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Health teams face real-life horror in Ebola battle

Isaac Kasamani / AFP - Getty Images

Officials from the World Health Organization wear protective clothing on July 28 as they prepare to enter Kagadi Hospital in Kibaale District, Uganda.

When officials in Uganda verified an outbreak of the Ebola virus on Saturday, it set international health workers in motion.

The hemorrhagic virus is the stuff of real-life horror — spreading through contact with infected individuals, their bodily fluids and even clothing they have worn. In many cases Ebola leads to a rapid decline marked by fever, diarrhea, vomiting and internal and external bleeding.

In the few days since it was reported, medical teams from in and outside Uganda have descended on the source of the outbreak in western Uganda, Kibaale district, where so far, there have been 38 confirmed cases of Ebola (formally Ebola hemorrhagic fever) and 16 deaths, according to the U.S. Centers for Disease Control and Prevention.

The bible for containing Ebola — and similar contagious viruses — is a 200-page guide to detection, isolation and sanitation procedures developed by international health officials and groups after the 1995 outbreak in the Democratic Republic of Congo. In that case, due to belated reporting, and the absence of precautions, more than 300 people contracted the disease, and about 80 percent of them died.

Among the groups scrambling to put these protocols in place are the U.S. Centers for Disease Control, Uganda Red Cross, World Health Organization and Doctors without Borders (Medecins Sans Frontieres), an international emergency aid group.

"Ebola is not completely unknown but it’s not like malaria which (they) see every day,” said Henry Gray, who is with a team from Doctors without Borders that arrived Monday night in Kigadi, the town about 100 miles west of Kampala where the first cases emerged. "When something like Ebola happens, it rarely hits the same place twice, so there’s normally a learning curve" for local personnel.

One third of the 100-bed Kigadi Hospital has been designated an isolation unit for Ebola infected cases, with a physical barrier restricting access to non-Ebola patients in the hospital, said Gray.

Within the isolated side, "there’s one area for people under observation, and another for people confirmed (with Ebola). There are other areas where there’s a pharmacy, an area where people get dressed and undressed from protective equipment."

When there is no space in the building to accommodate a given need, the team puts up tents in the courtyard, also part of the isolation zone.

Augustin Morales/MSF

A team from Doctors Without Borders are among those who have launched an emergency intervention against an Eboloa outbreak. Workers are shown at Kagadi Hospital in Western Uganda.

"The whole of the isolation zone has a risk attached — both low risk and high risk," said Gray. "High risk we don’t go in without full gear — that is not a millimeter square of skin showing so there’s no risk of being splattered by blood or fluids or whatever."

One of the priorities is to protect and support local medical staff who are frightened. In this outbreak, as in others, some of the first fatalities were two medical personnel who contracted the virus from patients before it had been identified as Ebola.

"One way to make sure we are supporting them is to put procedures in place. Once they are set we really minimize the risk," said Gray, an engineer. "That, for me, is a way for us to deal with it — to be really, really strict in that."

In coming days, Doctors without Borders will also be providing psychosocial support to help medical workers and patients cope with the crisis, and the fear it engenders. They have worked out safety procedures for counsellors working with patients who are in isolation, and cared for by people in hazmat suits.

"People are frightened," said Gray. "The poor people who catch it are in completely unfamiliar surroundings and don’t know what is going on."

One of the first priorities is to set up isolation units, sanitation procedures and safety gear to prevent the spread of Ebola from patients outside the hospital, and to protect care givers.

Doctors without Borders and others also provide psychosocial support, including psychologists to work with doctors and patients, as well as family and contacts of those infected.

So far, Doctors without Borders has a team of 22 expatriate and local staff in Kigadi, working alongside local hospital and health ministry workers, reinforcements from the capital Kampala, and other international groups.

Gray said the size of the team was expected to double, and could shift from setting up detection and treatment systems, to community education and outreach depending on how the situation develops.

Ugandan President Yoweri Museveni advised people to avoid shaking hands and promiscuity to reduce the chance of contracting the Ebola virus after a deadly outbreak. NBCNews.com's Dara Brown reports.

Ebola virus is fatal for anywhere from 20 percent to 90 percent of those infected, depending on the strain. This outbreak is Ebola-Sudan strain, which causes death in up to 70 percent of those infected, according to the CDC.

There’s no known cure for Ebola, but patients are treated for symptoms including vomiting, diarrhea and dehydration, and some survive.

It remains unclear to what extent the outbreak had been contained.

News that one victim of the virus had died in Kampala caused a flurry of panic in the capital city. But the World Health Organization said on Tuesday that the patient had been transferred to Kampala from Kibaale and no infections had occurred outside Kibaale district.

"The first case appears to have been a 3-month-old girl whose mother was also sick. When the girl passed away, her family tried to find out what she had died from but couldn’t find the answer — though there were rumors of witchcraft and magic," according to Olimpia de la Rosa, emergency coordinator for Doctors without Borders, cited in a news release.

Fifteen of the 65 people who attended the baby’s funeral became sick, and 11 of them have since died, she said.

The aid effort was ramping up to grapple with a potential influx of patients.

In a national address this week, Ugandan President Yoweri Museveni advised people to avoid shaking hands, casual sex and do-it-yourself burials to reduce the risk of spreading disease, Reuters reported.

"Fears of catching Ebola have twisted people's lives," Tumusiime Jamilo, a reporter at a local radio station told Reuters. "They can't go to the markets to buy things, (others can't) sell their products and that's hitting their pockets."

People also didn't feel free to travel or go to churches and mosques because of worries about the virus, the report said.

The World Health Organization did not recommend any travel or trade restrictions be applied to Uganda because of the outbreak.

It urged avoiding contact with dead animals, especially primates, and refraining from eating wild game or "bushmeat" — which is believed to be one source of the virus.

By chance, Secretary of State Hillary Clinton arrived in Kampala on Thursday where she was expected to stay one night on an 11-day diplomatic tour of seven African nations.

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