Ebola outbreak and medical supply theft.

Praise God that it appears the recent Ebola outbreak appears to be mostly contained for now, although new cases continue to show up. The 35 known deaths are tragic and more deaths are likely, but the potential toll could have been far, far worse. Included in those 35 dead are a number of health workers who gave their lives trying to help others. Sadly we know that the health center where they worked faced shortages such as a lack of gloves which likely contributed to their deaths. Recent headlines in the Ugandan paper shows that massive thefts of health supplies worth several hundred million shillings from the Ugandan National Medical Stores have been discovered. Stolen items included pain medicine, penicillin, IV fluids, bandages and gloves. If it were not for theft, would some of these people still be alive? We may never know exactly what happened, but human sin is part of life here on earth. One essential aspect in the effort of disease contol can never be stolen--that is health education. That is a gift which cannot be diverted and will serve for a lifetime.

Tip of the Antimicrobial Spear

photo by Samuel Nalwala

BUNDIBUGYO DISTRICT, UGANDA


A healthcare worker in the isolation ward of Mulago Hospital in Bundibugyo District wears full personal protective equipment. While government officials advice against shaking hands or gathering large numbers of people together, the lethal hemoragic fever caused by the Ebola virus infects both patients and their healthworkers. Though Budibugyo District is at the heart of the situation, as of December 8, there have been 101 cases and 22 deaths since August that have been attributed to the Ebola outbreak. With cases reported in Adjumani in West Nile, Mbale in the east, Masaka and Mubende in Buganda region and Kasese, Fort Portal (Kabarole) and Kanungu in western Uganda, fear of the spread of Ebola is affecting the country as a whole.

With the scarcity of healthcare workers, it is perhaps too easy for people in the west to look at the photo above and assume there are adequate resources to treat the epidemic. The reality is that in Uganda, health centers range from level one, which is basically a health care worker under a tree, to a level 5, which is a top referral hospital. The Bundibugyo hospital and the Kikyo Health Center IV combined have handled 33 cases. As of the most recent reports, there are 338 people under medical surveillance to see if they develop infections.

Kikyo Health Center IV's isolation ward is nothing like you've seen in the west. There are 2 watchmen, 2 cleaners, and 6 nurses. That's it. While the western hospital response would be full isolation in an ICU suite and a battery of antiviral drugs, the real need on the battlefield of emergent diseases is for community education, gloves, masks and gowns, booties, and detergents and disinfectants. Five healthworkers have died from Ebola in this outbreak as basics like gloves are not always available. Since there is such a shortage of healtworkers, the loss of these people also means many more people will be less able to receive medical care.

As NGO's scramble to form rapid response teams and stockpile supplies, the shortage of health care workers is critical.

While I did not travel to Bundibugyo District while in Uganda, I did spend time teaching on how to prevent the spread of infectious diseases. Missionary Dr. Scott Kellerman is likely the front line of this fight from recent reports. In Hoima, where SAMS missionary Shirley Morris is working and where we have helped empower community members with basic health knowledge, there is a district task force in place and is carrying out public education via FM radio and has recieved some treatment kits from the minstry of health.

Emergent diseases that are highly lethal, like the Ebola virus, tend to inhibit their own spread somewhat because they hit so hard and so fast. The basic reality is that victims who die in place in isolated communities often don't to spread the disease beyond the community. Unfortunately, fear can have devistating efffects. The health care worker's union is calling for health workers stationed at facilities which have not recieved proper personal protective equipment to flee the affected areas at this point. Infected people can and do leave an outbreak area, likely unaware that they are carrying the disease themselves. One isolation ward has been attacked by members of the local community who fear its presence. Family members told they could not care for infected patients have attacked staff. There have even been reports of ebola-infected patients attacking the medical staff when the staff could not provide transportation to a higher level health center.

Even before the recall, staffing was nothing like what was needed. With combined factors of both an existing shortage of healthcare workers, minimal outside help, and possibly infected healthcare workers and local residents fleeing affected areas, the potential for this situation to get worse is clearly there. The American CDC has been helpful, especially insetting up a testing lab to determine which patients are infected with ebola and which have other diseases instead.

