Last month I was in Uganda. As I planned for this trip, I wasn't sure
what to expect. Uganda is the only country served by the president's
Emergency Plan for AIDS Relief (PEPFAR) with a rising HIV incidence; I
anticipated that there might be problems.
What I saw instead was impressive progress.
Although Uganda will have challenges for many years as a result of
increased HIV infections over the past decade, and has much more to do, I
was struck by how much headway they've made in the past couple of
years. The country has scaled up lifesaving anti-HIV treatment as well
as voluntary medical male circumcisions, which sharply reduce the chance
of becoming infected.
While in Uganda, I got to peer into a cave -- the same cave where two
tourists got Marburg virus in 2007. This deadly virus, similar to
Ebola, was unknown in this location until identified by CDC staff.
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This is Python Cave -- and I was awed to see the python, which is at
least 12 feet long and 24 inches in diameter, or at least it seemed that
way to me! There are 10,000 bats in the cave, 5 percent of which are
infected with Marburg, and they provide a buffet for the python. The
bats, usually nocturnal, were very active at the time of our daytime
visit because the python was hunting for a meal. This viewing station
was built by CDC because no one without full spacesuit-like body
protection should enter the cave.
Uganda is vulnerable to a wide range of infectious disease threats in
addition to Marburg, including yellow fever, plague and Ebola, and is
home to more than 60 mosquito- and tick-borne infections. West Nile and
chikungunya, both potentially deadly viruses spread by mosquitos, were
first identified there.
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On this trip, we broke ground on a national reference laboratory
building. The new lab, funded by PEPFAR, is critical to detecting and
diagnosing these and other diseases. It is also tangible evidence of the
importance of CDC's Global Health Security project to improve lab
facilities throughout the nation. Stopping disease threats quickly is
key to ensuring the health security of Ugandans -- and also of
Americans, since diseases can cross any border.
One of the most exciting events in Uganda was my visit with
Ambassador Scott DeLisi to launch a system to transport laboratory
specimens by motorcycle and courier. Test results are returned by email
and can be retrieved and printed immediately anywhere in the country,
substantially reducing the time between disease detection and treatment.
Hewlett-Packard donated the GSM printers, a great example of a
public-private partnership in public health.
Perhaps the most impressive success is how quickly maternal health
care services have improved. In one year, Uganda's "Saving Mothers,
Giving Life" project has made striking progress in its goal to cut
maternal deaths by half. In the districts where this program is being
tested, there've been important improvements to medical facilities and
services, a large increase in deliveries of infants at these facilities
(eight-fold in one facility I visited), and increases in Caesarian
sections. Unlike in the U.S., the lack of facilities in Uganda leads to
far fewer Caesarian sections than medically indicated, a gap that
results in mother and child deaths and many other serious health
problems.
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CDC is proud to work closely alongside Ugandans to build these
programs. One leader told me, "When Ebola happens, people run away, but
CDC runs toward us to help." The new Minister of Health Dr. Ruhakana
Rugunda noted that CDC has embodied the "teach someone to fish, and
they'll fish for a lifetime" approach in his country.
It was an honor to see first-hand how much progress is being made,
and know that our work will improve the health of people not just in
Uganda, but also throughout Africa and around the world.
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CDC and Uganda's Viral Research Institute have partnered for many years to reduce plague in that country. Here, I'm learning fascinating things from the Ugandan team -- how to study fleas and rats and, more importantly, how to control them so that plague doesn't spread. The flashlight contraption is a way to catch and study fleas.
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A homegrown way to rid rats of fleas using a tube and a wick also has
promise to reduce plague. Last year, the staff of this station
mobilized and, in less than 24 hours, confirmed that a woman had plague
and gave preventive medicine to more than 130 exposed people, both from
Uganda and neighboring Democratic Republic of Congo, following up the
next day with spraying to further reduce risk. There were no further
cases of plague. More than a decade of collaboration in this remote
area is saving lives, building capacity and yielding innovations that
can benefit the world.
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