By Tom Clynes
On the Front Line of the Ebola Epidemic
Author’s note: With viral epidemics back in the news, I’m reposting this long-form feature article on the Ebola outbreak in Gulu, Uganda, which I reported with photographer Seamus Murphy for National Geographic Adventure. Dr. Mike Ryan, who co-led the international response to the Gulu outbreak, is now leading the World Health Organization (WHO) response to the coronavirus / COVID-19 pandemic.
When the old Czech prop-plane lurches to a halt at the side of the military airstrip, the six doctors unfurl their stiff legs, disembark, and begin unloading. They shift 47 boxes—a metric ton of laboratory gear—onto a truck and drive toward town, trailing a spiral of orange dust as they pass army checkpoints and outsized churches, roadside vendors and crowds of people listening to radios, talking, and singing.
The most surprising thing is how ordinary it all looks, at first. Set in the middle of a fertile, if unrelieved, savanna, Gulu could be any other East African provincial center. Everywhere, people are on the move, some pedaling bikes, others riding on the fringed rear seats of bicycle taxis, most just walking. They walk upright, with stone-straight posture, some carrying babies on their backs, some balancing loads on their heads, some bare-footed, others in sandals. They walk—and the doctors drive—past the field where the Pope once spoke, from atop two shipping containers still piled one atop the other; past the turnoff that leads to the witch doctor’s house; past another road that leads to a small village near the forest—the forest where, perhaps, it all started.
It takes a few minutes, as if the doctors’ eyes were getting used to a new light, before hints begin to emerge that life here is far from normal. There are none of the usual swarms of children in school uniforms. White trucks drive through town, emblazoned with the red crosses and acronyms—UN, WHO, MSF—that portend crisis. The hospital building, where the doctors pull up, is wrapped in white plastic sheeting. At the door, a hand-lettered sign warns “No entrance without permission.” The sign is illustrated with a crude human figure, with an X drawn over it.
Dr. Anthony Sanchez got the news on a Sunday afternoon in mid-October when he stopped by his lab at the Centers for Disease Control and Prevention, in Atlanta. Sanchez was surprised to find his boss, Pierre Rollin, in the office. Rollin told him that Ebola, after a four-year respite, had resurfaced in northern Uganda.
“Feel free to say no, Tony,” Rollin said. “But I’m putting together a team to go over and set up a lab; we could use you.”
Sanchez had a four-month-old daughter at home, his first. But the agency was already spread thin, with a team in Saudi Arabia covering a Rift Valley fever epidemic. An on-site laboratory could give the Ebola containment operation a tremendous advantage.
Sanchez, a low-key Texan, had spent much of his career researching the virus, often in the CDC’s maximum-containment lab, protected by a space suit. But he had never seen it operate in a human epidemic. Once, a few years ago, he had wondered if he had missed his chance, if the disease would ever come again.
Sanchez walked to his office and picked up the phone. He dialed his home number and told his wife that there was something he needed to talk about when he got home, something important. The line was silent for several long seconds, and then:
“I’m not going to be happy about this, am I?”
Five weeks into the crisis, a crowd of foreigners occupies a government office room in a yellow concrete-block building on the north side of Gulu. Doctors and scientists hunch over notebook computers and talk into walkie-talkies. Through the babble of languages and accents, an American voice speaks into a satellite telephone: “We’ve got more positives in Pabo now—we’ve got to get on top of this.”
After she hangs up the phone, I walk over and introduce myself to Cathy Roth, a World Health Organization physician who is, at the moment, coordinating the operation. When I extend my hand, she throws both of her hands over her head in a “don’t shoot!” gesture.
“Uh, we’re not actually doing that anymore,” Roth says, smiling down at my retreating hand. Ebola is spread through contact with bodily fluids, including sweat. And although it’s unlikely that either of us would be carrying the virus, people are avoiding handshakes like . . . well, like the plague.
A dozen or so exhausted-looking professionals trudge into the room for Roth’s afternoon update meeting. “Everyone’s getting really tired now,” she says. “We were thinking we had it under control, and I was thinking about giving the mobile teams a Sunday off. After five weeks of 24-7, they’re making mistakes, and they need rest.” But now Roth is worried that the illness is flaring up again, threatening to break through the containment operation.
In the past, Ebola had struck only rural areas, and the disease’s rapid death sequence had actually worked in favor of containment, since infected people couldn’t travel far before they toppled over. But the Gulu area is densely populated, with transport links to East Africa’s major cities—and, from there, to anywhere in the world. No one knows what might happen if the virus were given the chance to take advantage of these more favorable conditions.
CDC epidemiologist Scott Harper begins the meeting with bad news from Pabo, a refugee camp north of Gulu. “A woman came into the clinic last Sunday and miscarried, and there was a lot of hemorrhaging,” he says. “No one knew she was Ebola-positive, and she spent at least two days in the maternity ward, bleeding, before anyone noticed that her bleeding was rectal rather than vaginal.”
His colleague, Marta Guerra, picks up the story: “She had five women in the maternity ward with her, plus at least 15 visitors. Eleven nurses and other workers were exposed before they got her isolated. So far, we’ve taken blood from all but one.”
Roth pushes her hair behind her ears. “This thing has a potential to blow up into a huge problem,” she says.
The news from Pat Campbell isn’t much better. Campbell, an American physician with Doctors Without Borders, has just returned from Masindi, about a hundred miles to the south. Apparently, a woman traveled to Gulu and checked into the hospital with stomach trouble, “but when she saw the nurses dying, she panicked and fled,” unknowingly carrying the virus back to her village.
“But here’s the rub,” says Campbell. “There may have been 150 people at her funeral, and three of them have already died from Ebola. Eleven of the relatives traveled all the way from Kenya — and right now we’re tracking rumors from Kenya that one of them has gone ill.”
A few blocks from the international team’s headquarters, a teenage boy motions for me to follow him. “Miracle,” he says, and he leads me into a crowd gathered at a gate, peering into a brown-dirt courtyard. In the shade of a sprawling tree, a woman sits in a plastic chair, her head arched backward. Eyes wide and teary, she stares into the branches while another woman cuts her hair, felling the thin braids with slow, deliberate snips of the scissors.
A preacher stands in front of her, aiming a video camera with his outstretched left hand, rocking back and forth as he calls out a surreal narration: “She was mentally deranged for 12 years,” he says. “She was possessed by evil powers. The family took her to many witch doctors, but the demon inside would not relent.”
He turns toward the crowd. “We prayed and we urged her to surrender her witch-doctor gadgets. And now, look at her!” The woman smiles and sobs silently as her braids fall to the ground. “Look at her!” the preacher says, his voice rising. “The Lord has rescued her from demonic oppression!”
Watching the faces in the crowd, I have no doubt that everyone wants to believe that a miracle—be it religion, witchcraft, medicine, or science—could defeat a demon. But the woman’s gaze remains unsettled, and her eyes dart tentatively, searchingly, among the branches.
That evening, when the sun sets, a distant clanging begins. It starts faintly, a rhythmic din that gets closer and louder. Soon it’s joined by deeper drum beats. At the beginning of the outbreak, the drumming—on pots and pans as well as drums—became a nightly ritual to chase away the Ebola demon. After a few weeks it diminished, as the local population began to feel more secure. Now, the drumming is back.
Dr. Simon Mardel enters the dressing room outside the isolation ward at St. Mary’s Lacor Hospital and pulls a full-length surgical smock over his head. He stretches a first layer of gloves over the top of the smock’s tight elastic cuffs, then he pulls knee-high gum boots over his feet and tucks in his pants. He puts on a paper shower cap and a thick plastic surgical apron, then a second pair of gloves and a mask. Just before he walks through the first of two disinfectant boot baths, he places the final protective barrier—goggles—over his eyes.
An expert in emergency and refugee health care, Mardel had taken a leave of absence from his duties as an emergency-room physician in England’s Lake Region to assist at a recent epidemic of another highly contagious hemorrhagic fever—the Marburg virus—in Congo. He was on his way home in October when he was diverted to Gulu. A few years earlier, during the war in Bosnia, Mardel hiked into Srebrenica while the city was under siege, to treat wounded civilians—a heroic action that earned him the Order of the British Empire for humanitarianism.
Mardel arrived in Gulu with the first WHO team and took charge of the isolation wards, calmly demonstrating barrier-nursing techniques to terrified hospital workers. “Remember,” the clear-eyed 43-year-old told a group of nurses and nuns, “the system is only as strong as its weakest moment.”
