I generally slog out my days in the kilometer between home, school, and hospital. So it was a bit like a field trip yesterday to go with Scott, on the motorcycle, leaving the kids with teachers and self-supervision and the hospital in Scott Will’s capable hands. We zipped up to Bundibugyo first for the opening of a two-day seminar updating midwives and clinical officers on care for HIV-infected pregnant women. Pamela is a saint, a brilliant one, organizing the training for about 40 people and pulling in a doctor from the Ministry of Health in Kampala to join us. (It was fun also to note that about 8 of those had been sponsored in their medical training by us through WHM in some way). There are about 13,000 pregnancies per year in our district, and the Kwejuna Project has worked to strengthen prenatal care for all of those women. But the 400 or so who are HIV positive are our main focus, and now we are going to be able to give them a more complex regimen of antiretroviral medicines that will further reduce the risk of transmission to the baby.
From Bundibugyo we headed to Kikyo, which is about 25 km from where we live, perched on the side of the Rwenzoris. It is a small settlement that we had never visited before, but we went yesterday to see patients who are suffering from an unknown disease. The clinical officer there, Julius, could use prayers. He’s a competent, faithful, hard-working guy who has been caring for many very ill people. It seems that over the last few months a new infection has arisen in this area. Jonah first became aware and started investigating a few weeks ago, thinking at that point it might be a typhoid fever outbreak. But the tests for that were negative, as were tests for scary things like ebola and marburg viruses, and since then the government has sent people to collect more blood samples. Scott has been seeing some of the patients at Bundibugyo Hospital, but we had not reached Kikyo, the place with the most cases, until yesterday. We are still waiting for results from samples that were sent to South Africa and presumably the CDC, but it seems to be a viral illness, more severe in adults, with a long course (a month), some person to person transmission (nurses and care-givers have become ill), and a significant mortality rate (over 20%). It may be winding down already, there were only 7 patients in Kikyo and 2 in Bundibugyo as of yesterday. Key symptoms are fever, vomiting, diarrhea, abdominal pain/tenderness on exam, conjunctivitis, big spleen, rash (late, not all), and in a few patients bleeding particularly in the urine, some pulmonary edema (but that might have been secondary to over-treatment with IV fluids) . . . . One recovering nurse had peeling hands and feet. We’ve had lots of ideas about possible etiologies, but nothing quite fits all the data, so we’re hoping for a real answer from the tests soon. Meanwhile most of those receiving supportive care are recovering. It is causing some concern among people around here, and of course lots of rumors of poisoning, witchcraft, etc. You can pray for us to know our calling here . . We prayed for the patients which was much appreciated, examined, offered suggestions, appreciated the work of the staff, arranged for more IV fluid, and will keep making phone calls to follow up results.
From the epidemic we went back to the seminar, where Scott taught the afternoon sessions, and then back home. Riding a motorcycle in Bundibugyo is a bit like riding a horse, gripping with the thighs, bouncing out of the seat, the exhilarating breeze and the anxiety of losing control! I was grateful for the opportunity to soak in the sunshine (a rare day of that!), feast my eyes on the beauty of the mountains, wave at children who rarely see a mujungu, interact with medical staff from other units, and see Pamela and Scott in action.