The Risks--and Rewards--of War Zone Research

Jon Cohen*

Photos by Malcolm Linton

KAMPALA, UGANDA--At 2:00 a.m. on Good Friday in 1989, about 30 young rebels from the Lord's Resistance Army breached the gate of Lacor Hospital in Gulu, where Matthew Lukwiya worked as a clinician, and demanded drugs. A gatekeeper roused Lukwiya from bed, and he told the rebels that the Ugandan army was keeping the drugs in town. They threatened to take some of the elderly Italian sisters from the Comboni Missionaries, a religious group that runs the hospital. "I said, 'If you want to take the sisters, take me,' " recalls Lukwiya. Shoving people with their guns, the rebels did just that, grabbing five nurses, too.

"They said, 'Until you pay a ransom, we won't give them back,' " says Lukwiya. "They were very rough, and we thought they were going to kill us." After keeping the hostages in the bush for a week, the rebels released this kind-faced young doctor and the nurses unharmed. But their harrowing experience explains why few Ugandan doctors, to this day, work in Gulu. "People don't want to risk [going there]," explains Lukwiya.

Gulu, about 4 hours north of Kampala by car, is in an "upcountry" region torn by armed conflict. Residents are fearful of rebel soldiers, who have raped girls and seized boys to serve as fighters. Thousands of townspeople flood each day onto the guarded hospital grounds at dusk for a safe night's sleep. So upcountry clinical researchers like Lukwiya, a native of the Gulu district, play a critical role--and win high praise from their colleagues. "Matthew Lukwiya is the best doctor I have met in Africa," says Giuliano Rizzardini of the University Hospital in Milan, an AIDS clinician who lived in Gulu himself for several years during the mid-1980s and still travels there regularly.

Figure 1
Fear factor. Matthew Lukwiya works in rebel territory upcountry that colleagues avoid.

Lukwiya works in Gulu primarily because he wants to provide care for his own people. He also takes the risk because he believes research can help thwart HIV in a region that still has shockingly high infection rates--in contrast to other parts of Uganda that have successfully curbed HIV's spread. In 1999, for example, 35% of the outpatients at Lacor Hospital tested positive for HIV. "It's very important to work in Gulu because when AIDS research started, researchers all centered on Kampala," says Lukwiya, who in 1996 established a long-term research collaboration at Lacor studying immunologic responses to HIV with the University of Milan's Mario Clerici. (Lukwiya himself moved to the capital city last year but intends to return to Gulu soon.) "This cooperation with the Italians up north has done quite a lot for the people and the hospital," says Lukwiya. "There's a transfer of technology and a transfer of scientific culture."

With the Italian researchers, Lukwiya has published cutting-edge papers that may help explain why Africans are particularly vulnerable to HIV, and he says he has been able to offer his patients better care. "Our hospital is the only one in the country that has systematic computerized records," says Lukwiya. "We've been able to improve the training of our staff. And we've been able to link ourselves with good research centers in Italy." Lacor has also attracted international attention, including a 1997 visit by U.S. Secretary of State Madeleine Albright, who pledged to establish a $2 million endowment for the hospital (a promise as yet unfulfilled).

Lukwiya hopes that if the developed world better understands the devastation that HIV and AIDS cause in places like Gulu, it will work harder to provide treatments. "People are dying," he says. "They're dying here day and night."

* Jon Cohen was accompanied by photographer Malcolm Linton. For a gallery of additional photos and the stories behind them, see

Volume 288, Number 5474, Issue of 23 Jun 2000, p. 2159.
Copyright © 2000 by The American Association for the Advancement of Science.