Mardel enters the suspect ward, set aside for people who are symptomatic but unconfirmed as Ebola-positive. In one corner of the room, a male patient lies sideways on a bed, coughing and moaning. He holds a wad of tissues to his nose, which streams with black blood. He seems utterly indifferent to the doctor’s presence.
“Let’s get some blood from him,” Mardel says, and the patient offers his arm weakly to the needle.
Only about one-third of Ebola victims have the severe hemorrhaging often described as “bleeding out.” “Nobody explodes and nobody melts,” says the CDC’s Pierre Rollin. “What you read in the best-sellers and see in the movies is mostly bull—-.”
Still, Ebola’s symptoms are sufficiently wretched without embellishment.
“Most people come in with fever, vomiting, and diarrhea,” Mardel says, as he moves into the section of the ward set aside for confirmed Ebola-positive patients. “The spleen and liver are enlarged, and their circulatory system is usually going into shock. As the disease progresses, some have dementia, and many lose consciousness. Some die of respiratory failure and some of blood loss, but the majority die of shock due to fluid loss.”
Lacor hospital is well-endowed and well-equipped, by African standards, and its wood-trimmed wards and array of diagnostic equipment stand in contrast to the bare concrete of the government-run Gulu Hospital, across town, where doctors scrounge for basic supplies. In the mission-hospital tradition, Lacor’s care is intensive and hands-on. Because of the vomiting, the diarrhea, and the hemorrhaging, Ebola patients need massive care; at Lacor, nurses and nuns are responsible for everything from mopping up to helping patients die with as much dignity as possible.
Inside the isolation ward, health workers are fully enveloped in protective gear, their goggled eyes their only semi-recognizable features. To aid identification, many have scrawled their names with markers on the front of their surgical aprons.
Mardel spots an apron labeled “Dr. Matthew” across the room, and heads over to a corner where Matthew Lukwiya is treating an Ebola-stricken nurse. Lukwiya, Lacor’s medical superintendent, had been on leave in Kampala, 200 miles south of Gulu, when he received word of “a strange new illness” making its way through the hospital’s wards. He immediately left his wife and five children in the capital and drove up to Gulu. Within two days of his arrival, 17 people—including three nurses—were dead or dying with the same dire symptoms.
“At first it looked like some sort of super-malaria,” he says. “But the patients did not respond to quinine treatment, and it was killing people very quickly.” He began flirting with the possibility that one of the rare filoviruses, Ebola or Marburg, might have come in from Sudan or Congo. However unlikely this diagnosis—Ebola had never been seen in Uganda—he sent samples off to a laboratory in Johannesburg. Three days before the results were due, Lukwiya concluded that all signs were pointing to the worst possible scenario—Ebola—and that he needed to act immediately. He stayed up all night reading a manual titled “Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting,” downloaded from the Internet. In the morning, he and his staff started setting up a barrier-nursing environment, using whatever resources were on hand. They built hands-free boot removers from scrap wood and constructed an incinerator out of a 55-gallon drum. They fashioned aprons from duct tape and plastic sheeting and converted a hospital pavilion into an isolation ward. Then, from behind these crude protective layers, they began nursing Ebola patients.
Through the goggles, Mardel’s eyes meet Lukwiya’s, which are heavy with concern. The nurse he is treating is in critical condition.
“If she dies,” Lukwiya says, “she will be our seventh.”
In the morning, volunteer James Kidega reports to the Red Cross office, where a map hangs on one wall, dotted with push-pins: green for refugee camps, red for land-mine sites, pink for recent ambushes. Since the mid-1980s, a nebulous guerrilla force known as the Lord’s Resistance Army, whose stated objective is to carve a Christian state out of Uganda, has terrorized the region’s civilian population. To protect their children at night, when the rebels usually operate, most of the rural population has moved into impoverished refugee camps near Ugandan army barracks. Every day since the containment operation began, scores of Red Cross volunteers (they are actually paid about $3 per day) have fanned out to these “protected villages” to follow up on Ebola rumors, call for ambulances, educate the populace, and relay information about hospitalized relatives and neighbors.
Before the epidemic hit, the 25-year-old Kidega had worked at a charitable agency that helps children who have escaped from the rebels or been captured. Because of his extensive contacts in the villages and his polished demeanor—he is rarely seen without a clean shirt and necktie—Kidega was recruited as a volunteer leader.
Today, he will lead a team that will visit two villages north of Gulu. With red-and-white flags flying, two trucks set out. As Kidega guides the trucks north, he recalls the first few days. At Gulu’s two hospitals, he says, many nurses and orderlies stopped coming to work, fearing that they might be assigned to the isolation wards, and some international agencies based in Gulu streamed out of town. In the villages surrounding Gulu, rumors of sorcery circulated as entire families were wiped out. In Rwot Obilo village, the virus moved through one family so quickly that a dying grandmother told a boy, moments after his mother’s death, “Suck your mother’s last milk so you can die, too—there is no one here to look after you now.”
“It felt like being on a sinking ship,” Kidega says. “You can’t believe the fear.”
Some victims swarmed the hospitals, while others ran away in panic as nurses fell ill all around them. Even the rebels were spooked; the LRA released 40 prisoners, fearing that they might be carrying the virus.
When the trucks pull into Akwayugi, villagers look up from sifting maize and wheat. This isn’t as bad as Sub-Saharan Africa gets, but there’s serious squalor here. About a fifth of the children have the bulging bellies that indicate severe malnutrition.
The Red Cross volunteers divide into four-person teams and move through the village, asking questions of the small crowds that gather wherever they go: Did anyone have a fever? Did anyone have bloody diarrhea or vomit? Was there a sudden death?
The team has a “reintegration kit” for two girls who survived Ebola after they lost their mother to the disease. They find them with their father, Charles Odongo, outside the family’s round, mud-brick hut. Two weeks earlier, Odongo returned from the fields to find his wife in the hut with a headache and high fever. “It took six hours for the ambulance to get here,” he says. “And by the time they arrived, she had died.” When he sees the kit—cooking pots, blankets, soap, salt, and clothing—he smiles gratefully. “Immediately upon leaving for the hospital with my wife’s body, our things were burned by the neighbors,” he says.
Although the Ebola-Congo strain kills 90 percent or more of its victims, the Gulu virus is similar to the less-lethal Sudan strain, which has a mortality of about 50 percent. Odongo’s three-year-old daughter, Skovia, survived the disease that killed her mother. “You should not fear her,” volunteer Lucy Adoch says to a circle of onlookers, reaching down to pull the girl against her leg. “This is not a contagious little girl.” The motherless girl seems to brighten when she sees the dress the team has brought for her, but her nine-month-old sister, Geoffrey, clings to her father listlessly. She’s severely malnourished, weakened by the disease, and silent except for an occasional phlegmy cough. It’s hard to imagine her making it to her first birthday.
On the way back to town, James Kidega stops by his mother’s house for a cup of tea.
“James,” his mother says, putting the kettle on the stove, “why so many coffins passing by here today?”
“It’s going up again,” Kidega tells her. “We were beginning to think it was nearly over, that they would reopen the schools, but I think now they will wait. People are relaxing; they are hiding the facts. They think they will be shunned.”
“Why don’t they put the coffins inside when they transport them?” she asks. “This is making people very nervous.” As she pours the tea, her 20-year-old niece, Sarah, walks in.
“This Ebola, I wish we could see it,” Sarah says, clucking her tongue. “If we could see it, then we could beat it to death, with a stick.”
After sunset, Kidega’s radio crackles. A teenage girl has run into the clinic in Pabo, terrified of bleeding that would turn out to be nothing more than her first menstrual period. There’s gunfire on the road near Lacor. And north of town, a soldier in an armored personnel carrier has broken out in a fever, and is vomiting red inside the vehicle. The other soldiers have run away.
“Can you send an isolation ambulance?” the commander pleads.
Saturday morning at the hospital guest house, Tony Sanchez and Pierre Rollin are finishing breakfast, getting ready to suit up for the lab. Since arriving in Gulu they’ve been occupied controlling the outbreak; they’re hoping to soon shift their focus from containment to research.
“You can’t do productive field research on Ebola when it vanishes,” says Rollin. “So you need to get the information when you can.”
