#COVID-19UGANDA day 43, Easter day 21: public health, justice, and the constricted life

We made it to May. Congratulations to everyone in the deep red circles. A third of the world's cases are now in the USA, and our hearts are with our country-of-origin. In the great levelling reversal of this epidemic, we tune in almost every night to Cuomo's press briefing, just as the world has often watched Africa on the nightly news. We follow partly to grow with empathy, partly to learn where we might be in another month, or another six months. The map strikes me as a graphic of the first shall be last and the last shall be first.

Here in Uganda, I have to hand it to the public health mindset. This is a place that has soldiered through AIDS, Ebola, and war with very limited resources, yet generally outpaces its neighbours on measures of delivery of preventive type services. As our current cycle of sort-of-lock-down reaches its limit on Tuesday, we await the next plan. Right now the rules are: borders closed except to cargo trucks (no planes, no buses, no public crossing), no public transportation in the entire country, no driving a private vehicle anywhere, no churches, no schools, no public gatherings, no weddings or funerals of more than 10 people, no outdoor exercise at any time, curfew in place for no movement at all even by foot 7 pm to 6:30 am. Market sellers are supposed to sleep in the market and not move back and forth to home, as are factory workers. Food and medicine can still be sold, but all other shops are closed. Hospitals are open, and the top government official in each district authorises limited transport for patients and health care workers to and from the units. The ideal expectation is that each family is hunkered on their own compound of small houses and working daily with their hoes and machetes to garden food. The reality is that small groups of people move up and down the road on foot continuously, people sell piles of tomatoes or onions or matoke from mats on the roadside or tables under their eves, motorcycles zoom around with bundles of wood and packages of bread, kids roam and neighbours visit, patients have crowded back to the hospitals, and our work is as busy as ever without the conveniences we used to lean on or any sure timeline of a break.

Nevertheless, we have only 85 cumulative positive tests out of 33,818 tests done. Almost all of those are either Ugandans who returned from working in the Middle East in March and have now recovered, or Kenyan and Tanzanian truck drivers who are moving cargo. That's 0.2% positive tests (# positive out of all tests done), representing 0.0002% of population positive (# positive out of Uganda's 43 million people) after testing approximately 0.08% of the population (# tested out of Uganda's 43 million people). In the USA those numbers are 17% positive tests, representing 0.34% of the population positive after testing 2% of the population. America has tested 30x as many people relatively, but has almost 2000x the relative infection proportion. Because all the numbers are still so low, it is hard to know the truth. Uganda is testing returning travellers and truck drivers mostly, not just symptomatic people. America is testing hospitalised people mostly, not travellers, so it makes sense to find more illness. To help account for this, Uganda has embarked upon a country-wide sample to assess hidden community spread. This is going to bring in more helpful information.

Kenya has more cases, and most of theirs are community-transmitted. Even within East Africa inequalities abound. Burundi is our most hard-to-reach country, with fewest cases and a reluctance to test; Rwanda, Tanzania and Kenya are more connected, with more cases. Uganda is in between. DRC has many cases in the Kinshasa area but few in the East near our border, similar to South Sudan. Again, the great reversals of the Kingdom: if it's a hard-to-reach hard-to-stay place it is less likely to be overwhelmed by coronavirus yet, but more likely to have little ability to fight the disease once it takes hold. Therefore the strict measures to try and keep it out. The East African Federation is floating ideas of a self-sufficient region connected by trade via cargo trucks where the truck drivers have their own designated non-mingling safe houses along all the routes.

And as the pandemic machinery grinds on, money flows. Mostly of course to pharmaceutical companies eager to develop treatments and vaccines, trying to appear objective and community minded though we should all maintain healthy skepticism. But also it trickles even to Bundibugyo. Though other teams have been able to begin some quiet relief distributions in the face of economic stress (Nairobi mostly), here in Uganda the government decided to control all perceptions of largesse, so any funding has to be given to the government.  43 days later we hear that trucks of food will arrive soon, and there was a near revolt amongst health workers over the perception that risk-pay salary bonuses might be distributed unequally based on risk-taken rather than given to any and all whether they work or not. The values of this culture are very very strong for sharing benefits, and very quick to protest any perceived reward that is not whittled down to everyone getting a piece. On a macro level, the medical journal The Lancet in April published a commentary on the economics of this pandemic, noting that the US and Europe have poured money into their own economies while quickly fleeing from emerging markets to the tune of $83 billion, the largest resource shift ever recorded. The answer has been to expect IMF and World Bank to take up the slack, which they are doing by advising more loans with more interest, more cutbacks to services and salaries in low and middle income countries. Even money earmarked for health care will largely flow to private companies. The authors conclude: For decades, international financial institutions have pursued policies that undermine public health systems, allowing billions of people to remain without adequate health care. The COVID-19 pandemic is an opportunity to do things differently.  

