Ebola Bundibugyo: Sunday night report

Today, the non-medical side of Ebola . . . Or the real-life, long-term side of it perhaps. After Scott did his very public thanks and contact-greeting with survivor Fred, Pat gave him a Bible, and he came to our house for a coke and sandwich. Meanwhile a reporter for a Christian Dutch news service who had traveled to Bundibugyo showed up at church too, so he took advantage of the time to do interviews with the nurse, then with Scott, and briefly with me. He lives in Kampala but earns a living by writing stories and radio shows for the Netherlands. He was just leaving when the CDC team came, we had invited our fellow-Americans to cheer and encourage them with pizza and a break from the front lines. It was one of the hidden blessings of the outbreak, to enjoy the company of these young doctors, swap stories, and send them back into the battle a little fortified. Also the evening briefing is a bit more palatable after a good meal . . . The medical side continues to improve:

• Cumulative Cases: 123
• Cumulative Deaths: 34 (stable number once again); CFR 27.6%
• Laboratory: no news, no planes on Sunday, so no new samples analyzed.
• Contacts: reporting was a bit more fuzzy, the teams are definitely out there tracing, there is a concerted effort to add contacts of new cases to the list. The surveillance team seems to find questionable people on a daily basis who have some sort of symptom, but rarely get admitted, so then aren’t counted as cases. There seems to be a gap between contact tracing and case identification, hard to tell from the briefing but we might be missing some people, or focusing attention on people who aren’t real contacts, because the stakes are high. Either mistake is potentially costly, to leave infectious cases in the community, or to distract resources towards non-Ebola sick people.
• Admitted to Bundibugyo Isolation Unit: 4. Quite an improvement since last week! 0 new admissions, 1 discharge, 0 deaths.
• Admitted to Kikyo Isolation Unit: 8. 1 new admission (was a support staff who worked in isolation, so yet another health care worker contact falls ill), 1 discharge, 0 deaths. There was also a readmission of a previous Ebola case but he is a man with chronic hypertension, so his readmission was judged to be due to this chronic problem and not to Ebola.
• Politics: The entire two weeks we’ve discussed the lack of a vehicle for Kikyo to serve as an ambulance. They are supposed to have two separate trucks, one to bring patients in (ambulance) and one to go out and bury the dead. Every day the hard-working staff complains about the lack of a vehicle. Every day there is a different person to blame. It is broken, it is in the shop, the district hasn’t paid the bill, the fuel wasn’t available, it is back in the repair shop . . .and today’s explanation: the driver could not be found. It seems that drivers signed up for the extra allowance of being Ebola-response team members, but none actually want to go anywhere with Ebola, so Kikyo is not a preferred route. WHO suggested that drivers only be paid AFTER driving. Sounds good to me too.
• Cultural issues: a doctor from Kampala warned that Christmas might be a risky time because the local people would want meat and therefore poach wild animals from the forest, accelerating the epidemic. While isolated cases of this hunting probably did trigger the initial transfer of the virus from the supposed animal reservoir to humans, the entire district certainly doesn’t go poaching for Christmas. I guess I’ve lived here long enough that I felt personally offended by the underlying cultural superiority of the comment, people from other parts of Uganda look down on Bundibugyo people as primitive. I wanted to raise my hand but had already been attacked for a previous question, so I waited and was actually quite happy when our own DDHS very politely explained that as the senior indigenous person present, he wanted them to know that this is a season for cocoa, and the local people get money for their cocoa and use it to buy beef, goat, pork for Christmas, they do not go poaching from the parks. There was also a suggestion that circumcisions be deferred until after the epidemic. This was agreed to be a wise move. Usually Dec/Jan is the main season for circumcisions, boys are off school and can go through their initiation in groups. Some years seem to be more popular than others. Any procedure that involves blood and is not urgent should be delayed. So next year might be a better choice.

Today’s sermon was on Elizabeth and Zachariah, on God bringing joy into a situation of barreness. We so easily criticize Zachariah for his lack of faith, but I sympathize with him this year. This is a bleak season for health and the Kingdom in Bundibugyo. To see God’s work here takes faith, and I’m sure I’d be tempted to point out the facts to an angel. Praying for hope, for the nine-month view ahead to what God will do.