Researchers at the National Institutes of Health recently announced progress in developing an Ebola vaccine that works in monkeys, but the virus’s underlying logic is still beyond the reach of science. Since coming to the world’s attention in 1976, the disease has baffled a generation of researchers, who have collected hundreds of thousands of specimens from plants, animals, and insects. Humans are what research virologists like Sanchez and Rollin call “accidental hosts” for the Ebola virus. “We don’t know where it hides,” Rollin says. “It may turn out to be something right under our noses. There are different schools of thought. Some say it is carried by rodents, or insects, or bats . . .”
At that moment, as if summoned, Bob Swanepoel strides into the dining room decked out in a beige bush-hunter outfit. Swanepoel is a bat man. The director of the Special Pathogens Unit of the South African Institute for Virology, the goateed, 64-year-old virologist has made a career out of tramping to Africa’s remote jungles, looking for the reservoirs for Ebola and other hemorrhagic fevers.
“He’s at every outbreak,” says Rollin. Over the past 20 years, Rollin and Swanepoel have developed a bond that’s fed by a shared fascination for viral diseases. When they’re not working together at an outbreak, they communicate over the phone, from Atlanta to Johannesburg, at least once a week.
Swanepoel was in Saudi Arabia at the Rift Valley fever epidemic when the first samples of Ebola-infected blood, sent by Lukwiya, arrived at his Johannesburg lab. Now, a month later, he has finally arrived in Gulu, with two assistants and several bundles of nets and poles. “Pierre told me not to come,” he says, settling in at Rollin’s table. “He said there is nothing here, that we’re too far downstream in the epidemic. But what do you do when you hear that? Do you stay home? No, you have to see for yourself.”
Swanepoel is eager to do some reservoir hunting, but his bat-nabbing nets remain bundled outside his room. “Right now,” he says, “there are several hurdles. First, I need to know the focal point before I start trapping. Did one person get it first, or were there a lot of people who separately picked up this thing from nature? It’s the Sudan strain of Ebola, but was it brought in by a rebel from Sudan, or did it start near here? Northern Uganda and southern Sudan have roughly the same terrain and ecology, and the entire region is like a Bermuda Triangle of filoviruses. We’re close to the Ebola River, to Durba, Mount Elgon, Kitum Cave—all the hotbeds of Marburg and Ebola.
“The second hurdle is, I need approval. You go out in a place like this without approval, and the next thing you know you’re into ten kinds of shit. We got arrested in Congo, and it took half a day before they tracked down the colonel to vouch for us. He was at a brothel.
“Third, there are security issues. It’s best to work at night, but . . .”
Rollin finishes Swanepoel’s sentence: “But if you put a net up at night, you’re more likely to catch a rebel than a reservoir.”
Rollin often raises an eyebrow when he talks, which gives him a wizened, slightly comical look. “What I would like to know,” Rollin says, “is did somebody do something in the bush that people don’t normally do? Something seemed to be happening in September, before Matthew arrived. There was a lot of diarrhea, and rumors about some unusual malaria in a certain village. What you want to find is, was there a village where it started? But because of stigma, and because so much time has passed and so many people are dead, you don’t get the straight story.”
As Rollin talks, a dark spot forms above his left eyebrow. No one says anything, but in a minute, Rollin feels the liquid as it starts to run down his forehead. He wipes it with his index finger.
“Hmm. It’s blood. Very strange. I don’t think I cut myself here. And I haven’t shaved my forehead lately.”
He wipes it away. When it keeps coming, he gets up and grabs a tissue. He succeeds in stanching the flow and sits back down. All conversation has stopped.
“Maybe I have started to bleed with Ebola a new way,” he says, smiling as he raises an eyebrow. And everyone laughs. Nervously.
After breakfast, Tony Sanchez walks out of the guest house, toward the lab. An ambulance pulls around the corner, and Sanchez averts his eyes as an Ebola suspect is led into the ward.
“What we don’t experience up in Atlanta is the wards, the bleeding,” he says. “I talked to Pierre about what to expect, but to tell you the truth, I’ve never seen large numbers of people dead and dying before—and the way they suffer . . . During the day you’re doing your job, and you don’t think about it. But at night you see their faces. Your subconscious comes up with questions you can’t answer.”
Brother Elio Croce calls Sanchez’s name and trots over. A Verona father who runs Lacor’s technical and transportation services, Brother Elio is a plump Sean Connery look-alike with a compassionate demeanor balanced by a cranky sanctimoniousness.
“Tony, I need to take you out to Bardege Village,” Elio says, “to get blood and a skin sample for a biopsy from a little girl who just died. We need to get there before they bury her.”
With Elio is a soldier named Gordon Biforo, from Mbarara, in Uganda’s southwest. He’s the one who was vomiting in the armored personnel carrier last night.
“I had been feeling poorly from malaria,” the soldier says. “I had a bottle of orange Mirinda soda, and it came right up. It looked like blood so the others got scared.” The hospital gave him quinine and took some blood just in case, but he looks fine. Elio asks him if he’s angry with his army buddies for running away.
“I am sure I would have run too,” he says.
I introduce myself to Brother Elio and extend my hand—it’s amazing just how reflexive the custom is. Before I realize my mistake, Elio reaches out, grabs my hand, and looks me straight in the eye. “We’re not shaking hands here anymore,” he says, shaking my hand. “There’s an Ebola epidemic going on here you know.”
Actually, the Gulu epidemic was initially spread more by contact with the dead than with the living. According to local ritual, a dead body must stay in the house for a day or two while extended family and friends wash the corpse, eat and drink, and wash their hands in a communal basin. Then they bury the body next to the house.
“For you, the dead take care of themselves,” James Kidega had told me earlier. “For us, we take care of the dead.”
The viral count is at its peak in a just-expired body, but despite the risk and despite an aggressive education campaign, it’s been extremely difficult to get people to stop customs that have been entrenched for generations. For that reason, health workers have encouraged residents to report deaths in neighboring families.
Sanchez grabs his gear and jumps into the truck with Elio. As Elio drives, he talks nonstop in a sing-songy Italian accent that seems incongruous with the content of his monologue.
“The nurse, Grace Akulu, died. She was conscious until the very end—it’s not true that everyone is demented in the final stages. She died singing; she never feared to encounter our Lord. We buried her behind the hospital in a beautiful ceremony. I have tape-recorded the singing. I will play it for you later.”
“I thought it was supposed to be slowing down,” Sanchez says.
“I do not think it is slowing down now, Tony.” Elio says. “Tomorrow, we have to dig more graves.”
With the isolation ambulance trailing, Elio turns off the road and drives through the elephant grass, following a single-track trail that terminates in a tidy dirt courtyard surrounded by a half dozen round mud-brick huts with thatched roofs.
The deceased girl’s name is Sunday Onen; she was two years old. Her mother sits next to two other women who are nursing young children, while her grandfather, a well-spoken man named Peter Ola, talks to Sanchez and Elio.
“The child was healthy,” he says incredulously. “She ate breakfast around nine, then she had a fever and began vomiting. When her diarrhea became bloody, my daughter began to carry her to the hospital. But midway, she did not cry out any longer, so she brought her back here.”
Ebola doesn’t usually work that quickly, but there are enough Ebola symptoms that this must be treated as a suspect case. The villagers watch in silence as Sanchez suits up; the three ambulance crew members stand in the sun, sweating inside their protective clothing.
As Sanchez bends down and leans into the hut, Brother Elio pulls out his tape recorder and begins a peculiar commentary from outside.
“He’s down on one knee, entering the hut. Yes, that’s it, careful.”
Encumbered by the hut’s darkness and his layers of protective gear, Sanchez draws blood and cuts a skin sample from the tiny corpse. It takes longer than it should, because the lab has run out of biopsy punches, devices that work like high-tech cookie cutters to neatly remove a small patch of skin. He has to tug the girl’s skin up, then make the cut with surgical scissors, working slowly, with full awareness of the consequences of even the smallest nick to his hands.
“He’s down on both knees now,” Elio continues. “Yes. Respect. Respect.”
Sanchez backs out of the hut and straightens up, breathing hard through his surgical mask. He walks to the center of the clearing and lays out a sheet of white cloth, then he kneels down to pack the specimens. An ambulance crew member comes over with a garden-pump dispenser of disinfectant and sprays the bottoms of Sanchez’s feet. Then the sprayer follows the other two crew members into the hut. Sanchez stands up just as the three of them emerge, carrying a small white bundle.
“My God,” Sanchez says. “I thought this was going to be an easy day.” I notice that his right hand is twitching.
