The doctor who gave his life

During Dr Matthew Lukwiya's funeral, the pallbearers wore face-masks, latex gloves and surgical gowns, and the restricted number…

During Dr Matthew Lukwiya's funeral, the pallbearers wore face-masks, latex gloves and surgical gowns, and the restricted number of mourners pressed back from the tightly sealed coffin. Lukwiya would have approved of these safety measures - it was he who devised them.

In early October, Lukwiya suspected that a mysterious sickness killing student nurses at his hospital in Gulu, northern Uganda, was ebola. By the time a team of World Health Organisation (WHO) experts arrived, days later, there was little for them to do. Lukwiya had already got hold of their manual and begun isolating patients and setting up barrier nursing practices.

These are highly specialised techniques and ebola is not forgiving of mistakes. Even fleeting contact with infected body fluids pretty much guarantees infection. Within a week, soaring fever marks the virus's onslaught on the vital organs. By the 10th day, often after heavy bleeding from every orifice, the patient is usually dead from shock.

Nothing can be done to fight ebola other than to contain its spread: there is no treatment, no cure. But Lukwiya saw what must be done immediately. This was the first time ebola had emerged in a densely populated area with good transport links to major cities. And he was not curious to see how the virus would fare in these new, improved infection conditions.

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He saved many lives in his fight against ebola, but three weeks ago, with the epidemic apparently on the wane, the 43-year-old doctor became the 156th recorded victim of this outbreak. Two months of leading terrified nurses by example, cleaning up pools of lethal blood and vomit, had exhausted him. While easing the violent death throes of a colleague one night, he made a mistake and died because of it.

Dr Simon Mardel, one of the first to arrive with the WHO delegation, nursed Lukwiya. "A particularly cruel feature of this disease is that those who do the hands-on work, the hardest work, get exposed," he says. "It takes out your best people."

In fact, in the last major ebola outbreak in 1995, in the Democratic Republic of Congo (then Zaire), 65 health workers died out of a total of 244 who were looking after the victims.

While Lukwiya was just one of thousands of heroic medical workers in Africa, he was far from typical. The majority - 70 per cent - of newly qualified Ugandan doctors hotfoot it to lucrative practice in South Africa, Europe and the Middle East. Lukwiya was the brightest of young Ugandan doctors. He had scholarships and prizes to spare: the best school-leaving marks in Uganda; the best student in tropical paediatrics at the school of tropical medicine in Liverpool, England.

He could have chosen a career path that led towards riches. But he was never tempted. When he qualified in Kampala, he headed 300 km north to St Mary's, in Lacor, an Italian missionary hospital outside Gulu, the main town in the region of his own Acholi people.

Gulu is one crossroads, dotted about with several outsized churches bequeathed by competing Anglican and Roman Catholic missions. In the market, hawkers sell cassette tapes, nails and children's party dresses. In the streets, cyclists press radios to their ears to catch the news, muffling out the constant din of Congolese dance music. And every sun-baked inch is dusted with red earth. It is a thoroughly unremarkable African town. But it has suffered remarkably.

During Lukwiya's 15 years at Lacor, many of them as medical superintendent, Gulu has been ravaged by 12 years of conflict - with refugees swelling the town's population threefold to about 100,000 people - and by related epidemics of cholera, measles, malaria, meningitis and AIDS. Some might think doctoring there would be a thankless task. But for Lukwiya, it was enough to turn down a lecturing post in Liverpool and other softer options.

"There was never a doubt that he would stay in Gulu - he would always say, `My people need my service'," says Dr Bruno Corrado, Lacor's long-time administrator. "He felt that holding a position meant having responsibility."

Margaret Lukwiya, his widow, smiles at the thought of his leaving Gulu. "Matthew was not for worldly desires," she says. "He was just devoted to his patients. It was never business. It was just his patients. That was it." When rebels came for the hospital's nurses one Good Friday, Lukwiya persuaded them to take him hostage for a week instead. When the Lukwiyas were lying in bed one night, listening with their five children to the fighting outside, a grenade was tossed on to their window-sill but failed to explode.

"Many of the doctors took their families and ran away," says Margaret, "but because I was his wife, because I loved him, I could not leave him to the war. So I had to pick up his character and learn to live like him."

Thanks to Lukwiya, the hospital tripled its capacity to nearly 18,000 patients a year during this time - including the wounded of both army and rebels, according to Corrado. And this excludes 500 outpatients seen daily. For Gulu, having one of the best hospitals in east Africa at hand when ebola emerged was a rare piece of luck.

It started, says Sister Maria Disanto, Lacor's weary, grieving head of nursing, when three student nurses fell sick and died, one after the other. "We were thinking, `How can this happen?"' she says. "Then we started realising that they were all either bleeding or vomiting blood."

