Remembering the heroic fight by Dr Lukwiya against Ebola

Gulu. When the Ebola epidemic that has ravaged much of West Africa is finally contained, as it one day will, the true heroes and heroines of the struggle to contain it must be remembered as the men and women who risked their own lives and the well-being of their families, to save the lives of others.
So far more than 60 of the 600 dead are healthcare workers who have paid the ultimate price for their devotion to the sick, with their lives. Hundreds of others are weary unto death.
So the need to stem the epidemic couldn’t be more urgent. If the epidemic isn’t stopped, it will become endemic, a disease that will be forever entrenched in the region, ready to spread in a moment’s inattention.
The World Health Organisation (WHO) estimates that there could be more than 1.4 million cases of Ebola in West Africa by the end of January 2015, if the disease is not contained. The fear and stigma of Ebola now takes us back to the early days of the HIV/Aids.
Sadly, there has been only a trickle of volunteers among the medical community from the Western World. The weight of the epidemic has been left on the West African countries, who must shoulder the burden and act decisively, and without fear; with support from other African nations, to tackle what could soon become the ‘Aids’ of the next generation.
Remembering
Here in Uganda, we remember with humility the ultimate sacrifice that Dr Matthew Lukwiya, the Medical Superintendent at St Mary’s Hospital, Lacor in Gulu, northern Uganda, and his team paid to save our generation from Ebola in 2000.
Witness accounts indicate that on the morning of October 7, 2000, Lukwiya received a phone call from Dr Cyprian Opira – a medical doctor at Lacor Hospital - informing him that a mysterious illness had killed two of the hospital’s student nurses, all of whom had begun bleeding and vomiting blood.
Opira asked Lukwiya, who was in Kampala at the time, for help and he immediately rushed to Gulu arriving that evening, in time to witness the death of a third nursing student, Daniel Ayella. Lukwiya asked Sister Maria Di Santo, the head nurse, to bring him the charts of all unusual deaths in the past two weeks, from where he identified 17 cases with similar symptoms.
He and Sr Maria spent that night reading reports from the US Centers for Disease Control and Prevention (CDC) and literature from the World Health Organisation (WHO) on infectious diseases that caused bleeding. By the end of their review, they suspected Ebola.
The literature on Ebola, which was largely based on a 1995 outbreak in Kikwit, Congo that had killed four out of five patients, stated that the sicker a patient got, the more infectious they became and that dead bodies became highly contagious (see “Dr Matthew’s Passion”, New York Times, February 18, 2001).
The Ebola outbreak in Acholi was widely linked to the return of UPDF soldiers, who had been air-lifted from their operations in the DR Congo; directly to the UPDF 4th Division Air base in Gulu, from where they were then posted to different units.
The first batch of the troops touched down on March 1, 2000, headed by Capt James Sekaboja and Lt Col Charles Mwase of the 31st Battalion, they numbered 110.
At the time of the outbreak in October, Gulu and other Acholi districts had been at the centre of a brutal insurgency between the government and the rebels of the Lord’s Resistance Army (LRA) for 13 years and at least 90 per cent of the population had been confined to cramped up conditions in camps; so the community’s response to the Ebola outbreak there should be seen in this context.
According to reliable sources, Lukwiya informed staff of his suspicion that the illness was a viral haemorrhagic fever on the morning of October 8. On the same day, groups of local community leaders came to the hospital reporting that entire families were dying in their villages. Lukwiya had already set up an isolation ward for suspected Ebola cases, in line with the WHO guidelines.
The special ward was staffed by three doctors, five nurses and five nursing assistants, all volunteers. When a South African lab confirmed the Ebola outbreak on October 15, and a WHO delegation arrived in Gulu, they were astonished at the efficiency of the operation. Dr Simon Mardel, a member of the WHO team, is quoted as having said at the time: “I had thought people would not be unwilling to work. I thought we would be facing a situation where patients were totally neglected and an isolation ward to which people wouldn’t want to come because it would just be a mortuary. But they had implemented the manual – a very specialised recipe. They were giving highly sophisticated care. It was remarkable. There was even a little wooden device for pulling boots off they had made, exactly as the manual describes.”
Finding that their assistance was not required at St Mary’s, the WHO and Médecins Sans Frontières rapid response teams offered their assistance at the government’s Gulu Regional Referral Hospital, where they found corpses abandoned on their hospital beds.
Situation worsens
The crisis continued to worsen. By the third week of October, the number of Ebola patients had increased to almost 60, overwhelming the volunteers in the isolation ward. Lukwiya ordered other nurses to assist the patients and tried to lead by example, working with Ebola patients from 7am to 8pm. However, despite instituting risk minimisation procedures, including wearing of robes, multiple gloves, surgical masks and goggles, hospital workers continued to fall ill. Twelve more died. At the funeral of an Italian nun on November 7, he attempted to rally the morale of his workers.