As the disease spreads in areas where Islam is practiced, there is an additional health care concern. The bodies of the deceased are tradtionally washed prior to burial. The ministry of health has contacted the Mufti (Sheik Shaban Mubajje) and asked him to inform his subjects that the Muslims should not wash corpses, and that instead, they should be put in bags immediately and buried by trained heath care workers.

Approaching a local chuch in Buhima. In the church shown above, Janine helped with a health teaching class where she explained how to make a disinfecting solution using bleach (locally know as Jik). As Ebola threatens Uganda, basic health knowledge such as this is critical to preventing disease transmission.

Why not send a doctor?

Why not send a doctor? If the people of Masindi, Uganda need better health care, wouldn't it be the logical thing to send a misssionary doctor? Actually, for places like Masindi, sending a doctor may not be the best choice. The amount of expense and training for a doctor is, of course, much greater and so far I don't know of any doctor interested in moving to live in this place in rural Uganda--but there are other reasons also. Because of there extensive education and developed skills, doctors have to be concerned about constantly keeping their skills current, and keeping up with new procedures and medical developments as well as maintaining his/her certifications can be a challenge in remote areas. Also there can be a huge gap that is hard to cross in teaching those who have had little formal education. This can limit a doctor to focus on curative care instead of the far more cost-effective preventative education. A ministry that is locally reproducable, such as basic health teaching can have a far wider impact than curing one person at a time. A health educator can train a team of local people who can then train teams of more people and on further. A doctor may only be able to use a very small number of his or her skills with the limited infrastructure (e.g. electrical power) and limited available technology and would be hard pressed to train one person to replace him or her much less many to multiply the effect. Preventing disease is usually cheaper and clearly involves less suffering than waiting to cure problems. Proper handwashing, making sure water is safe to drink, preventing malarial mosquito bites and such can make a huge difference in many people's health. Ideally, as a health missionary I would like to work myself out of a job and no longer be needed. However, in a place like Uganda, I expect that to take longer than the three-year term with which I am starting.

Be ready to share your faith story. You never know when you will have a chance to tell how wonderful God is and how we can connect in a real, life-changing way. Yesterday, I was sitting in a fast food restaurant drinking a soda and looking at my pictures from Uganda. A guy I know came by. He was interested in seeing my Africa pictures (like the one above), so I showed him and told him about my mission. After talking for a bit, he basically asked "How did you get involved in all this Christian stuff" actually wanting to know. Your faith story is not hard to tell because you know it, and it is something people can often connect to. I normally don't try to tell people things they don't want to hear, or aren't interested in, but I think it is good to be ready and willing to tell about our wonderful God when people want to know.

On Friday, I was pleased to be able to meet up with Bishop Nathan Kyamanywa of Bunyoro-Kitara Diocese, Uganda, East Africa. It was quite an honor to show him around Maui and discuss a wide range of topics with him, including my upcoming ministry in Masindi, Uganda. What a blessing, and it was wonderful to hear how he is working on some awesome undertakings for the health of the people in his diocese. His diocese is the parent diocese of the diocese in which I will be working.

This picture is from my trip earlier this year to Uganda. You see me teaching on handwashing and how to make a disinfecting solution. Some of the women here were caring for the chronically ill, likely including diseases like AIDS. While bleach (called JIK) is locally available, they didn't know you could use bleach to make a disinfecting solution. All of the women were bible study leaders who will take the health teachings back to their bible study groups to share.

Africa Awaits!

Africa Awaits! A land of intense beauty, but also a land of intense human need. It is my calling to serve the people there, and with your help I will be travelling on a long term mission to Masindi, Uganda . Through the SAMS-USA organization, and the generous support of fellow believers like you, this calling is becoming a reality. SAMS Missionaries share the gospel of Jesus Christ throughout the world through words and actions in partnership with the Anglican Church. With your continued support, my mission will be to provide medical care outreach to a people who lack many of the basic health care needs we take for granted here. Thanks to all of you, they will know the love Jesus Christ has for them.