Last week I went on holiday in my own country. While enjoying the ever wonderful company of my friends and family I realised that living in the Netherlands is most certainly different from living in Uganda. Think shower water pressure, biking home alone late at night, speaking and hearing Dutch all the time and unlimited supplies of good cheese and hagelslag. However, October has arrived and while seemingly endless rain showers and grey days are now common practice in the Netherlands, I am enjoying an agreeable 25+°C and sunshine on our office terrace. It feels good to be home away from home.
Besides the ‘How are you and what is the food like?‘, many people asked me: ‘So, what is the deal with that Ebola outbreak?’. Living in Uganda comes with a constant fear of contracting any random tropical disease such as malaria, bilharzia or other parasites and amoebas. Though not to be taken lightly, an effective treatment exists for most of these. This week, it was announced that a Ugandan died in a Kampala hospital after being infected with the Marburg virus. In West Africa, 2,865 people have already died from the Ebola virus. Both viruses are extremely deadly and highly contagious. Personally, apart from reading about it in the news every day, the only time I really noticed something was when I returned to Uganda last week. Upon arrival at Entebbe Airport my hands were drowned in sanitizer, I had to fill out a question form promising that I was not bleeding from my eyes, and a gun-like device was aimed at my forehead, presumably to check my temperature. Beyond my personal experience, I know the CHAI office in Liberia has been closed, devoting all of the resources left to supporting the Ministry in containing the epidemic. A colleague in Nigeria was hospitalised with a serious fever that turned out to be severe malaria, something she was actually congratulated with given the circumstances.
Working in health in Uganda, I am aware of the challenges the health system faces even without the presence of a highly contagious and deadly virus. The Ministry of Health is currently going through the application process for a large donor grant for the next three years. One part of the application is gap analysis of costs to be made for health systems strengthening and procuring commodities and the actual funding that has been mobilised for this. Even before this gap analysis, it was already well-known that there is never enough money to attract enough skilled health workers and facilities stock out of crucial medical supplies such as gloves on a regular basis. Patients are not tracked in a systematic way and information and transportation infrastructure is underdeveloped. Imagine such a system having to battle an epidemic that requires a quick and comprehensive response, mobilising and informing thousands of people within the crucial first hours.
In the meantime, good advice is all around. Ugandan president Museveni advices not to shake hands, which is quite a big thing in a country where hands are held throughout entire conversations. The song ‘Ebola in town’ holds a similar warning. So how worried should I be? In recent years, Uganda has been a hotspot for outbreaks of both Ebola and Marburg, between 2008 and 2012 both viruses killed 25 persons.
On the one hand, there is a clear presence of both viruses in the country. On the other hand, the government claims that because of the recent experiences, Uganda is better equipped to handle such an outbreak than many other countries in Africa. In all fairness, despite its high mortality rate, people in Africa are still more likely to die from HIV/AIDS, diarrhoea or malaria than from Ebola or Marburg. So I will see how it goes without worrying too much.
Nevertheless, being more engaged in public health than ever before, I am following the current epidemic with a lot of interest. It has already caused more than twice as many deaths as all previous outbreaks combined. And we are nowhere near proper control, with the number of deaths per month still increasing and new cases being discovered every day.
People in the heavily affected countries (Sierra Leone, Liberia and Guinea) are not allowed to move freely and the economic impact is considerable. The World Bank has warned that the three countries face an impact on its gross domestic product of more than $30 billion. The loss is mainly a result of the impact on the labour market and trade in the region. Anxiety over the epidemic also impact affects global travel and thus airlines, hotels and travel companies. Hopefully we can find a way to make sure these countries are not obstructed in their development while keeping the virus from spreading further. For now I will sit tight, try to avoid bat caves and wash my hands a few extra times a day.