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Biosecurity BriefingAfter Ebola Outbreak, Uganda Looks Back at Challenges By Kunal Rambhia, February 29, 2008 A series of articles published within the last week provide new insight on the challenges Uganda faced in trying to control a recent outbreak of Ebola. On February 23, 2008, three days after the official end of the outbreak, The Monitor reported that scarcity of supplies and healthcare personnel in the region may have contributed to the spread of Ebola. According to the article, “the [Ebola] outbreak shone a light on the equipment and staffing shortages that hamper the country’s health system, limit care to patients and endanger the health workers.”1 According to the The Monitor article, one of the difficulties highlighted by the outbreak is that healthcare facilities often “lack even the most basic equipment such as rubber gloves.”1 As a result, healthcare workers had to decide whether “to stay on and fight the virus but risk death, or flee to safety.”1 In fact, the first healthcare worker infected with Ebola was exposed while taking a stool sample in a center that did not have gloves. According to The Monitor, the Ugandan government responded to the equipment shortages by spending approximately $1.7 million to distribute supplies and medicine to healthcare facilities country-wide. Shortages of healthcare staff, which was most evident in the larger healthcare facilities, also appears to have played a role in the length and severity of the outbreak. Although the “Ministry of Health establishes how many staff should be at each health facility”, the February 23 article notes that “only 65 percent of the hospital staff positions are filled.” In one facility, Bundibugyo Hospital, which served as the patient isolation center during the recent outbreak, the entire staff consisted of two doctors and 26 nurses—the Ministry of Health recommends that a fully staffed facility include 7 doctors and 46 nurses. To address the shortage of nurses, the Bundibugyo hospital hired locally trained nursing assistants.1 An article published in The Monitor on February 22, 2008, notes that misconceptions of how Ebola is spread led to violence and social isolation and may have hindered the control of the outbreak. Before the Bundibugyo Hospital was established as a center for isolating patients, another health center, which received the first five suspected Ebola patients, was vandalized. Patients in that facility fled after the vandals threatened to kill them. Additionally, after patients were sent to the Bundibugyo isolation center, “families of suspected Ebola patients were shunned and health care workers were refused service in supermarkets and restaurants.”2 Even now that the outbreak has officially ended, some people “have still not been fully accepted back into their communities,” The Monitor reports.2 An article published on February 25 by the Xinhua News Agency points out fears of the Ugandan virus strain “mutating and acquiring a longer latent period,” which also proved to be a complicating factor in controlling the virus.3 Laboratory tests have indicated that some individuals who had acquired the virus did not become sick. Health officials quoted in the article noted that this factor made it difficult to identify infected patients before “the disease could easily spread.” In light of this evidence, the Ugandan health ministry waited 42 days, or twice the longest incubation period without new infections, before declaring the end of the outbreak.3 References
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