Preventing disease outbreaks: lessons from Uganda
By Ashoka Contributor Group
Conservationist, veterinarian, epidemiologist, and health worker in the villages near wild habitat, Dr. Gladys Kalema-Zikusoka is an advocate for the well-being of both people and animals. She is teaching Ugandans how to achieve wildlife conservation through public health and prevent disease outbreaks. We asked Gladys for insights into the current novel coronavirus pandemic and how we can prevent future outbreaks.
The world is watching Covid-19 and learning a new word: zoonotic disease. What’s going on?
Some diseases cross species: animal to human, human to animal, or from one kind of animal to another, for example, from wildlife to cattle, which live in close contact with human beings. Ebola may have originally come from a still unknown source in the forest and hunters handling wild game spread it in their villages. We know that Marburg arose from fruit bat droppings here in Uganda. Both are deadly, with recovery rates as low as 10-20%. Scientists haven’t pinpointed the origin of Covid-19, but they suspect that it comes from eating wild animals. It has spread worldwide in weeks, probably because of air travel and a long incubation period. By contrast, Ebola victims get very sick very quickly. Ebola overwhelmed local health systems, but did not spread far or fast.
How does Uganda handle such disease outbreaks?
In much of Africa, the places where you find wildlife you also find very, very weak public health systems -- or none at all. You might walk 20 miles to reach a clinic. There's hardly any public transportation. People pursue the folk remedies they can afford. Such communities have close connections to the national parks and wild habitat for great apes. When we saw gorillas catching human diseases, we knew we had to deal with human and animal health together. We bring health services, we educate -- basic stuff, like washing your hands. The government has now rolled it out elsewhere. We also encourage people to refer anyone suffering from strange illness to the nearest health center.
How are early detection and warning systems in rural areas?
In this work, the first interface we manage is people and wildlife, and the second is people and government. We encourage people to report on local health conditions by SMS, make referrals, and seek treatment. A 2004 outbreak of anthrax in Uganda’s Queen Elizabeth Park killed 300 hippos and sickened 100 people who ate them. People trusted the community volunteer health workers and doctors enough to admit that they had eaten wild game. They told the doctor, “Look, I ate something strange and some people actually died.” They fear making such a confession to wildlife officials. We can treat anthrax with penicillin if we catch it in time, so the message needs to be that you will protect yourself and your family by seeking treatment quickly. In 2010, anthrax broke out again among the hippos. We joined the National Disease Task Force and educated people not to eat meat from unknown sources resulting in very few human cases and no deaths. Anthrax outbreaks tend to recur in ten-year cycles.