As the body is brought to the ambulance, the villagers suddenly become agitated. They gather around Brother Elio, talking to him in the Acholi language. Elio approaches Sanchez.
“See the problem now, Tony,” he says, “there’s been a misunderstanding. They thought that we would come out and test the girl, and if it wasn’t Ebola, we would leave her here for them to bury her according to tradition.”
Sanchez does his best to explain that he needs to bring the blood and tissue back to the lab to test for the Ebola antibody. The test takes several hours, and it may not be conclusive. They need to send the skin samples away for testing in Atlanta. The whole village may be vulnerable to infection if the body is not taken away and buried at the isolation graveyard.
After a few minutes, the villagers stop talking; they just stare at Sanchez, the white man in the white suit insisting that their loved one be sent off to the afterlife unprepared—buried as if she had never lived at all.
Sanchez takes Elio aside, and the two men’s roles flip-flop. Sanchez, the scientist, wants to compromise, to humanize the rules. The body was in good condition, he says. It may not have been Ebola. Maybe it was a snake bite. . . .
“But the grandfather said she did not cry out,” Elio says, sharply. Sanchez’s hand twitches again.
“What are we going to do?” he asks.
“We’re not going to do anything,” Elio snaps. His face is pinched, and the words come out that way, in a clipped staccato. “We can’t let them bury her here. They will not do it the way we want.”
We move toward the truck, and the villagers follow, forming a crescent around the front of the vehicle, continuing to stare as we get in. It feels as if the air has been sucked out of the sky.
Elio starts the truck and shifts it into reverse. He begins to let out the clutch—then he stops.
“Hey,” he says, looking at Sanchez. “What do you think? We let them bury her here. We stay, we supervise, they dig the grave very fast. It’s more human, no?”
In an instant, they’re out of the truck. Elio makes the announcement and the dirt starts flying, with Sunday’s father, who couldn’t be more than 17 years old, leading the dig. A half hour later the hole is completed, two meters deep. And the ambulance crew lowers Sunday Onen’s body gently into the ground.
On Saturday night, the team gathers in the courtyard at the Acholi Inn, tucked behind the roofless carcass of a burned-out building on the northern edge of town. Under a canopy of trees thick enough to block a light rain, a waitress runs back and forth with food and rounds of the local beer, Nile Special, politely requesting that the foreigners not lean back on the rear legs of the fragile plastic chairs. As the shadows lengthen, monkeys and an occasional rat scurry around the garden’s perimeter; after sunset, bats swoop among the overhead branches.
Even the Nobel Peace Prize-winning Doctors Without Borders is perennially short of recruits who are willing to turn their backs on comfortable, lucrative careers to come to needy places like Gulu, where the patient-to-doctor ratio approaches 18,000 to one (in the United States it’s about 400 to one). Yet despite the high stress and low comfort, despite the sound of machine-gun fire in the night, everyone seems to feel privileged to be here.
“I had been wanting to do something like this since I was a teenager,” says Patricia Campbell, an American physician with Doctors Without Borders. “I saw medicine as a passport to the world. But then I got married and had children, so I had to put it off until my kids were older.” Now in her mid-60s, Campbell says she’s “addicted.”
“I go home to Scarsdale [New York], and I wonder how anyone can stand it, treating rich kids for tonsillitis. After a few weeks, I’m saying, ‘Get me out of here!’”
The obvious question: Are you afraid?
“No,” Campbell says flatly. “You follow protocol. Unless you’re in direct contact with body fluids, you won’t get Ebola.”
Murmurs of agreement wash over the table. “If there was that high of a risk,” says Simon Mardel, “I wouldn’t be here.”
Of course, playing down the risks is a coping mechanism, a way of keeping panic at bay. Like cigarette-smoking (most of the doctors do) or gallows humor, denial keeps you functioning effectively in the presence of danger and death—whether you’re a doctor in a plague zone or a soldier in a battle zone.
For all the talk about managing risk, though, the odds don’t look very good for medical people in their ongoing battle with the Ebola virus. In the 1995 Ebola outbreak in Congo, 80 medical workers became infected; 63 died. Hospitals—especially deprived African hospitals—provide an ideal environment for the virus to prosper, and health workers are vulnerable targets because of their close contact with bodily fluids. As would soon become devastatingly clear to everyone on the team, Ebola does not forgive even the smallest mistake.
On Sunday morning, grief takes a holiday. James Kidega walks through the double doors of Christ Church, and joins the congregation in the throes of a full-blown dance party. At the front of the low altar, a band of musicians strum away on stringed gourd instruments; they’re nearly drowned out by a platoon of drummers, whacking away in a polyrhythmic fury. Around the musicians and into the back pews, people of all ages pogo up and down, driven in a raucous call and response by a young woman croaking through a distorted P.A.
“The love of Jesus has taken away the sins of the people,” she sings.
“Evil can’t touch us!” the dancers cry.
Two of the 11 Kenyans have tested positive for the Ebola antibody, indicating exposure to the virus. It’s not clear whether they are ill or not, nor how much contact they’ve had with others. And it’s not clear whether the Kenyan government has quarantined them. Pat Campbell is already on her way to Kenya.
The road north to Atiak is closed due to artillery fire, and a volunteer has destroyed one of the trucks in a rollover accident. The rental company has demanded the return of a van, after discovering that it’s being used in the plague zone. “We’ve tried begging,” says Derek Hardy, who handles logistics, “and it hasn’t worked. Now we’re going to try to stall.”
A few minutes later, Hardy is barking into the radio: “We need an infant feeding bottle, five teats, and a dozen cans of formula.”
“Have them bring it all to the Gulu Hospital,” Roth says.
Apparently, a woman who died yesterday had a baby just before coming to the hospital. The baby, now with the grandmother, is probably Ebola-positive and without proper care. Roth is hoping to convince a woman who recovered from Ebola but lost her baby to serve as a wet nurse or an adopter. The recovered woman should have antibodies that will make her immune to reinfection.
“It’s a bit of a tough sell,” Roth says, “so we’ve got to get someone really good to talk to her, maybe a nurse who was with her at Lacor.” In the meantime, Aikichi Iwamoto, a Japanese doctor, will go out to the village with infant formula to attend to the newborn.
Outside his guest room in a wooded corner of the lacor hospital compound, Bob Swanepoel slouches in a chair, flinging pebbles into the trees with a wrist-rocket slingshot. Nearby, Pierre Rollin sits on the concrete floor, his back against the door, his legs stretched in front of him. Someone brings over a straw-colored fruit bat killed by a local boy, and Swanepoel perks up.
“These things are vicious,” Swanepoel says, spreading the bat’s wings. “Look at these teeth, and these claws—they’re like razors. They’ll go after you like a dog.” He asks one of his researchers to put it in the fridge, along with a cobra that was killed on the Lacor grounds yesterday after menacing some nurses.
Swanepoel’s bat-trapping expedition has been approved, but he’s pessimistic about what the fieldwork might turn up. Without knowing where the epidemic started, he says, “it’s a shot in the dark.”
“Also, we’ve learned that the caves in the Kalak Hills aren’t what we thought they were. Apparently, there are lots of very narrow caves that are difficult and dangerous to navigate. Maybe we can go up to the top and drop the nets—I don’t know.”
Brother Elio rides up on his bike. He wants Rollin to test him for Ebola.
“That will be the third time you’ve been tested,” says Rollin. “You keep thinking you’re infected.”
“We lost another nurse today,” Elio says. “That makes eight, plus a nurse’s boyfriend. We can’t figure out how the boyfriend was exposed, since the nurse did not get Ebola. He was a young man, and strong. At the end, he told me he wanted to get married before he died, so I got the priest and sent for the girl. But, as she was on her way here, we realized that we had time only to give him his last sacraments. When she arrived, the father went out to meet her.” Elio pauses.
“He told her that he had already left for the long safari.”
At headquarters, Derek Hardy is on the porch, having a smoke, when the rental van rolls in with Aikichi Iwamoto, back from his baby-formula mission. He’s sure the baby is Ebola-positive, but he’s not a pediatrician, and he didn’t have a needle small enough to take a sample. Her condition, he says, is “very grim.”
He shuffles onto the porch and asks Hardy for a cigarette.
“I didn’t know you smoked, Aichi,” Hardy says.
“I just started again.”
Cathy Roth comes out and announces that she’s “cancelled the cancellation of this afternoon’s meeting.” Everyone troops inside.
