Uganda: Out of the Wild
Reported by Serene Fang
SERENE FANG, Reporter: [voice-over] In the lush mountains of western Uganda, tourists come to these dense forests in search of rare and exotic animals. What they don't anticipate is to come in contact with some of the world's rarest diseases. That's what happened to an American tourist recently who came down with a mysterious and deadly disease after visiting this cave known for its bats.
Dr. STUART NICHOL, Centers for Disease Control and Prevention: We're still not exactly sure how she acquired the infection. So we know that she did enter into the mouth of the cave but didn't go very deep into the cave.
SERENE FANG: A team from the Centers for Disease Control found that she'd contracted Marburg virus, a hemorrhagic fever that causes extensive internal bleeding. Hers was the first case to reach the U.S.
Dr. STUART NICHOL: She would have had to put her hands down. You can imagine it's hot and sweaty. You know, you brush your face to, you know, push your hair back or something, and there's ways that you could get the virus onto your mucous membranes and get very efficient virus infection.
We've slowly pieced together that Marburg, this nasty hemorrhagic disease, they're getting it from the bat reservoir.
SERENE FANG: During the same period, another outbreak of hemorrhagic fever was devastating a remote village in the same region. It was discovered to be a new strain of the Ebola virus which scientists believe was transmitted to humans who ate infected bush meat.
NURSE: [subtitles] The blood is very, very contagious. I've cleaned it with chlorine, and someone from the CDC will come for the sample.
SERENE FANG: For public health experts, the Ebola and Marburg cases in Uganda were chilling examples of just how dangerous animal diseases could be to humans.
Dr. ALI KHAN, Centers for Disease Control and Prevention: One of the common factors that links these emerging and new infectious diseases is that all of them actually started with an animal somewhere. So what we call these diseases is zoonotic diseases, diseases that are transmitted from animals to humans.
SERENE FANG: Uganda lies at the front lines for diseases that cross the species barrier. Plague, Ebola, anthrax, tuberculosis and HIV are all endemic here. The CDC has made Uganda a special focus for its work.
[www.pbs.org: Pandemics throughout history]
Dr. ALI KHAN: Uganda is also a really good example of a hotspot for where diseases arise. Infections due to animals represent 75 percent of all the emerging infectious diseases, and so if you're really going to tackle these diseases, you can't just focus on people. You need to focus on the animals, you need to focus on the environment, and that interface where those come together, to decrease infectious diseases worldwide.
SERENE FANG: The Bwindi Impenetrable Forest lies on Uganda's southern border. It's home to half the world's remaining population of mountain gorillas. We're headed into the forest to track a new gorilla family with Dr. Gladys Kalema-Zikusoka. She's been studying diseases in the gorillas for 15 years and is known as the Dian Fossey of Uganda.
Dr. GLADYS KALEMA-ZIKUSOKA, Wildlife Veterinarian: This is where they rested, over here.
I think what's so special about the great apes is that they're so similar to us. We share over 98 percent genetic material both with gorillas and chimpanzees, and it means that we can learn a lot about ourselves by studying them.
When you go to visit them in the wild, you actually feel like you're connecting. They look at you, you look at them, and there's some kind of connection. It's actually very therapeutic watching them. And the infant gorillas are very playful, just like humans. Like, when I see them playing, I think of my two children.
SERENE FANG: Gladys became Uganda's chief veterinarian when she was 26.
Dr. GLADYS KALEMA-ZIKUSOKA: I've always loved animals ever since I was little. And then at the age of 12, I really decided I wanted to be a vet.
SERENE FANG: The BBC even made a documentary about her first year on the job.
BBC NARRATOR: This young woman's got a fight on her hands, but she's determined to make her mark in a tough world.
SERENE FANG: Nine months into the job as country's chief vet, Gladys was called to treat a family of gorillas who were suffering from a troubling new disease.
Dr. GLADYS KALEMA-ZIKUSOKA: The gorillas are losing hair and developing white, scaly skin. The baby gorilla had lost almost all its hair and was very thin. And the mother, where she was carrying the baby, had also lost a lot of hair. And the baby was making crying sounds, which is extremely abnormal for gorillas. And I visited a human doctor friend of mine because they could have picked it up from people. And she said it's scabies.
SERENE FANG: Scabies is a minor skin infection for humans, but gorillas were naive to the disease. For Gladys, it was the first time she saw a human disease jump to mountain gorillas with fatal consequences.
Dr. GLADYS KALEMA-ZIKUSOKA: This is a really good area to show that there's no buffer zone and the forest cuts directly onto the hill. So that means gorillas come out often because they think it's still part of their normal range, and that's when they get in touch with contaminated items from people. They could even? like there, there's a field? they could even just find dirty clothing on a scarecrow which is set out to scare wild animals, and then they get sick.
SERENE FANG: Recognizing this link between wildlife health and human health marked a turning point in Gladys's thinking.
Dr. GLADYS KALEMA-ZIKUSOKA: It made me realize that you can't protect the gorillas if you don't think about the people living around the park who have very little health care. And because we're so closely genetically related, we can easily get diseases from each other. The only long-term and sustainable method to improve the gorillas' health is by improving the health of the people living around the park. And not just the people, but their livestock, as well.
Dr. WILLIAM KARESH, Wildlife Conservation Society: When we say that there's human health or there's livestock health or there's wildlife health, and that? we just made that up. That's not? there's only one health.
