July 30, 2014

Dear Prayer Partners

As many of you are aware from the national news, the Ebola virus epidemic in Liberia and in the West African region has been getting worse and affecting more people.

I have been wanting to send out an update for the last couple of days, but the situation keeps changing so fast that it has been hard to settle down and put something into a cohesive letter. For those of you who are on Facebook, Debbie or I have been posting some more frequent updates about the situation in Liberia there, so it would be good to follow along there if you are praying and want more details.

The key points to be aware of now are these:

The Ebola virus has increased in severity in Liberia. ELWA Hospital, in cooperation with Samaritan's Purse, has been running an isolation unit there caring for patients affected by Ebola. However, over the weekend two of our missionaries tested positive for the virus and now are undergoing treatment for the disease. Their names are Dr. Kent Brantly and Nancy Writebol.

Ebola is a virus which is spread only by people who are sick-those who are not ill cannot spread the disease. It is spread by direct contact with a sick individual or with bodily fluids. It carries a high mortality rate, often in the 50-90% range. There is no specific treatment-only IV fluids and other supportive measures while waiting for the person's immune system to respond.

I had been planning to make a trip later in August to ELWA to help there for a few weeks. I am praying now and consulting with our SIM leadership about the timing of my trip. Please pray for us as a family as we are asking the Lord to lead and guide.

Prayer items:

*Please pray for Kent and Nancy, for their recovery, and that the Lord would draw near to them.

*Please pray for the team in Liberia, both missionaries and Liberians  who are caring for many of the sick, as they are getting tired out and of course are experiencing fear themselves.

*Pray that good information about Ebola will be distributed and understood, so that precautions can be taken and so that the current epidemic can come to an end.

*Pray that Debbie and I would receive guidance from the Lord about my going to Liberia.

By prayer, Rick and Debbie Sacra

Reflection: Obstacles to stopping the Ebola epidemic

In the last four months or so, a major epidemic of the Ebola virus has spread through the three nations of Guinea, Sierra Leone and Liberia.  Over 600 have been infected and over 400 people have died.  The epidemic started out from an animal source—either bats or monkeys. It continues to spread when someone has close contact with a sick individual (touch or contact with infected bodily fluids—blood, vomit, diarrhea). It is felt that between 60 and 90% of confirmed cases will die. ELWA Hospital set up an isolation unit in April and had to start using it in June to treat patients infected with Ebola.  Here are some links with more information on the epidemic and the response from ELWA Hospital and Samaritan’s Purse.

http://simusa.org/content/latest-news/4312/elwa_ebola_update

http://www.samaritanspurse.org/article/ebola-virus-claims-more-lives-in-west-africa/

We in the medical field often feel that the solution to a health problem is getting the right diagnosis, or the right medication, or the right knowledge.  Once the right info is in the hands of the doctors and the patients, everything will be OK.

But the current Ebola epidemic in Liberia points out another major issue that we sometimes overlook:  Fear and lack of trust, and how it becomes an obstacle to tackling a major health issue.

The fear which the Ebola epidemic has created leads to conflict between those who desire to make a difference and those they are trying to reach.  This quote is from a CNN article posted online in the last 24 hours:  “There is also a real sense of mistrust toward health workers from communities. In Sierra Leone and Guinea, WHO has said that community members have thrown stones at health care workers trying to investigate the outbreak.”  In Liberia as well, there are teams investigating the epidemic or doing contact tracing (trying to keep track of and monitor those who have been in close contact with someone who came down with Ebola). These teams have run into resistance from communities, sometimes not even being allowed to talk with people who may have come in contact with the virus.  In several cases government officials have had to intervene.  And finally from a recent SIM update:  “Still unreported are the sick in hiding, too afraid to confirm their fears that they have contracted the virus. Just last week, three possible Ebola patients came to ELWA Hospital seeking medical help, only to leave before doctors could put on the protection suits required to treat them safely.”   I’ve talked with ELWA staff about this on the phone. Fear grips family members and they run.  When you put yourself in the shoes of a family member of someone who is sick, it is easy to understand the storm of emotions they are facing.

I am not in Liberia right now—I’m currently in Massachusetts.  But I’ll be returning to ELWA Hospital again at the end of August for three and a half weeks to help the team there. As I think about the situation my teammates are facing in Liberia, and the challenge confronting the entire healthcare community, I find myself wondering how the Ebola epidemic will be stopped.  An effective treatment would be nice, but that is years and millions of dollars away.  The above events move a different set of priorities to the top of my list. How do we respond to the kind of fear that grips communities in the shadow of this kind of threat?  How do we foster trust; how do we build the kind of relationships that will make the difference?   How do we give people the courage to face all the facts about this disease and take the steps to allow the health authorities to contain the epidemic? The best chance of survival right now lies in receiving supportive care like what is being offered at ELWA—how do we give people the confidence to come early on for testing and treatment?
I don’t have answers for this… but I know that when the answers come, they will be based on love, trust, courage, and faith.  Lord, please pour out your Spirit of wisdom and love on all of us who are involved in caring for those infected and those at risk. 

