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Saturday, December 22, 2007

Ebola Bundibugyo, Saturday Night Numbers

The Saturday night numbers…

- Cumulative cases: 134
- Cumulative deaths: 34
- Current admissions: Bundibugyo Hospital 3, with one new admission and one discharge. Kikyo 3 with one admission and no discharge. No deaths in either ward.
- Contacts: 584 cumulative, with 125 finished their 21 day follow-up and 379 visited today.

Issues discussed in the Task Force Meeting…

Most significant and distressing. A woman presented to the outpatient department of Bundibugyo Hospital yesterday with symptoms consistent with a miscarriage (vaginal bleeding after a period of amenorrhea). Because of her bleeding she was questioned about the presence of other symptoms related to Ebola (and any history of contacts). She denied such. She was admitted to the Female Ward as a run-of-the-mill spontaneous abortion. A few hours later she developed bloody vomiting with nose bleeding. She was promptly transferred to the Isolation Ward where she is being handled as a suspected Ebola case.

As you might guess, the hospital staff has been thrown into a “fresh panic”, and rightly so. The triage system failed, possibly due to misrepresentation or deceit on the part of the patient in an effort to avoid admission to the Isolation Ward or possibly due to an error in judgment on the part of the triage staff. Hard to say with my limited information. Triage protocols are being reviewed and the staff is being counseled. The situation reemphasizes the reality of the risk of accidental Ebola exposure to general health workers in Bundibugyo. Those NASA-like space suits completely protect health workers from Ebola virus in the Isolation Wards who are knowingly exposing themselves to Ebola, but we can’t live our lives wearing those suits. Sadly, this dark cloud of doubt will probably linger in the minds of Bundibugyo health workers for months (or years) to come. Whenever a patient presents with fever and vomiting, nurses and doctors will wonder if Ebola is possibility. It’s frightening.

On a brighter note, the biggest Bundibugyo market of the year, the Nyahuka Saturday-before-Christmas Market occurred today. A frenetic rush to procure new clothes, shoes, sodas, and other party provisions (goats, chickens, and palm oil…egg nog and ice are not on the list). Excitement (and perhaps are bit of desperation) seemed to be the prevailing emotion of the day…rather than fear…and for that I am very thankful.


Anonymous said...

You continue in our prayers! As Don has shared with us his experiences with you this summer, the physical distance between us draws closer through the Holy Spirit. You and the people of Bundibugyo will forever remain in our hearts! God's peace to you today!

MD in Philly said...

The clinical scenario is certainly worrisome for Ebola, on the other hand, couldn't a retained spontaneous abortion lead to DIC +/- sepsis?? If she indeed has been pregnant and is now bleeding sounds like a real problem for everyone. I don't imagine your local hospital has platelets and FFP on hand for emergency surgery (if "only" a D+C) on someone already in DIC whether from Ebola or from retained placenta.

Unfortunately this underlines part of the problem you are dealing with as you've already discussed, Ebola that doesn't always present like Ebola.

While the NASA-suits are appropriate for known Ebola cases, apparently some/many health care workers cared for people with Ebola but didn't get ill. Were there specific precautions that some people took that gave a degree of protection, that could be used more "routinely" on a wider population of people presenting with acute illness in spite of the relative lack of resources and supplies?

My most serious TB exposure came from a person who presented as an acute respiratory infection without anything to suggest otherwise. But, even an unknown TB exposure and conversion to a + PPD is orders of magnitude less severe than exposure to unknown Ebola.

On the other hand, this would not be the first time that information given to triage was deceptive, whether purposefully or unknowingly withholding vital information.

Carol M said...

Scott, fear and tears still remain when reading the daily blogs. Danger of exposure lingers. Our prayers continue. May our Savior Jesus Christ continue to hold you, Jennifer, your children, and the team in his loving arms.. prayers, Carol