Doctor Loses Life to Ebola in Outbreak

Dec. 11, 2007 — -- According to reports by the Associated Press, the Ebola outbreak in Uganda's Bundibugyo District had claimed 29 lives as of Monday. An additional 113 people are suspected to have fallen ill with the disease.

Today, fears remain that the outbreak could mushroom into a major epidemic affecting the capital Kampala.

It seems that the only thing that has spread faster than the virus itself is fear of infection. The AP reports that banks and supermarkets in the capital city issued their staff with protective rubber gloves for handling money they feared could be contaminated with the virus, which often causes victims to bleed to death through their ears, eyes and other orifices.

With the exception of one case, all who have been infected so far have died in Bundibugyo district.

The sole exception is Dr. Jonah Kule, who after treating infected patients died soon afterwards in a Kampala hospital. His story, relayed through doctors who are now held under quarantine within the district, is told below by ABC News contributor Dr. John Spangler.

***

"Dr. Jonah Kule died this evening, Tuesday 4 December, at Mulago Hospital [of Ebola hemorrhagic fever] ...

"Ebola is horrific. There are no words to express our grief. And this makes the whole epidemic even more frightening, if that were possible."

So writes Dr. Jennifer Myhre, a medical missionary, who, along with her husband, Dr. Scott Myhre, has lived in Bundibugyo District in remote western Uganda for 14 years serving the poorest of the poor.

"We have lost one of our best friends," she continues.

The Myhres -- Scott, a family physician, and Jennifer, a pediatrician, knew Kule since they began work in this virtually unknown corner of the world.

Bundibugyo is a place that rarely makes the news -- that is until a week ago when the deadly Ebola virus erupted with vengeance into a ghastly epidemic.

Native to Africa, Ebola is not well known in the United States. But in central and eastern parts of Africa, where it periodically explodes into fatal, bloody outbreaks, the mere mention of the word sparks dread and panic.

The Horror of Ebola

According to the Centers for Disease Control and Prevention (CDC), Ebola hemorrhagic fever (Ebola HF) is a relentless, frequently lethal disease in humans, gorillas, monkeys and other nonhuman primates. It has appeared sporadically since its initial recognition in 1976.

Scientists conjecture that outbreaks initially occur by exposure of humans to infected animals. Symptoms include fever, vomiting, diarrhea and, commonly, bleeding from all body orifices. Patients usually die of shock or respiratory failure, likely as a result of massive bleeding, including bleeding into the lungs.

Epidemics spread through contact with the blood or body fluids of the ill.

Kule, who grew up in Bundibugyo, had recently returned to this deprived rural district after completing medical school in the capital city of Kampala.

Kule passed up lucrative career opportunities in Kampala and other large Ugandan cities to work among his tribesmen in a place where few Ugandan doctors venture, and even then, venture only when assigned as part of government service.

Kule was one of the few from Bundibugyo to ever attend medical school.

"He refused to charge patients extra fees for his services, even though that is widely practiced in government hospitals," writes Jennifer Myhre. "He was completely trustworthy with his responsibilities and resources.

"He [believed] that God was the one who provided his opportunities," she continues. "A person who stands against corruption meets obstacles here. He struggled. But we always thought he would eventually prevail."

He did not. In treating the poor he came to serve, he died a horrible death.

"I have seen [Ebola] patients die, and I know that I am dying," he said the morning of his death.

According to Myhre, moments before he died he said, "I am going to die now. And I pray that no one should ever have to die of this disease again."

At the End of the Road, a Killer

The road, such as it is, ends in Bundibugyo. You cannot travel farther without leaving Uganda and crossing into the Congo.

Winding through the steep terrain, one descends from Fort Portal to Bundibugyo, Uganda, passing through spectacularly beautiful jungle and savannah, with views to the west of the snow-capped equatorial Rwenzori mountains.

Margherita Peak towers in the misty distance at 16,795 feet; it is the third highest peak in Africa after mounts Kilimanjaro and Kenya. In the Semliki Valley below, hot springs attract tourists, lured here by the beauty of the incredibly rare and varied topography.

This is where Sir Henry Morton Stanley found Dr. David Livingstone in 1889, purportedly uttering the words, "Dr. Livingstone, I presume." Stanley was the first European to discover this mountain range, which he dubbed "mountains of the moon."

Along the Bundibugyo road, perched on the steep Rwenzori slopes, lies the village of Kikyo.

"This epidemic began in Kikyo, which is about 14 kilometers from Bundibugyo town and above the Semiliki National Forest and hot springs," noted Dr. Scott Myhre. "There has been confirmation that the first family afflicted were hunters who ate a monkey."

