When the cost of love is death

THREE YEARS AGO this month, Dr. Matthew Lukwiya died of Ebola at a hospital in Northern Uganda. The doctor who had led a fight against the virus became one of its victims. He was one of a number of medical heroes who have given their lives struggling against deadly illnesses.
In September 2000, five hospital staff at Saint Mary’s Hospital of Lacor in Gulu died of a mysterious illness. Suspecting it might be Ebola, Dr. Matthew Lukwiya, the hospital’s most senior doctor, took a four-hour drive south to Kampala, Uganda’s capital, to raise the alarm and have blood samples tested. By the time the virus was confirmed, he was already back at Saint Mary’s setting up an isolation ward which earned the praise of world experts arriving days later.
Lukwiya was born in Northern Uganda in 1957 and studied medicine, first in Uganda and then in England. At the end of a course in Tropical Paediatrics at Liverpool he was invited to join the teaching staff. This would have ensured him a brilliant career as a world expert, but he preferred to accept a post back home in Gulu. During his 15 years at Saint Mary’s, many of them as medical superintendent, Gulu was ravaged by 12 years of conflict, refugee influxes and related epidemics of cholera, measles, malaria, meningitis and AIDS.

Cutting edge research

Dr Lukwiya chose to work there primarily because he wanted to provide care for his own people. Until the Ebola outbreak, he had focussed primarily on HIV infection, for the region had shockingly high infection rates, in contrast to other parts of Uganda that had successfully curbed HIV’s spread. In 1999, for instance, 35% of the outpatients at Saint Mary’s Hospital tested positive for HIV. “It’s very important to work in Gulu because when AIDS research started, researchers all centred on Kampala,” said Lukwiya. In 1996, he had established a long-term research collaboration at Saint Mary’s, studying immunologic responses to HIV with the University of Milan. With the Italian researchers, Lukwiya published cutting-edge papers examining HIV infection in Africa. He hoped that if the rich Northern countries understood the devastation that HIV and AIDS cause in places like Gulu, they would work harder to provide treatments. “People are dying,” he said. “They’re dying here day and night.”
When another deadly disease - Ebola - struck in the closing months of the millennium year, Lukwiya did not shirk the challenge. Nothing can be done to fight Ebola other than to contain its spread: there is no treatment, no cure. He praised his medical staff for not abandoning the hospital, but of course he too had opted to deal with the crisis himself rather than remain in Kampala. Ebola is an illness that hits remote areas in Africa from time to time, kills a few hundred victims, and then disappears. “It does not capture the public imagination, and so the business world is probably never going to invest many resources in research and treatment,” he told his staff. “But this is not my way of thinking” he continued. “However difficult it might be, we have to know more and do whatever we can to save lives”.

A call from God

During October and November 2000 two doctors and 15 nurses - all volunteers - nursed up to 70 Ebola patients at a time. Hospital staff fell ill and many were assisted to the end by Lukwiya. He was invited to speak at the funeral mass of Sister Pierina Asienzo, 45, of the Congregation of the Little Sisters of Mary Immaculate who had died of Ebola. He said: “Since the beginning of this epidemic, I have been reflecting and it has brought about a change in my life as regards the medical profession. We chose it at some point in our lives, maybe for the prestige it gives us, or because we want to save lives. Now I understand more deeply that it is a call from God. This service cannot be separated from the willingness to give one’s life.”
By early November, over 150 people had died, fifteen of them nurses and employees of the hospital. Lukwiya told Sister Dorina Tadiello, a Comboni sister, “When I go home in the evening, I do not dare to embrace my five children. I look at them from a distance. We are a few inches from death. The next one may be a doctor.” He was constantly on the front line. One day in mid-November an Ebola patient went berserk, vomiting blood and running around the room in fury. “Get out of here,” Lukwiya shouted to the nurses. He remained alone and had to resort to physical force to block the patient to his bed and sedate him. When he emerged from the room, his face was covered in blood. Sister Dorina later said that, “his words of a few days before came to my mind as sharp as a knife: ‘The next one may be a doctor’”. With tears streaming down her face, she handed him the result of his blood test a week later which confirmed that his high temperature was indeed the first symptom of Ebola. Ironically, this happened at a time when admissions had slowed to a handful and nearly half the patients were recovering.
Lukwiya immediately transferred to the isolation ward as a patient and his situation worsened rapidly. He was eventually put on a breathing machine under general anaesthetic, after first praying with his wife and mother and giving a final greeting to those closest to him on the Ebola ward. He never woke from that sleep. The 43-year-old doctor became the 156th recorded victim of that outbreak on 5 December 2000.
Saint Mary’s hospital took care of most of the 370 suspected victims in the region and Lukwiya is credited for keeping the death toll at a low 40% of victims. In previous outbreaks, 90% had died. During his funeral, near to the hospital, the pallbearers wore face-masks, latex gloves and surgical gowns - measures he himself had put in place.

Sacrifice

The sacrifice of Dr Matthew Lukwiya was mirrored earlier this year when, on 29 March 2003, the World Health Organisation (WHO) doctor who first identified SARS, the fast-spreading pneumonia that eventually killed more than 750 people worldwide, himself died of the disease. “Dr. Carlo Urbani, an expert on communicable diseases, died today of Severe Acute Respiratory Syndrome or SARS”, the Geneva-based UN health agency said in a statement.
The 46-year-old Italian, married with three children, was the first WHO official to identify the outbreak of this new disease in an American businessman who was in hospital in Vietnam. Urbani first saw the patient on 28 February, two days after he had been admitted to a hospital in the Vietnamese capital Hanoi. His early detection allowed global surveillance to start and slow the spread of the disease. Although Urbani had worn a mask, he lacked goggles and other protective clothing. He began demanding that Hanoi hospitals stock up on protective gear and tighten up infection control procedures. There were shortages of supplies, like disposable masks, gowns, gloves so containment was a mammoth task. Soon, the Vietnam-France Hospital was closed to all but infected health workers and those who cared for them. Those still on the job were joined by doctors and nurses from around the world. The danger didn’t deter Urbani and he remained at the hospital.
After three weeks of round-the-clock effort, Urbani’s supervisor urged him to take a few days off to attend a medical meeting in Bangkok, where he was to talk on childhood parasites. The day after he arrived, he began feeling ill with symptoms of the new disease. He called his wife, Giuliana, his childhood sweetheart, now living in Hanoi with their two sons of 17 and 8 years and a 3-year-old daughter. “Go back to Italy and take the children, because this will be the end for me,” he told her, according to his longtime colleague Nicoletta Dentico, Italy’s Director General of aid group Médecins Sans Frontières. Urbani died in Bangkok, having been in isolation since his arrival.
“Carlo Urbani’s death saddens us all deeply at WHO,” the UN agency’s Director-General Gro Harlem Brundtland said in the statement. “His life reminds us again of our true work in public health,” she added. As he was buried in Italy, the measures he helped put in place before his death helped Vietnam to control the SARS outbreak there.
Three years on from Dr. Matthew Lukwiya’s death, local people still gather at his grave near Saint Mary’s hospital - especially in the evenings - to sing and pray. His service to the community has not been forgotten. Dr. Carlo Urbani’s sacrifice was very publicly commemorated on Good Friday, 18 April, during the Way of the Cross in Rome led by the Pope John Paul II. As the 82-year-old pope presided at the candlelit service around the ruins of Rome’s ancient Colosseum and prayed for crucified peoples throughout the world, Urbani’s family carried the cross during part of the ceremony.