Tom Clynes

When Mike Ryan arrives from London, three-quarters of the international team and seemingly half the town converge within minutes to greet him. A WHO medical officer, Ryan had been in the Alps, hiking with his parents, when a colleague called with news that Ebola had emerged in Uganda. Ryan’s team hit the ground first, and he spent the next four weeks leading the containment operation before being summoned to London to represent the WHO at an infectious-disease conference. Now he’s back, and with his long red sideburns bursting out from under his baseball cap, he jumps from a rented van and immediately starts greeting people with big handshakes and bear hugs.
Suddenly, the energy seems cranked up.
“We managed to convince ourselves that it was under control,” Ryan says, torching a cigarette as he addresses a group of mobile-team members. “Everyone’s getting lethargic and exhausted. But we’ve got 17 people in the hospital now, and four new ones already today. We’ve got 45,000 people living in Pabo, and we can’t afford to let it go. We can’t take our eyes off the ball.”
From the porch, Scott Harper watches Ryan waving his arms and bellowing, as the volunteers look on, rapt. “Everything’s critical with Mike,” Harper says. “He’s a total hot-head, and the locals respect him completely. He gets things done.”
Waving his arms and bellowing, Ryan manages to get his audience guffawing, then he springs onto the porch. Just before dashing into the room, he turns and yells back at the group, loud enough for the entire parking lot to hear: “Let’s keep our boots down on the neck of this bastard!”

Hoping to raise awareness and morale, Ryan accompanies a mobile team to Goro village. He videotapes a local group called the Romboys, recording a new song called “Ebola.” Then he drops in on a drama group that’s performing an educational skit. Dressed in a devil mask and grass skirt, one actor portrays Ebola. When he comes onstage the other actors run up and beat him with sticks.
Ryan and the team pass a brew house, where women ferment beer from cassava and sorghum. A group of people stand around a clockwork radio, listening to a poem that a listener has sent in:
Ebola, Ebola, do you have children?
Do you know how painful giving birth is?
Do you know the pain of losing a child?
Ebola, you are killing without mercy, day and night.
At a Q&A session at a church, someone asks Ryan if it’s possible to get Ebola by handling money (the answer is no), and another person suggests that faith in the Lord will see them through the epidemic.
“Yes,” Ryan replies, “but don’t forget that the Lord gave us the tools to fight this. Is it not sacrilegious to ignore the gifts God gave us?” The Gospel according to Mike gets the congregation’s elders nodding in agreement.

At noon, Bob Swanepoel’s team finally rolls out of Gulu for the Kalak Hills, escorted by 13 soldiers and a Mamba armored personnel carrier. They drive along the dirt roads, between walls of eight-foot-tall elephant grass, dodging bicyclists and pedestrians. Arriving at the protected village of Guruguru, Swanepoel negotiates with the villagers—two of whom say they dined on bats earlier that day—and sets out with a team of bat-hunters and porters. In a scene that’s vaguely reminiscent of some Great White Hunter epic, Swanepoel’s party—soldiers, hunters, porters, and scientists—trudges over the hills toward the Kalak caves, trailed by an enthusiastic swarm of village children.
“This is a shot in the dark,” Swanepoel says again, wiping sweat off his forehead. “It’s very unlikely that we’ll turn anything up. You could test 100,000 bats for a virus before you find it; that’s the sort of job we face.”
Swanepoel decided to turn his gaze upward, to arboreal virus carriers such as bats and canopy-dwelling insects, after exhaustive tests on ground-dwelling animals failed to reveal anything conclusive.
“At several points,” he says, “bats have figured prominently in outbreaks of Ebola and Marburg. In some of those incidents, so have monkeys and chimps—but they died just like humans, so they can’t be the reservoir. It has to be something that can carry Ebola without coming to harm. In the lab, when we injected Ebola into bats, we found that it could grow to a very high titer, but it did not kill them. In fact, some of them excreted virus in their feces.”
Arriving at the cave entrance, Swanepoel assembles the lab on a large rock. The caves are narrow and steep, and the locals have been climbing in on rope labbers and using thorny branches to hook bats. But it’s dangerous work; in the past year more than ten residents of Guruguru have died in the caves, most falling off the ladders. It’s agreed that the bat hunters will work only in the most accessible caves, to lessen the chance that anyone will be hurt. They head into the caverns, outfitted with nets and instructions to bring the animals back alive.
In Zaire, Swanepoel used huge nets mounted on bamboo poles; in Gabon, he hunted with slingshots and live traps; in Ivory Coast, he ascended elaborate walkways built in the treetops. He has used UV light traps and fogging machines to collect insects. But today the expedition is decidedly low-tech, with teenage hunters wielding simple nets. As they bring in the bats, Swanepoel extracts vials of blood and puts the bodies in a freezer box for later dissection.
After four hours, the sun is moving toward the horizon, and the army commander indicates that it’s time to go. The hunters have collected only nine bats, and Swanepoel is clearly disappointed. “To do this properly you need hundreds, and you should really work at night. Like I said, it’s a shot in the dark. I doubt we’ll find anything—but we’ll be back.”
When the convoy pulls into town at dusk, Ryan and Kidega come out to the parking lot, looking relieved. All afternoon, they’ve monitored radio reports of an ambush near where the expedition was working. The rebels attacked a vehicle, blowing it up with rocket-propelled grenade and killing three people.

