Tom Clynes

When the old Czech prop-plane lurches to a halt at the side of the military airstrip, the six doctors unfurl their stiff legs, disembark, and begin unloading. They shift 47 boxes—a metric ton of laboratory gear—onto a truck and drive toward town, trailing a spiral of orange dust as they pass army checkpoints and outsized churches, roadside vendors and crowds of people listening to radios, talking, and singing.
The most surprising thing is how ordinary it all looks, at first. Set in the middle of a fertile, if unrelieved, savanna, Gulu could be any other East African provincial center. Everywhere, people are on the move, some pedaling bikes, others riding on the fringed rear seats of bicycle taxis, most just walking. They walk upright, with stone-straight posture, some carrying babies on their backs, some balancing loads on their heads, some bare-footed, others in sandals. They walk—and the doctors drive—past the field where the pope once spoke, from atop two shipping containers still piled one on the other; past the turnoff that leads to the witch doctor’s house; past another road that leads to a small village near the forest, where, perhaps, it all started.
It takes a few minutes, as if the doctors’ eyes were getting used to a new light, before hints begin to emerge that life here is far from normal: There are none of the usual swarms of children in school uniforms. White trucks drive through town, emblazoned with the red crosses and acronyms—UN, WHO, MSF—that portend crisis. The hospital building, where the doctors pull up, is wrapped in white plastic sheeting. At the door, a hand-lettered sign warns “No entrance without permission.” The sign is illustrated with a crude human figure, with an X drawn over it.

Dr. Anthony Sanchez got the news on a Sunday afternoon in mid-October when he stopped by his lab at the Centers for Disease Control and Prevention, in Atlanta. Sanchez was surprised to find his boss, Pierre Rollin, in the office. Rollin told him that Ebola, after a four-year respite, had resurfaced in northern Uganda.
“Feel free to say no, Tony,” Rollin said. “But I’m putting together a team to go over and set up a lab; we could use you.”
Sanchez had a four-month-old daughter at home, his first. But the agency was already spread thin, with a team in Saudi Arabia covering a Rift Valley fever epidemic. An on-site laboratory could give the Ebola containment operation a tremendous advantage.
Sanchez, a low-key Texan, had spent much of his career researching the virus, often in the CDC’s maximum-containment lab, protected by a space suit. But he had never seen it operate in a human epidemic. Once, a few years ago, he had wondered if he had missed his chance, if the disease would ever come again.
Sanchez walked to his office and picked up the phone. He dialed his home number and told his wife that there was something he needed to talk about when he got home, something important. The line was silent for several long seconds, and then:
“I’m not going to be happy about this, am I?”

Five weeks into the crisis, a crowd of foreigners occupies a government office room in a yellow concrete-block building on the north side of Gulu. Doctors and scientists hunch over notebook computers and talk into walkie-talkies. Through the babble of languages and accents, an American voice speaks into a satellite telephone: “We’ve got more positives in Pabo now—we’ve got to get on top of this.”
After she hangs up the phone, I walk over and introduce myself to Cathy Roth, a World Health Organization physician who is, at the moment, coordinating the operation. When I extend my hand, she throws both of her hands over her head in a “don’t shoot!” gesture.
“Uh, we’re not actually doing that anymore,” Roth says, smiling down at my retreating hand. Ebola is spread through contact with bodily fluids, including sweat. And although it’s unlikely that either of us would be carrying the virus, people are avoiding handshakes like . . . well, like the plague.
A dozen or so exhausted-looking professionals trudge into the room for Roth’s afternoon update meeting. “Everyone’s getting really tired now,” she says. “We were thinking we had it under control, and I was thinking about giving the mobile teams a Sunday off. After five weeks of 24-7, they’re making mistakes, and they need rest.” But now Roth is worried that the illness is flaring up again, threatening to break through the containment operation.
In the past, Ebola had struck only rural areas, and the disease’s rapid death sequence had actually worked in favor of containment, since infected people couldn’t travel far before they toppled over. But the Gulu area is densely populated, with transport links to East Africa’s major cities—and, from there, to anywhere in the world. No one knows what might happen if the virus were given the chance to take advantage of these more favorable conditions.
CDC epidemiologist Scott Harper begins the meeting with bad news from Pabo, a refugee camp north of Gulu.
“A woman came into the clinic last Sunday and miscarried, and there was a lot of hemorrhaging,” he says. “No one knew she was Ebola-positive, and she spent at least two days in the maternity ward, bleeding, before anyone noticed that her bleeding was rectal rather than vaginal.”
His colleague, Marta Guerra, picks up the story: “She had five women in the maternity ward with her, plus at least 15 visitors. Eleven nurses and other workers were exposed before they got her isolated. So far, we’ve taken blood from all but one.”
The news from Pat Campbell isn’t much better. Campbell, an American physician with Doctors Without Borders, has just returned from Masindi, about a hundred miles to the south. Apparently, a woman traveled to Gulu and checked into the hospital with stomach trouble, “but when she saw the nurses dying, she panicked and fled,” unknowingly carrying the virus back to her village.
“But here’s the rub,” says Campbell. “There may have been 150 people at her funeral, and three of them have already died from Ebola. Eleven of the relatives traveled all the way from Kenya — and right now we’re tracking rumors from Kenya that one of them has gone ill.”

