Ebola

We have been avoiding the topic, honestly, because it is a raw one for us.  In 2007 we lived through an ebola epidemic.  In the remote area of Uganda where we worked, along the Congo border, ebola crossed over from the animal reservoir in the Ituri forest and began infecting humans.  We were both exposed before we knew that the disease was ebola.  Our best Ugandan friend and colleague Dr. Jonah Kule died, and the only other doctor besides us in the district of over 200,000 people became infected but recovered.  When the disease was confirmed, we sent our kids away to stay with other missionaries until we completed a 21 day disease-free incubation.  We decided at one point that only Scott would see patients and I would not, to minimize the risk of both parents going down.  For months we lived with the lingering cloud of doubt, the on-edge expectation of potentially deadly touches in our medical care, the grief of losing our friend.

So we have been following the news of this epidemic very closely, communicating with some of the organizations involved, praying.  It would not be an exaggeration to say that it has dominated much of our mental and emotional energy for the last month.

Now that 2 people have been infected in America, and there is mass hysteria, perhaps a few words are in order, even though we are actually no closer to the epicenter here than most people reading from America are (we are several thousand miles away).

This is a West African epidemic.  It is sad and regrettable that one of the hundreds and hundreds of travelers who come to the USA from this area happened to have been exposed in an act of kindness, and got sick.  And that two nurses are now infected.  However this in NO WAY makes the American experience in any way comparable to Liberia, Guinea, or Sierra Leone.  That is two transmissions out of hundreds of millions of people.  The risk in America is extremely low.   Americans have gloves and masks and running water and bleach and hospitals and suits and disposable everything and money and transportation and doctors and nurses and janitors and experts.  Americans have panic, and demands.  In American culture, no-risk of a disease is considered to be a birthright; yet people routinely drive too fast, eat and drink too much, play with guns.  Or fly in airplanes or rock climb or do a thousand other things more likely to kill them than ebola.  The point is that in spite of headlines about school closings and plane cleanings and it's all Obama's fault somehow, the virus will be contained in America.  West Africa is another story.

Ebola is a tragic and frightening disease, because it is transmitted by the most basic human acts of community.  Wiping tears, carrying a child, cleaning up a mess, hugging.  And it seeks out those most caring.  I think it frightens by being mythically diabolical, killing the very people who are most bravely fighting against it.  The PPE's turn people into spacemen, aliens.  The origin is in Africa and that is always suspect.  So it is hard to separate the emotional layers from the facts. (This graphic on health care workers is from a Forbes article: 232 deaths out of 404 infections).

Ebola does not have to have a 90% mortality.  One of the surprises of this epidemic is that a good number of the people who by nationality or connection got airlifted out and received intensive excellent care actually survived.  The official stats are running at just over 50% mortality, though the treatment centers see more like a 70% fraction of death.  Our own epidemic was less than 50%.  I thought that was because our virus was different.  But maybe it was just good care (smaller numerator) and compulsive case finding (bigger denominator).  Medical care makes a difference.  The sick should not be written off as hopeless, and locked in isolation to die.

The leaders in compassionate response are the African doctors and nurses and community health mobilizers and ambulance drivers and taxi-owners and parents and friends.  But they were too few six months ago, and they are many fewer now.

I am glad that the American military is responding.  I know it is not politically savvy to be in favor of marital law.  But this epidemic needs an infusion of organization, of money, of can-do, of discipline. In Bundibugyo, MSF came in with tents and supplies.  Our airstrip became the staging area for sending samples out and people in.  Our district leader (RDC in Ugandan parlance) was ex-military, and he kept everyone working together.  Every night we had a close-of-day meeting and coordination time.  It was local, and we were far from the rest of the world, and it worked.  In the current epidemic, decades of civil war, resource pillaging, injustice, poverty, distrust, corruption, etc. have weakened not only the health infrastructure but the political organizing ability to gain momentum.  So if that requires a temporary military infusion, so be it.  Allowing people to continue to suffer insecurity and chaos is not helping anyone.  If we say we care about justice, then it is legitimate to respond to this need JUST BECAUSE PEOPLE ARE SUFFERING and not because we're trying to protect the plague from coming to America.

There are two things that will stop the epidemic:
1.  Treat the sick, humanely, safely, respectfully, compassionately, expertly.     For this we need those treatment centers built, now.  And staffed. The American military is one of the best organizations on earth poised to mobilize buildings and equipment and expertise.  So please don't object.
2.  Trace and monitor the contacts, isolating anyone with symptoms the very hour they become sick.  In Bundibugyo we had massive community mobilization.  There was nowhere to go really.  It was horrible to never touch anyone, to sit apart, to be so careful.  But when we were in our 21-day riskiest period, we did that.  It is possible to stop transmission if this is carefully followed.  Personal liberties have to be curtailed for a while.  Asymptotic people are not a danger to anyone else, but it makes sense to lay low in case this is the day symptoms would start.

And neither of those two things are happening very fast.  The countries involved have resources similar to Bundibugyo, meaning not many.  The few responding organizations are overwhelmed, and don't even have the administrative capacity to do much more.  So . . .
1.  Be informed.  Here is Paul Farmer's analysis.  The New York Times and the Washington Post have sane and thoughtful articles.
2.  Support SIM, MSF, IMC, Americares, Samaritan's Purse.  Support our troops.
3.  Pray.

Jesus would be more concerned about helping the sick in Liberia than castigating the CDC in America.  He would be touching the contaminated, and comforting the mourners, and bringing hope.  Let us do the same.