The mysterious disease that has infected people in Bundibugyo was this morning revealed to be Ebola virus (verified by the CDC-Atlanta laboratories). 79 cases have been identified since August, with a 43% death rate. So far all cases have come from a village area called Kikyo, which is 25 km from our mission, or through direct prolonged contact with patients from that area. Ebola is a panic-inducing word. We are treating this news with sober respect, but thought we’d put out a few facts proactively.
- Ebola is a filovirus. There are four subtypes: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast, and Ebola-Reston. Yes, Reston, the latter is from monkeys who were imported through Dulles airport, but did not cause any human infection. Our epidemic does not seem to fit any of these four strains and so may represent a new form of the virus. The good news is that it seems to be slightly less virulent.
- This is the 17th documented outbreak of Ebola since 1976. Almost all the cases have come from Africa. The most recent Ugandan outbreak was in the north of the country in 2000; the most recent outbreak at all was in DRC Congo from April to October this year.
- The patients we are seeing look ill, but not that different from most patients. The Hollywood version is not what we’re seeing. Most people just have fever, vomiting and diarrhea, some with a rash and some with conjunctivitis (eyes red). A few have bleeding.
- More than half of people are recovering, with very basic care. We have met with two nurses who took almost a month to pull through but are OK now. The clinical officer Julius who has managed the majority of the patients is OK.
- We consider our non-medical team members to be at low risk. The virus has never been documented to spread through the air to infect humans. The mode of transmission is direct contact, touching body fluids or soiled linens or blood, or by contaminated instruments such as needles. Unless this strain is very different from other Ebola strains, people who are not sick do not spread the disease. We won’t contact it in our homes, or in normal daily life.
- The health care workers of Bundibugyo are the ones at risk. We want to support them in every way possible, with gloves, masks, bleach, bandages, IV fluids, etc. Thankfully the World Health Organization, the CDC and MSF (Doctors without Borders), organizations with great experience in this kind of epidemic, are aware and will arrive by air tomorrow to help. We as doctors are taking every possible precaution when we see patients to avoid becoming ill.
- Our Overseas Director Paul Leary is ready to field any questions about our team (info@whm.org); more medical information can be seen on the Ebola Information page on CDC web site.
- I’ll update the blog regularly with more information too.
Please pray for our doctors and other health workers. Dr. Jonah is in Kampala now, but he saw quite a few cases before he left, as did Dr. Sessanga. Scott has attended to many of these patients already. Pray for us to wisely support the health system in our district, to graciously care for the ill, to be alert to any danger to our team and children, and to advocate for the best possible response that Bundibugyo can receive from international aid workers.
Sometimes around Christmas we find that people are looking for meaningful gifts to give their families. This year we have a great idea: give a goat. For $110 you can purchase a dairy goat. They are a bit smelly and loud to keep in your yard, and you probably prefer your milk clean, cold, pasteurized, in a plastic bottle in the fridge. So instead of sending you the real live goat, you’ll get the little locally hand-crafted ornament pictured above, to hang on your tree. And a family in Bundibugyo will get the goat. A baby whose mother has died, or one whose mother has HIV infection, will be able to drink the goat’s milk, possibly the difference between living and growing up, and dying in infancy.
For more information, check out <http://www.bundinutrition.blogspot.com> (also a link on our sidebar). Briefly, you can either mail a check to : World Harvest Mission Donations Processing Center, Box 1244, Albert Lea, MN 56007-1244; or go on line to this link <https://www.whm.org/donate_online?DESIG=12371> to donate. Be sure to designate Uganda Infant Diaconal Fund (BundiNutrition) #12371 on your check. Karen Masso will eventually get your address from the donation list, and mail you the ornament, but if you’d like it earlier to put on your tree or give as a gift just email her (masso@iname.com) so she can send it to you. All donations are tax deductible.
Jesus’ birth was announced to shepherds; he spent his first hours on earth in the company of goats. It is our prayer that this project will enable 75 more babies to get the calories and protein they need to live, and allow 75 American families the blessing of celebrating Christmas the way He did.
