At 1:20 in the morning, on December fifth, 2000, Dr. Matthew Lukwiyas rapidly hemorrhaging lungs overflowed with blood.

His eyelids were engorged to the point that he could barely open them, but by that time it was likely a blessing to be blinded from the horrors that had beset his hospital. The battle he had fought against Ebola, in his own body and those of his people, was ended for him. He was buried in a polyurethane sack.1 Dr. Matthew was the head doctor of St. Marys Hospital Lacor in Gulu Town, Northern Uganda the largest hospital in the region and he was regarded as a savior of his people. Boys in town would dare each other to jump from high places, saying if we break a leg, Dr. Matthew will fix it.2 Unfortunately, the sickness in the destitute north ran deeper than even Dr. Matthew could have healed. The sickness in Uganda ran down off the plains, into the buildings of the government, and from there across the savannah, through the jungles and over the wide, blue Atlantic into American pockets. The sickness in northern Uganda - be it the AIDS, tuberculosis, cholera, or at its most brutal, the Ebola hemorrhagic fever outbreak - is symptomatic of far reaching government oppression and corruption, and American imperialism. At the time the Gulu town Ebola outbreak began, the region had been terrorized by a rebel group called the Lords Resistance Army for fifteen years, and by Museveni and Idi Amin before that, as long as anyone could remember. For the Acholi tribes-people, the most obvious pains were those closest to home. The countless incidents of violence and oppression against them brought down a heavy weight to bear: a creeping infection which came to stifle the northerners into silence. The pestilence and hunger which the Acholi had to struggle against
1

Blaine Harden, Dr. Matthews Passion, New York Times Magazine, Feb. 18, 2001 (http://www.nytimes.com/library/magazine/home/20010218mag-ebola.html)
2

New York Times Magazine, Feb. 18, 2001

came from years of violence and oppression, the conditions of which left them vulnerable and lacking the means to treat themselves. It is this violence that ultimately brought the worlds most deadly virus out of the forest, leaving the Acholi people in a terrifying accretion of gore. Among the worst contributing factors which ultimately resulted in the outbreak was the violence of the Lords Resistance Army. The L.R.A. was and still is led by Joseph Kony, a guerilla terrorist who claims to have the word of god on his side. He has used warped scripture and a core army of two hundred men supplied with funds and weaponry by the Sudanese government to execute a campaign as mysterious in its motivation as it has been brutal in its practice.3 While he claims his intent is to fight for the freedom of his fellow Acholi people in the north, his will in practice has entailed the abduction of their children and brutal murder of any who wont join him. For years the L.R.A. frequently invaded villages at night, hacked people to death with machetes, cut off ears and lips, and forced children to murder their maimed parents so that they would fight for the L.R.A. without any ties to their old homes.4 In response to this constant horror, villagers often fled their towns in the evening. By tens of thousands, these night commuters would head to the streets of larger cities, to relief shelters set up in gymnasiums, and to military relief camps, seeking out safety from the attacks.5 In military camps like Pabbo, however, the smell of fear was not quite as prevalent as that of feces and disease. Where these refugees sought sanctuary, their own government waged a quiet campaign of terror against them. The grounds of Pabbo contained some 6,000 tiny mud huts which were home to 63,000 refugees a night, and food and water supplies were stringently
3

Journeyman Pictures, Meeting Joseph Kony

Sam Farmar, Ugandan Rebel Leader Breaks Silence, BBC Two Newsnight, June 28, 2006 (http://news.bbc.co.uk/2/hi/programmes/newsnight/5124762.stm)
5

