Tuesday, December 11, 2007
Ebola Bundibugyo Tuesday Mid Day
The roller coaster continues to rise and plunge, from hour to hour. One day we wonder if the world as we know it is ending in an ever escalating toll of death, the next day we realize that some people are recovering and feel hopeful about putting this tragedy behind us. A BBC (Network Africa show) reporter interviewed Scott at 7 am this morning, and he was able to speak sincerely about our loss of our friend Jonah . . . We wanted to honor him. But then this afternoon Bamparana, Ndyezika, and Byarufu all rushed to our house, having just heard on VOT (Voice of Toro Fort Portal radio) that Scott had Ebola, a misinterpretation of comments regarding Scott's history of contact with Ebola patients made in the BBC interview. They were reassured to see him fine, and we were reassured to know that at least a few people are out there who would come and check on us . . . And so it goes, up and down. Today’s big event was the visit of the Minister of Health, the Honorable Dr. Stephen Mallinga, along with the Commissioner of Community Health Services, Sam Okware. We were steering clear of the hooplah by running a training for NHC staff but the RDC and the temporary medical superintendent from MOH stopped Scott on his way back from discharging Dr. Sessanga (cured!!) this morning and told him that they had assigned the training to one of their own doctors, instead he should come greet the minister. He turned back to Bundibugyo, and Scott Will and I went to Nyahuka to meet with about 40 staff, along with a doctor finishing his Masters in Epidemiology at Makerere and a senior nurse who survived the 2000 epidemic in Gulu. (We had just started when a helicopter hovered into sight and then landed at Christ School’s football field! It was the ministerial delegation, a bit lost. They eventually found their way to town while we continued our training.) The doctor lectured on the basic facts of Ebola, and both he and the nurse provided a lot of confidence, a boost in morale, an appeal to get back to work. She stood up in her navy blue uniform spattered on one side with purple bleach fades, and said proudly this was her badge of having worked in the isolation unit. I liked that. But of course NHC is not an isolation site, so the focus there needs to be on normal health care. One lesson I’ve learned is that the Ministry needs to clearly state the non-Ebola guidelines at the very beginning. Staff are confused about who needs to wear what protective gear, when, how to access more, how to call for help, whether there should be labs open, etc. It is getting worked out now, but it has taken more than a week. I like the doctor who came, he’s done a number of C-sections already and seemed fairly reasonable . . . But he did give out some misinformation, and he did imply that MSF was not running the isolation unit properly but now that the Gulu nurses were here that would all be sorted out. I spoke up on that, I feel that there should NOT be any even slight spirit of one-up-man-ship, of blame, but rather respect for each person’s work and contribution. Another lesson we’ve seen is that it is much easier to tell people what to do than to actually provide what they need to do it. The staff listened to the lectures, but now they have to organize a requisition and fight for their own gloves and boots and bleach. In this kind of crisis it seems that the supplies should be pushed down from above, not held until they are clamored for from below. Meanwhile Scott met the Minister, Dr. Mallinga. This was very confidence boosting, an upsurge on the roller coaster. Another lesson of this crisis is that there are some brilliant and dedicated doctors in this country. The Minister is one of them. Scott said he addressed the issues of witchcraft and discrimination that have arisen by saying that we are like full glasses of water, when trouble comes we are shaken and whatever is inside spills over, the trouble of life merely reveals the heart. It sounds a bit like what Jesus said to the Pharisees . . .For some that means the evil just below the surface comes out. For others that means the charity and self-sacrifice are called forth. He appealed for the latter. The government has now allocated 6 BILLION shillings to the response, which is 6 billion more than they had last week. . . . The crisis has also pointed out the problem of medical staffing. The Minister said Uganda has lost about 200 doctors to South Africa, 3 anesthesiologists to Rwanda, countless nurses to Kenya, more new grads to Sudan where NGO’s are paying huge salaries. Even here in Uganda some of the best minds and hearts we’ve seen responding to the crisis are Ugandan doctors who have left Ministry of Health to work for the WHO. This discourages me, how can the country be covered when the Ministry system is poorly paid, bureaucratic, frustrating, and easily circumvented for more lucrative jobs? Why isn’t medicine more like the military, you have to do your two years of service after school, you are posted all over the country and everyone has to put in their time? It used to be that way, and this is one instance where decentralization has probably hurt more than helped. I can already see that some of these hard working and helpful men are going to be gone in the next few weeks, and we’ll be left with the same hobbling health system we had before, minus Jonah. It is a week today since Jonah died. Though Melen and I had a little cry together this morning, I can see some signs that she is emerging, thinking a little bit into the future beyond the 21 day contact isolation period, she even smiled once this morning at her daughter Sarah’s antics. Thanks for praying for her.