On September 27, 2024, Rwanda found itself facing a terrifying new reality: the country announced its first outbreak of Marburg virus, a deadly pathogen closely related to Ebola. The news sent tremors through the nation’s medical community, not least because more than three-quarters of those infected in the early days were doctors and nurses. At the heart of the crisis was Dr. Tsion Firew, an emergency room physician at King Faisal Hospital in Kigali and chair of emergency medicine at Africa Health Sciences University in Rwanda. Her personal journey through the outbreak would become a testament to courage, sacrifice, and the power of decisive public health action.
It began with a simple, cryptic message: "Pray for her." Dr. Firew had just completed a first aid training session when she glanced at her phone and saw the note about a young nurse she’d been working with only days earlier. "She's very young, full of energy, one of the smartest nurses I've ever worked with," Firew recalled in an interview with NPR. The nurse was now in the intensive care unit, disoriented and barely conscious. The gravity of the situation hit home for Firew when she saw her colleague’s condition: "I was overcome with emotion — crying," she said. A fellow doctor offered comfort, embracing her in the hospital hallway. But the comfort soon turned to dread; later that night, the same colleague texted Firew to say he’d developed a fever and was in isolation. The next message was worse: the young nurse had died, leaving behind a partner and a toddler. "That's when I was like: Oh God. This is — this is real," Firew said.
The Marburg virus is notorious for its lethality, sometimes killing up to 90% of those infected. It spreads through bodily fluids, even sweat, and has no approved treatment. Firew’s mind raced as she replayed the hug in the hallway—had she been exposed herself? And what about her family? "Telling a 1-year-old and a 3-year-old: 'Stay in a corner. Don't touch me!' was not going to fly," she admitted. Her husband, an engineering consultant, was stranded in Atlanta by Hurricane Helene, unable to return home. With no other option, Firew arranged for her children to be flown to Ethiopia, where her parents live, accompanied by a cousin and a nanny. "She realized she had no choice but to send her kids away," as NPR reported.
All the while, her phone was buzzing with messages from colleagues falling ill. "They would go isolate. They'd test positive. And then, especially in the first three, four days, most of them died," Firew recounted. The outbreak’s toll was staggering: of the 66 patients eventually diagnosed, more than three-quarters were healthcare workers, many of them Firew’s friends and colleagues. The outbreak likely began when a 27-year-old miner contracted the virus from a bat in a rural mining tunnel, according to NPR.
Firew tried to shield her parents from the full truth, telling them only that the children were on an Ethiopian holiday. But the day after their arrival, her 3-year-old son developed a fever. "Of course, I freak out," Firew said. The boy called her, pleading, "Mommy, I need you now. Where are you? Why are you not with me?" For a moment, Firew’s resolve wavered; she bought a ticket to Ethiopia, then canceled it. Her parents took the boy to the hospital, while Firew went to her own hospital, where Rwandan health officials had already established Marburg testing. She tested negative, and her son was diagnosed with tonsillitis, not Marburg.
Despite the emotional turmoil and family pressure to step back, Firew felt compelled to return to the front lines. "She had to keep doing her part," NPR reported. She donned full protective gear—often ill-fitting, as it wasn’t designed for women—and cared for Marburg patients, including the colleague who had hugged her in the hallway and was now on the verge of death. "The course of the disease, for me, was extremely shocking. I called it the kiss of death. There's bleeding from the mouth, and other orifices," Firew recalled. The relentless stress took a toll. After five days with almost no sleep, Firew began to hallucinate. "I was hearing voices. It was voices of my colleagues," she said. The most vivid was that of her colleague from the hallway, calling her name as hospital machines beeped in the background. "It was just a complete nightmare — I mean, that's an understatement," she admitted.
Yet, even in the darkest moments, Firew and her colleagues pressed on. Rwanda’s response was swift and coordinated. Within days, authorities set up testing and isolation wards. A clinical trial for a Marburg vaccine began within 10 days of the outbreak’s announcement. There was no shortage of gloves or protective gowns. "They were no Marburg deniers. There were a lot of COVID deniers," Firew noted, contrasting the response to her experience during the COVID pandemic in New York City. The government’s proactive approach became a model for outbreak response.
Firew herself spearheaded an unprecedented intervention: administering the experimental antiviral remdesivir to more than 150 healthcare workers with high-risk exposures—before they even developed symptoms. "The idea was brought on that Tuesday. It was started on that Wednesday, and we gave it to over 150 health care workers that had high risk exposures," she explained. The research on the impact is still ongoing, but the results were remarkable. Rwanda achieved the lowest death rate ever recorded for a Marburg outbreak: 23%. Only 15 of the 66 patients died, a stark contrast to the virus’s historical mortality rates.
The outbreak officially ended on December 20, 2024, after six harrowing weeks. Firew’s husband and children were finally able to return home. The reunion at the Kigali airport was emotional and cathartic. "My three-year-old, he ran across the airport when he saw me and it was like this prolonged hug — he just did not want to let go of me," Firew said through tears. "It was a feeling that I've never had before."
Looking back, Firew reflects on the lessons learned and the resilience required to face such a crisis. She acknowledges the pain of loss and the persistent question of whether she could have saved one more life. Yet she also takes pride in the collective effort that helped Rwanda beat the odds. As she put it, "Just to be part of this extraordinary response is such a big — I guess I'll say, a big opportunity."
In a world where public health efforts are often questioned and scientific facts challenged, Rwanda’s Marburg response stands as a beacon of what can be achieved through determination, unity, and faith in science.
