Health officials in Uganda's western Kibaale District are struggling to deal with an outbreak of Ebola, as the number of suspected cases stretches local health systems.
The Ugandan government has so far reported 16 suspected Ebola deaths; four have been confirmed by testing carried out at the Uganda Virus Research Institute in Entebbe. The Ministry reports another 22 suspected cases, all in Kibaale District.
According to the Kibaale District Ebola Taskforce (KDET), reports of possible Ebola cases in the west continue to rise: health officials reported that they were following up on 176 people thought to have been in contact with infected patients on 31 July, up from 40 suspected contacts the day before. The disease is transmitted through direct contact with an infected person or their body fluids such as blood and sweat.
Meanwhile, a shortage of trained health workers has affected containment efforts; just 56 percent of health worker positions in the country's public health sector are filled.
Burials in the affected communities have been taken over by KDET, whom the ministry has supplied with vehicles, though there have been delays in providing them with fuel. The ministry has also set up a telephone hotline for citizens to report suspected cases.
Though these efforts have been boosted by the Uganda Red Cross, Médecins Sans Frontières (MSF), the US Centres for Disease Control, the UN World Health Organization and others, KDET chairperson Steven Byaruhanga said suspected cases are quickly outpacing relief efforts.
"At sub-county health centres, we are getting reports that they are shying away from handling patients because they don't have protective gear," he said.
According to Byaruhanga, the district is asking for the equivalent of US$334,000 to upgrade Kagadi Hospital - the centre of the outbreak - to increase awareness messages and to support traumatized health workers.
"Some of them are demoralized, others are stigmatized because their colleague has passed away," he said. "They need at least some motivation."
Byaruhanga said the facility was already dilapidated when the outbreak began, citing an irregular water supply and electricity, a broken sewer system and no medical incinerator.
Local media reports this week said patients at the hospital had protested about the lack of food and water, and wanted to leave.
The Ministry of Health is requesting emergency supplies from the Prime Minister’s Office - responsible for disaster preparedness - as well as support from developing partners such as MSF, who are helping to build isolation centres.
On top of that, the ministry has access to a 2.5 billion Uganda shilling ($1 million) reserve fund for emergencies, according to its permanent secretary, Asuman Lukwago. "We can frontload that money and use it early," Lukwago said.
The outbreak was reported by the government on 28 July, but the first case is thought to have appeared weeks earlier.
The death of a clinical officer from Kagadi in Kibaale District who was taken to Mulago Hospital in the capital, Kampala, sparked fears of an outbreak in the city, but health officials say seven health workers being held in isolation at the hospital have not shown any symptoms, 11 days after their potential exposure. By 1 August, no further cases had been reported in the capital.
The nearly month-long delay in identifying the current outbreak was in part due to the spiritual beliefs of the community. According to Byaruhanga, the virus wiped out nine members of one family, who believed they were "cursed". He added that the delay also erased any real hope of tracing the source of infection.
"It blindfolded other research that would have taken place," he said.
The UN World Health Organization has identified the strain in Kibaale as Ebola-Sudan, the same strain responsible for some 425 infections and 224 deaths in Uganda in 2000-2001 and one death in 2011; another strain, Ebola-Bundibugyo - named after a western Ugandan district - killed some 42 people in the country in 2007-2008.
Byaruhanga also said health officials did not recognize the Sudan strain, which can achieve a 70 percent fatality rate, as it presented differently from the previous Bundibugyo strain, with a 30-40 percent fatality rate; patients presented with fever and vomiting rather than the more typical haemorrhaging usually associated with Ebola.
"We thought it was a strange disease because the symptoms first of all were not like the previous Ebola - that's why people were not cautious about it," he said.
Uganda's President Yoweri Museveni has cautioned the public against physical contact. "Avoid shaking of hands; do not take on burying somebody who has died from symptoms which look like Ebola - instead call the health workers to be the ones to do it and avoid promiscuity because these sicknesses can also go through sex," he said in a statement.
In Kibaale District, Byaruhanga said more than 250 schools had been closed, markets abandoned, and public gatherings banned.