A year ago, we were preparing for our East Africa retreat when we got the news of a new Ebola epidemic confirmed in the DRC . . . followed shortly by a dreaded phone call from one of our teams that they suspected a case had presented to their hospital. We had to make hard decisions about their travel to the retreat, potentially bringing a world-panic virus across international borders and potentially putting at risk our entire Serge group of workers. Because the story didn't stack up and we were fairly certain their lack of connection to the early cases at that point meant the chance of their patient being an Ebola patient were very very small, we decided to proceed on faith, and all was well. But a year of mounting cases, the setbacks, the worries, the one actual exposure which occurred months later, the prayers, the anguish over our people and our Congolese and Ugandan colleagues, the scanning the news, the checking email, the phone calls day and night on holidays, the political insecurity, the attacks on treatment centers, the dwindling vaccine supply, and the relentless surging on of this virus takes a toll.
We remain peripheral. The one case that came to our Serge team's hospital in the DRC was handled with remarkable discipline, and NO OTHER CASES occurred from that patient. Our Bundibugyo team remains much closer to the past and current epicenter, but inexplicably protected. The bleach hand-wash station was empty when I checked mid-day, and the temperature screening tent was unmanned. Yet God has been gracious to not allow the disease to cross over to Bundibugyo.
This past week was significant for the epidemic, however, because for the first time, Ebola was not only carried to Goma but transmitted in Goma. Goma has been under scrutiny for some time, as it is the largest city in the region with a million people, and sits perched on the Rwanda border close to the Ugandan border too. It's a gateway type of place where international NGO's set up their programs. And until now, it was far enough south of the epidemic to be safe. But a father-of-ten miner working hundreds of kilometers north evidently passed right through the hot zones on his way back home to Goma, and picked up an infection which went unrecognized for a week. He and his 1-year-old daughter are dead, his wife is sick, and between him and his sister who fled town there are now another 200 at-risk contacts. Meanwhile the DRC's minister of health resigned when the President's office took control of the epidemic response, and the epidemic was finally declared an international emergency, as two new attacks near Beni by the ADF disrupted that epicenter and many other Congolese fled to Bunia displaced by a separate internal war.
Everyone points to the Congo as the reason this epidemic is smoldering. People are mistrustful. They attack each other. They refuse to be vaccinated. They lie about their origins or symptoms, they disappear, they don't follow protocols.
But what if it's actually much more complex than even that? For instance, if there was a nearly universally fatal disease that had spread over a large portion of the state of New Jersey and infected 2,713 people killing 1,823, and there was a vaccine 97% effective, wouldn't we have immunized everyone in New Jersey by now? Think about it.
Or if the New Jersey epidemic caused an influx of Russian and Iraqi doctors, who started driving around in flashy cars and upbraiding Americans for dwelling on the Cold War or 9/11 as ancient history and telling them to trust the new treatments they had brought, would people be lining up for care?
Or if the government and world approved funding to build a brand new hospital that would be dismantled as soon as the epidemic was under control and placed it in the very place where New Jersey residents lacked care, would they consider that to be legitimate?
Yes, Eastern DRC is a complicated, murky, often dangerous environment, but focusing on that seems to me to border dangerously on blaming them for a problem that the vast majority of those infected have little control over. That strikes me as hypocritical coming from a country where the anti-vaccine movement thrives, where people get their facts from social media, consume calories and avoid exercise to their death, and support the right to assault weapons even as the number of school shootings rivals the number of Congolese rebel attacks. We're all pretty much the same.
It seems to me that the best thing we world could do now is to:
1. Ramp up vaccine production and immunize the entire region.
2. Send in long term bridge-building people who are willing to do the hard and risky work of taking on life in Eastern Congo alongside the Congolese, listening, working together on common goals, generating trust.
3. Fund the small local on-the-ground hard-working health workers who are the front line day in and day out.
None of that will be easy. Uganda is way more functional, yet today my first few patients were all children with malaria and severe anemia and THE MALARIA MEDICINES WERE OUT OF STOCK. The nurses were late. People kept jamming their problems into my hands. So much felt out of control--a child sent two days post-op from a complex neurosurgical procedure with high fevers and cerebro-spinal fluid leaking out of her head, a child with TB infected by an uncle whom we have yet to track down but suspect drug resistance, a child who has spent three weeks with an infected wound that almost never gets bandage changes, a child in pain with sickle cell disease who has not had pain medicine dispensed, trying to problem-solve so we can split vials of medicine and share doses, a child with malnutrition not improving whom I gather from the dad and the neighboring beds is rarely on the ward because the dad takes him home between rounds to care for his other two kids since his wife left him, a patient with measles breathing virus on the open ward because the isolation order wasn't carried out. Not a single patient with a vital sign taken. It is just this side of complete chaos and frustration. But minute by minute hour by hour God's people touch, listen, think, talk, care and slowly by slowly, patient by patient, treatment is given and transfusions hung and a remarkable number improve.