Lukwiya was called back from leave at the University of Kampala and sat up overnight, going over the unexplained deaths of the previous month. The next day, he called in ministry of health virologists to take samples. But already, three days before the results were due back from South Africa, Lukwiya had diagnosed the disease.

Some 17 people were dead or dying with the same symptoms. And Lukwiya was convinced that viral haemorrhagic fever, the family of extremely rare and highly infectious diseases that ebola heads, was the cause. Overnight, he set to work with Sister Maria, nursing patients from behind protective layers.

"We had two WHO manuals about the virus," she says. "He took the English one, I took the French one. We read them one night and in the morning we started. It was not perfect. But if we had waited 10 days, it would have been terrible."

The results astonished the WHO. "I had thought people would be unwilling to work," says Mardel. "I thought we would be facing a situation where patients were totally neglected and an isolation ward to which people wouldn't want to come because it would just be a mortuary."

"But they had implemented the manual - a very specialised recipe. They were giving highly sophisticated care. It was remarkable. There was even a device for pulling boots off they had made, exactly as the manual describes."

So the experts of the WHO and, a day or two later, of the French agency, Medicins Sans Frontieres (MSF), took themselves off to the smaller and less favoured Gulu hospital, where they found corpses lying in the wards and doctors less than keen to implement procedures.

At the height of the outbreak that followed at Lacor, two doctors and 15 nurses - all volunteers - nursed up to 70 ebola patients around the clock. Sister Maria worked 50 14-hour days in the isolation ward in succession, knowing that the smallest contact would be fatal.

"Every night I was thinking: `I hope I have done everything well'," she says. "You never knew. You might have 10 severely sick patients to yourself, dealing with their blood, changing one bed, changing another. That is how it was."

Josephine Latoo, 35, was admitted at that time, along with her mother and two daughters. Only her mother died. "I was vomiting blood and had terrible fever," she says. "The doctors wore strange clothes. But Dr Matthew welcomed me to the isolation ward and I was not scared. I trusted he would help me. We all did. He was working with God."

Staff nurse Babu Washington Stanley was on duty the night Lukwiya contracted the disease. Half-crazed, a dying nurse started thrashing about, spraying blood and vomit. "Blood was pouring from his nose and eyes like tap water," says Stanley. "He started to become confused, fighting death tooth and nail. He started pulling out his tubes, trying to leave the ward, and we got scared - we thought he might become violent. So we called Dr Matthew."

In his haste, Lukwiya put on protective clothing, mask, cap, gown, apron and two pairs of gloves, but didn't bother with goggles. "There was a lot of tension and hurry to help this boy - he was one of our colleagues," says Stanley.

By the time the nurse died an hour later, not only Lukwiya, but also Stanley and another nurse - both of whom were fully dressed in protective clothing and one of whom had not even touched the patient - had been infected.

When Lukwiya started to get sick a week later - of malaria, it was first thought - the epidemic seemed to be burning out. Traditional funerals, where the body is communally washed and the virus runs riot, had been all but stopped; thousands of people at risk of infection were being monitored; admissions had slowed to a handful a day. And nearly 50 per cent of patients were recovering - compared with 10 per cent in previous outbreaks.

But even now, a month later, cases are still appearing. "You can't speak of the virus being under control because we can't stop people gathering," says MSF project co-ordinator Catherine Bachy. "Every case can be the start of an epidemic."

There are fears of a new wave of infections. Corrado thinks Lukwiya's death is symbolic of this insidious lingering: a terrible omen after the hospital's success against the first wave of infections. "Everybody wanted Matthew to survive not only for him, but as a proof that the disease can be defeated," he says. "We could have said: `We fought together and we won'. But this is not the case, unfortunately."

Because of the terrible risk of infection, Lukwiya had insisted his wife and children stay in Kampala. "Then they called to say he had a fever," says his widow. "He didn't want me to come, but he thought I should be told. So I went."

Dressed in full space-suited protection, Margaret Lukwiya saw her husband twice a day for two days. "They had not told me it was ebola but malaria, so, when I saw him, I broke down. I was wailing and crying," she says. "But he said: `If you cry, you'll start rubbing your face, which won't be safe. Cool down and stand firm. Just keep praying."'

Lukwiya was buried beneath leafy mango trees and bright bougainvillea in the grounds of Lacor. "His culture says you must be buried in your own place," says Corrado. "But he decided his own place was here."

A couple of miles from the grave, its blanket of wreaths still drying, lies an isolated patch of ground, half the size of a football pitch, slashed and burned from the bush. On approach, the termite mounds seem strangely regular. But of course they are not termite mounds.

Soil trickles off these recent graves, as the red earth bakes and crumbles. There are 160 of them, and to the side, a dozen more holes are being dug. Were it not for Matthew Lukwiya, there would be many more. And that would be enough for him, says his widow: "I don't think he would regret this. He knew the risk. He saw what was needed for his patients and he did it. That was him."