Just past sunset, most of the team gathers in the Acholi Inn’s courtyard. After dinner, they linger under the trees, drinking Nile Specials and occasionally getting scolded for leaning on the hind legs of the chairs. The talk gets around to the first few days of the epidemic.
“This is the one that could have gotten away,” Ryan says. “And it still might. But if we manage to contain it, we’ve got Matthew [Lukwiya] to thank. By the time we got here, he was already mobilizing the community and building a containment operation, and that gave us a head start we haven’t had in other outbreaks.”
Looking back, Ryan says he’s amazed by Lukwiya’s instincts: “Ebola isn’t the first thing you’d think about here; it’s not even the 10th thing. But Matthew put two and two together—and he got shite for an answer. Had he not taken action when he did, I don’t know what would have happened.”
By all accounts, though, the first few days were shambolic. When Ryan arrived, he found Gulu in the grip of panic. Immediately, he began coordinating the multi-agency, multilingual war against the virus, cracking jokes and chain-smoking cigarettes, winning the confidence and support of local health officials and military personnel. “We needed to train, to get equipment, to get people off 24-hour shifts,” he says. “We stopped all IV interventions and cut down admissions to only the most life threatening. We needed to get simple things right, like standardizing disinfectant mixes and training people to use the protective gear.”
Ryan orders another round. “When we arrived,” he says, “there were bodies piling up at the morgue. It’s an old brick building that sits in the middle of a field on the outskirts of town, like something out of a 19th-century horror story.”
Once an isolation graveyard was established, several military personnel were assigned the grim, dangerous task of burying the highly contagious bodies.
“The first guys,” says Simon Mardel, “when they saw us coming with the bodies, they ran away. We were yelling ‘Hey, at least leave your shovels!’”
“They were terrified,” says Ryan. “They were convinced they’d get Ebola if they got anywhere within an arse’s roar of the virus. Simon and I realized that we couldn’t expect them to do it if we weren’t willing to do it ourselves. So we suited up and jumped in with the shovels. We were trying to joke with the fellows—saying things like, ‘Hey, you just volunteered for the graveyard shift’—but they were pretty grim at first. I’m sure there were sphincter problems because I had a few myself. But in the end, they became the Olympic burial team; we wouldn’t have had a prayer without them.”