Our dear teachers, Miss Ashley and Miss Sarah, posing today with Caleb, Julia, Jack, Louisa and Joe. We had a planning meeting today to consider how to incorporate twice as many kids with the same two teachers: Gabriel and Quinn add in for Kindergarden, Lianna and Naomi return to 3rd grade and Acacia to 5th, Jack, Julia and Caleb all continue but juggle schedules with CSB classes, and Luke lands back on RMS post-O levels to study math and literature . . . We’re clinging to the promise of strength in weakness! Or fun in chaos!
I generally slog out my days in the kilometer between home, school, and hospital. So it was a bit like a field trip yesterday to go with Scott, on the motorcycle, leaving the kids with teachers and self-supervision and the hospital in Scott Will’s capable hands. We zipped up to Bundibugyo first for the opening of a two-day seminar updating midwives and clinical officers on care for HIV-infected pregnant women. Pamela is a saint, a brilliant one, organizing the training for about 40 people and pulling in a doctor from the Ministry of Health in Kampala to join us. (It was fun also to note that about 8 of those had been sponsored in their medical training by us through WHM in some way). There are about 13,000 pregnancies per year in our district, and the Kwejuna Project has worked to strengthen prenatal care for all of those women. But the 400 or so who are HIV positive are our main focus, and now we are going to be able to give them a more complex regimen of antiretroviral medicines that will further reduce the risk of transmission to the baby.
From Bundibugyo we headed to Kikyo, which is about 25 km from where we live, perched on the side of the Rwenzoris. It is a small settlement that we had never visited before, but we went yesterday to see patients who are suffering from an unknown disease. The clinical officer there, Julius, could use prayers. He’s a competent, faithful, hard-working guy who has been caring for many very ill people. It seems that over the last few months a new infection has arisen in this area. Jonah first became aware and started investigating a few weeks ago, thinking at that point it might be a typhoid fever outbreak. But the tests for that were negative, as were tests for scary things like ebola and marburg viruses, and since then the government has sent people to collect more blood samples. Scott has been seeing some of the patients at Bundibugyo Hospital, but we had not reached Kikyo, the place with the most cases, until yesterday. We are still waiting for results from samples that were sent to South Africa and presumably the CDC, but it seems to be a viral illness, more severe in adults, with a long course (a month), some person to person transmission (nurses and care-givers have become ill), and a significant mortality rate (over 20%). It may be winding down already, there were only 7 patients in Kikyo and 2 in Bundibugyo as of yesterday. Key symptoms are fever, vomiting, diarrhea, abdominal pain/tenderness on exam, conjunctivitis, big spleen, rash (late, not all), and in a few patients bleeding particularly in the urine, some pulmonary edema (but that might have been secondary to over-treatment with IV fluids) . . . . One recovering nurse had peeling hands and feet. We’ve had lots of ideas about possible etiologies, but nothing quite fits all the data, so we’re hoping for a real answer from the tests soon. Meanwhile most of those receiving supportive care are recovering. It is causing some concern among people around here, and of course lots of rumors of poisoning, witchcraft, etc. You can pray for us to know our calling here . . We prayed for the patients which was much appreciated, examined, offered suggestions, appreciated the work of the staff, arranged for more IV fluid, and will keep making phone calls to follow up results.
From the epidemic we went back to the seminar, where Scott taught the afternoon sessions, and then back home. Riding a motorcycle in Bundibugyo is a bit like riding a horse, gripping with the thighs, bouncing out of the seat, the exhilarating breeze and the anxiety of losing control! I was grateful for the opportunity to soak in the sunshine (a rare day of that!), feast my eyes on the beauty of the mountains, wave at children who rarely see a mujungu, interact with medical staff from other units, and see Pamela and Scott in action.
