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Sunday, December 09, 2007

Ebola Bundibugyo: Sunday numbers, no sabbath

As usual we headed to Bundibugyo town this evening, but this time we stopped first in Kirindi. Jonah’s brother had called me earlier in the day, and I had gathered there was something he wanted to tell me though the connection was terrible.  All I could ascertain was that everyone was OK . . . So we drove up there at 4, bringing mosquito nets and insect repellant in response to massive numbers of insect bites I’d seen on the girls, and more air time for Melen’s phone in case one of the family became ill.  We found Melen sitting outside for the first time, in a clean dress for the first time, and then it became clear that the message was about the Oluku, funeral rites, they had been inviting me to participate.  Oh well.  After four days of mourning there is a tradition of bathing, washing clothes, and bringing closure.  I’m glad they were able to achieve this, and make some slight progress in life.  Jonah’s mother and brother continue to remain symptom free.

The task force meeting occurred as usual outside, a circle of plastic chairs, in the shade of the RDC’s office building.  Tonight he went on the offensive immediately.  He wanted answers, and results, and now.  We like him, he’s an effective and persuasive man. But tonight he was looking for people to blame, and this was the tone of the meeting in general.  Everyone is under stress.  Some of that may be related to unfavorable press in the Sunday papers questioning government response, some may be due to the growing possibility that this epidemic spread by travelers to a handful of other districts before Ebola was identified as the cause.  It is not a simple or hopeful picture.  So here we go:
  • Cumulative cases:  112
  • Cumulative deaths:  28 (Case Fatality Rate 25%, which while horrific is certainly not as bad as the 90% sometimes seen)
  • Contacts identified:  368
  • Traced today:  189 (51% and building, they feel they are able each day to improve their outreach.  This is the key to containing spread!  I confirmed with Melen that their family had been checked on daily for the last three days).
  • Social Mobilization:  many churches were visited, but no one outshone our own Scott Will for sheer volume of services rendered!
  • Isolation Ward, Bundibugyo:  19 current census.  5 new admissions today, 2 deaths, 3 discharges .  . . And another 5 nearly recovered and ready for discharge.  3 however remain critical.
  • Isolation Ward, Kikyo:  13 current census.  2 new admissions, 0 deaths, 3 discharges.  Of these  13, 2 are considered critically ill.
  • Staffing:  complete staff of 16 nurses now in Bundibugyo but some still in training so only 7 functional, staff in Kikyo 8 of the desired 12.  There was some controversy about doctor staffing.  The RDC looked severely at Scott and asked why expatriate doctors weren’t working in the isolation ward.  Hmmm.  But MSF denies needing help.  We’re not sure where that leaves us.  If we could help build trust by being in the mix Scott would do it, but we don’t want to get in the way either.  It is difficult to get people to understand that a 25% CFR in Ebola is actually good news; they tend to feel that the announcement of any death represents a medical failure of care.
  • Labs:  No results yet.  6 more samples collected.
  • Controversies:  besides staffing, the main discussion points were spraying and herbs.  There is a public perception that spraying the house of an infected person with chlorine solution (bleach) will stop transmission.  MSF routinely instructs their ambulance teams to spray the home after picking up a patient to transport in to the ward.  However the district would like to see the homes of all 112 cumulative cases sprayed.  We talked a long time about the fact that the virus can’t live more than a few hours outside of a host, so going back to spray the homes of people sick weeks or months ago seems pointless, except for the psychological benefit, which may not be justifiable if it drains precious human resources from stemming the current spread.  On herbs, some of our district leadership truly believes that the local culture may have herbs that cure this disease.  It seems that patients don’t want to enter isolation because then they’ll be cut off from their local remedies.  The CDC voice of reason pointed out that we don’t know if any of these treatments might actually be harmful, and that if they are administered by cuts or enemas they could promote transmission of the disease.  The RDC voice of reason stated categorically that we will only use science to determine treatments.  But it was clear that most of the people present at the meeting who were actually from this district had their doubts, and were holding onto the hope that some herbal combination would provide a cure.

Please pray for our team in Kampala tonight.  Three members will leave in the morning, two for normally scheduled ends of their terms, and one for an earlier-than-scheduled month-long trip.  The rest of the team remains in the competent and caring hands of Dan and Gini Herron.  Tonight there was some panic because of a typical minor illness in one of the kids, the kind that happens on almost every trip to Kampala, different food and water leading to fever and a bit of diarrhea.  This is not Ebola.  But we realize now that as a team we’ll be living with that added stress, the impending doom feel that every head ache or loose stool could be the beginning of the end.  That’s pretty difficult for all of us.


Anonymous said...

Our church is praying for you: wisdom, strength, courage, stamina: for God to be glorified in and through this crisis. Some of us have been to Bundibugyo, LOVE the people, give thanks for your committment there. Prayers continue ... Love, Barb of NPC

Luke said...

which three are leaving, who was sick?

Blanchard Pickles said...

My heart is very heavy at hearing this news about the virus. We at our church (River Of Life in Orlando FL) are praying for you, your family and the people. I know God is in this, but just not sure the purpose. He will be lifted up in all of this. I pray for strength, health, safety and the love of Christ for you in all this..
We will continue to pray and lift the healthy and sick up to HIM
God bless
Darby Blanchard of ROL

Blanchard Pickles said...

My heart is very heavy at hearing this news about the virus. We at our church (River Of Life in Orlando FL) are praying for you, your family and the people. I know God is in this, but just not sure the purpose. He will be lifted up in all of this. I pray for strength, health, safety and the love of Christ for you in all this..
We will continue to pray and lift the healthy and sick up to HIM
God bless
Darby Blanchard of ROL

a volunteering foreign resident from central uganda said...

my prayers and those of my friends are with you. Be blessed, may GOD strengthen you and keep you and your children healthy and safe. thank you for you ministrie and also for your reports.

Anonymous said...

First Presbyterian Church in Bristol, TN joins the countless others that are lifting you, your family, and the Bundibugyo community in prayer. Thank you for your faithful witness as you minister to both physical and spiritual needs. To God be the glory!

Katherine said...

Pamela, Stephanie and Kim are leaving. Send me your email and I'll forward you the email I got from Pamela.

Omw. Muhoozi said...

Please keep on writing in the same tone, do not be swayed by what came out in the Sunday Vision. And yes we pray for you. My church-All Saints Cathedral here in Kampala- prays for you in Bundibugyo and indeed all the areas where suspect and confirmed cases of Ebola have been reported. You keep up the good work. We ought not judge you. None of us appointed you to do what you are doing in Bundibugyo, it is He, and it will be He the LORD God who created all of us, that will protect you, guide and reward you in His own way and time. May you be blessed.

Kami Rice said...

Dear Jennifer and Scott and the rest of the WHM team--I'm praying with you and others for God's glory to shine through this crisis. I'm so, so sorry to hear of Dr. Jonah's death. Your words describing his integrity and his good friendship are ringing in my ears. As much as I can, I grieve with all of you. I've just returned to the US and received Amy's message describing what's going on there. May God pour out His wisdom, protection and strength in these days.

Janey Estrada said...

Let me add the prayers of our church family at Covenant Community Church in Scottsdale, AZ. We had a team in Rakai this summer and fell in love with the land and the people.

Thank you for your faithfulness. We are praying for strength, for a continued hedge of protection against the virus around the workers and your team, and family members that had to leave. We are praying for peace for you, to keep reminding yourselves that God is sovereign and everything passes first through his hands. God Bless you and keep you..

CCC Family