Kule was the first to investigate this Ebola outbreak sometime in October. There had been rumors of a mysterious illness with fever, abdominal pain, vomiting, diarrhea, and, inexplicably, rapid death.

"I remember well the day he [Kule] came into the pediatric ward and told us about it," Jennifer Myhre continued. "I gave him gloves and my bottle of alcohol hand gel -- pitifully inadequate measures [as I look back on it] now."

In the beginning, the Myhres suspected a cholera outbreak. Kule promptly planned an excursion to learn more.

"I remember him slinging his backpack on, and getting on his motorcycle, saying 'If I die, I die,'" she writes.

Kule returned to Bundibugyo later that day. "He guessed typhoid fever, due to the prominent abdominal pain and even what seemed to be two cases with intestinal perforation," Jennifer Myhre writes.

He held community meetings to emphasize hygiene, and dispelled rumors of witchcraft or poison.

Ominously, back in Bundibugyo, Kule cared for an older gentleman who had also recently returned from Kikyo, having visited many of the sick there. Within a week, this gentleman died. Ebola still was not yet suspected.

On Nov. 29, results of blood samples that had been sent to the CDC in Atlanta came back.

"It was a bombshell -- Ebola, a new strain," remembered Jennifer Myhre.

The finding made international news immediately. Concerned, the Myrhes called Kule in Kampala where he had traveled to attend to personal business.

"That [Thursday on which] we talked to Jonah, he had a headache he said, maybe early malaria, he'd watch," recalled Jennifer Myhre. "By Friday morning he found it prudent to admit himself to Mulago hospital. That was his last act of bravery and wisdom. We talked on the phone [Friday and] he sounded so normal, so himself."

From Friday through the weekend, things seemed hopeful for Kule. He was walking and talking.

But his urine output was diminishing, and malaria seemed less and less likely.

"Still, Jonah was a strong man, healthy, smart," Myhre said she thought at the time. "He was in the country's main hospital, not out here in Bundibugyo. He was getting lab tests. He had a team of doctors, including [Doctors without Borders from Spain]. We had hope.

"Then suddenly [Tuesday] night they called back. He had died. Maybe there was bleeding, involving his kidneys and lungs..."

She trails off, not knowing how to complete the story.

"To my surprise, the Bundibugyo Ebola epidemic is not what I imagined Ebola would look like," writes Scott Myhre. "I imagined blood oozing from every orifice. A sort of melting or gelatinizing of the human body. The reality is a much more nonspecific 'viral syndrome': fever, vomiting and diarrhea, [although] we are seeing bleeding symptoms (blood in the urine, vomit, or stool) in about one-quarter of patients."

According to the Myhres, at the time they wrote their correspondence the cumulative count of infected in the district was 93, and the death count was 21.

Continuing the Fight

Scott Myhre, along with Doctors without Borders, continues to see patients at Bundibugyo Hospital.

"The protocol now to see a patient involves changing into surgical scrubs in a clean changing area and then donning the hot zone suit (every centimeter of skin covered plus goggles). You are sprayed with chlorine solution after emerging," he writes.

Still, the stark, understaffed hospital remains nearly empty except for those with Ebola, out of fear of contact with the disease.

One of the main concerns now is contact with the dead bodies, discovered to be a risk factor for acquiring Ebola during this epidemic. A few brave health care workers soldier on, placing themselves at risk to care for their sick compatriots.

"On average," Scott Myhre explained, "the incubation period for Ebola is between five and 10 days, the duration of symptoms is two to three weeks, and if the patient dies, the time between onset of symptoms and death is about a week."

The Myhres are forbidden to leave the Bundibugyo District until a symptom-free three-week interval has passed since their last contact with a known case.

Their children, and their missionary colleagues, left earlier this week. Jennifer Myhre has been prohibited by World Harvest Mission, for whom the Myhres work, from seeing patients so that she may reunite with her children as soon as her three weeks are up.

But to the Myhres, this story is clearly not about themselves.

It is about Dr. Jonah Kule.

"Tomorrow his body will arrive," writes Jennifer Myhre, "having been carefully decontaminated (as far as possible) and enclosed. Whenever we speak of him again to someone who cared about him, the tears come freely. We have seen some men here cry like we never saw men cry before.

"I think Jonah was perceived as a resource, a gift, to the whole district," she continues.

"Everyone feels bereaved and robbed of their man, their doctor, the one they could trust and count on. When we see his family, we will have the complication that they are now [Ebola] contacts, too like we are, and we should not be touching each other. So we have to go to the burial of our dear friend without any hugging, comfort his wife and children without touch.

"That feels harsh."

Dr. John Spangler is a professor of family medicine at Wake Forest University School of Medicine.

Associated Press reports contributed to this story.