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Tuesday, March 24, 2020

#COVID-19UGANDA day 2-3; escalation and preparation

Our first confirmed case in Uganda was announced Sunday. Today we have 9 known cases, all in the capital. But since the extra 8 came from testing 35 more recent flight arrivals, if a quarter of the tests were positive we have to assume that hundreds have entered and the virus has spread. The chance that our cases from Dubai represent the absolute first cases to enter the country are vanishingly small. Kenya and Uganda are both awaiting the now nearly-daily addresses from our Presidents. We had borders closed, airports closed, churches and mosques and bars and schools closed. Kenya limited the number of people on matatus and buses, and locally our district pronounced only ONE passenger (in addition to the driver) per boda (motorcycle taxi). Today we expect more draconian rules. Meanwhile the worldwide exponential curve grows. The USA is filling with the red circles. Luke and Abby are working extra shifts. Jack's town is in lock-down, so he's writing his graduate school papers from his room. Julia is still allowed to work on her farm, which seems like a pretty essential service. Caleb is completing a language course today and in limbo with the army after that.

Day 2 out here in Bundibugyo started with a war council. On Friday, we had a staff CME, but the positive cases in Kampala over the weekend brought the reality home. Thankfully Dr. Ammon our medical superintendent and dear friend, who got a sponsorship to med school thanks to the post-Ebola scholarships, had started daily morning staff meetings a few weeks ago.
So Monday, we worked through a 6-part plan based on experience in Hong Kong and Singapore protecting health care workers. Wearing masks, hand hygiene, cleaning surfaces, triage, isolation with more extensive PPE for the suspect cases, keeping distance. Those six things we can do. I find that when I read what other hospitals are preparing, with advice like "you should have 10L/min flow of oxygen for every bed" and we have a total of about 20L/min for 24 hours in the ENTIRE HOSPITAL . . it does feel panicky. So we try to focus on the simplest measures. 

After the meeting, Dr. Marc organised final disposition of a medical supply container that had arrived more than six months ago. It was stuffed with lots of marginally useful items, but last week he found some N95 masks. Many, actually, and some PPE. That means that more than 2 years ago, God enabled a former missionary to prepare this container and it was sitting there at just the time we needed it. Pretty amazing.

Don't cringe if you're an infection control nurse but our reality is that we will wear our masks all day, not changing them, and take them off and store them with hygiene, and then re-use it for a week. Our reality on Paeds is that half our patients have respiratory illnesses, and zero attempt to limit their coughs. So we're wearing them now to get used to it. Half of me felt out of breath and suffocating as temps soar over 90 (no A/C on the equator, congested and stifling). But most of me felt relieved that I was not breathing in a corona soup.
While Marc was sorting and Jessie, Clovis, and I were seeing patients, Scott was pulled into a District response meeting.  Christ School closed Friday, so he came to the hospital to resume his long-delayed clinical life. Only to be diverted yet again into politics and leadership. (Below with Dr. Ammon and head admin Francis, keeping their #social_spacing)
For Bundibugyo, on a border, security is a primary issue, so the meeting with all sectors was a mix of medical and military.
The ward was still full, but full in a way that only maybe 1/5 of patients were on the floor and there were visible areas of floor with no patients. Meaning perhaps that people will start avoiding the hospital as the pandemic picks up. Which could be wise, but may be fatal. I suspect for kids we will lose untold numbers to malaria, sepsis, anaemia, other pneumonias and infections, diarrhoea and dehydration, untreated malnutrition, because the non-COVID health care will wane. We made a new diagnosis of HIV infection in a couple with a very sick baby. Getting people treatment for other fatal disease is still important. 

Patients like this one make me pause. Her respiratory rate was over 40, her saturations were about 90%, her breath sounds were decreased. Is this a run-of-the-mill virus or the new one? Will we ever know?  

After six straight hours of crouching and leaning, listening and writing, searching and explaining, everyone had been seen. We walked out into the blazing sun and washed hands in bleach, removed our masks and sprayed them with alcohol and put them in a bag, then washed our hands with bleach again.  Back to our house for another many hours of emails, texts, phone calls, a Serge emergency committee meeting by zoom, listening to concerns, praying with team mates.  

These are tense days. The weight of our zero-options existence seems to increase with every passing day's pronouncements.  Real prayer, writes Eric McLaughlin in Promises in the Dark, is fundamentally helplessness. I think we're really praying. now. Evacuation insurance doesn't help if the borders are shut. Knowing how to manage a ventilator doesn't help if there is no ventilator. We have some oxygen but it seems pitifully small. Yet we know that God can preserve our lives. We just don't usually feel like we need Him to, we usually feel like we're applying ourselves to that process. 

And we do get glimpses of why there is meaning and value in this season of risk. It is a privilege to stand with the least-resourced people on earth and fight a pandemic that affects everyone around the globe. It is encouraging to them to feel they are not forgotten or alone. Sometimes we actually offer something, like our stash of masks! Other times we just offer hope.

We may not be able to do this again very soon, but this was our team worship. We're basically a big family, and we took the 2 Chron verse seriously: we don't know what to do, our eyes are upon you. Like the original pray-ers of that prayer, we met the enemy with worship. This is what faith looks like where we are, on the edge. Helpless to stem the tide, but seeking the presence of God in the sea of uncertainty and glimpsing ways (masks! friends!) God provides.

And like everyone else around the world who has a phone, our days often end with a message or call with family, who are in more intensely affected areas and being very obedient quarantiners. 

Pray for all your medical workers and leaders; just the number of decisions and thoughts is exhausting.  Lord, have mercy.

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