A few blocks from the international team’s headquarters, a teenage boy motions for me to follow him. “Miracle,” he says, and he leads me into a crowd gathered at a gate, peering into a brown-dirt courtyard. In the shade of a sprawling tree, a woman sits in a plastic chair, her head arched backward. Eyes wide and teary, she stares into the branches while another woman cuts her hair, felling the thin braids with slow, deliberate snips of the scissors.
A preacher stands in front of her, aiming a video camera with his outstretched left hand, rocking back and forth as he calls out a surreal narration: “She was mentally deranged for 12 years,” he says. “She was possessed by evil powers. The family took her to many witch doctors, but the demon inside would not relent.”
He turns toward the crowd. “We prayed and we urged her to surrender her witch-doctor gadgets. And now, look at her!” The woman smiles and sobs silently as her braids fall to the ground. “Look at her!” the preacher says, his voice rising. “The Lord has rescued her from demonic oppression!”
Watching the faces in the crowd, I have no doubt that everyone wants to believe that a miracle—be it religion, witchcraft, medicine, or science—could defeat a demon. But the woman’s gaze remains unsettled, and her eyes dart tentatively, searchingly, among the branches.
That evening, when the sun sets, a distant clanging begins. It starts faintly, a rhythmic din that gets closer and louder. Soon it’s joined by deeper drum beats. At the beginning of the outbreak, the drumming—on pots and pans as well as drums—became a nightly ritual to chase away the Ebola demon. After a few weeks it diminished, as the local population began to feel more secure. Now, the drumming is back.

