Standing a few metres away from the gathering at the Kassanda district offices in central Uganda, Sam Kassamba’s face is a picture of disbelief.
He has just figured out that the public meeting on Ebola he is attending is not about food distribution or when the 21-day lockdown imposed on Kassanda and Mubende districts will end.
“If not taken seriously, Ebola can wipe out a whole district,” Dr Jane Ruth Aceng, Uganda’s minister of health, tells the crowd. Yet Kassamba remains unmoved.
Not even the fact that 53 people have died of Ebola in Uganda and 136 have been infected since September seems to bother him. He then repeats one of the conspiracy theories making the rounds in the community. “I hear someone’s grandmother died of old age, and they said that it was Ebola. Lies,” he says.
The Ebola outbreak was declared in Mubende on 20 September, sparking immediate concern among medical professionals because there is no vaccine for this strain of the virus. Cases of the Sudan strain have spread to the capital, Kampala, 150km from Mubende, with 18 cases confirmed so far – prompting the World Health Organization to update the country’s risk level from high to very high.
Bars, places of worship and entertainment venues in Mubende and Kassanda were closed last month and a curfew introduced.
Fewer people can be seen on the streets of Mubende town, and there are fewer cars and boda-boda motorcycle taxis on the roads.
The normally jostling market, known for its roadside grills selling plantain, and for stalls of beef and chicken, is silent. Occasionally, young people gathered in small shops and centres call out to passing vehicles to see if they finally have the food the government has promised to send to see them through the lockdown. Children in uniform can still be seen trekking to school on the roads.
But coming so soon after the Covid pandemic, the outbreak and lockdown have been met with fatigue, which has morphed into indifference.
Marion Logose, a nurse at Madudu health centre in Mubende, one of five Ebola treatment units set up to deal with the outbreak, is familiar with the views expressed by Kassamba.
“They talk like that until they turn positive,” she says. “Even as they sit here waiting for their results, they argue that this disease is a lie.”
The disbelief helps explain why the body of a Muslim man who died of Ebola and was buried by a team from the health ministry was then dug up and reburied by family and friends because he wasn’t buried correctly according to Islam, putting them at grave risk of infection.
“It is now OK, I have two Muslims on my burial team, this cannot happen again,” says Godfrey Ekuka, who leads the burial team.
Uganda’s president, Yoweri Museveni, has blamed the rise in cases on people seeking treatment from traditional healers. But Mpuga Teribirye, the Uganda national inspector and chairperson of traditional healers in Mubende, refutes this. “As soon as I heard about the disease outbreak, I took it upon myself to make sure all my people were protected and not handling patients,” he says. “In fact, no single traditional healer is sick.”
Annet Nampenjja’s family were probably infected with the virus after she and her three-year-old son, who has special needs, visited a small clinic in Mubende at the end of September. The clinic had unknowingly just treated an Ebola patient. When the discovery was made, the clinic traced 500 people who were there around the same time and needed to be tested.
“I have never experienced anything like that,” Nampenjja says of the ordeal that followed. Nampenjja, her husband, daughter and son all contracted the virus. Her daughter died. The rest of the family were bedridden for weeks.
“Look at my son’s lips,” she says, pointing at the pink scars on the visibly weak boy. “I know he had problems before, but at least my son had started walking, now he can’t.”
Nampenjja did not expect the stigma that followed after the family left hospital. “I have a shop at the trading centre in Madudu, people no longer come to buy anything from me because they think I have Ebola,” she says.
Organisations working with the ministry, including Mildmay Uganda, a health NGO, and Unicef, are now offering support programmes for people discharged from hospital, as well as educating people on prevention and holding gatherings to help reintegrate survivors back into their communities.
“It starts with community engagement; telling people what to do in case they are exposed, showing them how it spreads and empowering them to make better decisions,” says Alexander Chimbaru, public health emergency adviser to the WHO. “This starts from leadership, into communities and to individuals.
“The outbreak is still moving, but I trust Uganda to manage,” he says. “When there was an outbreak of Ebola in Sierra Leone, the people that helped us set up the system were from Uganda. These are the same people here today.”
Andrew Bakainaga, the WHO district health systems adviser in Uganda, says surveillance mechanisms are in place to track the disease. “We know that we cannot close borders. Most of these are porous and communities mingle freely. But we are ensuring that all the countries bordering Uganda have amplified surveillance, and should there be heightened risk, WHO is mandated to bring it to the attention of every member state.”
Dr Daniel Kyabayinze, the director of public health at the Uganda ministry of health, confirms there are three potential vaccines that could be used against the Sudan strain of Ebola at various stages of review. Makerere University in Kampala is scrutinising the results.
“In the whole world, there are no approved vaccines for Ebola disease caused by the Sudan virus,” says Kyabayinze. “For now, this outbreak will be managed without vaccines, like it was done last time.”