There have been five deaths today, so far. The CDC’s Scott Harper reports that six people were admitted yesterday, and they aren’t on any contact lists. “People seem to be hiding family members,” he says; “the system seems to be breaking down. In Atiak, a suspect was buried, and no one got a specimen.”
In Pabo, some recovering patients have been lost. At Gulu Hospital, an Ebola-positive patient “escaped” last night. (He later turned up at Lacor.) As for the miscarriage, there are now 32 contacts, including 11 health-care workers. There were two deliveries after the infected woman’s, on the same table.
Dr. Paul Onek, the district health officer, gives voice to everyone’s frustration. “If we have escaped patients, if we are not even able to take specimens from deceased people, then we are back to square one.” He is silent for half a minute, then he speaks. “Yesterday, we breathed a sigh of relief. But now . . .” He purses his lips and sighs. There’s no relief in it.
After the church service, James Kidega travels across the field where the Pope spoke, and approaches a cluster of huts. The witch doctor, Abodtu, is in, although the authorities ordered him to remove his “traditional African healing” banner after a witch doctor in Rwot Obilo treated—and possibly infected—up to 30 people before dying of Ebola.
But Abodtu doesn’t claim to cure Ebola—at least, not yet.
“Right now, I have no medicine for this,” he says, lighting a candle. “I cure people who are lame, or berserk. I make the leg stop swelling, and the brain start working. Or, I send death to someone who has done wrong to your family.
“As for the white man’s medicine and the white man’s religion, I do not cross there. This is what I know.” He sweeps his eyes toward his altar—a clutter of beads and bones, snake skins and rattles, jugs and strings of shells.
Where does Ebola come from?
“I have asked my bad-thing where it came from. The spirit tells me to wait for instructions, then to go to the forest and look up to a special big tree. This tree has the answer; it will tell me where it comes from.” He inhales deeply. “I will look up to the tree, and I will learn from the tree how to stop it.”
Mike Ryan arrives from London, and three-quarters of the international team and seemingly half the town converge within minutes to greet him. A WHO medical officer, Ryan had been in the Alps, hiking with his parents, when a colleague called with news that Ebola had emerged in Uganda. Ryan’s team hit the ground first, and he spent the next four weeks leading the containment operation before being summoned to London to represent the WHO at an infectious-disease conference. Now he’s back, and with his long red sideburns bursting out from under his baseball cap, he jumps from a rented van and immediately starts greeting people with big handshakes and bear hugs.
Suddenly, the energy seems cranked up.
“We managed to convince ourselves that it was under control,” Ryan says, torching a cigarette as he addresses a group of mobile-team members. “Everyone’s getting lethargic and exhausted. But we’ve got 17 people in the hospital now, and four new ones already today. We’ve got 45,000 people living in Pabo, and we can’t afford to let it go. We can’t take our eyes off the ball.”
From the porch, Scott Harper watches Ryan waving his arms and bellowing, as the volunteers look on, rapt. “Everything’s critical with Mike,” Harper says. “He’s a total hot-head, and the locals respect him completely. He gets things done.”
Waving his arms and bellowing, Ryan manages to get his audience guffawing, then he springs onto the porch. Just before dashing into the room, he turns and yells back at the group, loud enough for the entire parking lot to hear: “Let’s keep our boots down on the neck of this bastard!”
Hoping to raise awareness and morale, Ryan accompanies a mobile team to Goro village. He videotapes a local group called the Romboys, recording a new song called “Ebola.” Then he drops in on a drama group that’s performing an educational skit. Dressed in a devil mask and grass skirt, one actor portrays Ebola. When he comes onstage the other actors run up and beat him with sticks.
Ryan and the team pass a brew house, where women ferment beer from cassava and sorghum. A group of people stand around a clockwork radio, listening to a poem that a listener has sent in:
Ebola, Ebola, do you have children?
Do you know how painful giving birth is?
Do you know the pain of losing a child?
Ebola, you are killing without mercy, day and night.
At a Q&A session at a church, someone asks Ryan if it’s possible to get Ebola by handling money (the answer is no), and another person suggests that faith in the Lord will see them through the epidemic.
“Yes,” Ryan replies, “but don’t forget that the Lord gave us the tools to fight this. Is it not sacrilegious to ignore the gifts God gave us?” The Gospel according to Mike gets the congregation’s elders nodding in agreement.
At noon, Bob Swanepoel’s team finally rolls out of Gulu for the Kalak Hills, escorted by 13 soldiers and a Mamba armored personnel carrier. They drive along the dirt roads, between walls of eight-foot-tall elephant grass, dodging bicyclists and pedestrians. Arriving at the protected village of Guruguru, Swanepoel negotiates with the villagers—two of whom say they dined on bats earlier that day—and sets out with a team of bat-hunters and porters. In a scene that’s vaguely reminiscent of some Great White Hunter epic, Swanepoel’s party—soldiers, hunters, porters, and scientists—trudges over the hills toward the Kalak caves, trailed by an enthusiastic swarm of village children.
“This is a shot in the dark,” Swanepoel says again, wiping sweat off his forehead. “It’s very unlikely that we’ll turn anything up. You could test 100,000 bats for a virus before you find it; that’s the sort of job we face.”
Swanepoel decided to turn his gaze upward, to arboreal virus carriers such as bats and canopy-dwelling insects, after exhaustive tests on ground-dwelling animals failed to reveal anything conclusive.
“At several points,” he says, “bats have figured prominently in outbreaks of Ebola and Marburg. In some of those incidents, so have monkeys and chimps—but they died just like humans, so they can’t be the reservoir. It has to be something that can carry Ebola without coming to harm. In the lab, when we injected Ebola into bats, we found that it could grow to a very high titer, but it did not kill them. In fact, some of them excreted virus in their feces.”
Arriving at the cave entrance, Swanepoel assembles the lab on a large rock. The caves are narrow and steep, and the locals have been climbing in on rope labbers and using thorny branches to hook bats. But it’s dangerous work; in the past year more than ten residents of Guruguru have died in the caves, most falling off the ladders. It’s agreed that the bat hunters will work only in the most accessible caves, to lessen the chance that anyone will be hurt. They head into the caverns, outfitted with nets and instructions to bring the animals back alive.
In Zaire, Swanepoel used huge nets mounted on bamboo poles; in Gabon, he hunted with slingshots and live traps; in Ivory Coast, he ascended elaborate walkways built in the treetops. He has used UV light traps and fogging machines to collect insects. But today the expedition is decidedly low-tech, with teenage hunters wielding simple nets. As they bring in the bats, Swanepoel extracts vials of blood and puts the bodies in a freezer box for later dissection.
After four hours, the sun is moving toward the horizon, and the army commander indicates that it’s time to go. The hunters have collected only nine bats, and Swanepoel is clearly disappointed. “To do this properly you need hundreds, and you should really work at night. Like I said, it’s a shot in the dark. I doubt we’ll find anything—but we’ll be back.”
When the convoy pulls into town at dusk, Ryan and Kidega come out to the parking lot, looking relieved. All afternoon, they’ve monitored radio reports of an ambush near where the expedition was working. The rebels attacked a vehicle, blowing it up with rocket-propelled grenade and killing three people.
Just past sunset, most of the team gathers in the Acholi Inn’s courtyard. After dinner, they linger under the trees, drinking Nile Specials and occasionally getting scolded for leaning on the hind legs of the chairs. The talk gets around to the first few days of the epidemic.
“This is the one that could have gotten away,” Ryan says. “And it still might. But if we manage to contain it, we’ve got Matthew [Lukwiya] to thank. By the time we got here, he was already mobilizing the community and building a containment operation, and that gave us a head start we haven’t had in other outbreaks.”
Looking back, Ryan says he’s amazed by Lukwiya’s instincts: “Ebola isn’t the first thing you’d think about here; it’s not even the 10th thing. But Matthew put two and two together—and he got shite for an answer. Had he not taken action when he did, I don’t know what would have happened.”
By all accounts, though, the first few days were shambolic. When Ryan arrived, he found Gulu in the grip of panic. Immediately, he began coordinating the multi-agency, multilingual war against the virus, cracking jokes and chain-smoking cigarettes, winning the confidence and support of local health officials and military personnel. “We needed to train, to get equipment, to get people off 24-hour shifts,” he says. “We stopped all IV interventions and cut down admissions to only the most life threatening. We needed to get simple things right, like standardizing disinfectant mixes and training people to use the protective gear.”
