A general in the war against Ebola

“I remember the feeling I had when I first heard about Ebola. We didn't know what it was, but the fear crept up on us. Then my colleagues began to die,” says Samuel Okware, a recent PhD graduate at the University of Bergen.

Doctor Samuel Okware, PhD graduate January 2015 from the Centre for International Health at the University of Bergen.
FIGHTING HIV AND EBOLA: Dr. Samuel Okware (born 1948) is a doctor and public health specialist with 30 years’ experience of leading infection control work for the ministry of health in Uganda. He was involved in early ground-breaking work on HIV prevention in Uganda. He also coordinated the national response to Ebola.

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Even now, the 67-year old doctor Samuel Okware’s memory when it comes to his first encounter with Ebola is vivid. For more than 30 years, he has been fighting death and disease in his home country of Uganda. When the main enemies are invisible viruses and the battlefield is clouded by a lack of knowledge, too few resources and rumours and superstition, this is no easy job for any doctor.

“We have to act quickly when an Ebola outbreak comes,” says Samuel Okware. He has received several national and international awards for his contribution to the prevention of HIV and the control of Ebola outbreaks.

In January 2015, he got his PhD at the Centre for International Health the University of Bergen (UiB). In his thesis, he studied how the fight against Ebola includes more and more knowledge about the virus and how best to combat it.


Leading in the work on Ebola

Ebola. Often fatal, infects quickly, no vaccine, no effective treatment. Heavy bleeding from bodily orifices, high fever, pain and intense lethargy. This is Ebola in a nutshell.

The fearful illness called Ebola was first discovered in 1976, since when it has triggered a number of deadly epidemics in Africa. Last year, more than 20,000 people in West Africa were infected, and more than 8,000 of them died.

When Ebola came to Uganda in 2000, Okware was working at Uganda’s ministry of health as head of his country's AIDS programme. He was a valued public health specialist who had been involved in early ground-breaking work on HIV prevention in Uganda.

“When we heard of the first cases of Ebola, I was tasked with leading and coordinating the work of preventing the spread of the disease,” explains Samuel.

“We have had five outbreaks of Ebola in Uganda since 2000. With the exception of the outbreak in the town of Bundibugoy in 2007, which involved a new type of Ebola virus, we have managed to get the situation under control within a couple of weeks.”

With his massive experience in the field, Samuel Okware is clear about what is most important in the fight against Ebola: early diagnosis and rapid intervention. And good leadership.

“This also applies to local leaders in the districts that are affected. These are the ones who are responsible for mobilising health personnel, tracing sources of infection, organising isolation, sharing knowledge and supporting special burial teams,” says the doctor.

Burying those who have died of Ebola is actually one of the most common ways of becoming infected. Direct physical contact with a corpse is particularly dangerous. During the final hours before an Ebola patient dies, the virus becomes extremely active and the risk of infection from the dead body is much higher. The normal burial ritual in these communities is that people wash and touch the body of the deceased, to show love and respect. But this means that a final farewell to a loved one can make you ill yourself.


The epidemic of fear

According to Okware, when the Ebola virus spreads, a parallel epidemic is created. This could be described as an epidemic of fear.

“When you have insufficient capacity to begin with, in terms of health personnel, protective clothing, isolation and other equipment, the spread of fear, rumour and superstition becomes especially dangerous. People need to be assured that the right measures are being taken, or they begin to believe the rumours, not the vital facts,” says Okware.

“What we did was to work closely with the media, so as to make important facts and information known. Our approach was an open and transparent dialogue with the public. In this way, panic among the people can be avoided. Nobody works well in a pressured situation if they are surrounded by rumours and superstition instead of hard facts.”

Media the world over had a massive focus on Ebola last year. For Okware, a one-sided media focus is a two-edged sword.

“Ebola is scary, of course it is. But it is easy to lose sight of the big picture when the media coverage is so intense and so one-sided. Ebola is not just a relatively new disease for poor countries to cope with, it comes on top of other public health problems,” he says.

“You could say that up until 2013, Ebola was not the biggest health issue we had in Africa. There had been 25 outbreaks and about 2,000 patients in total. The outbreak we see now in West Africa with 8,800 dead, on the other hand, is quite obviously a big problem. And the resources have been taken from other places, such as from work to fight malaria – a common disease that can be cured. Or be fatal. Initiatives to help with family planning and reduce poverty were affected.”

He pauses.
“So the media can really help if they go for open, factual coverage. We did what we could to use the media in the best possible way.”


Ebola in the future

Samuel Okware's work has brought him many national and international awards for his contribution to the prevention of HIV and the control of Ebola outbreaks.

“We must do our best to replace desperation and the feeling of hopelessness with hope, confidence and greater knowledge. We must act quickly when an Ebola outbreak comes and local leaders must have more resources and competence. And we must stop telling people that Ebola is a death sentence, because good treatment can save lives and give people fresh hope and motivation to contact the health services if they are infected,” says Samuel Okware.

“It was the local communities in Uganda that made the difference in limiting the epidemic, and local communities throughout West Africa must be involved in the same way, so that they can protect themselves and their people.”