Dr. Simon Mardel enters the dressing room outside the isolation ward at St. Mary’s Lacor Hospital and pulls a full-length surgical smock over his head. He stretches a first layer of gloves over the top of the smock’s tight elastic cuffs, then he pulls knee-high gum boots over his feet and tucks in his pants. He puts on a paper shower cap and a thick plastic surgical apron, then a second pair of gloves and a mask. Just before he walks through the first of two disinfectant boot baths, he places the final protective barrier—goggles—over his eyes.
An expert in emergency and refugee health care, Mardel had taken a leave of absence from his duties as an emergency-room physician in England’s Lake Region to assist at a recent epidemic of another highly contagious hemorrhagic fever—the Marburg virus—in Congo. He was on his way home in October when he was diverted to Gulu. A few years earlier, during the war in Bosnia, Mardel hiked into Srebrenica while the city was under siege, to treat wounded civilians—a heroic action that earned him the Order of the British Empire for humanitarianism.
Mardel arrived in Gulu with the first WHO team and took charge of the isolation wards, calmly demonstrating barrier-nursing techniques to terrified hospital workers. “Remember,” the clear-eyed 43-year-old told a group of nurses and nuns, “the system is only as strong as its weakest moment.”
Mardel enters the suspect ward, set aside for people who are symptomatic but unconfirmed as Ebola-positive. In one corner of the room, a male patient lies sideways on a bed, coughing and moaning. He holds a wad of tissues to his nose, which streams with black blood. He seems utterly indifferent to the doctor’s presence.
“Let’s get some blood from him,” Mardel says, and the patient offers his arm weakly to the needle.
Only about one-third of Ebola victims have the severe hemorrhaging often described as “bleeding out.” “Nobody explodes and nobody melts,” says the CDC’s Pierre Rollin. “What you read in the best-sellers and see in the movies is mostly bullshit.”
Still, Ebola’s symptoms are sufficiently wretched without embellishment.
“Most people come in with fever, vomiting, and diarrhea,” Mardel says, as he moves into the section of the ward set aside for confirmed Ebola-positive patients. “The spleen and liver are enlarged, and their circulatory system is usually going into shock. As the disease progresses, some have dementia, and many lose consciousness. Some die of respiratory failure and some of blood loss, but the majority die of shock due to fluid loss.”
Lacor hospital is well-endowed and well-equipped, by African standards, and its wood-trimmed wards and array of diagnostic equipment stand in contrast to the bare concrete of the government-run Gulu Hospital, across town, where doctors scrounge for basic supplies. In the mission-hospital tradition, Lacor’s care is intensive and hands-on. Because of the vomiting, the diarrhea, and the hemorrhaging, Ebola patients need massive care; at Lacor, nurses and nuns are responsible for everything from mopping up to helping patients die with as much dignity as possible.
Inside the isolation ward, health workers are fully enveloped in protective gear, their goggled eyes their only semi-recognizable features. To aid identification, many have scrawled their names with markers on the front of their surgical aprons.
Mardel spots an apron labeled “Dr. Matthew” across the room, and heads over to a corner where Matthew Lukwiya is treating an Ebola-stricken nurse. Lukwiya, Lacor’s medical superintendent, had been on leave in Kampala, 200 miles south of Gulu, when he received word of “a strange new illness” making its way through the hospital’s wards. He immediately left his wife and five children in the capital and drove up to Gulu. Within two days of his arrival, 17 people—including three nurses—were dead or dying with the same dire symptoms.
“At first it looked like some sort of super-malaria,” he says. “But the patients did not respond to quinine treatment, and it was killing people very quickly.” He began flirting with the possibility that one of the rare filoviruses, Ebola or Marburg, might have come in from Sudan or Congo. However unlikely this diagnosis—Ebola had never been seen in Uganda—he sent samples off to a laboratory in Johannesburg.
Three days before the results were due, Lukwiya concluded that all signs were pointing to the worst possible scenario—Ebola—and that he needed to act immediately. He stayed up all night reading a manual titled “Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting,” downloaded from the Internet. In the morning, he and his staff started setting up a barrier-nursing environment, using whatever resources were on hand. They built hands-free boot removers from scrap wood and constructed an incinerator out of a 55-gallon drum. They fashioned aprons from duct tape and plastic sheeting and converted a hospital pavilion into an isolation ward. Then, from behind these crude protective layers, they began nursing Ebola patients.
Through the goggles, Mardel’s eyes meet Lukwiya’s, which are heavy with concern. The nurse he is treating is in critical condition.
“If she dies,” Lukwiya says, “she will be our seventh.”