SERENE FANG: Dr. William Karesh heads the global health program at the Wildlife Conservation Society.
Dr. WILLIAM KARESH: There's just a tiny percentage of diseases that only affect one group. So when we eradicated smallpox around the world, that was a simple one because that's one of the few diseases that only affects humans.
SERENE FANG: He says the most difficult diseases are the ones we share.
Dr. WILLIAM KARESH: We want to work upstream. If animals are the source of a disease, we want to break the chain from people from getting it. If people are the source of the disease, we need to break the chain going in that direction. And it really does play out at the local level. Until you get it on the ground, like Gladys is doing, it doesn't really mean anything.
SERENE FANG: We've come to a small village near the forest boundary, where Gladys has gathered the community to watch a drama play about tuberculosis, a serious problem in Uganda.
Dr. GLADYS KALEMA-ZIKUSOKA: This is showing a good family and a bad family, so that the bad family, like, threw rubbish next to the garden and defecated. And the gorillas came and was exposed to this. So then the good family, which is a man dressed as a woman, came in and cleared everything up and told them off.
ACTOR: [subtitles] Oh, my God! You've started bringing your waste from your home to my garden! Now what's going to happen? Won't the wild animals catch TB?
SERENE FANG: High rates of HIV/AIDS and little available health care leave people highly susceptible to infectious diseases like TB. Simple hygiene education can help.
Dr. GLADYS KALEMA-ZIKUSOKA: So this is a family. They're dirty. Some of them don't have shoes?
SERENE FANG: But Gladys also finds volunteers to gather samples from villagers with chronic coughs?
MAN: So he says he has been coughing for about five months.
SERENE FANG: ?and makes sure that those that test positive for TB follow through with the full course of treatment. There's a problem with the local cattle, as well. They carry a strain of bovine tuberculosis which can sicken humans who drink infected cow's milk.
Dr. GLADYS KALEMA-ZIKUSOKA: These cows could carry TB infection into the humans, which would be a big shame in this community because are improving the health of the community. So we're going to carry out TB testing with the samples. And if there is any cow that has TB, unfortunately, it has to be euthanized.
SERENE FANG: She's doing all this because she knows how easily this disease could jump to gorillas.
Dr. GLADYS KALEMA-ZIKUSOKA: If the gorillas got TB, it would be a disaster. TB requires daily treatment every day for eight months, and it's impossible to do that in the forest setting. It's easier for people to get that.
I'm just trying to record all the gorillas I've seen so by the end of the visit, I can tell [unintelligible] gorillas in the group.
We're developing an early warning system for disease outbreaks. If we collect fecal samples regularly, then when there's an outbreak, we'll be able to tell what's different and be more informed and give a proper treatment.
SERENE FANG: What began a decade ago for Gladys as an understanding that animal and human health are tethered together has become a new policy for organizations like the CDC.
Dr. ALI KHAN: We think of ``one health'' as not just about human public health, ``one health'' is about human and animal public health. And increasingly, what this strategy is telling us is we need to be working more closely in an integrated manner with the animal public health field.
SERENE FANG: In Bwindi, Gladys remains worried. Diseases far worse than TB have caused major die-offs in other primate populations. In the Congo basin, wildlife experts estimate that more 5,000 lowland gorillas have died of Ebola over the last decade.
Dr. GLADYS KALEMA-ZIKUSOKA: In Congo-Brazzaville, they've had people dying of Ebola who ate gorillas that died of Ebola. They were very encouraged by what we're doing in Uganda, and so now they're trying to bring the wildlife authorities together with the public health authorities to address these issues.
SERENE FANG: Health authorities are also concerned about the further spread of these emerging diseases.
Dr. ALI KHAN: Once upon a time, it would have taken days, weeks, months to go from one continent to another continent. Nowadays, within 24 to 48 hours, you can travel from one place to the other place and still be incubating the disease. So its very easy to transmit diseases worldwide.
Dr. GLADYS KALEMA-ZIKUSOKA: Sometimes it gets frustrating when you're trying to promote conservation. There's so many other pressing issues. But what gives me hope is that by promoting conservation, we're improving community public health around a very remote area of Uganda.
That's it. We're done here. We can head back.
ANNOUNCER: There's more of the world to explore on our Web site. Visit Carbon Watch, a multi-platform investigation into the carbon economy and just voted a winner in this year's Webby Awards. See more of our coverage on immigration and the border. Also, hear a story of survival from the forest. Discuss the world and tell us what you think of our Stories From a Small Planet at PBS.org.
Next time on FRONTLINE
He still had Iraq inside of him.
I didn't even want to go home.
You took a broken soldier and you sent him back.
I didn't want to leave.
You just feel like everybody's against you.
ANNOUNCER: FRONTLINE investigates the invisible scars of war.
We give up part of our morality to go to war.
It allows us to survive. It allows us to kill.
ANNOUNCER: The Wounded Platoon next time on FRONTLINE.
FRONTLINE/World's The Carbon Hunters is available on DVD. To order, visit Shoppbs.org or call 1-800-PLAY-PBS. [$24.99 & s/h]
FRONTLINE/World is made possible by Shell, supporting freedom of the press and the independent journalists who tell the stories of our time. And by the John D. and Catherine T. MacArthur Foundation, committed to building a more just, verdant and peaceful world, and by the Skoll Foundation.
With additional funding from Scott Fearon. Funding for The Carbon Hunters is provided by the Nathan Cummings Foundation.