Keith Morrison and Tim Sandler, In War Torn Uganda, Kids Only Emerge at Night, MSNBC Dateline, Sept 26, 2006 (http://www.msnbc.msn.com/id/9006024/)

limited. One well was offered for every 5,000 people, many of whom were infected with cholera, malaria, tuberculosis, HIV or a host of other diseases.6 Most of the refugees only ate once a day, and lacked sufficient nourishment to fight off even a cold. Whether gross neglect or murderous intent was behind the Acholis treatment at Pabbo, the end result was the same. Tens of thousands were infected with scores of diseases their bodies had no way of combating. In these camps, supposedly guarded by the National Resistance Army, children learned quickly to seek shelter toward the center of the camp. Even in the army camp, people in outer huts were frequently dragged off into the night and hacked to pieces or kidnapped, right under the noses of the national army. It may seem incredible that the ill equipped and under-aged forces of a guerilla army would be able to stage routine abductions from a National Resistance Army camp, but the feat seems a lot less impressive when one considers that the camp was run in part by what have been dubbed Ghost Soldiers. Internal inquiries have shown that many enlisted people in the National Resistance Army were in fact fabricated persons.7 Army payrolls are full of slips of paper with no bodies attached to them, but the fact that the people never actually existed hasnt stopped them from being paid. Most of the soldiers with legs to walk on and hands to carry guns are stationed in the relatively wealthy southern region of Uganda, so Pabbo was always guarded in part by the ghosts: the ghosts of ill intentions, the ghosts of refugees murdered families, the ghosts of their past. Only a handful of flesh and blood soldiers were there patrolling the camp at any given time.

World Health Organization Disaster Report, Update on Cholera Outbreak in Pabbo IDP Camp, Gulu District, http://www.who.int/disasters/repo/15156.pdf (Oct. 24, 2004)
7

Peter Greste, Q&A, Ugandas Northern War, BBC News, Aug. 29, 2006 (http://news.bbc.co.uk/2/hi/africa/3514473.stm)

While refugees at Pabbo lived in fear of abduction, they had no good will for the occasional clutch of N.R.A. guards that wandered around the camp. The bad blood between the Acholi and the army runs deep. In the years following Musevenis 1986 coup, his army ravaged the north. The defeated Ugandan National Liberation Army, which had initially fled into Sudan, began trickling back across the border, bringing threats of civil war. In response to these threats, Musevenis N.R.A. rode through the north, burning Gulu to the ground. They broke into homes and led a campaign of terror, murdering suspects in the streets, tearing babies from their mothers breasts and hurling them against trees. Of those they didnt kill, some 100,000 were left homeless.8 The atrocities of that time have been lost to [first world] history, but not to the memories of those who survived it. The N.R.A.s neglect at Pabbo is another benchmark of ill will against the northerners by their autocrat. It is this neglect and suppression which nurses the creeping disease of malnutrition and infection that afflicts the Acholi. The nonprofit organization Christian Aid has accused the Ugandan government of shirking their responsibility to protect their northern citizens. In a statement, the group claimed that Musevenis lack of action in protecting or aiding them is borne out of lack of will. Citing the herding of people into camps [such as Pabbo] without anything resembling adequate care or protection, they accused Museveni of being totally indifferent to the plight of the Acholi people. In a responsive statement, the government called the accusations completely unfair.9 If one supposes that the accusations against Museveni are, in fact, unfair, the only way to consider his innocence is if he was bound by material inability. That is certainly not the case. Since Musevenis coup, Uganda has enjoyed a burgeoning export market. While the poor in
8

Caroline Lamwaka, The Peace Process in Northern Uganda, 1986-1990, Accord, 2002 (http://www.c-r.org/ourwork/accord/northern-uganda/peace-process-1986-90.php)
9