The next day, Mardel joins Lukwiya for rounds in the Lacor isolation ward. The two play a “good cop, bad cop” routine as they urge the more coherent patients to drink their oral rehydrating fluid. Among the most serious cases are several nurses. Despite efforts to improve staff safety procedures and reduce fatigue, Lacor’s nurses continue to get infected. But Mardel has a plan, and he tries to convince Lukwiya to buy into it.
“From now on, how about if we have the mobile teams bring all the new cases from the community to Gulu Hospital, to give your people a rest? We could still treat existing patients at Lacor, until they die or recover, and let self-referrals choose their hospital. That way we keep all avenues of admission open.”
Lukwiya says he’ll consider it, but the following morning dawns with more bad news. Two nurses and a nun have died during the night, and the surviving nurses walk out in frustration, grief, and terror. They assemble in a meeting hall and send for Lukwiya.
Lukwiya is calm and resolute as he walks into the room.
Born in a mud hut near Gulu, Lukwiya had attended medical school on scholarship, and as a highly honored graduate of the Liverpool School of Tropical Medicine, he was expected to embark on a life of comfort abroad—as some 70 percent of Ugandan medical school graduates do. But Lukwiya turned down a job offer in England and headed home to practice hardscrabble medicine among his own Acholi people.
For the past 17 years, he has been the stabilizing force at Lacor, the gentle but unyielding leader who refused to let a civil war, a lack of resources, or anything else get in the way of helping his patients. A few years ago, on Good Friday, a band of rebels came to the hospital to take nurses as hostages. Lukwiya stepped forward and persuaded the guerrillas to take him instead. He spent a week on the move with them, treating their wounded soldiers, before they let him go.
Lukwiya tells the nurses of the plan to shift the bulk of the isolation work to Gulu Hospital, and of his efforts to convince the government to provide hardship pay and compensation to the families of fallen nurses. He reemphasizes the need for full vigilance and adherence to the barrier-nursing techniques, especially at night, when tired workers are more likely to let down their guard.
“Those who want to leave, can leave,” he says, finally. “As for me, I will not betray my profession.”
Lukwiya’s words and the afternoon funerals, which take place in a downpour with lots of singing and praying, have a calming effect. The nurses return to work.

Lukwiya has seen more than a hundred Ebola patients, but none have developed the relatively rare hemorrhagic form of Ebola. Unfortunately, one of his nurses, 32-year-old Simon Ojok, is the first. Sanchez, who had begun to think that the stories of spectacular bleeding were “a bunch of crap,” now sees it with his own eyes.
Ojok’s condition deteriorates quickly, and in the middle of the night he starts thrashing in his bed, pulling off his oxygen mask and spraying bright-red, oxygen-saturated blood all around him. He stumbles out of bed, and as night-shift nurse Stanley Babu pleads with him to stay put, Ojok walks out of the room, tearing away from his IV tube. Agitated and mumbling, Ojok stands in the hallway, coughing infectious blood and mucous onto the walls and floor. Terrified, Babu runs to Lukwiya’s quarters and wakes him.
“Blood is pouring from his eyes and nose like tap water,” Babu tells Lukwiya. “He is confused, fighting death. We are afraid to take him back to bed because he seems violent.”
Lukwiya sprints across the compound and hurries into the dressing room. He can hear the commotion through the wall as he pulls on his gown, his boots, his apron. Then his mask, his cap, his two pairs of gloves. He does not put on his goggles.
When Lukwiya enters the room, Ojok has stumbled back into bed and is gasping for breath, wrapped in his blood-soaked gown and sheets. Lukwiya props him up to help him breathe, and changes his gown and bedding. Just past dawn, as Lukwiya is mopping the floor, Ojok passes away.

