Ebola Bundibugyo, Monday night

Just when I thought the tears had run dry, someone sent us a beautiful picture of Scott and Jonah together taken a few months ago. I still can’t believe he won’t come back from Kampala any day and sort things out. I do think sometimes about him meeting my Dad in Heaven. They had a good relationship of respect, and I like to think of them recognizing each other there.

OK here is today’s report. Scott was gone from morning to night. The day began with a clinical conference, with Scott, Dr. Jackson Amoni from Ministry of Health, our heros Dr. Yoti from WHO ( also a Ugandan and formerly with MOH) and chief nurse Rosa from MSF. The four of them were tasked to sort out protocols and procedures for caring for the sick in isolation. Our main contribution is to agree with Dr. Yoti and confidently endorse him to everyone else. Scott then went to Kikyo to try and install the Gray’s “village phone”, which includes an antennae we hoped would overcome the mountainous terrain and distance from the tower and allow that health center immediate phone access at all times. Sadly it did not work, but we are still grateful that the Grays let us try. Somewhere in there he managed to get the lawnmower back to complete the airstrip mowing for the daily flights, and to pick up mosquito nets for pregnant and HIV positive women, and to see some maternity patients too I think. The day ended with the two of us zipping back up to Bundibugyo on the motorcycle for the evening task force meeting, while Scott Will, who had been working at Nyahuka Health Center today, stayed back to cook us dinner. Very nice.

The meeting tonight was a bit calmer and more amicable, thanks for prayers for cooperation. Here are the facts:

• Cumulative cases: 115
• Cumulative deaths: 29 (CFR 25.2%)
• Contacts: 368. 298 were seen today! Amazing really if you think about the challenges.
• Bundibugyo Isolation Ward: 17 inpatients, 4 discharges today (!!), 2 admissions, 0 deaths, with 2 of 17 remaining in critical condition.
• Kikyo Isolation Ward: 12 inpatients, 1 discharge, 1 admission, 1 death (sadly a 17 year old boy), and 1 of 12 remaining in critical condition.
• LABS AT LAST!!: 17 patients had samples run today in Entebbe, some were specimens that had been collected days ago. 10 of 12 samples from Bundibugyo were positive for Ebola, either by antigen detection or production of antibody response. ZERO of 5 samples from other districts were positive. In other words all confirmed cases to date stem directly from Bundibugyo. There is still a large back-log of tests so we are not quite ready to breathe a sigh of relief, but at least the initial news is good, the spread may not be as fast and violent as feared.
• Jonah’s labs: his initial test done on Saturday (day 4 of illness, day 2 of admission) was positive for antigen (presence of the virus) but negative for IgM antibody (he was not yet mounting a detectable immune repsonse). The sample two days later was positive on both counts. It is no surprise that he truly died of Ebola, but provides some closure to have it confirmed.
• Tribalism: Sadly almost all the cases stem from the Bakonjo tribe (including Jonah). The Bakonjo are a minority in the district; most of them live in Kasese and Congo. The majority tribe here, the Babwisi, have been relatively spared. Since transmission is person to person, this makes sense, that the disease would stay within one primary ethnic group. However even in ADF days there was suspicion and accusation between the tribes. Now the Bakonjo are accusing the Babwisi of poisoning them, and we heard that today some refused to buy rice in market that was grown by the Babwisi women. Yet another way that fear and misunderstanding can be used to foment ethnic unrest.
• More unrest: on the Fort Portal side of the mountains, that district had decided to locate their isolation unit as close to the Bundibugyo district border as possible, in Kichwamba. But local people rioted last night, breaking windows in the ward, and forcing transfer of two suspect cases back to Fort Portal Town’s main hospital. These tensions are essentially the same that sparked Rwanda, the fear that one’s own family and tribe are at risk and therefore the justification to lash out violently against those perceived to be enemies. We are praying for peace. Thankfully no violence here where the real cases are, but the mistrust and bickering is a smaller symptom of the same issue.
• More discrimination: a local government official who has been conspicuously absent all week showed up today, complaining that in Kampala he was ostracized as “the walking dead” because he was from Bundibugyo. We all acknowledge that the country is in a quandary, most people are very upset about the possibility of catching Ebola, and anyone from Bundibugyo is suspected to be a carrier. The district’s ONLY bank closed today, in spite of pleas by the security officer that there was no danger in banking. Inability to access money will definitely put a damper on the response.
• Tomorrow’s tasks: The minister of health himself and three other top ministry officials will fly in for an official visit tomorrow. Before that Scott and Dr. Yoti will ceremoniously discharge Dr. Sessanga from his home isolation, declaring him cured. Then the Scotts (both) will be participating in training staff at NHC to help allay fears and provide adequate protection so patient care for non-Ebola cases can proceed.
  

We can’t thank you enough for your care. We’ve been particularly encouraged by several people contributing to the emergency response fund. We will be spending some immediate money on more gloves, and trust that the school fees for Jonah’s children will be provided by the time they need them in late January. It is good to sense how clearly we are only one small part of the larger community of Christ in this time.