Global Security Military Conflict Database, Uganda Civil War, http://www.globalsecurity.org/military/world/war/uganda.htm (accessed Nov 30, 2008)

northern Uganda starved, Museveni burned crops and began growing coffee, tea and cotton to trade on the global market.10 USAID has helped to fund these efforts, citing Strategic objectives [to] address economic growth, among other ways, to revitalize Ugandan exports and encourage trade and investment.11 While the Unites States satisfies the Bretton Woods agenda, sacrificing Ugandas sustainability in order to obtain the cheapest imports they can to cement their position of global superiority, Ugandas economy, if not their people, has also had some success. During the United States investment period in the 90s, Uganda has enjoyed an annual growth rate of 7.2% by way of their inedible crops.12 To offset the food shortages incited by American investment, international aid organizations have donated food for the Acholi refugees. While the efforts are helpful, the northern camps still suffer high rates of malnourishment. This is largely because the Ugandan government has completely dropped the ball: food donated by foreign aid makes up 100% of the Acholi diet in camps.13 Astonishingly, the rate of impoverishment in Uganda has experienced an increase in direct correlation to the rate of economic growth. In the 1990s the number of people living on less than one dollar a day rose from 34% to 38%.14 The north has felt this shortage acutely. While money changes hands in the south, the northerners have less and less to live on. The cost of constant struggle against the rebels and economic strife has had harsh results. As hardships mounted at Pabbo, people instead sought safety after dark on the streets of Gulu town. The night commuters piled in greater and greater
10

USAID Budget Summary, Uganda, http://www.usaid.gov/policy/budget/cbj2006/afr/ug.html Ibid

11

12

The CIA World Factbook, Uganda, https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html, accessed Dec 1, 2008

13

USAID Budget Summary The CIA World Factbook

14

numbers into schools, warehouses and garages, and soon Dr. Matthew Lukwiya took notice. The head doctor at St. Marys Hospital Lacor knew that an influx of refugees, with their various acquired diseases, would instigate an epidemic on the streets of Gulu. In order to prevent this and to alleviate the humanitarian atrocity he and his staff erected shanties within the hospital grounds. Drawn by the safety of the hospital fence and allotted higher rations and a great deal better health care, people began sleeping on the hospital grounds. As word spread, more and more people came to sleep there, numbering up to 9,000.15 Soon the influx of refugees was taking its toll. Many of them had been injured by the L.R.A. and were missing fingers, ears or limbs and required surgery and care. The diseases that they had contracted at Pabbo still ran rampant; though the hospital staff did everything they could to stop it. Injured children and tuberculosis patients took up hospital beds for long periods in ever increasing numbers and filled more and more beds every year in an ever increasing tide, until they spilled out onto the hospital floors. By October of 2000, the hospital was operating at 128% capacity.16 With more and more sick and injured refugees, more and more violence and less and less space for refugees to sleep, beds to treat them on and food for them to eat, something had to give. As the generator whirred into activity each evening and the electric lights illumed nurses stepping over patients, from room to room, the refugees who didnt need immediate care bedded down next to one another in the yard - and as the sun swung toward the horizon, a shadow fell over the hospital. The night sounds of the jungle echoed across the hospital grounds serving as a constant, eerie reminder to those displaced by the terror of the L.R.A. The thick jungle bordering on Gulu is one of the lushest in Africa, and houses the hideout
15

James Astill, The Death of Dr. Matthew, The Guardian, 2 Jan. 2001 (http://www.guardian.co.uk/g2/story/0,3604,416866,00.html)
16

St. Marys Hospital Lacor Annual Summary, 1999, Fondazione Piero e Lucille Corti, http://www.lhospital.org/rapporti_annuali/eng_moreinfo_1999.shtml, accessed12 Nov. 2008

of Joseph Kony and base of the Lords Resistance Army; it was also the home of another terror, even more deadly, and entirely unknown to the Gulu people. The Bwindi Impenetrable Forest is three hundred and thirty one square kilometers of dense, protected jungle. In addition to being home of the L.R.A. it is the home of almost all of the worlds mountain gorillas, which are a heavily studied, endangered species.17 In an effort to raise more funds, the Ugandan government sponsors guided tours into the jungle to observe the primates and the Bwindi Impenetrable Forest has become a hot tourist destination. Due to constant contact with tourists and biologists, the gorillas have become increasingly bold, and are known to wander into nearby settlements. The gorillas will occasionally menace children and pilfer food, but for what they take from the villages they also give in disease. While officially the source of the Ebola virus is unknown, all African outbreaks of the disease have bordered on the Bwindi Impenetrable Forest.18 The mountain gorillas have had numerous documented outbreaks of the virus, and likely many more away from the eyes of tourists and biologists.19 The virus is presumed to be zoonosic transmitted to human populations from other animals and with a genetic makeup 97 to 98% identical to that of humans20, transmission from mountain gorillas seems highly likely, especially in instances of sustained contact to a large population.21 In Gulu town, in 2000, the gorillas had free access to