A few days later, Lukwiya sends for Rollin and Sanchez. Could they please come to his office—and could they bring their blood-sampling gear?
When they arrive, Lukwiya is calm. “I’ve developed a fever,” he says. Rollin tells him that it’s probably just the flu or malaria, nothing to worry about.
Rollin draws the blood, then heads to the lab, where he changes into a respirator suit with a battery-powered filter unit. He centrifuges the blood and generates a master plate, then dispenses a measured amount of the sample into the dimpled well of the plate. Pausing often to wipe the sweat from his face with the inside of his cloth hood, he deposits and rinses the various ingredients—among them are mouse and rabbit antibodies, horseradish peroxidase, and skim milk—in a strict order. Finally, some five hours after he began, he positions the pipette tip over the sample well and adds the final reagent, the telltale chemical that will turn green if the sample contains Ebola. The mixture doesn’t turn green.
“Tony, he’s negative,” Rollin says. There’s no sign of Ebola.
That night, Lukwiya vomits and develops a headache. When Rollin draws blood the next morning, Lukwiya’s eyes have gone a ghostly gray. This time, the reagent turns a weak green.
OK, Rollin thinks, there’s a 50 percent chance that he’ll make it. The viral count is still low. Maybe he’ll develop a mild case.
But the next day, the test goes a solid green, and Lukwiya asks to be taken to the isolation ward. “If I die,” he tells the hospital’s administrator, Bruno Corrado, on the way in, “I only pray that I am the last.”
He requests that his wife, Margaret, be told only that he has a fever, and that she should not come up from Kampala. She comes anyway, of course, not letting herself imagine where she will be led when she walks through the hospital’s front gate. Then it’s as if she has practiced walking toward the building covered in plastic, practiced suiting up, practiced being strong and cheerful as she enters the ward to see her husband, dying of Ebola.
“Look here, Margaret,” Lukwiya says when he sees her. “It is dangerous in here. Don’t even come in.” Then: “If you must come in, please stay for just one minute.”
Wearing protective clothing, Margaret Lukwiya sees him twice a day for the next two days, unable to embrace or even touch him. Once, she breaks down.
“If you cry,” Lukwiya says, “you’ll rub your face, which won’t be safe. Cool down, Margaret—and stand firm. Keep praying.”
Mardel and Dr. Yoti Zabulon team up to treat him, experimenting with aggressive interventions. As Lukwiya’s breathing becomes more and more labored, they decide to artificially ventilate him.
His pulse returns to near normal and his fever comes down. A second round of chest x-rays looks better, and hospital administrators announce that his condition has begun to improve. But later that night, he hemorrhages into his airway, and the doctors realize that what is happening to their friend is beyond their power to arrest, or even influence.
“Now, there’s nothing more anyone can do,” Ryan says. “Except say good-bye.”
On December 5, at 1:20 a.m., Matthew Lukwiya, who fought so hard to keep the statistics down, joins the numbers himself, the 156th recorded victim of the outbreak.
The next afternoon, he is buried—in a tightly sealed coffin, with pallbearers wearing head-to-toe protective gear—in the shade beneath a mango tree in the Lacor Hospital courtyard.
“I don’t think he would regret this,” Margaret Lukwiya says at the Memorial Service. “He knew the risk. He saw what was needed for his patients and he did it. That was him. Matthew was not for worldly desires.”
Sadly, Corrado, Lacor’s administrator, sees Lukwiya’s death as a symbol of defeat—a defeat made more painful by the hospital’s initial success in containing the outbreak’s first wave. “We all wanted Matthew to survive, not only because he was our colleague and friend but as living proof that this disease could be defeated,” Corrado says. “We wanted to be able to declare that we fought against this thing together, and we won. But this is not the case. We did not defeat it.”

Yet, by the time of Lukwiya’s death, the epidemic was on the wane, largely due to his efforts during the first days of the outbreak. After a brief flare-up, admissions slowed to just a handful each day, all of whom were now directed to Gulu Hospital. And although several workers temporarily left as a result of his death, the majority stayed on, inspired by his dedication. True to his hopes, Lukwiya was the last of the hospital staff to die.
On January 23, Uganda’s last known Ebola patient was discharged, and Ebola retreated back to nature, taking its secrets—among them, when it will come again—along with it. The international team scattered back to families and routines, in Geneva, Tokyo, Johannesburg.
In Atlanta, months later, Gulu already seems to Tony Sanchez like another life in another universe, a place that exists in flashes of memory and unaccountable longings—for that place where he dealt with things as they were, not as he wished they were; where he felt at once close to death, and unimaginably alive. Sometimes, the place comes back in dreams, images piled one atop the other. In one, he is in the isolation ward, treating a terrified little girl not much older than his own little girl (whom he was afraid to touch for a few days after he returned). In the dream, sometimes, one becomes the other, and he’s helpless—he can’t soothe her with his touch, and he can’t save her life.
But there are good memories too. One night at the Acholi Inn, as bats swooped overhead, Mike Ryan held forth on one subject after another, a font of vinegar and piss. The waitress came out and scolded him for leaning back in his chair, and he apologized. Then he settled back onto all fours, and requested another round of Nile Specials.
“Ah, the source of the Nile,” he said when she returned. And he smiled mischievously, and rocked back in the chair again, unthinkingly. And she smiled back, and said nothing.
A few minutes later, Mardel and Roth said goodnight, and Ryan leaned back with his hands clasped behind his neck, and let out a big sigh. “What a bloody ride this is,” he said, looking up into the dark foliage overhead.
Like the woman and her exorcist, like the witch doctors in the villages and all the churchgoers in Gulu, like the doctors and nurses and virus hunters, Ryan imagined that there might be answers up there. But until somone manages to coax those answers out of the darkness, Ryan and the others will be there to stanch the blood.
The truth is, you can’t always slay the dragon. But sometimes, if you manage to keep your boot down on his neck long enough, you can quiet him.
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