“It is our vocation to save life. It involves risk, but when we serve with love, that is when the risk does not matter so much. When we believe our mission is to save lives, we have got to do our work.”
Things were at their worst at this point and November was possibly the worst month for Lacor, yet Lukwiya believed that the disease could and had to be contained.
In the 24-hour period ending at the dawn of November 24, seven patients died, three of whom were health workers. Two of these were nurses who did not work in the isolation ward. The thought of infections being passed to health workers who did not directly care for Ebola patients panicked many and the nurses mutinied. The day-shift did not go to work; instead 400 health workers, nearly the entire staff of St Mary’s, gathered in the assembly hall of the nursing school.
When Lukwiya rushed down to ask what they wanted, at least one nurse yelled that the hospital should be closed.
Lukwiya silenced the nurses, most of whom he had trained himself, by stating that if the hospital closed he would leave Gulu and never return. He then spoke on how he had let himself be abducted by the rebels rather than risk the hospital and that they would be responsible for the deaths that would result if the hospital closed.
After hours of contentious discussion that extended into the afternoon, Lukwiya switched back to a conciliatory approach, stating that he would remain no matter if everyone left. The meeting ended with him and the nurses singing a song together; he had prevailed.
After finishing his days in the isolation ward, Lukwiya would sit with members of the WHO, CDC and other medical teams that had set up in the hospital compound to offer assistance and take blood samples that allowed them to map the course of the disease. His main question for them was how to stop his staff members from becoming infected.
The likely explanations in most cases are momentary lapses. Health workers at Lacor hispital worked 14 hours shifts for weeks in a row while in layers of protective clothing that were stifling in the equatorial country. All that would be required for infection is for a health worker to lose focus for a moment and, after touching a patient, slip a gloved finger under their mask to scratch an itchy nose or rub an eye. One infected health worker who may have been infected in this way was nurse Simon Ajok.
In the early morning of November 20, Ajok was in the Ebola ward and critical, bleeding from both his nose and gums. Fighting to breathe, Ajok pulled off his oxygen mask and coughed violently, sending a fine spray of blood and mucus against the nearby wall. He then astonished and terrified the night-shift by rising to his feet and staggering into the hallway. The night nurse on duty called Dr Lukwiya for help. Woken out of bed, Lukwiya put on protective clothing, mask, cap, gown, apron and two pairs of gloves, but not goggles or a face shield to protect the eyes.
Explanations for this range from grogginess at being newly awoken or haste to reach a colleague that he had helped train. While it will never be known for certain, the care for Ajok, who died one hour after the doctor arrived, is the most likely candidate for Lukwiya’s infection.
On the evening of Sunday, November 26, two days after he had convinced the nurses to remain on the job, Margaret Lukwiya was startled to hear her husband’s voice sounding heavily congested. He told her that he had a “terrible flu”. The next morning, he and Sister Maria agreed that he had malaria. “We said malaria, but we thought Ebola,” she later said. His fever grew worse through the day, a Monday, and by Wednesday he was vomiting and Dr Pierre Rollin of the CDC took blood samples for testing.
A nurse who was administering an intravenous drip that evening at his home was surprised when he began speaking distinctly, though not to her: “Oh, God, I think I will die in my service. If I die, let me be the last.” Then, in a clear voice, he sang Onward, Christian Soldiers.
Rollin came back with the results the next morning; it was Ebola. Lukwiya immediately asked to be put into the isolation ward, stating “Since I am the boss, I should show an example.”
Wife by Lukwiya’s side
Margaret was finally called on Thursday afternoon and she arrived the next morning. However, Lukwiya’s colleagues were strict in the protocols. While she was forced to sit on a stool three feet away from his bed, she was eventually allowed to hold his foot through three layers of glove.
On Sunday, his breathing had become so laboured that he was put on a respirator. By early Monday evening the oxygen level of his blood was rising and his pulse was near normal. It appeared that he might pull through but later that evening Lukwiya’s lungs began haemorrhaging, a worst-case scenario. Lukwiya died at 1:20am on Tuesday, December 5 2000. When Margaret was informed and came to the ward, the body had already been put into a polyethylene bag. When she asked if they could unzip it a little so she could have a last look, she was denied; the body was too infectious to take any risks. (see James Astill, “The death of Dr Matthew”, The Observer, January 2, 2001).
Lukwiya, you gave your life for us and you lived by example…. we shall forever be grateful for your humility and love for your people, you probably saved a generation. May your light continue to shine in Acholiland and beyond, you will forever be remembered as a hero the world over. RIP.
The writer is a human rights advocate.

