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.