Ryan orders another round. “When we arrived,” he says, “there were bodies piling up at the morgue. It’s an old brick building that sits in the middle of a field on the outskirts of town, like something out of a 19th-century horror story.”
Once an isolation graveyard was established, several military personnel were assigned the grim, dangerous task of burying the highly contagious bodies.
“The first guys,” says Simon Mardel, “when they saw us coming with the bodies, they ran away. We were yelling ‘Hey, at least leave your shovels!’”
“They were terrified,” says Ryan. “They were convinced they’d get Ebola if they got anywhere within an arse’s roar of the virus. Simon and I realized that we couldn’t expect them to do it if we weren’t willing to do it ourselves. So we suited up and jumped in with the shovels. We were trying to joke with the fellows—saying things like, ‘Hey, you just volunteered for the graveyard shift’—but they were pretty grim at first. I’m sure there were sphincter problems because I had a few myself. But in the end, they became the Olympic burial team; we wouldn’t have had a prayer without them.”
The next day, Mardel joins Lukwiya for rounds in the Lacor isolation ward. The two play a “good cop, bad cop” routine as they urge the more coherent patients to drink their oral rehydrating fluid. Among the most serious cases are several nurses. Despite efforts to improve staff safety procedures and reduce fatigue, Lacor’s nurses continue to get infected. But Mardel has a plan, and he tries to convince Lukwiya to buy into it.
“From now on, how about if we have the mobile teams bring all the new cases from the community to Gulu Hospital, to give your people a rest? We could still treat existing patients at Lacor, until they die or recover, and let self-referrals choose their hospital. That way we keep all avenues of admission open.”
Lukwiya says he’ll consider it, but the following morning dawns with more bad news. Two nurses and a nun have died during the night, and the surviving nurses walk out in frustration, grief, and terror. They assemble in a meeting hall and send for Lukwiya.
Lukwiya is calm and resolute as he walks into the room.
Born in a mud hut near Gulu, Lukwiya had attended medical school on scholarship, and as a highly honored graduate of the Liverpool School of Tropical Medicine, he was expected to embark on a life of comfort abroad—as some 70 percent of Ugandan medical school graduates do. But Lukwiya turned down a job offer in England and headed home to practice hardscrabble medicine among his own Acholi people.
For the past 17 years, he has been the stabilizing force at Lacor, the gentle but unyielding leader who refused to let a civil war, a lack of resources, or anything else get in the way of helping his patients. A few years ago, on Good Friday, a band of rebels came to the hospital to take nurses as hostages. Lukwiya stepped forward and persuaded the guerrillas to take him instead. He spent a week on the move with them, treating their wounded soldiers, before they let him go.
Lukwiya tells the nurses of the plan to shift the bulk of the isolation work to Gulu Hospital, and of his efforts to convince the government to provide hardship pay and compensation to the families of fallen nurses. He reemphasizes the need for full vigilance and adherence to the barrier-nursing techniques, especially at night, when tired workers are more likely to let down their guard.
“Those who want to leave, can leave,” he says, finally. “As for me, I will not betray my profession.”
Lukwiya’s words and the afternoon funerals, which take place in a downpour with lots of singing and praying, have a calming effect. The nurses return to work.
Lukwiya has seen more than a hundred Ebola patients, but none have developed the relatively rare hemorrhagic form of Ebola. Unfortunately, one of his nurses, 32-year-old Simon Ojok, is the first. Sanchez, who had begun to think that the stories of spectacular bleeding were “a bunch of crap,” now sees it with his own eyes.
Ojok’s condition deteriorates quickly, and in the middle of the night he starts thrashing in his bed, pulling off his oxygen mask and spraying bright-red, oxygen-saturated blood all around him. He stumbles out of bed, and as night-shift nurse Stanley Babu pleads with him to stay put, Ojok walks out of the room, tearing away from his IV tube. Agitated and mumbling, Ojok stands in the hallway, coughing infectious blood and mucous onto the walls and floor. Terrified, Babu runs to Lukwiya’s quarters and wakes him.
“Blood is pouring from his eyes and nose like tap water,” Babu tells Lukwiya. “He is confused, fighting death. We are afraid to take him back to bed because he seems violent.”
Lukwiya sprints across the compound and hurries into the dressing room. He can hear the commotion through the wall as he pulls on his gown, his boots, his apron. Then his mask, his cap, his two pairs of gloves. He does not put on his goggles.
When Lukwiya enters the room, Ojok has stumbled back into bed and is gasping for breath, wrapped in his blood-soaked gown and sheets. Lukwiya props him up to help him breathe, and changes his gown and bedding. Just past dawn, as Lukwiya is mopping the floor, Ojok passes away.
A few days later, Lukwiya sends for Rollin and Sanchez. Could they please come to his office—and could they bring their blood-sampling gear?
When they arrive, Lukwiya is calm. “I’ve developed a fever,” he says. Rollin tells him that it’s probably just the flu or malaria, nothing to worry about.
Rollin draws the blood, then heads to the lab, where he changes into a respirator suit with a battery-powered filter unit. He centrifuges the blood and generates a master plate, then dispenses a measured amount of the sample into the dimpled well of the plate. Pausing often to wipe the sweat from his face with the inside of his cloth hood, he deposits and rinses the various ingredients—among them are mouse and rabbit antibodies, horseradish peroxidase, and skim milk—in a strict order. Finally, some five hours after he began, he positions the pipette tip over the sample well and adds the final reagent, the telltale chemical that will turn green if the sample contains Ebola. The mixture doesn’t turn green.
“Tony, he’s negative,” Rollin says. There’s no sign of Ebola.
That night, Lukwiya vomits and develops a headache. When Rollin draws blood the next morning, Lukwiya’s eyes have gone a ghostly gray. This time, the reagent turns a weak green.
OK, Rollin thinks, there’s a 50 percent chance that he’ll make it. The viral count is still low. Maybe he’ll develop a mild case.
But the next day, the test goes a solid green, and Lukwiya asks to be taken to the isolation ward. “If I die,” he tells the hospital’s administrator, Bruno Corrado, on the way in, “I only pray that I am the last.”
He requests that his wife, Margaret, be told only that he has a fever, and that she should not come up from Kampala. She comes anyway, of course, not letting herself imagine where she will be led when she walks through the hospital’s front gate. Then it’s as if she has practiced walking toward the building covered in plastic, practiced suiting up, practiced being strong and cheerful as she enters the ward to see her husband, dying of Ebola.
“Look here, Margaret,” Lukwiya says when he sees her. “It is dangerous in here. Don’t even come in.” Then: “If you must come in, please stay for just one minute.”
Wearing protective clothing, Margaret Lukwiya sees him twice a day for the next two days, unable to embrace or even touch him. Once, she breaks down.
“If you cry,” Lukwiya says, “you’ll rub your face, which won’t be safe. Cool down, Margaret—and stand firm. Keep praying.”
Mardel and Dr. Yoti Zabulon team up to treat him, experimenting with aggressive interventions. As Lukwiya’s breathing becomes more and more labored, they decide to artificially ventilate him.
His pulse returns to near normal and his fever comes down. A second round of chest x-rays looks better, and hospital administrators announce that his condition has begun to improve. But later that night, he hemorrhages into his airway, and the doctors realize that what is happening to their friend is beyond their power to arrest, or even influence.
“Now, there’s nothing more anyone can do,” Ryan says. “Except say good-bye.”
On December 5, at 1:20 a.m., Matthew Lukwiya, who fought so hard to keep the statistics down, joins the numbers himself, the 156th recorded victim of the outbreak.
The next afternoon, he is buried—in a tightly sealed coffin, with pallbearers wearing head-to-toe protective gear—in the shade beneath a mango tree in the Lacor Hospital courtyard.
“I don’t think he would regret this,” Margaret Lukwiya says at the Memorial Service. “He knew the risk. He saw what was needed for his patients and he did it. That was him. Matthew was not for worldly desires.”
Sadly, Corrado, Lacor’s administrator, sees Lukwiya’s death as a symbol of defeat—a defeat made more painful by the hospital’s initial success in containing the outbreak’s first wave. “We all wanted Matthew to survive, not only because he was our colleague and friend but as living proof that this disease could be defeated,” Corrado says. “We wanted to be able to declare that we fought against this thing together, and we won. But this is not the case. We did not defeat it.”
