Tuesday, December 4, 2007

Ebola and Black Mambas

Bundibugyo, Uganda
Volume 2, Issue 13
November 29, 2007

-Ebola and Black Mambas-
…deadly virus, deadly snake, and me…

Let me preface the rest of this e-mail by saying that I am alive and well and God is still my King, that being said, here goes….

The incredibly unforeseen events of the past 12 hours have been unlike any other I have ever experienced, and hopefully never will again. Discouragement, frustration, confusion, excitement, bewilderment, joy, fear, angst, have all come and gone as this day comes to closure, and quite honestly, I am thankful this day is ending, and I eagerly ask God that a better day is coming.

Since my last e-mail I have been continually encouraged by Ugandans, Americans, and God. Sometimes I hesitate in sending out messages that things are not going ‘peachy-keen’, as I think to some that translates that life for me is miserable, which is very untrue. I’ve already decided to stay longer, so something must be good, and it is. I’ve had a few rough moments recently, but my everyday life is good, really good. Any time I can treat sick kids, interact with smiling, laughing adults, play duck duck goose with healthy children, get fresh tomatoes and green peppers from the local market, and see the mountains is a good day, and fortunately for me most of my days involve just such things. Today involved some of those things, but also some unasked for news.

Over the past few weeks there has been an epidemic about 45 minutes north of where I am living, a so aptly named “Mysterious Disease” because no one knew what the disease was, hence the title, but it is pretty harsh causing major illness and mortality (death rate of those affected). In retrospect, I was in the epicenter of the disease outbreak region just a few days before the first case appeared. A week or so ago I went with doctor Scott Myhre and we saw several of the patients affected by the disease, trying to figure out what is causing it. I also attended a meeting for clinical staff in the area describing and detailing the cases so far. The words Ebola hemorrhagic fever and such have been thrown around, but the disease does not follow any of those patterns, and until today we did not know what the illness was. We had sent blood samples to the Ministry of Health three weeks ago, and were originally told it was not Ebola or any other hemorrhagic fever, but today we received confirmation regarding the diagnosis. It is Ebola.

Now before you panic, recalling The Hot Zone, let me explain some more…Ebola has cropped up at various times and world wide locations over the past few decades, and it is usually a very self-limiting disease. In most cases of Ebola the mortality rate is extremely high, meaning those that contract the disease do not survive, and usually the virus progresses extremely quick from initial symptoms to death. As such, most people die before they are able to transmit the disease. More details will no doubt arise over the next few days, but it appears that the Ebola in Bundibugyo district (where I live) is a new strain, meaning it has never been identified or seen before, anywhere. The viral strain appears less virulent then previous types. As such, the initial mortality rate is lower, which may seem like a good thing, but what this may mean is that people can suffer from the disease for a longer period of time, with less severe symptoms, and may go untreated or diagnosed initially, allowing the virus to spread more easily and to a wider range of people, thus harder to control and eradicate.

The disease is spread from person to person, and a few healthcare workers have been affected. As a health care worker myself, I am at greater risk. In fact, as mentioned above, I have already worked directly with some of the people known to have the disease. No, this does not mean that I will definitely develop the disease, but it means I may encounter more people with the virus, and that I have been directly exposed.

The virus does not have a known cure, and the only treatment is supportive care (caring for all the symptoms, such as dehydration, diarrhea, abdominal pain). The best thing is preventative measures, wearing gloves, masks, personal protective equipment. This being Bundibugyo, Uganda, the “most forgotten and forlorn place in the world” very few of those supplies exist, but more external supplies are coming soon. In fact, tomorrow a team from MSF (Doctors Without Borders) and UNICEF are flying in to the area, a team of experts in just such situations, who will be bringing many supplies, hopefully. I’ll be meeting them with Scott Myhre when they arrive at the airstrip. The World Health Organization (WHO) and the Centers for Disease Control (CDC) are also now involved and may be dispatching teams soon. I’ll keep you posted.

World Harvest Mission has been very accommodating of the team here, and Drs Jennifer and Scott Myhre have been encouraging and incredibly supportive throughout the day. They have always, and are currently backing me 100%, whether I decide to leave or stay in Uganda. No pressure either way, just encouragement whatever I decide. A lot remains to be determined, but we received a phone call from an American friend a few hours ago, and he stated that the news has already been posted on FOX News website in America, so no doubt you may have already heard some details. All I can say is “Wow”, news spreads fast, as the results were just released this morning and now it’s already covered by FOX news.

If the above news were not enough for today, I came home from a very frustrating day at the pediatric clinic to find that there was a snake in my house. A very long, pitch black, very poisonous black mamba, no doubt the same snake I saw a few days ago. I am too tired and worn out to write much more, but let it suffice to say that at one point I was crawling around on my ceiling/attic area with a flashlight in one hand and a slasher (long metal blade) in the other thinking to myself “it’s either the snake or me”, well I am still alive and unfortunately I think the snake is too. It remains to be determined whether or not he is still in my house….

Tonight I walked home in the still, deep blackness of the strangely absent moon lit night, coming from the Myhre’s after our team meeting, only to walk in the door and then feel things biting my legs. “IMPALI!!” I screamed, as I ripped off my pants and shirt killing the large biting ants that were crawling over my entire body. Imagine me standing in my underwear as I swat all over and jump around, truly “ants in my pants”. Then a few minutes later I hear my guest that is staying with me (Robert Carr) say “Scott, you need to see this”. I walk outside in the dense blackness and shine my headlight on my choo (outhouse) to see a swarming mass of brown and black creatures, so amazingly dense, as if a solid organism moving in rhythmic motion. More Impali. Millions and millions of ants were swarming all over the concrete entrance to my toileting throne. All I could do was laugh (instead of cry). I’ll worry about them tomorrow, for tonight I am peeing in the grass.

I believe in bad moments, not bad days. Today was full of bad moments, but also glimpses of redemption, joy, and love. Please join me in prayer, for the people of Uganda, especially those living in Bundibugyo – “The ends of the earth”; for the WHO, CDC, MSF, UNICEF workers that are or may be coming to this district, that they may be extremely helpful and productive, and kept safe from harm; for the WHM team, as we individually and collectively decide how to proceed; for Drs Scott and Jennifer Myhre, they have both been very involved in the epidemic and recently traveled to the epicenter of the disease area to investigate and pray over patients and staff, before today they had did not know they were dealing with Ebola, so this comes as a pretty hard hit, they are married and have four children also living in Uganda; and please pray for me, to not be discouraged, to seek God daily, to find joy and love amidst a place of trial, and also for physical safety, I have no doubt been working with people who have the virus and lately the insects and reptiles around my home have been anything but inviting.

I am thankful for you and your prayers. Though weary, I’m alive and well, and He is still my King,

Scott J. Will


*Attached below is the posting from the Myhres on their blog site:

Dear Praying Friends,
The mysterious disease that has infected people in Bundibugyo was this morning revealed to be Ebola virus. 79 cases have been identified over the last several months, with 43% dying. 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.
1. Ebola is a filovirus. There are four subtypes: Ebola-Zaire, Sudan, Ivory Coast, and 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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, 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.
7. 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 CDC web site: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/qa.htm. I’ll update the blog regularly with more information too. ( http://www.paradoxuganda.blogspot.com/)

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.
Thanks so much for standing with us in this,
Jennifer and Scott

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