Third Culture Kids celebrate American Thanksgiving, but consider it normal to actually kill the turkey and certainly don’t miss the opportunity to collect its feathers. Sometimes I think my kids are pretty insulated from Kibwisi culture, but when I saw them take the turkey feathers and sticks and turn them into the kind of staff one would see a traditional dancer carry, I realize something is percolating in there. . . Then the day after Thanksgiving Caleb came back from his cross-country practice with pockets full of grasshoppers. They had run to the airstrip, where the vast expanse of grass has become the central hunting ground for grasshoppers, newly in season. The team spent a long break collecting as many as they could, removing their wings to carry them back live for a nutritious snack. Caleb fried his in oil, and we all crunched them, sort of like a shrimp tail . . .Earlier that morning I had seen one of our kwashiorkor patients with a handful, so thought this could be a great way to get a little free protein. So after dinner we snagged Scott Will and the kids and drove back to the airstrip in the dark, on the theory that the grasshoppers would swarm in front of our headlights and be easy prey. Not so, they dove down into the grass when they saw us coming. It was still fun to be out in the dark (unusual and no doubt frowned upon by the security men), full moon, breeze from the motion of the car, laughing and jumping out to trap as many as we could. The take was not nearly enough to bring to the crowded ward, so we fried up this batch too, for desert.
In what is now becoming a tradition, the kids wrote Thanksgiving poems. I can’t find Julia’s right now, but here’s Jack’s, which is also along the theme of protein, but from a unique angle. I guess part of being a third culture person is being able to identify with others, even the main course!
The day was here, turkey’s doom.
I was to be taken away very soon.
They came for me on a big red horse,
Then the man took out is purse.
He handed my owner the money for me,
And when I called out they ignored my plea.
Then everything whirled around like a tornado
And I fainted right then and there don’t you know.
When I awoke I was with a mad beast
Soon to be killed for a great feast.
Alas the killing of me came time
And they chopped off my head with an axe so fine.
There my poor life came to a stop,
But at least I was enjoyed with the season’s crop.
Today is the actual Thanksgiving Day . . . So I saved the best for last, my man. Right now Scott and Jack are out in our truck turkey hunting . . . No, not in the woods, they are looking for the home of a friend of ours who claims he has a humongous bird he’s happy to sell us. We proactively bought a turkey some months ago but as of yesterday he only weighed a whopping seven pounds, not exactly a feast for the 20-some people we’re expecting. Hopefully they’ll be back soon, to do the gruesome killing with a panga or knife. He’s already got a big pot of water on the segili (charcoal burner) outside so he can scald the dead turkey, making feather removal more efficient. Then he'll clean it, dress it, and grill it on our Weber grill. While the turkey is roasting he’ll be dealing with other issues, such as the current list of : helping the district plan the December 1st World AIDS Day celebration that promotes sexual faithfulness, overseeing three charitable house construction projects (a widow, an orphan, and an elderly friend who all have house crises), meeting with team mates who are leaving for prayer and debriefing and review, wading through a ridiculously expensive bureaucratic process to get a lawnmower imported to keep our airstrip functional, fixing team bikes and his motorcycle, evaluating referrals of complicated patients, meeting with elders regarding wedding negotiations for one of our boys, coordinating with MSF (Doctors without Borders) to get supplies for a mysterious epidemic the district is investigating (not so close to us, but we want to help), and that is just a few of the things I’ve actually seen him up to in the last 24 hours. Add to that holding me together in the midst of team transition and goodbye . . . There is no one else like Scott. I’m thankful for him!
Yes, dogs, not very a very spiritual sounding praise, but there it is. Angie and Star may look like ordinary yellow labs, but they may also be guardian angels in disguise . . . We have been here more than 14 years now. That’s the marathon pace, not the sprint. And Angie and Star help set the pace. On Saturday, for instance, there were about a dozen kids at my house: two classmates of Luke now on holiday reading Hardy Boys, two classmates of Caleb studying for exams with him, four young kids giggling with Jack and Julia as they beat drums and played Christmas carols, and a few other assorted acquaintances. Without the dogs that number could swell to 50 or more at the drop of a hat, and then my kids would retreat into the safety of their room. Instead the friends they know and want to be with also know the dogs and are not afraid of them, while random passers-by on the road take a look at the two big white dogs and decide to pass on. Angie and Star are part of what makes this house a home, what makes my children long to come back here in spite of the lure of distant luxuries. Angie and Star are part of the reason I can stay here alone when Scott has to travel, providing at least an illusion of security and decent sleep in spite of armed military patrolling nearby.