Yet, by the time of Lukwiya’s death, the epidemic was on the wane, largely due to his efforts during the first days of the outbreak. After a brief flare-up, admissions slowed to just a handful each day, all of whom were now directed to Gulu Hospital. And although several workers temporarily left as a result of his death, the majority stayed on, inspired by his dedication. True to his hopes, Lukwiya was the last of the hospital staff to die.
On January 23, Uganda’s last known Ebola patient was discharged, and Ebola retreated back to nature, taking its secrets—among them, when it will come again—along with it. The international team scattered back to families and routines, in Geneva, Tokyo, Johannesburg.
In Atlanta, months later, Gulu already seems to Tony Sanchez like another life in another universe, a place that exists in flashes of memory and unaccountable longings—for that place where he dealt with things as they were, not as he wished they were; where he felt at once close to death and unimaginably alive. Sometimes, the place comes back in dreams, images piled one atop the other. In one, he is in the isolation ward, treating a terrified little girl not much older than his own little girl (whom he was afraid to touch for a few days after he returned). In the dream, sometimes, one becomes the other, and he’s helpless—he can’t soothe her with his touch, and he can’t save her life.
But there are good memories too. One night at the Acholi Inn, as bats swooped overhead, Mike Ryan held forth on one subject after another, a font of vinegar and piss. The waitress came out and scolded him for leaning back in his chair, and he apologized. Then he settled back onto all fours, and requested another round of Nile Specials.
“Ah, the source of the Nile,” he said when she returned. And he smiled mischievously, and rocked back in the chair again, unthinkingly. And she smiled back, and said nothing.
A few minutes later, Mardel and Roth said goodnight, and Ryan leaned back with his hands clasped behind his neck, and let out a big sigh. “What a bloody ride this is,” he said, looking up into the dark foliage overhead.
Like the woman and her exorcist, like the witch doctors and the churchgoers, like the doctors and nurses and the virus hunters, Ryan imagined that there might be answers up there. But until somone manages to coax those answers out of the darkness, Ryan and the others will be there to stanch the blood.
In the end, you can’t always slay the dragon. But sometimes, if you manage to keep your boot down on its neck long enough, you can quiet it.
Author, photojournalist and National Geographic speaker Tom Clynes travels the world covering the adventurous side of science, the environment and education. His work appears in National Geographic, The New York Times, Nature, Popular Science, The Atlantic, and other publications. As a keynote speaker, Tom works with organizations that want to catalyze creativity and engagement at their events, inspiring audiences and bringing them along on assignment to some of the world’s most intriguing places. To contact Tom and discover more about his memorable and inspiring programs, please email email@example.com.
By Tom Clynes
One parent’s quest to raise analog kids in a digital age
Authors note: This essay first appeared in Issue 4 of Adventure Journal.
I was at the campfire, flipping pancakes, when 13-year-old Ethan came over and asked if he could use my phone.
“I want to show those guys a YouTube video,” he said, nodding toward his brother, Sam, and my sons, Charlie and Joe.
I looked up and arched an eyebrow. “Seriously, Ethan?” I said. “We all agreed this would be an electronics-free camping trip. Remember?”
“I know,” he said, “but it’s a video about camping.”
Before Ethan could fall further into the irony hole he was digging, I plopped a flapjack onto his plate and he rejoined the other boys. “I guess we’ll have to watch it when we get home,” he sighed.
Keeping kids connected with nature used to be simpler. For my own parents, it was mostly a matter of opening the back door and setting us loose in the neighborhood, where we’d find an orchard or a brush pile or some other semi-wild place to fool around.
But for 21st-century children, such improvised outdoors scenarios are increasingly rare. My parents’ generation didn’t use “parenting” as a verb, and what they called just kids being kids is now called free-range—a concept that alarms hyper-vigilant would-be advocates. Kids don’t have the same kind of license to run around outside, and even if they do there’s the ever-present draw of electronics. As smartphones and social media become ever more ubiquitous and embedded, the love of nature—what E.O. Wilson called biophilia—is morphing into videophilia, a love of electronic media.
“We’ve quickly gone from a place where the average child would choose active outside activities to one where kids choose sedentary activities involving computers and smartphones and video,” says conservation ecologist Patricia Zaradic. She and Oliver Pergams co-authored two studies that found that per-capita visits to national parks and forests, and other indicators of nature recreation, have declined in developed countries since the late 1980s, due in large part to the increase in the amount of time spent on electronic media.
The trends they’ve identified have alarmed conservationists, whose efforts to protect wilderness depend on the support of people who connected with nature during their formative years. A rising generation of adults with little experience with wild places and little understanding of their value may ultimately have a greater impact on biodiversity and ecosystem health than bulldozers, invasive species, or even greenhouse gas emissions, some think.
“If Pergams and Zaradic are right and these trends continue,” says Peter Kareiva, the former science director at the Nature Conservancy, “then the pervasive decline in nature recreation may well be the world’s greatest environmental threat.”
More immediately, the rapid shift from active outdoor activities to sedentary time with electronic devices has made today’s children the subjects of a vast, unplanned experiment—one whose effects are just beginning to be extensively studied and understood.
Of course, previous generations wrung their hands over the dangers of everything from comic books to rock n’ roll. Is this just the next thing for parents to fret and nag about?
“I’m entirely skeptical of those claims that every generation makes about how much worse things are now,” says Douglas Gentile, a child psychologist at Iowa State University. “But if you look at the data, it’s clear that there’s something going on now that’s entirely unprecedented.”
In the 1950s, the average adolescent spent about 55 hours per week sleeping, 30 to 35 hours in school, and another 15 eating and attending to personal care. That left 65 to 70 hours for everything else.
By 1980, TV had taken 14 hours of that free time. Television-watching doubled to 28 hours in 2000 and peaked at 31 hours in 2010. But by then video games were gobbling 13 hours and other computer time was taking 10.
“That leaves only 10 to 15 hours a week for anything else,” says Gentile. “And that’s the average, so half the kids have even less time.”
Until recently, much of the research on the effects of electronic entertainment focused on content. We know, for instance, that children who play violent video games tend to become more aggressive and less empathetic. The other side is what kids are not getting—the opportunity costs. “When children are spending 50-plus hours a week on a screen,” says Gentile, “that’s time not spent creating, exploring, running around outside.”
Though our understanding is still developing, a growing body of research from a variety of disciplines shows that digital technology has a measurable, negative impact on the human brain. Computers, video games, and smartphones—which, we may forget, did not exist 10 years ago—are tweaking our synapses in ways that affect our sleep, moods, concentration, memory, and learning. These effects are amplified in “digital natives”—younger people who started using technology during critical stages of brain development.
American teens are now smoking and drinking less, but are far more likely to be addicted to social media or video games. Many school counselors believe that social media is playing a major part in the spike in major episodes of teenage depression, which jumped by 37 percent between 2014 and 2015, according to a just-released study in the journal Pediatrics. Other recent research links technology overexposure in developing brains to cognitive delays, impaired learning, and attention deficits.
Sedentary kids who spend most of their time indoors are more likely to be obese and more likely to carry that extra weight into adulthood—boosting their risk of diabetes, stroke, and heart attack. Largely due to obesity, the current generation of children may be the first in modern human history in which a high percentage of individuals will not outlive their parents.
If exposure to digital technology has a demonstrated and measurable impact, so too does exposure to nature—and it seems to be almost wholly beneficial. Researchers have found that the ever-shrinking fraction of children who regularly connect with nature achieve more academically and are healthier physically, socially, and emotionally. Exposure to nature also contributes to faster stress recovery, improved self-esteem and cognitive functioning, and boosts in focus, self-discipline, problem-solving, and communication skills. Compared to digital junkies, they’re like the Six-Million-Dollar Man: smarter, faster, stronger, better in every way.
Beyond the evidence, I’m certain that helping my kids fall in love with the outdoors is critical to boosting their chances of having high-quality lives. I suspect that a species that loses touch with its habitat cannot be fully alive. When we can’t see a wild animal, stride over uneven ground, or sleep under the stars, we lose our connection to the original source of our values, and our imagination.
My own parents weren’t hikers or campers; it was my high school friends who opened up the backcountry for me. Later, I was able to build a career around traveling to wild, remote places. Today my job, like so many others, includes far too much screen time, to the point that the natural world can at times become a mere intellectual concept, severed from the joyful experience of the real thing. When that happens I feel less human; my life becomes less fun.
