three year-old Samuel. I said this before we started and I seriously meant it after, “This will make up for the four and half hour bus ride, and three and a half hours of waiting for the bus to depart, because I let myself be directed to the wrong departing bus.”
Almost immediately I picked up air off my seat and smashed my head on the ceiling.
“Watch your head,” Bob smiled through the rearview mirror.
“I’m used to it, that was number twenty-five.”
“Twenty-five?” Someone asked like I had already hit the ceiling that many times.
“Twenty-five times since arriving in Africa I’ve hit my head on low door frames, beams, rocks, whatever. I’m keeping track.”
“You’ll hit it a bunch more times on this road,” Bob assured me.

“I can’t wait.” The road snaked over what seemed like dozens of ridges in replace of switchbacks as we climbed to probably 8,000 feet.
“We have to stop at the lookout. It’s my favorite spot,” young Elizabeth claimed, one of nine passengers in the vehicle including Samuel and myself. The vehicle bounced.
“Twenty-six.” And bounced again. “Twenty-seven.” Everyone laughed. Glad I could provide comic relief. 

From the lookout, a vast gully between mountains receded into the flat plains of the Democratic Republic of the Congo (DRC). Outside the Rwenzori National Park, the mountains resemble a quilt, as Elizabeth observed, of various crop plantations patching the landscape. It is believed by one tribe the land is more fertile on the mountain slopes. Either that, or people don’t want to admit location, location, location is everything and worth the insane effort it must require to haul material and food through the forest and up onto those slopes.

By thirty and thirty-one, we arrived at what must have been the most anticipated destination on the 

entire drive, second only to our destination: the bridge. But not just any bridge, at maybe three cars’ length it is the flattest surface anywhere in the region.
The Land Cruiser shutters with bated anticipation then … silence. Everyone sighs a happy relief enjoying the moment of tranquility. Then, back to shuttering. This brought on a series of songs from “B-I-N-G-O” to “Ol’ McDonald”. In between travel ballads, my dialogue exchange didn’t quite go this way, but I’d like to remember it did:
“Can’t you sing some

thing with a little more pep to it?” I asked to no one in particular.
A pause. “It’s a small world after all…”
“No. No. Anything but that!” I cried. But in actuality, I prompted the song just so I could shoot it down quoting that last line.
Thirty-two.

OCTOBER 2007

Unlike traditional Ebola, this new unofficially titled Bundibugyo strain is weaker and partially asymptomatic killing roughly 30% of patients against a typical 70-90% mortality rate without the sensationalized “bleeding” from every orifice. These factors contributed to a prolonged identification and the much needed guidance of outside experienced organizations.

By late October, the mystery illness inspired the attention of Dr. Jonah Kule from nearby Bundibugyo hospital. The following is excerpted from Scott and Jennifer Myhre’s blog titled, “Grief and Fear” with an excerpt from “Bundibugyo, Where the Tears Never Run Dry”. The entry summarizes the events transpired at that time, text and pictures courtesy of the Myhres:

Jonah was a man of integrity. He refused to charge patients extra fees for his services, even though that is widely practiced in government hospitals. He was completely trustworthy with his responsibilities and resources. He was a leader who knew how to motivate, listen, draw consensus. He was not afraid.
Jonah first went to investigate this epidemic weeks ago; it was probably still October then. Rumors had reached him of a mystery illness. I remember well the day he came into the Pediatric Ward and told us about it. I gave him gloves and my bottle of alcohol hand gel, pitifully inadequate measures now. We had not heard of any bleeding, just vomiting and diarrhea and unusual deaths. We wondered if it was a cholera outbreak. I remember him slinging his backpack on, and getting on his motorcycle saying, “If I die, I die.”
When he came back he guessed typhoid fever, due to the prominent abdominal pain and even what seemed to be two cases with intestinal perforation. He noted the family grouping of the cases and held some community meetings to sensitize on hygiene, the basics of hand washing and latrines. He dispelled rumors of witchcraft and poisons. He wrote up a report. Then over the next week or two there was a task force set up, some Ministry of Health epidemiologists came and took blood samples.
We got the good news that it was not Marburg or any Viral Hemorrhagic Fever based on samples sent . . . Not sure where. Then there was the message that more samples had been sent to South Africa. Days went on. Uganda’s attention was on CHOGM. Jonah continued to attend to patients as they came into Bundibugyo Hospital, as did Scott. Jonah was the primary doctor for Muhindo, Jeremiah, an older gentleman who had been active in visiting the sick in Kikyo then fell ill in Bundibugyo. [Friday November 23 is the day Jonah believed himself to have been infected. That was the day he and Scott examined Jeremiah Muhindo. In between two of the times they saw the patient together, Jonah went in alone and arranged a facemask of oxygen onto the dying man, hoping to provide some relief or comfort. He was not wearing gloves because he could not find any at the hospital at that moment, and he felt that his friend needed the oxygen. That was his greatest exposure.] A week and a half ago Muhindo died.
A few days later Jonah went to Kampala on personal business; he has a house there still from medical school days with rooms he rents out, and three of his daughters are in school in Kampala, and his mother and brother stay with them there. We went to Kikyo the day Jonah went to Kampala, all of us still wondering what this disease could be, still being told the samples had been sent from South Africa now on to the CDC in Atlanta. Then last Thursday the bombshell announcement came, that it was Ebola, a new strain. That day we talked to Jonah on the phone, he had a headache he said, maybe early malaria, he’d watch. By Friday morning he found it prudent to admit himself to Mulago hospital. That was his last act of bravery and wisdom. We talked on the phone that day, he sounded so normal, so himself. I went to find his wife Melen who was still here. We prayed and wept and embraced and called him again.
Saturday morning I drove her early to town to get on transport to go to Kampala, even though she knew she would not be allowed to see him. She’s six months pregnant with their sixth child. From Friday until 4 pm yesterday every report we got from the doctors was hopeful. He was walking and talking, drinking. His doctor even said he was wanting to call and talk to us but they were looking for a way to charge his phone which he had with him in the isolation. He did have a couple of days of reduced urine output indicating an effect on his kidneys, and he did continue to have fever. With each new symptom and passing day the hope that it was all just malaria became less and less. Still Jonah is a strong man, healthy, smart. He was in the country’s main hospital, not out here in Bundibugyo. He was getting lab tests. He had a team of doctors, including MSF Spain. We had hope. Then suddenly last night they called back. He had died. Maybe there was bleeding, involving his kidneys and lungs, I don’t have the real story yet.

You can read the Myhre's complete blogs entries at: http://paradoxuganda.blogspot.com