Ebola Bundibugyo: Thursday Night, Living on the Edge

The facts:

• Cumulative cases: 118
• Laboratory confirmed cases:  32, all still from Bundibugyo
• Cumulative deaths:  34 (28.8%CFR)
• Contacts:  368, with 264 seen today (71.7%)  This is the heart of containment, having surveillance teams face to face daily with contacts to monitor any who become ill, and encourage them to come in for isolation and care.
• Admitted in Bundibugyo:  8 (!), with 5 discharges, 3 new admissions, and 1 death.
• Admitted in Kikyo: 9, with 0 new admissions, 0 discharges, and 1 death.  We learned today that two of these are women who are breast feeding babies (age 3-4 months), and since the virus is highly transmissible in breast milk we are providing formula tomorrow so that the babies can be watched in isolation for symptoms but separated from their mothers . . . Another sinister aspect of this disease and the way it insinuates into the very relationships that should bring comfort and support.
• Stories:  well, there were a couple of sad ones.  First, a pastor died, a man who had prayed for Ebola patients before we knew it was Ebola.  In my view it is just like the health workers dying.  This man laid down his life by caring for others.  He probably laid his hands on Jeremiah Muhindo as he prayed for him.  So did Scott.  That always sobers us, though each day we move further and further from the common incubation period, and closer to the 21 day safety zone.  The clinical officer Joshua Kule’s son is another problem story—it came out in the meeting that a surveillance team visited him and determined that the fever he had was improving on antimalarials so he did not have Ebola.  At that point our MSF nurse spoke with obvious conviction and care:  it is DANGEROUS, she said, for the surveillance team to think they can make that judgment.  Any contact with fever has to be evaluated by a medical person and tested!!!!  This man was the primary caretaker for his father, who died, and is exactly in the incubation period for symptoms. Cases like this make it clear that we are not yet out of the woods.  Because people fear the isolation ward, they will try to hide or minimize symptoms, and thereby put their families and communities at risk.  
• High of the day:  Scott was able to visit four of the five families of health workers who died, taking them some food and comfort and words of Scripture about God’s care for the orphan and widow.  I think it was a touch of kindness and contact in a disease that is otherwise frightening and isolating.  And a way to show extra respect for the lives of these men and women.  He also tracked down the children of a woman admitted now, who is not dead, but whose children have been reported to be fending for themselves.  
• Low of the day:  Well, several really.  One is that the voices of reason and wisdom and experience may be thinning out as we end our second week of crisis response.  We hear rumblings that the CDC team is narrowing down to one (a really nice guy, but still only one of him) and our trusted WHO doctors and epidemiologists are also hinting they won’t stay much longer.  An experienced person warned us today to expect things to temporarily deteriorate again between Christmas and New Year as people slack off .. . Which makes us feel like we should be here then.  I miss my kids a lot tonight, more than usual, maybe hearing about them first-hand from Pat.  It was a discouraging meeting tonight, focused on money, and while I respect the hard work and leadership of most people involved, I feel the cross-cultural tension of distaste for the fact that the biggest budget items are extra allowances for most of the politicians.  My American viewpoint is that they are doing their job, so why should UNICEF money go to their pocket?  But I know the African view would be that they are underpaid, and that they are putting in extra hours, and that it is only right that their work be valued in this way.  But I have to confess it still grates on me.
• Unlikely heroes:  MAF.  Mission Aviation Fellowship flies people in and out almost daily, ferries blood samples to the lab, brings supplies here.  They also have found our team a house to stay in in Kampala, and helped them with everything from a generator to groceries.  We are a small mission, and in many ways MAF functions as our support base.  The pilot today even took an extra hour on the ground just to visit us and pray for us.  We are so grateful.
  

I’m wearing a shirt tonight in honor of Pat returning, a shirt that she gave me after buying it right off the back of a man in the market who was wearing it, during the ADF years.  It says:  If you aren’t living on the edge, you’re taking up too much room.  Here we are on the edge, hanging on.