A Trip Inside An African Hot Zone

By Simon Robinson/Gulu

One of the first to die was Esther Owete. Sometime in early September, the 36-year-old from Kabedo-Opong, in northern Uganda, began complaining of "a coldness in her body," remembers her brother Richard Oyet, standing outside her mud-and-thatch hut. "Then she said she had pains in the muscles in her legs." Owete's chest began hurting. She became feverish and vomited blood. "We thought it was malaria," says a neighbor, Justin Okot. At a clinic in the nearby town of Gulu, Owete was injected with the antimalarial chloroquine and sent home. "She didn't even last 24 hours," says Okot. "We didn't understand that someone could die that quickly. We began calling this thing gemo, which in [the local language] Luo is a type of ghost or evil spirit. No one knows about it, but it comes and takes you in the night."

Ugandan health officials suspected, and tests in South Africa two weeks ago confirmed, that this ghost was real and goes by the name Ebola. A lethal virus first identified in northern Congo in 1976, Ebola attacks almost everything in the body except bone, destroying the immune system in fast-forward and causing organs to melt down, hemorrhage and then bleed out through the body's orifices. The period between infection and the onset of sickness is three to 14 days. Death follows within a fortnight. Ebola-Zaire, the first strain identified, kills 90% of those infected. The strain that hit Uganda is called Ebola-Sudan; it struck twice in Sudan in the late 1970s and disappeared until this latest outbreak. It kills roughly 50% of those infected. Ebola seems to jump species, can mutate, and occurs regularly every few years in areas where civilization butts up against nature. "Why here? Why now? Nobody knows," says Dr. Guenael Rodier, director of communicable disease surveillance and response at the World Health Organization and a veteran of five previous outbreaks. There is no known cure.

Experts say they cannot pinpoint the first infection in this outbreak until the virus is contained. But if Esther Owete was the first case, then ground zero is her mud hut, now boarded up. There, minutes after her death, according to neighbors, Owete's distraught mother cried out for her grandson, Owete's one-year-old son Sam, to "suck your mother's last milk so you too can die. There is no one here to look after you now." He survived just four days. The Ebola was really moving by then, rushing through the family as members cared for their dying relatives. Owete's mother died Oct. 1, and three sisters and a nephew soon followed. Seven people in just over three weeks. "One died in that hut, my mother in there, one over there, the kid in there," says brother Richard, 35, making his way around the tiny village. "There is nothing left, no one to look after me. The pain is too difficult to tell."

Local officials first realized they had a problem on Oct. 10, when a health worker rushed back from a visit to his local village to report that people were dying of a disease that seemed to melt the body. A doctor from St. Mary's Hospital in Lacor, just outside Gulu, had noticed the same thing. The Health Ministry immediately set up a task force to identify the killer and stop it. But training and traditions made that job difficult. The first cases admitted to Gulu's two hospitals were put into general wards and treated by doctors and nurses with no proper protection. At least three hospital workers were infected. In part that was because they had no idea what they were dealing with, and in part "because we are used to treating HIV patients without gloves," says Josephine Abur, a nurse at Gulu Referral Hospital. "It isn't nice to touch them with gloves. It hurts their feelings, and people know you can't get AIDS just from touching. But this one--we didn't know."

Once Ebola was identified, Ugandan officials began a campaign to "sensitize" locals about how to avoid infection. They closed schools and isolated patients as best they could. WHO officials and medical supplies began arriving from Europe last week. Because it kills so quickly, leaving victims little time to infect others, Ebola usually burns itself out. So far, 47 people have died in the Ugandan outbreak; an additional 75 are known to have the virus.

Scientists are beginning to understand how Ebola affects the body, and could one day develop a vaccine for it. But no one is any closer to explaining where it comes from and why it suddenly attacks. "What we don't understand is how it lives in nature," says WHO's outbreak coordinator, Mike Ryan. All we know is that the virus is out there, ready to attack another day.