Angie is now 11 1/2 years old. It has been a decade since we ran for our lives with her . . . She’s getting old, arthritic, sleeping a lot. Star is still a bouncy 7-year-old, the liveliest puppy of the litter whom we took on Luke’s longing against the advice of the breeder that we choose a calmer family dog. Star and Jack have grown up together, the dog and human sides of one wild soul. God gave Adam the animals right away, before he even had human companionship. I’m thankful for our dogs.
Today I am thankful for team. We’re in the end-of-the-year process of annual reviews, which is a good time to reflect on how God’s faithfulness has brought us through a year. Today we met with Stephanie—a year ago she was just settling in and trying to figure out her plan and calling, meeting barriers and disappointment on funding prospects, and dealing with some unexpected changes in personal plans. Now a year later we can look back with amazement and joy to see what God has done: a chicken project producing eggs for malnourished kids, sustainable protein in the form of ground nuts being farmed and locally ground into paste, two outlying health units with trained staff and new kids enrolled in pilot outpatient programs, a dozen kids getting lifesaving milk on the inpatient ward and dozens more who’ll be helped this week through the ART clinic, even little Chance going home today a perky smiling 7 kilograms, back on the road to health, and even the personal disappointments do not look so drastic now . . . Plus a year ago we didn’t even know that the Massos would be on an HMA, but God provided Stephanie to learn from Karen and then take on her time-consuming administration and supervision of the whole BundiNutrition program.
Our team has pared down in the last few weeks and will soon tighten again. But those who are here continue to work and cry out and cook and live and love . . . Pamela is running a last hurrah massive TBA training and party tomorrow at the Community Center, a chance to say goodbye to these148 older ladies who attend to most of the deliveries in Bundibugyo. Pat is gearing up for more services to HIV positive people through a new program. Kim has been visiting two local primary schools weekly to encourage the teachers in redemptive approaches to their students, and has two different overnight visits planned with local families this week. Sarah and Ashley teach our kids every day, and find time to sing Christmas carols with little neighbors or coach girls’ soccer. Scott Will sees dozens and dozens of patients weekly, CSB students and HIV positive adults and pediatric admissions, and when he comes up for air from that he organizes games for the crowds of loitering children the rest of us would like to chase home! And in spite of constant illness and threatened discouragement the Barts are hanging in there to finish the CSB year strong. We have a great team of people who press on in weakness, who pause to enjoy the beauty of life here, who long for relationships and meaning and real impact, and who are willing to create community in a tough place. I’m thankful for our team.
Today I’m thankful for traveling mercies . . . That phrase that echoed in old-fashioned prayers in our church growing up, and Anne Lamott uses to describe the grace which carries us through this life’s journey. Specifically I’m thankful that Luke made it to America, a mercy not to be taken for granted as a missionary coming the other way to Fort Portal got temporarily stranded in Dubai, and even vehicles trying to get to and from the airport in Entebbe have been stranded by flooding here. This trip called life involves lots of bumpy roads, detours, washed out bridges and impassable mud, so I’m very thankful when we get to rise above the muck and fly smoothly. How quickly I forget the grace which sustains us every day, until near-disaster lurks close enough to realize how blessed we are. That came this week as Savannah had her first febrile convulsion, she’s better now, but seeing one of our mission kids limp and pale is always a reminder to be thankful for the hourly traveling mercies which carry us along.
Luke was up for 40 straight hours on this trip from Bundibugyo all the way to Grammy’s house. Maybe he’ll be a doctor after all . . .
