Ebola Bundibugyo: The Saturday Numbers and other things

Scott’s report from tonight’s task force meeting:

• Cumulative cases: 106 (note that he discussed with the CDC the fact that most of the early cases had been excluded.  This is understandable, they are retrospective diagnoses, but it is good to remember that this number is at best a guess.  It does not include the first dozen (?20 ?30) cases from the Kikyo area, before a real epidemic had been recognized.  On the other hand it probably includes a number of non-Ebola cases that have similar non-specific symptoms.)
• Deaths:  26.  There were two more in Bundibugyo, and one in Kikyo.  One of the Bundi deaths was a lady who had been admitted on a general female ward and then developed a rash . . .the rash is usually a late sign and this lady died soon after transfer to the isolation ward.  It points out again the difficulty in distinguishing cases because of the different not-so-hemorrhagic nature of this strain.
• Hospital Census:  19 Bundibugyo (2 died, 1 was discharged, no new ones . . . 3 of the patients are critical).  Kikyo 14 (1 died, 2 new, 3 were discharged, including 1 health worker, also have 3 critical cases.)
• Health Care Workers:  16 nurses are now in play, only about 4 from Bundi working on the isolation ward but a good number from MSF in other parts of Uganda or Europe.  We’ve met two young female doctors (Belgian and Nordic).  The MSF team is now huge with their WatSan (water and sanitation), logistic, anthropologic experts, etc.  We met the airplane today with the CDC health communications man, whom we then hooked up with Hannington Bahemuka as a good source of cultural information and language appropriateness.
• Contacts: 340.  Today 158 received check-in visits from mobile teams (46%).
• Lab: was supposed to do a practice run with non-Ebola blood today to ascertain safety precautions were intact, first run of potential Ebola samples tomorrow.  We’re all on the edge of our seats for this news.
• Fear:  definitely there.  It is hard to really overestimate the impact Jonah’s death has had on the public perception of the epidemic.  He was such a loved and public figure, his death has very much intensified the feeling of vulnerability that people carry.  Sadly the families of patients who have died, especially Jonah’s and Joshua Kule’s, have experienced isolation, neighbors running away from them, merchants refusing to accept/touch the money they are offering to buy food.  Even we have heard that people are afraid of us, and avoiding us.
  

Pray for the churches tomorrow to bring messages of hope, consolation, and be channels of information that will help people cope with the stress of this disease.  Pray for us to know if we should shift from supporting medical care to mobilizing public health efforts in the community.

I visited Melen today, actually walked half of the way there and back because Scott is so busy with other efforts . . . I found her sitting on the floor of the house with Jonah’s mother and sister, all looking drained and blank.  As before, and as with Job’s friends, it seemed the best thing to do was just to silently sit.  Eventually I tried to get Melen to talk a bit, but she was unable, saying her thoughts were “disorganized”.  I assured her that was OK, and that we were making every effort to provide for the children, so that at least that worry would not weigh upon her.  I was thankful to see that Jonah’s mother was well.  What a strong woman, to have buried now 3 of her 9 children and her husband, to have been exposed to Ebola but so far not succumbing . . The girls are distracting themselves with the books I brought, and there were a handful of relatives around the house, though still nowhere near the number of consoling visitors one would otherwise expect.  The district has sent food, and they seemed to be provided for, just overwhelmed with grief.

The most surreal moment of the day was a visit from a very kind and sincere American endocrinologist researcher, whom we met a few months ago in conjunction with his study of iodine deficiency in the Rwenzori region.  He decided to drive 10 hours from the southwest tip of Uganda where he is now working, just to check with his own eyes that Scott was OK and Dr. Sessanga was really recovering, and bring them both thoughtful and costly gifts.  That kind of generous concern from someone we have known only briefly humbles us, just like the many kind comments and sincere prayers from people around the world.