17

The Mountain Gorilla, Accessed Dec. 2008, Gorilla Tracking in Bwindi National Park (http://www.gorillatrackinguganda.com/Uganda-Wildlife-Gorillas.aspx)
18

A CMS Agreement for the Conservation of Gorillas and Their Habitats, 28 Aug. 2007, Facts on Ebola Virus: Human and Animal Outbreaks (http://www.naturalsciences.be/science/projects/gorilla/aboutgorilla/ebola)
19

Gorilla Agreement, 28 Aug. 2007 Ibid

20

21

Gupta, Manisha, Siddhartha Mahanty, Patricia Greer, et al., Persistent Infection With Ebola Virus under Conditions of Partial Immunity, Journal of Virology, accessed 12 Nov. 2008 (http://jvi.asm.org/cgi/reprint/78/2/958)

the sparse foodstuffs of 9,000 sick, cramped refugees a night, and Ebola had thousands of opportunities to infect starved people with weakened immune systems. All it took was one lucky mutation, and the virus would be set loose on a tremendous new population. On October 8, 2000, an outbreak of an unusual febrile illness with occasional hemorrhage and significant mortality was reported to the Ministry of Health (MoH) in Kampala by the superintendent of St. Mary's Hospital in Lacor, and the District Director of Health Services in the Gulu District. A preliminary assessment conducted by MoH found additional cases in Gulu District and in Gulu Hospital, the regional referral hospital.22 Dr. Matthew first noticed it when his nurses began dying. One by one they fell ill and died within days, vomiting blood or bleeding intensely from the mouth and nose. Dr. Matthew performed test after test to determine the cause of infection, but all were inconclusive. He sent samples off to the ministry of health for further examination. After a week, he and one of the resident nuns, Sister Maria, spent a night under the fluorescent glow of Dr. Matthews study poring over CDC disease factsheets. By the end of the night they were almost certain that the infection was Ebola virus.23 The next day word came in from the CDC confirming their guess. Ebola had and still has no known cure or treatment, and it is incredibly infectious with mortality rates as high as 80%. Contact with infected bodily fluids frequently leads to infection, increasingly so as the virus wears on. Infected cadavers are the most infectious, and contact with them should be avoided at all costs. In a tribe where the dead are washed ritually before burial, this sort of virus constituted a worst case scenario for anyone hoping to avoid an epidemic. As word of the virus carried about the hospital grounds, the refugees staying there became nervous, and many left for the streets of
22

Oyok, Dtc&E, T, C Odonga, Mbchb, et al., Outbreak of Ebola Hemorrhagic Fever - Uganda, August 2000 January 2001, Morbidity and Mortality Weekly Report, 12 Nov. 2008 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm)
23