I desperately want to keep my children out of the traps I’ve fallen into. Back in 2003, a couple of years before Richard Louv coined the term “nature deficit disorder” to describe the growing gap between children and the environment, my ex-wife and I moved our family from Brooklyn to Vermont. For the next seven years our sons’ world was forests and mountains, swimming holes and rope swings, sledding and skating and skiing. At times it seemed as if we were living in a Norman Rockwell painting, populated by like-minded rural progressives.
Divorce and its aftermath pulled us down from the Green Mountains and into the flatlands. We wound up in a Midwestern college town nearing the end of a long transition from countercultural oasis to could-be-anywhere suburb. My spirits drooped when I heard Charlie’s first-grade teacher gushing about new computers in the classroom (education researchers say that it’s clear that technology in lower-elementary classrooms impedes social development and learning); they fell even lower as I came to realize that no visit to a nearby park or “natural area” would ever be unaccompanied by the sound of motors.
When I saw a smart-phone-immersed parent at a restaurant, ignoring a child who was in turn ignoring her parent and the rest of the world as she poked away at a tablet, I’d cluck with disapproval. Before long, though, I’d catch myself sneaking glances at my own phone in restaurants, unable to resist a quick dopamine hit from a colleague’s comment, a dating-site match, a nugget of news or gossip. I didn’t need an expert to tell me that the behaviors we’re modeling for our kids are unhealthy. The more we attach to technology the more we detach from our children—who then attach to their own devices, often in addictive ways.
Even though my sons’ lives are less dominated by electronics than many of their friends, I’ve noticed that the more time they spend in the online world, the more distracted and irritable they seem. And I can’t resist comparing their childhoods to what I imagine I could give them if we could go back to a place where human-to-human connections are more valued, and where a four-season playground is as close as any door in the house.
But that’s probably not going to happen. With each passing year, electronics and all they bring are woven more deeply into our culture, and my dream of raising analog kids feels further away.
I know I’m not alone. “Parents often say that they feel out of control with technology, that they can’t have any impact,” says Gentile, the child psychologist. Gentile’s team studied 1,300 third- to fifth-graders over the course of a school year and found that when parents are involved in children’s use of electronics, the results are impressively positive. Kids whose parents set limits on media got more sleep, scored higher grades, exhibited more cooperative social behaviors, gained less weight, and were less aggressive with their peers.
“It’s clear that parents can have a big impact and that the ripple effects extend across several different areas of children’s lives, out into the future,” says Gentile.
We parents need to throttle back our own media use. And we need to insist that schools balance technology with outdoor classrooms and nature-based programming, and support novel and promising alternative programs like “forest kindergartens,” where much of the learning takes place in nature.
We also need to provide better outdoor alternatives for kids, or at least some communal oversight of them so other parents will feel comfortable letting their kids run wild—as Zaradic and her husband did when they moved their young family to a new neighborhood in Pennsylvania. “We made ourselves available to be outside and vaguely supervising the kids, so other parents could send their kids out to play,” the researcher says.
Within months, the presence of so many children playing outside actually began to attract more young families to the trend-bucking block.
“It became the neighborhood where the kids are always outside, creating their own fun,” says Zaradic. “It wasn’t fully intentional; we were just living out our values. But it created a cultural shift. All it takes is a couple of parents to say ‘I’ll be the one.'”
But there’s a big difference between domesticated, neighborhood nature and the Great Outdoors. It’s one thing to swing on a jungle gym; it’s another to camp in a real jungle.
When my sons and I spend more than two or three days away from houses and roads—whether we’re backpacking in the Grand Canyon, rock climbing at Joshua Tree, or caving in Kentucky—I begin to notice changes in my kids, and me. Away from electronics, we chill out and lose the insecurity of FOMO. My sons’ eyes, so used to looking down at two-dimensional screens, begin to brighten as they look up and around, taking in a world that’s infinitely richer than two dimensions could ever convey. Distracted by a jumping fish rather than the ping of an incoming message, the kids begin to pick up on details and cues with all their senses. I can see them regaining their equilibrium.
As they learn how to take care of themselves in the wild, their growing confidence is tangible. Freed from the captivity of to-do lists that don’t relate to survival or fun, we all begin to regain our footing, with the world and with each other. We operate together with an ease that’s harder to come by when we’re among the flat-screen distractions that we’ve somehow come to accept as real life.
I realize, though, that my dream of raising analog kids may not be possible, or even desirable. We’re not going back to the pre-internet days. And adolescents, wherever they grow up, need to be part of the social world of their peers. The surge in cyber-bullying notwithstanding, social networks help to connect kids when they’re not physically with each other. Portable tech has certainly made the outdoors more accessible to 21st century biophiles, helping us plan our adventures, guide us to trailheads, and remind us where we parked our cars. How many excursions has Google Earth inspired, how many expeditions has it made better, safer, more fully planned? How many more miles of running or vertical feel of cycling has Strava spurred into the world?
The answer, I realize, is not to think in terms of analog or digital, but to help kids (and maybe each other) develop what Louv calls “hybrid minds,” by balancing exposure and maximizing the skills that come from both the virtual and natural worlds.
“The future will belong to the nature-smart,” says Louv, who argues that the more tech-dependent we become, the more we’ll need nature to keep our senses.
That sort of duality seems worthy of embracing. If we can’t give our children simpler times, we can at least fortify them against the increasing stresses of society and help them learn how to keep themselves happy, healthy, and human.
Recently, my sons and I were looking at pictures—yep, on a computer—from summer backpacking trips. For the last few years we’d been tackling sections of Vermont’s Long Trail, which runs along the spine of the Green Mountains. I marveled at the transition from the days when the shy post-toddlers could walk just two or three miles a day and Dad carried everything and did everything. Now, they pack their own packs, set up tents, start fires, and laugh and learn from the thru-hikers we meet along the way.
And they jump off cliffs: We came across some shots we’d taken last year, right after our arrival at a campsite at a mountain lake rimmed by 30-foot-high rock ledges. It must have taken 25 minutes, maybe more, for Charlie and Joe to muster the courage to make the leap into the water, a feat that I recorded in a quick series of still photographs. Months later, gathered around the computer, we stitched the frames together and created a slow-motion moving image of their launch and long free-fall, followed by a splash and then two faces surfacing, elated and triumphant.
“We need to show this to Ethan,” Charlie said, laughing. It took me a moment, then I got it: We were finally watching that video about camping—and we’d made it ourselves.
Author, photojournalist and National Geographic speaker Tom Clynes travels the world covering the adventurous sides of science, the environment, education, and archaeology. His work appears in National Geographic, The New York Times, Nature, Popular Science, The Atlantic, and other publications. As a keynote speaker, Tom works with organizations that want to catalyze creativity and engagement at their events, inspiring audiences and bringing them along on assignment to some of the world’s most intriguing places. To contact Tom and discover more about his memorable and inspiring programs, please email email firstname.lastname@example.org.
Lessons From a 45-year Study of Super-Smart Children.
A long-running investigation of exceptional children reveals what it takes to produce the scientists who will lead the twenty-first century.
On a summer day in 1968, professor Julian Stanley met a brilliant but bored 12-year-old named Joseph Bates. The Baltimore student was so far ahead of his classmates in mathematics that his parents had arranged for him to take a computer-science course at Johns Hopkins University, where Stanley taught. Even that wasn’t enough. Having leapfrogged ahead of the adults in the class, the child kept himself busy by teaching the FORTRAN programming language to graduate students.
Unsure of what to do with Bates, his computer instructor introduced him to Stanley, a researcher well known for his work in psychometrics — the study of cognitive performance. To discover more about the young prodigy’s talent, Stanley gave Bates a battery of tests that included the SAT college-admissions exam, normally taken by university-bound 16- to 18-year-olds in the United States.
Bates’s score was well above the threshold for admission to Johns Hopkins, and prompted Stanley to search for a local high school that would let the child take advanced mathematics and science classes. When that plan failed, Stanley convinced a dean at Johns Hopkins to let Bates, then 13, enroll as an undergraduate.
Stanley would affectionately refer to Bates as “student zero” of his Study of Mathematically Precocious Youth (SMPY), which would transform how gifted children are identified and supported by the US education system. As the longest-running current longitudinal survey of intellectually talented children, SMPY has for 45 years tracked the careers and accomplishments of some 5,000 individuals, many of whom have gone on to become high-achieving scientists. The study’s ever-growing data set has generated more than 400 papers and several books, and provided key insights into how to spot and develop talent in science, technology, engineering, mathematics (STEM) and beyond.