Likewise, a year on, Ebola is still lurking and spreading, but the people of Congo are also still hopeful, loving, fighting on, working, caring for each other, performing educational dramas, tracing contacts. Slowly by slowly the good will prevail. Just wish it could be a little faster and more definitive!
Our hospital entrance, but the handwashing jug here is empty and there is no one in the tent . . .
the red arrow points to our DRC team, the green arrow to our Uganda team, the box is the epicenter and the size of the circle reflects the number of cases.
This past week was significant for the epidemic, however, because for the first time, Ebola was not only carried to Goma but transmitted in Goma. Goma has been under scrutiny for some time, as it is the largest city in the region with a million people, and sits perched on the Rwanda border close to the Ugandan border too. It's a gateway type of place where international NGO's set up their programs. And until now, it was far enough south of the epidemic to be safe. But a father-of-ten miner working hundreds of kilometers north evidently passed right through the hot zones on his way back home to Goma, and picked up an infection which went unrecognized for a week. He and his 1-year-old daughter are dead, his wife is sick, and between him and his sister who fled town there are now another 200 at-risk contacts. Meanwhile the DRC's minister of health resigned when the President's office took control of the epidemic response, and the epidemic was finally declared an international emergency, as two new attacks near Beni by the ADF disrupted that epicenter and many other Congolese fled to Bunia displaced by a separate internal war.
Everyone points to the Congo as the reason this epidemic is smoldering. People are mistrustful. They attack each other. They refuse to be vaccinated. They lie about their origins or symptoms, they disappear, they don't follow protocols.
But what if it's actually much more complex than even that? For instance, if there was a nearly universally fatal disease that had spread over a large portion of the state of New Jersey and infected 2,713 people killing 1,823, and there was a vaccine 97% effective, wouldn't we have immunized everyone in New Jersey by now? Think about it.
Or if the New Jersey epidemic caused an influx of Russian and Iraqi doctors, who started driving around in flashy cars and upbraiding Americans for dwelling on the Cold War or 9/11 as ancient history and telling them to trust the new treatments they had brought, would people be lining up for care?
Or if the government and world approved funding to build a brand new hospital that would be dismantled as soon as the epidemic was under control and placed it in the very place where New Jersey residents lacked care, would they consider that to be legitimate?
Yes, Eastern DRC is a complicated, murky, often dangerous environment, but focusing on that seems to me to border dangerously on blaming them for a problem that the vast majority of those infected have little control over. That strikes me as hypocritical coming from a country where the anti-vaccine movement thrives, where people get their facts from social media, consume calories and avoid exercise to their death, and support the right to assault weapons even as the number of school shootings rivals the number of Congolese rebel attacks. We're all pretty much the same.
It seems to me that the best thing we world could do now is to:
1. Ramp up vaccine production and immunize the entire region.
2. Send in long term bridge-building people who are willing to do the hard and risky work of taking on life in Eastern Congo alongside the Congolese, listening, working together on common goals, generating trust.
3. Fund the small local on-the-ground hard-working health workers who are the front line day in and day out.
None of that will be easy. Uganda is way more functional, yet today my first few patients were all children with malaria and severe anemia and THE MALARIA MEDICINES WERE OUT OF STOCK. The nurses were late. People kept jamming their problems into my hands. So much felt out of control--a child sent two days post-op from a complex neurosurgical procedure with high fevers and cerebro-spinal fluid leaking out of her head, a child with TB infected by an uncle whom we have yet to track down but suspect drug resistance, a child who has spent three weeks with an infected wound that almost never gets bandage changes, a child in pain with sickle cell disease who has not had pain medicine dispensed, trying to problem-solve so we can split vials of medicine and share doses, a child with malnutrition not improving whom I gather from the dad and the neighboring beds is rarely on the ward because the dad takes him home between rounds to care for his other two kids since his wife left him, a patient with measles breathing virus on the open ward because the isolation order wasn't carried out. Not a single patient with a vital sign taken. It is just this side of complete chaos and frustration. But minute by minute hour by hour God's people touch, listen, think, talk, care and slowly by slowly, patient by patient, treatment is given and transfusions hung and a remarkable number improve.
Reasons to hope: a faithful mom of twins feeding her malnourished cuties, and the team that enables her to get the food.
Another reason to hope: data. The Kwejuna Project that Scott started has become standard care for the District, and here we are in a weekly staff meeting poring over HIV and TB follow up and outcome data !
Likewise, a year on, Ebola is still lurking and spreading, but the people of Congo are also still hopeful, loving, fighting on, working, caring for each other, performing educational dramas, tracing contacts. Slowly by slowly the good will prevail. Just wish it could be a little faster and more definitive!
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