New York Times Magazine, Feb. 18, 2001

Gulu town or the huts of Pabbo. The threat of brutal death likely seemed more horrifying coming from within ones own body than from without. The exodus brought with it some newly infected people, helping to spread the virus abroad. With abysmal local conditions, limited funding and abilities on the part of the hospital staff, death at the hands of terrorists and disease already at a peak and traditional burial rituals helping to spread the disease, Dr. Matthew and his staff had a containment nightmare on their hands. Having studied the CDC manuals on the disease, Lukwiya knew virtually everything there was to know about containing the Ebola virus, and when official outbreak containment crews began appearing on the scene, their managers were impressed to see that their guidelines were already being followed to the tee. He had released PSAs forbidding the practice of ritually bathing corpses and had devoted a wing of his hospital to the virus, where the most stringent containment guidelines were put into place. Many layers of latex gloves were worn, face masks were a must, Dr. Matthew had even had a wooden boot-jack constructed for removing the shoes of the infected. Outside of the hospital walls, however, fear of the virus was spreading fast, and rumors abounded. People entering and exiting containment zones were hosed down with JIK, an inexpensive and concentrated bleach which is widely available in Africa. When a rumor began to spread that the virus was contained in the stomach, people poisoned themselves by drinking JIK in an attempt to cure the virus. When Dr. Matthew heard of this he quickly released another PSA forbidding people to drink the product. Despite his stringent precautions, Dr. Matthew himself would succumb to the virus. He is presumed to have contracted it one night in November when he was called to the hospital to help control his infected nurse and friend Simon Ajok. In Ajok, the virus had progressed to its final

stage, and as he retched, spraying blood into the air, he tore himself from his bed and staggered into the hall. Blood was pouring from his mouth and nose like tap water nurse Babu Washington Stanley remembers. He was fighting tooth and nail, trying to escape the ward. Stanley was panicked and called the director. Perhaps it was due to being woken from the first sleep he had gotten in days, or perhaps it was because his good friend was dying whatever the reason though, as Dr. Matthew Lukwiya rushed from his home he forgot to put on a protective mask. While comforting his dying friend, the fine spray of blood in the air rushed into Lukwiyas lungs. In the following days he deteriorated rapidly, and at 1:20 in the morning on December fifth, 2000 the virus killed him. By the blessings of luck and the hard work of Dr. Lukwiya and the containment teams, Matthew was the last to die of the virus.24 There are many lessons to be learned from the Gulu town Ebola outbreak. The incident provides new evidence to help prove the origin of the virus, and the heroic efforts of Dr. Matthew show the methods of infection and the importance of working culturally and spreading awareness in containing outbreaks. If the lessons we learn are primarily epidemiological, however, we miss out on the most important lessons of the incident. The Gulu town Ebola outbreak could never have occurred if the government hadnt responded to the brutality facing the northern people with deep neglect. If the National Resistance Army had been called into action, guarding the townships of the north against guerrilla attacks, residents would never have had to flee their homes into conditions of disease and squalor. If funds had gone toward providing adequate care for refugees in camps instead of being embezzled from the paychecks of ghost soldiers, conditions in Gulu would never have reached that critical mass which drew out the virus. If USAID had been more interested in alleviating violence and starvation than in

24

All biographical information concerning Dr. Matthew is from New York Times Magazine, Feb. 18, 2001

floating the American economy on inexpensive foreign crops, Museveni would not have had motivation attempt negligent genocide against the Acholi people. In 2001, President Yoweri Musevenis term ended on the guidelines set in Ugandas new democratic constitution and he ran for re-election. Despite the seemingly overwhelming popularity of his opponent, Kizza Besigye, Museveni won re-election with 63% of the vote. After Besigye filed with the courts for a recount, Museveni drove him into hiding, threatening to kill him and accusing him of being a traitor to the government. Despite his accusations and the threatening presence of special police at the court hearing, two of the five judges noted rampant illegalities in the election proceedings involving incorrect vote tallies and problems with the ballot boxes in certain regions. Besigye was arrested for treason. As long as America continues to condone and fund the genocidal action and inaction of a military dictator, Uganda will never be free from the epidemics of malnourishment, violence and disease that led to the Gulu town Ebola outbreak. The significance of the situation goes beyond that, however. The human race has limitations. There are some things we cant fight, and the heroic efforts of people like Dr. Matthew will not always be enough to save us. Unless we act to change first world policies that force the worlds demons out into the open, there will come a day when the outbreak is not stopped, when the hero is not the last to die and god help us on that day.