Friday, December 7, 2007

Entering Bureaucrats Outweigh Lowly Africans?

Was Ebola kept under wraps to ensure that CHOGM proceeded as planned?

I met her in a club down in Bundibugyo

Where you eat jackfruit and it tastes just like cherry-cola

C-o-l-a

Cola

She walked up to me and she asked me to dance

I asked her her name and in a dark brown voice she said Ebola

E-b-o-l-a

Ebola

bo-bo-bo-bo-bola

Well I’m not the worlds most physical guy

But when she squeezed me tight she nearly caused serious symptoms, such as diarrhea, dark or bloody feces, vomiting blood, red eyes due to distention and hemorrhage of sclerotic arterioles, petechia, maculopapular rash, and purpura and other secondary symptoms such as hypotension, hypovolemia, tachycardia, organ damage as a result of disseminated systemic necrosis, and proteinuria. The interior bleeding is caused by a chemical reaction between the virus and the platelets which creates a chemical that will cut cell sized holes into the capillary walls. After several days the person will die literally of "a million cuts."

Hot on the heels of CHOGM, Ebola has arrived in Uganda for the first time since 2001. So far 93 cases have been confirmed, resulting in 22 deaths. The timing of the outbreak’s official announcement has provoked accusations that the government withheld information from Bundibugyo district (on the border with DRC in western Uganda) in order to avoid alarming foreign delegates that came to Uganda for CHOGM last month. Cases of unexplained febrile illness have been documented in Bundibugyo since September, and Marburg virus, which belongs to the same family, Filoviridae, was documented back in July. In the government’s defense, there are approximately one gazillion potential causes of febrile illness in this part of the world, and this strain of Ebola has not shown all of the typical symptoms, nor has it produced 90% mortality rates as occurred in DRC in 2003. Furthermore, diagnosis is delayed by the fact that samples must be shipped out of Uganda for diagnosis. So, it may be reasonable to need two months to confirm that a virus is indeed Ebola. Then again, it may not. The question remains: Were Ugandan lives sacrificed to ensure that the conference would proceed without a hitch?

Starting tomorrow, UVRI may be able to prevent such desperate and delayed decision-making. The institute will become the second institution in Africa capable of diagnosing Ebola (the other is in Gabon). A team from CDC Atlanta is here modifying one of the labs in order to meet – just barely – the recommended safety standards. It will be an important step for Uganda to reduce its reliance on other nations and for UVRI to move towards the operational excellence it was known for prior to the wars in the mid-1980s.

Lost of course in all the Ebola hub-bub is the everyday epidemic of malaria.
Assuming that the 100,000 annual deaths in Uganda attributable to malaria are spread evenly throughout the year, then roughly 1,900 Ugandans have died from malaria since the Ebola outbreak was announced on 30 November. Malaria didn't scare the CHOGM delegates because it is primarily a disease of the poor. If you live in a shoddy house, you don't have a bednet and you don't buy newer medication to which Plasmodium isn't resistant, then you are likely to fall victim. That was the case in the southern U.S., Italy and many other places before the widespread DDT campaign in the 1950s and 1960s concurrent with the construction of better-sealed homes.

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