At a morning meeting in early September 2022, as department heads at Mubende Regional Referral Hospital in central Uganda reported out, it became clear that something was very wrong. Patients from each unit were showing up with similar symptoms: high fever, convulsions, diarrhea and blood-stained vomit. And all of the patients were from the same location.
A surveillance team of 12 from the Ministry of Health (MOH) was sent to the area to gather more information. There, the team discovered that seven people had died showing the same symptoms as those at the hospital. They collected samples that were transported to the Uganda Virus Research Institute in Entebbe for testing, more than a three-hour drive from Mubende Regional Referral Hospital. The samples tested positive for Ebola virus disease.
On September 23, 2022, the government officially declared an outbreak of Ebola virus disease in Mubende District. The district would be the initial epicenter of this outbreak, the first Ebola outbreak the country had seen in a decade.
In the thick of the storm: Quick actions and steps taken
Swift action followed. The MOH set up a coordination center at Mubende Regional Referral Hospital, reassigned medical teams to the hospital and immediately issued personal protective equipment, handwashing stations, medicines and supplies. Mubende town was locked down.
Nurse Halima Adam was working at the accidents and emergencies unit when she was moved to the Ebola treatment unit (ETU), a temporary canvas structure set up within the Mubende Regional Referral Hospital compound. “As soon as the outbreak was declared, I called in six nurses to work fully at the ETU. A duty roster was made, and we coordinated procurement of medical items,” she said.
By the second day, eight patients presenting with Ebola symptoms were isolated at the ETU.
One evening as her shift ended, Juliet Nayiga, a laboratory technician at the hospital, was called to collect blood samples from the patients in the ETU, a daunting task under the circumstances. “I remember it was dark and the lights had not been set up at the ETU. I was panicking. With minimal protective gear and a torchlight, I went in and took samples,” says Juliet.
Out of the eight patients in the ETU, six tested positive for Ebola.
Prepared and equipped: Galvanizing the team to weather the storm
Back at the ETU, Halima’s team had grown to 30 nurses—providing supportive care to patients around the clock.
“Partners such as the World Health Organization and Jhpiego stepped in to help us. We created storage areas for the personal protective equipment and handwashing items. We learned how to set up the red and green zones to manage and treat confirmed cases,” Halima said.
Hospital staff later joined emergency medical teams and responders from various regions at a training conducted by the MOH, Doctors Without Borders, World Health Organization (WHO), UNICEF and Jhpiego to strengthen the skills of health workers. Halima lauded the importance of the training, saying: “It equipped us with skills in site layout, triaging, emergency care and management, donning and doffing, sanitation and hygiene procedures.”
Jhpiego provided the technical component of the training on infection prevention and control and coordinated with the MOH to identify the responders who had previously been trained by WHO during the COVID-19 crisis. Jhpiego-trained staff were part of the responders seconded to the national incident management team, which was responsible for oversight during the Ebola outbreak, as pillar administrators to cover logistics, surveillance, risk communication, laboratory work, strategic information research and innovation.
A total of 168 health workers were identified from three regional hospitals—Mubende, Gulu and Naguru—to be part of the training on infection prevention and control procedures, clinical care and psychosocial support. All affected districts enhanced their surveillance systems to ensure that all contacts would be identified, documented and followed up with for 21 days.
“It was tough at the beginning, but as time went by, it got better. Building on our previous experience from COVID-19 and the training by WHO, infection prevention and control processes became easier,” Halima said.
Uganda had a total of 164 Ebola patients in nine districts (142 confirmed cases and 22 probable), with 55 confirmed deaths. Mubende District reported the highest numbers, with 64 confirmed cases and 29 deaths due to Ebola virus disease. The last confirmed case was reported on November 14—exactly 56 days after the first confirmed case.
Calm after the storm
“Working as a team—the health care workers at the hospital, MOH and partners—was a critical aspect that contributed to managing the Ebola outbreak in Uganda,” says Deogratius Kamulegeya, Jhpiego’s technical officer in Uganda and part of the Mubende response team.
“Today, Jhpiego is working with the MOH through the Enhancing Global Health Security project, funded by the U.S. Centers for Disease Control and Prevention, to develop an outbreak management support manual and set up a central data warehouse for all surveillance data for epidemic intelligence to support quick detection of outbreaks in Uganda,” said Peter Muwereza, Jhpiego’s Program Manager for the Enhancing Global Health Security project in Uganda.
To this end, Jhpiego seconded six staff members to the MOH and is supporting the MOH and other implementing partners to develop tools such as data visualization and analytics, ensuring operationalization of the data warehouse and integrating data with the electronic medical records system.
Reflecting on the outbreak, Halima said: “I would have left when it got worse. But I stayed because of my experience working in the emergency unit for 11 years and responding to COVID-19. We admitted 64 patients and I had 30 nurses looking up to me. I mastered the courage to stay on because we were prepared and equipped to respond.”
Joan Nduta is Jhpiego’s Senior Communications Manager, Africa Region. Alisha Horowitz is a Senior Editor for Jhpiego. Josephine Watuulo, Knowledge Management Coordinator for Jhpiego Uganda, contributed to this story. Photo by Peter Caton for Jhpiego.
Aleisha Rosario, Director of the Enhancing Global Health Security project, provided a technical review of this story.
