Ebola's enduring effects

Life is back to a semblance of normal, but not quite normal.  A neighbor shook my hand this morning, spontaneously, the fear of touching now dissipating but I found myself surprised by the gesture.  The hospital is open, but many services that involve blood (testing pregnant women for HIV, or immunizing babies) have not yet resumed.  Trade and traffic are flowing, but there is still a tentativeness about the future.

As I sat in the HIV clinic seeing patients today, I reflected on the parallels between HIV and Ebola.  HIV attacks the disease-fighting cells of the body, so that a person succumbs to other illnesses.  Few AIDS patients are technically killed by the HIV virus alone, almost all die from things like TB or fungi or common bacterial infections that can no longer be resisted.  On a macro level, Ebola acts in a similar way.  Ebola attacked the disease-fighting personnel and programs of this society.  Only 37 people died of Ebola during the epidemic, but many more, untold numbers, have died because of the lack of medical services.  I think we will never really know the true impact.  Our pediatric ward is still half the usual census, and the ones that come are extremely sick, having waited to the last possible moment to risk coming to the hospital.  How many wait a few hours beyond the last possible moment, and die at home?  How many malaria deaths alone occurred over the last month because Ebola had attached itself to the health care system, essentially shutting it down?  How many kids will get diseases because the immunization coverage has been suspended for two months?  Today every kid I examined had last been seen in mid November.  Some had run out of ARV’s but did not get them refilled.  A very cute baby had a negative HIV result from the 22 of November (Ebola was declared on the 29th) but no one had interpreted the test for the mother, so she spent two extra months breast feeding the child and putting her at risk of infection, potentially a matter of life and death.  Another patient yesterday came to find me, after she had missed an entire month of TB therapy.  How much will resistance increase due to this sudden interruption?  

And now that it is time to pull the system back into function, we are left to do so without a few of our key allies.  In the HIV clinic I could see Dr. Jonah’s signature on the charts, a reminder that he was central in the fight and he will not be easily replaced, not in this generation anyway.  It is a weary-ing prospect, not only to work to bring back services but to do that work without our leader.  Like a body trying to recover from pneumonia without its immune cells, we are a district trying to recover from disaster without our most important doctor.  The attention of the world moves on, as it should, but the reality of recovery here remains, requiring patience and a long view.