In the morning, volunteer James Kidega reports to the Red Cross office, where a map hangs on one wall, dotted with push-pins: green for refugee camps, red for land-mine sites, pink for recent ambushes. Since the mid-1980s, a nebulous guerrilla force known as the Lord’s Resistance Army, whose stated objective is to carve a Christian state out of Uganda, has terrorized the region’s civilian population. To protect their children at night, when the rebels usually operate, most of the rural population has moved into impoverished refugee camps near Ugandan army barracks. Every day since the containment operation began, scores of Red Cross volunteers (they are actually paid about $3 per day) have fanned out to these “protected villages” to follow up on Ebola rumors, call for ambulances, educate the populace, and relay information about hospitalized relatives and neighbors.
Before the epidemic hit, the 25-year-old Kidega had worked at a charitable agency that helps children who have escaped from the rebels or been captured. Because of his extensive contacts in the villages and his polished demeanor—he is rarely seen without a clean shirt and necktie—Kidega was recruited as a volunteer leader.
Today, he will lead a team that will visit two villages north of Gulu. With red-and-white flags flying, two trucks set out. As Kidega guides the trucks north, he recalls the first few days. At Gulu’s two hospitals, he says, many nurses and orderlies stopped coming to work, fearing that they might be assigned to the isolation wards, and some international agencies based in Gulu streamed out of town. In the villages surrounding Gulu, rumors of sorcery circulated as entire families were wiped out. In Rwot Obilo village, the virus moved through one family so quickly that a dying grandmother told a boy, moments after his mother’s death, “Suck your mother’s last milk so you can die, too—there is no one here to look after you now.”
“It felt like being on a sinking ship,” Kidega says. “You can’t believe the fear.”
Some victims swarmed the hospitals, while others ran away in panic as nurses fell ill all around them. Even the rebels were spooked; the LRA released 40 prisoners, fearing that they might be carrying the virus.
When the trucks pull into Akwayugi, villagers look up from sifting maize and wheat. This isn’t as bad as Sub-Saharan Africa gets, but there’s serious squalor here. About a fifth of the children have the bulging bellies that indicate severe malnutrition.
The Red Cross volunteers divide into four-person teams and move through the village, asking questions of the small crowds that gather wherever they go: Did anyone have a fever? Did anyone have bloody diarrhea or vomit? Was there a sudden death?
The team has a “reintegration kit” for two girls who survived Ebola after they lost their mother to the disease. They find them with their father, Charles Odongo, outside the family’s round, mud-brick hut. Two weeks earlier, Odongo returned from the fields to find his wife in the hut with a headache and high fever. “It took six hours for the ambulance to get here,” he says.
“And by the time they arrived, she had died.” When he sees the kit—cooking pots, blankets, soap, salt, and clothing—he smiles gratefully. “Immediately upon leaving for the hospital with my wife’s body, our things were burned by the neighbors,” he says.
Although the Ebola-Congo strain kills 90 percent or more of its victims, the Gulu virus is similar to the less-lethal Sudan strain, which has a mortality of about 50 percent. Odongo’s three-year-old daughter, Skovia, survived the disease that killed her mother.
“You should not fear her,” volunteer Lucy Adoch says to a circle of onlookers, reaching down to pull the girl against her leg. “This is not a contagious little girl.” The motherless girl seems to brighten when she sees the dress the team has brought for her, but her nine-month-old sister, Geoffrey, clings to her father listlessly. She’s severely malnourished, weakened by the disease, and silent except for an occasional phlegmy cough. It’s hard to imagine her making it to her first birthday.

On the way back to town, James Kidega stops by his mother’s house for a cup of tea.
“James,” his mother says, putting the kettle on the stove, “why so many coffins passing by here today?”
“It’s going up again,” Kidega tells her. “We were beginning to think it was nearly over, that they would reopen the schools, but I think now they will wait. People are relaxing; they are hiding the facts. They think they will be shunned.”
“Why don’t they put the coffins inside when they transport them?” she asks. “This is making people very nervous.” As she pours the tea, her 20-year-old niece, Sarah, walks in.
“This Ebola, I wish we could see it,” Sarah says, clucking her tongue. “If we could see it, then we could beat it to death, with a stick.”
After sunset, Kidega’s radio crackles. A teenage girl has run into the clinic in Pabo, terrified of bleeding that would turn out to be nothing more than her first menstrual period. There’s gunfire on the road near Lacor. And north of town, a soldier in an armored personnel carrier has broken out in a fever, and is vomiting red inside the vehicle. The other soldiers have run away.
“Can you send an isolation ambulance?” the commander pleads.

Continue to Part II.