“If I Die, Let Me Be the Last”: Reflecting on Dr. Lukwiya and Uganda’s Efforts Against Ebola
APN 2015 individual research grantee Dr. Pamela Khanakwa at the APN-AU-IPSS-UNDP-OXFAM roundtable held April 4, 2016. Photo credit to Dagan Rossini.
In late November 2000, Dr. Mathew Lukwiya fought for his life in the isolation ward for Ebola patients at St. Mary Lacor Hospital in Gulu, Uganda. Dr. Lukwiya, a physician and supervisor of the same hospital, had been at the forefront of the battle against the Ebola Virus Disease (EVD) when it broke out in Gulu in October 2000.
At the time of the outbreak, Dr. Lukwiya was in Kampala pursuing further studies when he received a telephone call drawing his attention to “a strange disease” killing people in Gulu. He rushed to Lacor Hospital where he studied patients’ charts and compared their symptoms with information found in publications by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) relating to infectious fevers that cause bleeding. Highly suspicious that this could be Ebola, he informed the authorities at the Ministry of Health (MoH) in Kampala. Without waiting, Lukwiya instituted control measures. He isolated the patients to a unit which he had set up in line with the WHO guidelines, organized ambulance teams for taking patients to the hospital, and constituted burial teams. At the same time he encouraged staff and volunteers to care for patients. A team dispatched to Gulu from the Uganda Virus Research Institute carried out investigations and confirmed Ebola. The MoH, WHO, CDC, and other partners all organized a press conference to send out the message. In the villages in Gulu, several people were hired to do a door-to-door search for the sick hidden by families.
There was also an official announcement that dead bodies must be immediately wrapped in polyethylene bags and buried. This seemed more of a disposal, however, rather than a burial as understood in the cultural context. According to the Acholi tradition, the female relatives of the deceased had the responsibility of washing and dressing the dead before burial. Thereafter, those who had participated in funeral preparations would wash their hands in a common basin together with other mourners. Although intended to symbolize solidarity, this practice had to stop in the midst of the Ebola outbreak. Working with other partners, Dr. Lukwiya engaged the communities and explained to them the risks associated customary burial practices. People heeded, but this caused a lot of anxiety.
Meanwhile, the number of patients at Lacor increased daily, so much so that by the third week there were sixty patients and only three doctors, five nurses, and five nursing assistants who had volunteered to work in the isolation unit. Unlike the common practice in most hospitals in Uganda where family members give care to the sick, this could not be done in the isolation unit. This left the few medical workers to tackle the disease on their own with limited capacities.
Moreover, most of the health workers were not used to wearing protective gear such as gowns, gloves, masks, and goggles, nor were they used to the practice of constantly washing hands after contact with patients. There were certainly some lapses in covering up properly or even washing hands and, as a result, several medics got infected and died. It is reported that when called out of bed to attend one of the infected nurses in critical condition, Dr. Lukwiya forgot to put on goggles thereby violating one of his fundamental rules: ''Think with your head, not with your heart.''
Later, it was confirmed that Lukwiya was Ebola positive and he was whisked to the isolation ward where he did not allow even his emotion-filled wife, Margaret, to get close for fear of infecting her. Margaret was very frustrated that she could not even touch her husband or take care of him. As he lay on the hospital bed in the isolation ward, Dr. Lukwiya expressed worry about his condition, claiming “Oh my God, I think I will die in my service.” He appealed to God, praying, ''If I die, let me be the last.” He drew his last breath at 1:20am on December 5, 2000, and his body was immediately zipped up in a polyethylene bag. His wife was not allowed to look at the body because it was highly infectious. Reflecting on a video clip on Lukwiya’s burial, Balein Harden writes:
An Ebola burial team, dressed in protective gear that seemed suitable for a lunar landing, rolled up to the grave site at 4:00pm in a white ambulance. They whisked a simple wooden coffin out of the ambulance and lowered it into the grave with ropes. All the while, one member of the burial team sprayed the coffin, the ropes, and his colleagues with Jik bleach. More a disposal procedure than a burial, it was over in less than five minutes.
In total, the outbreak killed 224 people. Indeed, Dr. Lukwiya, who had proven himself a fearless fighter of EVD, was the last casualty of the 2000 Ebola outbreak in Uganda. Unfortunately, however, he was neither the last Ugandan nor African to die of the killer disease. Seven years after his death, in 2007 Uganda was hit with yet another Ebola catastrophe killing thirty-seven people in Bundibugyo, and in 2011 another outbreak in Luwero killed one person. In July 2012 yet another outbreak killed seventeen in Kibaale and shortly after, in December 2012, another instance killed four in Luwero. These later outbreaks were certainly better contained because of epidemiological work and a well-coordinated response system that had been developed following the 2000 disaster. This gave some hope that an African country struggling with all sorts of infrastructural problems could, with support from various global and local partners, be in a position to contain the epidemic.
However, the loss of about 11,000 lives to Ebola in West Africa in 2014 was such a catastrophe that must have caused Lukwiya to turn in his grave. It confirmed Africa’s inability to contain a disaster of such magnitude. African states and leaders of government therefore need to seriously reflect on the catastrophe and put in place a set of mechanisms that will adequately address such outbreaks when they occur and fulfill the promise of “Never again to Ebola.”
African countries need to prioritize the healthcare system in terms of infrastructure, human resource, equipment, supplies, and logistical support. There is no peace without healthcare, and people should be confident that when they go to hospitals, they will receive proper treatment. Families should not hide patients from health workers or fear those taken to hospitals will surely die. Calls should be put in place for a standby response team—a sort of African epidemiological high command—that can be quickly mobilized and dispatched to the field when catastrophe strikes. Moreover, promoting public awareness about the disease and developing mechanisms of social support to victims and affected communities is extremely critical because the outbreaks of virus diseases such as Ebola are social issues inasmuch they are medical issues, and go beyond biomedical concerns alone. None of these tactics, however, are possible without good governance and effective leadership, which we as Africans must advocate for and hold our leaders accountable.