ABOUT DR LUKWIYA

Dr. Matthew Lukwiya was born in Kitgum (Northern Uganda).
He soon distinguished himself at school: top of his class in primary school and top school-leaving marks in the country. He attended Makerere University Medical School through a series of scholarships. He was among the very first interns to arrive in Lacor Hospital when this hospital was approved for the internship of newly graduated medical doctors in 1993. His exceptional medical skills and human qualities were immediately evident: in his report to the government authorities on Dr Matthew’s probation period, Dr. Corti stated that following the series of “outstanding” and “above average” marks, his final comment was that “the marks given are self-explanatory: Dr Lukwiya will soon make an outstanding physician”.
The years between 1996, when Dr Matthew started working as a medical officer in Lacor Hospital, to 1999 were characterised by an armed conflict against Museveni. Lacor Hospital was often targeted by guerrillas who would loot and sometimes abduct nurses to be ransomed for money and drugs. In 1999 during one such looting Dr Matthew took responsibility as head of the hospital in the Corti’s absence (he was Deputy Medical Superintendent since 1988) and offered himself as a hostage instead of the targeted Italian nuns. He was dragged through the bush by the rebels for one week before being released. The Cortis, who had immediately returned upon hearing the news of his abduction, believed that both staff and students could not continue to work at such price and decided to close the hospital and start evacuation...
In order to allow him some reprieve from the stress and heavy hospital workload, in 1991 Dr Corti obtained a sponsorship for Dr Matthew who took a Master’s in Tropical Paediatrics at the Liverpool School of Tropical Medicine.
He became Lacor Hospital’s Medical Superintendent in 1997. His duties combined being head of paediatrics with a very large workload and limited staff, running a large institution and managing child health and immunisation services in the community, including refugee camps. He had a particular interest in haematology and oncology. He had experience of managing outbreaks such as cholera, and he demonstrated his particular organisational skills during a large outbreak of meningococcal disease that affected northern Uganda in the early 1990s.
In October 2000, Dr Lukwiya was finishing a Masters in Public Health course in Kampala when the hospital requested that he return to Lacor to investigate the unexplained deaths of some patients and three student nurses during the previous month.

What others SAY
“I lived with the man and i used to holiday at his home during our breaks from Laysco. He was passionate about his job. He gave up everything including a job he had been offered at Liverpool University, to try and sort out this mysterious illness that had broken out in Gulu. He paid the ultimate sacrifice. We must remember him...”
By Samuel Olara, human rights advocate

“The memories of how the disease struck Acholi land like lightening are still so vivid in my mind. Beautifully narrated, If words could come to life, this certainly did. RIP Dr Lukwiya,”
Jackie Lakaraber

“Always smiled and died doing the job he loved so much. We won’t forget his sacrifices, and we shall also remember the genesis of this Ebola...”
Robert Ojara

“There only three phrases to describe Dr. Lukwiya; human compassionate, committed to duty, and love for his people. He was an Acholi who makes any Acholi proud. May his soul rest in peace,”
Philip Okelo

“To belong to the same tribe with Dr Lukwiya, I am so proud with that I know he is up there watching over us,”
Jane Onoo

“A true soldier ...Further to this, Ugandan experts are sharing their experience of this tragic episode with their West African counterparts,”
Joy Oloya

“Dr Lukwiya and your team who lost their lives, may God give you all eternal rest Amen,”
Robina Atima

“Dr Lukwiya so loved the people that he sacrificed his life in fighting Ebola epidemic so that the people shall not perish but have nornal life. Rest in eternal peace Doc,”
Polber Dso

“Dr Lukwiya was a true Acoli hero who broke all protocols to save his people. May his soul rest in peace,”
Margaret Acirokop

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