Lessons Learned from Past Ebola Outbreaks in Uganda

By Joseph Byonanebye, MPH
October 28, 2014

The Kibaale District in Uganda

The Kibaale District in Uganda

In August 2012, on this same platform, I shared my wonderful experiences from Uganda. After actively participating as a member of the National and District Ebola Task Forces (NTF), which was coordinated by the Ministry of Health, to some extent,my write-up represented my admiration for the seemingly simple approach that was nevertheless effective in rural Kibaale and Luwero Districts of Uganda. In this part of the country, communities do not have the best access to medical services and struggle to earn a living, but like in many parts of Uganda, there is a good sense of social support and community organization. When the 2012 Ebola outbreak occurred in this East African country, one expected an elevated infection and fatality rate, comparable to the recent 2014 Ebola in West Africa. Differently, Uganda was accorded an Ebola-free status within a few months after the first index case was identified. What then could have happened in Uganda? Are there any lessons learned from this pearl of Africa?

In Uganda, the outbreak never crossed borders and fewer cases succumbed to the disease. A total of 24 probable and confirmed cases were recorded, of which 11 were laboratory confirmed by the Uganda Virus Research Institute and with only 17 deaths recorded. As compared to the recent 2014 Ebola outbreak in West Africa, where the disease has crossed nations and continents and taken a toll of more than 4,900 deaths, the Uganda situation was fair.

As soon as Uganda suspected the onset of an Ebola outbreak, the Ministry of Health (MoH) set up a National Task Force, which: planned and ensured quick preventive and response interventions; monitored the situation on a daily basis; and bridged the communication between stakeholders. This task force therefore formed subcommittees: coordination committee; case management committee; surveillance and laboratory committee; and social mobilization committee, which were composed of a diverse group of stakeholders from national and international organizations.

Amazingly, even though Ebola is a well-known threat, within these NTF meetings, I never felt a sense of panic but rather a commitment from groups of people, who apart from the usual economic resource constraint, confidently suggested solutions. For example, these NTFC meetings that began every day at 9 am with updates from the chair, who had a good sense of humor, followed by reports from committees which often proceeded calmly. Generally, I felt that there was a good coordination by the NTF, which routinely shared information with the rest of the stakeholders and ensured collaboration. For example, the community members of the affected districts were encouraged to participate in contact tracing by reporting to the relevant authorities, and stigmatization seemed of cases seemed not to be an issue. In addition, there was the high level of ownership and responsibility accorded by Uganda government, through the MoH, which worked closely with subnational, national, and international stakeholders. Additionally the NTF minimized rumors, by engaging the media through the MoH public relations officer, designated public talks on TV and radio; there was no political interference, but rather, teamwork in fact finding and solution seeking for the purpose of protecting people.

Because of Uganda’s past experience, therefore, my hypothesis could be that Uganda is more aware and therefore resilient to outbreaks. Notably, 2012 was not the first time when Uganda experienced an Ebola outbreak. The first outbreak was recorded in 2000/2001, followed by 2007/2008, 2011, and 2012. Additionally, during this span, Uganda paid attention to alerts for the reason that outbreaks occurred in neighboring countries of the Democratic Republic of Congo and Sudan, which are also known as the first countries to report an Ebola outbreak in 1976.

The other hypothesis could be that the recent Ebola is more virulent, probably spreads faster, and is harder to control. More thoughts can be suggested, however, we need to conduct more research so as to answer the unknown. We need to document lessons learned from past and current experiences for the purpose of providing evidence-based solutions. Through it all, coordination and cooperation are essential. Think beyond.

Joseph Byonanebye, MPH SGU ’09
Doctoral Student, Public and Community Health, Medical College of Wisconsin

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