So that is where we stand on a cloudy Saturday on the edge of the rainforest, picking up mangos and avocados from our trees, watching the world, wondering what is true, and returning once again to the basics. 27 out of 29 people on our team have been sick in the last few weeks with yet another viral crud, not corona. The good news is that most everyone is improving and we probably flattened our little crud curve from days to weeks; the bad news is that in spite of thinking we were taking precautions like meeting outside, chairs far apart, canceling events, trying to keep sick kids inside, not having shared meals, not having team worship . . . this team lives like a big family. In a time of social constriction, we have stayed spiritually and emotionally connected but at a considerable physical cost, and we soberly admit that once corona comes, as abnormally as we are living now it is going to get even harder.


In the meantime, Josh has embarked upon the huge task of rebuilding the main water system destroyed in the landslides. Ike works on mission infrastructure and occasionally arranges fresh vegetables or other staples to be delivered by motorcyle. Mike is beginning to delve into helping John with accounting and administration, while responding to a request to deliver a written sermon to our locked-down church members in the community. Jessie, Kacie, Marc, Scott and I join our Ugandan colleagues (when well) to keep delivering food for the hungry kids, malaria treatment, safe deliveries, titration of feeds for prematures, soaking of wounds and measuring breathing, slogging through long rounds or rushing into emergency surgeries. Ann has re-organized the library space and encourages anxious visitors who come to her for comfort. Lindsey, Alexis, Anna and Patrick teach kids when enough are well, and plan for next year's school plus mentor CSB leaders. Patrick has taken on the CSB communication role, and we know funds will be needed since we are still paying staff as a matter of justice even though parents are not paying fees. Students have received their second round of home-delivered packets of work, and our kitchen/grounds staff are working in the CSB garden. Stephanie's literacy program teachers are reading books on the radio, and teaching phonics songs on-air. Lubwisi language helpers still slip onto the mission to teach our newest team mates. Neighbours still come knocking every day with their stories of high food prices and unpaid salaries and needing loans. We still pray in staff meetings and on wards, still point to Jesus as our source of help and hope. When we walk up and down, we receive cheery greetings, and hope and believe that the small humble inputs and the continued presence of this team communicates a bit of global Kingdom solidarity, and the love of God.

Like the rest of the world, we are constricted to this small space and time. We don't know what next week or month holds. We don't know when we will get a respite, or more coffee beans, or mail delivery. We don't know what we can do if a real emergency arises. We don't know when coronavirus will trickle its way into larger portions of our environs, so we live on alert and in the dark. We make decisions as best we can, we embrace waiting and praying and reading and hoping and serving. Which is, in effect, embracing a life. Even a small one can be a deep one.

Another view of the project beginning, note the height!

Back to filling up the floors . . . 

Don't forget that malnutrition is a much bigger problem in the world than COVID-19

So many kids with sickle cell anemia, in pain, with infections, often doubly damaged by malaria too

Happy client, her 4 month old life nearly ended but now she's going home

This is a NOT SOCIALLY DISTANT staff meeting, but it did generate some good improvements in NICU care!

Nursing station

Admin is tedious, but it is necessary to track patients and justify receiving more nutritional supplements.

Because rescuing puppies is always a good idea, even moreso in times of crisis. 

Almost every day a life is saved when Scott, Isaiah, Marc, Ammon, Obwot do a C-section, often two, in this case four: Scott delivers triplets. 

Triplet girls at 33 weeks. Names are Nyangoma, Nyakato, Kiiza. These are traditional names for "first-born girl twin, second-born girl twin, and the next sibling to come along after twins". Triplets that survive are rare, so most Kiiza's are a sibling a few years down the road, not a few seconds. Praying for these three, who would be our second set of surviving triplets in 2020. 

And our first set in the new NICU

you've heard of face-masks; this is mask-face (lines etched after a long day of continuous N-95)