Andrew Maykuth Online
The Philadelphia Inquirer
December 15, 2000
A hero amid Ebola outbreak becomes one of its victims
E-mail from Uganda
Dr. Matthew Lokwiya (Jim Adriko photo)

GULU, Uganda - Dr. Matthew Lokwiya reclined in a rocking chair three weeks ago, exhausted by the unrelenting challenges at Lacor Hospital since the deadly Ebola virus broke out the month before.

"It's a horrible thing," said Lokwiya, 43, the hospital's medical superintendent. "It is so dramatic. Somebody is sick, taken to the hospital, and then they die."

As he spoke, Lokwiya betrayed no suspicion that the unmerciful virus was already multiplying inside his body. The next day he would get sick - the staff said it was malaria. By the fourth day, he was admitted to the hospital.

He died the next week, nine days after my visit, one of 160 victims of a disease that kills with ruthless speed.

I went to interview Lokwiya that warm Sunday afternoon at his apartment at the hospital where he worked for 17 years. World Health Organization doctors had praised him for identifying the outbreak at an early stage and for urging the Ugandan government to take aggressive action.

Soft-spoken and gracious, Lokwiya sat that day in his salon, a room modestly decorated with a few photos and framed biblical quotations. He was quick to commend the bravery of his staff for treating Ebola patients, though several nurses had already died.

He learned of the outbreak on Oct. 7, while he was attending a seminar on public health in Kampala, the capital. His staff called to tell him that a student nurse had died of a mysterious illness and that the sickness appeared to be spreading.

Lokwiya returned the next day to Gulu, a provincial capital of more than 100,000 people in the rolling savanna of northern Uganda. He found five other patients in the hospital who were suffering from similar conditions. He looked at records and identified a dozen other recent cases, classified as dysentery or malaria, that were also suspicious.

"There was fever, diarrhea but no bleeding," said Lokwiya, who grew up in the neighboring Kitgum region of Uganda. "But the symptoms were quite clear."

Lokwiya had never seen Ebola, but he suspected the disease that killed the student nurse might be some hemorrhagic fever, a type of illness that rapidly attacks cells, causing internal bleeding. On Oct. 9, Lokwiya drew blood from the patients and shipped it to South Africa for testing.

Meanwhile, he called the Uganda Ministry of Health and warned them of the dangers. "I was very blunt and straight: 'What we have here is viral hemorrhagic fever.' "

When the government confirmed on Oct. 14 the outbreak was Ebola, the world's most terrifying hemorrhagic fever, Lacor Hospital was poised. Lokwiya had segregated the patients into an isolation ward and instructed staff members to protect themselves with masks and gloves.

"It was like learning on the job," he said.

The staff at Lacor is accustomed to responding to crises. The well-equipped hospital, operated by Italian Catholic missionaries, is on the outskirts of a city that has been under siege for 14 years by the Lord's Resistance Army, a rebel movement whose trademark is abducting children and hacking off the ears, lips and limbs of civilians. The rebels once kidnapped Lokwiya and held him for a week, demanding a ransom of drugs.

"The war is pretty scary," Lokwiya said. "The rebels came and attacked. They abducted nurses and took them into the bush. It has been one constant emergency since 1986."

Lokwiya knew that hundreds of thousands of people live in the region's crowded refugee camps, where an opportunistic virus like Ebola might easily spread. The health ministry quickly warned the public to avoid contact with suspected Ebola victims, and particularly to halt the ritual bathing of bodies that had been the suspected cause of the virus' rapid spread.

Named after the river in Congo where the virus was discovered in 1976, Ebola remains largely a medical mystery. It is unknown where the virus resides between outbreaks - probably in a mammal or an insect. Doctors know it spreads through direct contact with body fluids from an infected person. They also know it has no cure.

"All we can do is provide supportive therapy," Lokwiya said. "We treat symptoms.. . . Patients need a lot of psychological support. Many of them start to cry and kind of give up."

He acknowledged the hospital's medical staff, including himself, faced risks. "It's a real mess," he said. "There's a lot of diarrhea and a lot of vomiting and bleeding. The health workers are exposed."

Most of the health workers who became infected came into contact with patients before they were diagnosed. Lokwiya and the staff members who work in the isolation ward theoretically took plenty of precautions - they wear disposable caps, paper gowns, rubber aprons and gloves. A few wear goggles. They all rinsed their gloved hands frequently in bleach. It is obsessively sterile.

I arranged to return the next day to accompany Lokwiya on his rounds. I wanted to get a sense of the work in the Ebola ward and to photograph him at work. But when I returned on Monday, the hospital staff said the doctor had fallen ill with malaria. I made plans to try again the next day.

He was still unavailable on Tuesday, so I put on a mask and two layers of latex gloves and joined Dr. Samuel Yoti and several nurses as they ministered to patients.

Two of the 10 patients in the isolation ward that day were Lacor nurses. One nurse was suffering from the advanced virus. She writhed in delirium, rhythmically moaning in pain. Yoti apologized that her arm was tied to the bed rails with strips of cloth to keep her from dislodging the intravenous drip. She later died.

The other nurse was recovering, though her eyes were filled with fear even as Yoti examined her and told her signs were encouraging.

"They say this is a disease of health-care workers," Yoti said. Twenty-six health workers have contracted the illness, and 13 have died.

I left the hospital and Gulu that day without seeing Lokwiya.

A week later, he was dead.

The New Vision newspaper in Kampala quoted doctors who said Lokwiya bled from the lungs and breathed with difficulty during his last days. He was given oxygen. I wondered about his state of consciousness because he, more than anyone, was familiar with the destructive capacity of the virus.

His body was zipped into a plastic bag on Dec. 5 and buried a few hours later without the tender caresses from his family, an integral part of the grieving process in Uganda. He left his wife and five children.

This week Lokwiya was honored as a hero at a memorial service in Kampala. Donors from America and Europe rushed to acknowledge his contribution. The U.S. Agency for International Development donated $100,000 to Lacor Hospital in Lokwiya's memory. The U.S. Centers for Disease Control and Prevention, which sent a mobile lab to Lacor to assist with the outbreak, financed two annual awards in Lokwiya's memory at Kampala's Makerere University.

No one can calculate how many lives Lokwiya saved by reacting so quickly. With a virus like Ebola, one victim might infect up to 20 other people if precautions are not taken. A week's delay can allow the plague to spread exponentially.

But Ebola is an unforgiving disease, and even the smallest mistake can be fatal, as Matthew Lokwiya sadly demonstrated. home page   
Recent news
  | Africa coverage  |  Archives  |  Afghanistan coverage  |  E-mail from Africa  |  Magazine articles | Photographs  |  Bio 
African Odyssey
  |  Apartheid's Secrets  |  Democracy's Promises  |  The Forgotten Wars  |  Rwanda: Aftermath of Genocide

Copyright 2001-2006 Andrew Maykuth