Reflections at the end of Response Week 1

Yesterday marked one week since the diagnosis of Ebola was announced.  In that week we moved from thoughtful concern to alarm to grief to acceptance of the daily reality of work.  As soon as we heard the news last Thursday Scott was setting up chlorine and gloves at the health center and communicating with MSF and Ministry of Health, and holding meetings with our team to inform and calm.  A week ago today the advance team flew in and out.  In the first few days help seemed to come in slowly, this is a remote place, not easy to access with tons of supplies.  It took time for the experts to set up barriers and isolate people, to train staff on protective techniques.  In those first days we felt the crunch of panicked patients, fearful and sometimes absent staff.  But now a week into the response the sheer volume of people who have arrived is astonishing. We find ourselves moving more and more to the periphery as agencies much bigger than ours, and people with more power and experience take over.  And the non-Ebola medical needs are becoming more difficult to quantify as people stay home, afraid.

Three comments on the big picture:

1. I have come to appreciate more deeply our relationships with local government and leadership in Bundibugyo, by seeing the contrast with the current moderate tension and jockeying between agencies.  I think I took it for granted, but now I don’t.  Local people may just want to take advantage of us . . .but for the most part they have always acted like they liked us, and we like them.  When we interact with our health and government leaders, the exchange is amicable and respectful.  We don’t trust everything that goes on, but we do cooperate.  Now our district leadership has been overwhelmed by Ugandans from other parts of the country; and the foreign presence has ballooned.  I can feel the undercurrents, I’m sure much of it based on good reason, as the Ministry of Health tries to hold onto control of the situation, as people from Kampala and elsewhere make their pronouncements.  They need the outside expertise, but they resent the outsiders a bit too, flying in with their resources, their computers and cell phones, their rules.  It was more like that in Kenya, and the absence of that mild tension of race is one of the things I have forgotten to love about Bundibugyo and its relative lack of exposure to the western world.  We find ourselves lumped with the foreigners in the eyes of the MOH people.  Sigh.
2. The mis-information in the press is a daily astonishment.  The wrong names, the wrong titles, the wrong numbers, the wrong science.  Much of that comes from local papers and then gets multiplied when picked up by bigger news agencies.  So today when I found an article in the Monitor (one of Uganda’s two national dailies) that was articulate and wise I was very impressed.  The author turns out to be a member of parliament from Kanungu (remember the people who locked themselves in the church and burned it, one of Uganda’s sad moments in the last decade) who is also a physician.  I hope this man gets appointed to greater and greater responsibility as his career progresses, because he is a voice of reason and clear thinking (like Dr. Yoti) in the midst of a lot of bluster and blame.  Pray for more young people to rise up like him, and like Jonah.  Here is the link to his article:  http://www.monitor.co.ug/artman/publish/opinions/Tracing_the_origin_and_nature_of_Ebola.shtml, and to the tribute to Dr. Jonah (which has a few errors but is still quite good and positive):  http://www.monitor.co.ug/artman/publish/news/Fallen_Hero_A_tribute_to_Dr_Kule.shtml.  The Monitor is doing a better job than most at this moment.
3. The calls for martial law, for quarantine, for force are being voiced in the papers, mostly from people far from the problem, sitting in Kampala and worrying that it could spread.  Yesterday one of the MSF people told us that after a few weeks in another epidemic in another country, the local people turned on them, began to blame them for actually BRINGING the disease, and began to throw stones and DEAD MONKEYS at them!  They left abruptly, but thankfully had trained their local counterparts to handle the isolation techniques, so the epidemic was contained (it was not Ebola).  I think I felt the medical care and epidemiology were so important the first week,  but now in week two I think the “social mobilization”, the education, is probably the most important work being done.  Walking the fine line of warning, to keep people from doing dangerous things, and yet to not paralyze the entire economy and community with fear, is not easy.