Doctor Loses Life to Ebola in Outbreak

"That [Thursday on which] we talked to Jonah, he had a headache he said, maybe early malaria, he'd watch," recalled Jennifer Myhre. "By Friday morning he found it prudent to admit himself to Mulago hospital. That was his last act of bravery and wisdom. We talked on the phone [Friday and] he sounded so normal, so himself."

From Friday through the weekend, things seemed hopeful for Kule. He was walking and talking.

But his urine output was diminishing, and malaria seemed less and less likely.

"Still, Jonah was a strong man, healthy, smart," Myhre said she thought at the time. "He was in the country's main hospital, not out here in Bundibugyo. He was getting lab tests. He had a team of doctors, including [Doctors without Borders from Spain]. We had hope.

"Then suddenly [Tuesday] night they called back. He had died. Maybe there was bleeding, involving his kidneys and lungs..."

She trails off, not knowing how to complete the story.

"To my surprise, the Bundibugyo Ebola epidemic is not what I imagined Ebola would look like," writes Scott Myhre. "I imagined blood oozing from every orifice. A sort of melting or gelatinizing of the human body. The reality is a much more nonspecific 'viral syndrome': fever, vomiting and diarrhea, [although] we are seeing bleeding symptoms (blood in the urine, vomit, or stool) in about one-quarter of patients."

According to the Myhres, at the time they wrote their correspondence the cumulative count of infected in the district was 93, and the death count was 21.

Continuing the Fight

Scott Myhre, along with Doctors without Borders, continues to see patients at Bundibugyo Hospital.

"The protocol now to see a patient involves changing into surgical scrubs in a clean changing area and then donning the hot zone suit (every centimeter of skin covered plus goggles). You are sprayed with chlorine solution after emerging," he writes.

Still, the stark, understaffed hospital remains nearly empty except for those with Ebola, out of fear of contact with the disease.

One of the main concerns now is contact with the dead bodies, discovered to be a risk factor for acquiring Ebola during this epidemic. A few brave health care workers soldier on, placing themselves at risk to care for their sick compatriots.

"On average," Scott Myhre explained, "the incubation period for Ebola is between five and 10 days, the duration of symptoms is two to three weeks, and if the patient dies, the time between onset of symptoms and death is about a week."

The Myhres are forbidden to leave the Bundibugyo District until a symptom-free three-week interval has passed since their last contact with a known case.

Their children, and their missionary colleagues, left earlier this week. Jennifer Myhre has been prohibited by World Harvest Mission, for whom the Myhres work, from seeing patients so that she may reunite with her children as soon as her three weeks are up.

But to the Myhres, this story is clearly not about themselves.

It is about Dr. Jonah Kule.

"Tomorrow his body will arrive," writes Jennifer Myhre, "having been carefully decontaminated (as far as possible) and enclosed. Whenever we speak of him again to someone who cared about him, the tears come freely. We have seen some men here cry like we never saw men cry before.

"I think Jonah was perceived as a resource, a gift, to the whole district," she continues.

"Everyone feels bereaved and robbed of their man, their doctor, the one they could trust and count on. When we see his family, we will have the complication that they are now [Ebola] contacts, too like we are, and we should not be touching each other. So we have to go to the burial of our dear friend without any hugging, comfort his wife and children without touch.

"That feels harsh."

Dr. John Spangler is a professor of family medicine at Wake Forest University School of Medicine.

Associated Press reports contributed to this story.

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