Kampala - Four months since the deadly Ebola fever broke out in western Uganda, there is still no clear explanation of where the original victim contracted the virus from. But government now believes the outbreak may have come as a result of people eating monkey meat.

Officials in Bundibugyo district were by press-time still noncommittal about what sparked off the current outbreak. Chief Administrative Officer (CAO) Elias Byamungu, said that investigations were continuing, while Resident District Commissioner (RDC) Samuel Kazinga, who chairs the district's Ebola Task Force, promised to make the information public once investigations were complete.

Tracing this "index case" is important to scientists trying to understand exactly where the Ebola virus hides between outbreaks. Knowing this natural reservoir would help the country cope better with any future outbreaks.

Initial reports said that the first victims had eaten a dead goat suspected to have been bitten by a monkey. But speaking in Kampala last week, President Yoweri Museveni cast doubts at monkey-goat theory, suggesting instead that the initial victims might have eaten a monkey.

This appears to be the official view. The minister of State for Health, Emmanuel Otaala, said early this week that investigators had failed to find any trace of the goat suspected to have been bitten by the monkey.

"We tried to trace for the skin of the said goat but in vain," Otaala said by telephone. "So we think the victims actually ate the monkey. And you see Ebola is not known to stay in goats but it can affect primates like monkeys."

The Ministry of Health says the strain of Ebola in Bundibugyo and Kabarole is different from previous types identified in Zaire, Ebola Sudan, Ebola Ivory Coast and Ebola Reston (USA). Medical authorities suggest that this latest strain of Ebola may not be as lethal as previous ones and should not be hard to contain.

Ebola is a highly infectious viral disease without a cure - characterised by fever, joint pains, vomiting and bleeding, among other symptoms. In most outbreaks, up to 70 percent of those infected die.

Health workers try to contain Ebola by isolating patients and sensitising the public to bury the dead immediately and observe higher levels of personal hygiene. By press time, the Ebola death toll stood at 29 out of 113 cases.

Minister Otaala said volunteers had contacted at least 200 people who had come into contact with confirmed Ebola cases. Such people are being advised to stay in their homes for three weeks, after which they can be cleared.

Otaala said the next three weeks would be critical; if the contacts co-operate, then the outbreak should be tamed within this period.

Changing lifestyle

The second coming of Ebola has thrown much of the country into a state of panic. The first case of the current outbreak has been traced back to August 20 this year, while confirmation of Ebola only came three months later. This has given the impression that in that period the disease could have spread far and wide, making many more people vulnerable.

During the just concluded Commonwealth summit (CHOGM), many guests spoke fondly of the kindness and warmth of the Ugandan people. They were not exaggerating. In a country where greetings tend to be elaborate, handshakes abundant and the dead are seen off with body-washing, outpouring of grief and communal meals, Ebola is threatening to shake up Ugandans' way of life.

Here is why. The guide book the public is reading on how to avoid Ebola reads like this: Avoid handshakes - just wave. Avoid contact with (even suspected) Ebola patients. Avoid burials where the deceased's clan and friends cry and dine. And from junior Health Minister Emmanuel Otaala: Avoid washing bodies before burial. Some people even suspect you can get Ebola by visiting a public toilet used by someone carrying the Ebola virus.

According to Dr. Chris Baryomunsi, a medical doctor and MP for Kinkiizi East in Kanungu district, there is a risk in each of the above practices, even if sometimes it is remote. Part of the problem is that the person you shake hands with on the street may appear healthy when in fact he or she is carrying the Ebola virus.

Baryomunsi says you may contract the virus if you come into contact with body fluids of such a person incubating Ebola. (Other medics however say that only a person with full-blown Ebola can spread the disease - Ed) So while a 'dry handshake' with an old friend on Kampala Road may pose no risk, you cannot be sure it will be dry; you cannot be sure if they came into contact with Ebola the day before; so you leave out handshakes altogether.

The same goes for other measures, like avoiding congested public transport and communal burials. You just can't be sure.

"The incubation period of Ebola is between two and 21 days, and even if one does not show overt Ebola symptoms, they can still pass on the disease if there is contact with body fluids," Baryomunsi said.

Caution or alarm?

But people like CAO Elias Byamungu who are in Bundibugyo feel that people outside the epidemic area are being unduly alarmed.

Byamungu compared today's situation to the early days of AIDS in the 1980s when people feared they could catch the disease by sharing a toilet with an HIV-positive person.

"People now think that because I am in Bundibugyo I am dead meat," Byamungu said. "But people in Kampala and elsewhere should not fear, we are getting this thing under control. Me I am on my desk and I shall be here tomorrow."

Yet with this highly infectious disease on the loose, officials are being stretched trying to respond to alarm bells from all directions.

Early this week suspected Ebola cases in seven districts were declared false alarms. But there is no room for complacency because while those cases were declared Ebola-free, other people in the epicentre were being monitored and others isolated.

"We have just received information that there is another case at Rwebisengo," Byamungu said. "This is an isolated case and we suspect it could be something else, but we are going there."

Bundibugyo RDC Samuel Kazinga summed up the situation as both negative and positive: "Some people are dying, others are being discharged".

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