May trip update

Scriptsfrom the Sacras

“...And He sent forth His Word, and healed them”  -Psalm 107:20

I (Rick)  returned on May 20 ^th from a 3 week trip to Liberia. I was grateful for the opportunity to bring 6 pieces of luggage full of medications and lab supplies for the hospital, and to fill in for 2 of my colleagues who were attending a medical conference in Greece, especially with the possibility that there would be a serious need for medical care at the time. You may have heard about the outbreak of Ebola virus in West Africa in the last few months. While there are still a few Ebola cases in neighboring Guinea and Sierra Leone, Liberia has not had any cases for over a month.  ELWA Hospital prepared an isolation ward to be ready if needed, but we have not actually had any patients  admitted to it. We thank God that  the virus was contained so quickly.

Nonetheless, the hospital is very busy these days.  I do want to share a story about one patient that I took care of during my trip.  

Little Peter (not his real name) was sitting on a bench outside the lab.  He’s only 5. His cheek was swollen up, and he was drooling.  He had a terrible “bad breath” smell about him, and looked quite malnourished. Frieda Schmidt, the administrator of our dental clinic, was walking by and noticed this boy.  She asked the people nearby about him.  Peter was not even being seen at the hospital—he was just there with his mother who was also sick, and she had no money to pay for Peter to be seen and treated. 

Frieda brought Peter’s situation up with me and a couple of the other doctors.  As we talked it over, we knew that we couldn’t allow Peter to go home.  He wasn’t eating and would soon become critically ill.  SIM missionary Dr. John Fankhauser, our Deputy Medical Director, gave the official “OK” for us to tell his mother that we would admit him to the hospital and that the admission deposit would be waived. 

When we brought Peter into the emergency room and examined him, it turned out he had a very severe gum infection that had spread into the cheek, and that he wasn’t able to eat anything.  So we started him on antibiotics and saline rinses to help clear the infection.  We also did some labs, to see if we could find any underlying cause. That soon became apparent when Peter’s HIV test came back positive.  Little Peter had AIDS. 

ELWA Hospital has a Counseling Department focused on helping our 500 plus HIV positive clients live positively and remain healthy on antiretroviral treatment (ART).  This department was opened up in 2000 with the support of an SIM project.  Bee Mason, one of the counselors, met with Peter’s mom several times while he was in the hospital, to educate her about HIV, its cause, how it spreads, and how important it would be for Peter to take medication regularly, every single day for the rest of his life.  We also asked Peter’s mom to be tested and her test was positive as well.  The initial counseling process is quite intensive as we help people get past their denial and their despair to see that there is hope for those with HIV, both through good medical care, and through a relationship with God. 

Within a few days, little Peter’s mouth got better, and he was able to start eating.  But his mom required some help and education about what foods would help him regain strength, restore lost weight, and support his immune system.  It took over a week for his weight to start improving, but by the time he went home he was thriving and looking more active. 

Peter and his mom will be able to connect with others who have HIV through the ELWA Hospital support group—there’s even a special group just for kids, and this allows children who are a little older and who have had HIV for years to be an encouragement to those younger or newly diagnosed, to play together and to demonstrate the active healthy life which is possible for them.  It also gives our clients the opportunity to share the new life many of them have found in Jesus. 

Your prayers and support are deeply appreciated!  I will be making another trip, most likely in August.  We’ll keep you informed with another update in a month or so. 

Mystery Photo

Some of you may remember our Mystery Photo posts where we posted something to see who knew or could guess what it is.  Today's Mystery Photo is a mystery to US!!

Last week Dr. Debbie Eisenhut and I were taking a back way through Sinkor and stopped at a fruit stand, where a girl had a table of these:

She called them bush cherries.

The ripe ones are burst out of a husk of some kind.

Here are some unripe ones, this must be what they look like on the bush or tree or however they grow.  The girl selling them did not really know much about how or where they grow. The cherries (I think they are some kind of berry actually) were very sour, like a cranberry, and they have a soft pit inside, that you just eat along with the berry.  Even though they are sour, they are not entirely unpleasant to eat plain.  As it turns out the pit is the bitter/sour part. 

I discovered that when I tried to make jam, but the seeds stayed whole when I mashed the fruit and when I chewed one, it was quite unpleasant.  So I strained the fruit to make juice and made jelly instead.  It's not low sugar, and it's still quite tart, but I like my jelly that way.  Also it didn't set up quite right, but African Bush Cherries are not on the list on the pectin container. 

So if anyone knows anything about these fruit, fill us in.  In the meantime, we will enjoy our jar of homemade jelly!  

I've always noticed how God has taken care of me as I move around Monrovia and managed to avoid having car trouble at times or places that were dangerous or without access to someone to help me.  Yesterday, I was reminded again of how He is looking our for His daughters. Dr. Debbie Eisunhut and I went to Vai town on Thursday to look for some clothes and household things in the used goods market.  Just as we were looking for a place to park the car, she noticed that the brake pedal went to the floor under her foot. She was alarmed and pulled right into a parking space (amazing thing #1 -- there was one). Amazing thing #2 -- we were just a one mile (maybe a tad less) walk from our mechanic's shop -- so we hiked over there and got the mechanic and he came and got the car, took it to the shop and fixed it while we did our shopping. My legs were exhausted by the end of the day from all that extra walking, but we reflected on how amazing (thing #3) it was that she was not alone, not going 40 mph and stopping suddenly for a pedestrian, and really so close to the shop (which is no where near where we live!) Our Father's watchcare is so personal!! and amazing, right?!

I have come back to Liberia from the US many times over the years, but this time is different.  Because I am doing something new (starting a Family Medicine training program), the journey feels very much like it does to travel a new road to a new destination—as I move along, I am aware of every interesting turn in the road, and each glimpse I get of the goal far up ahead, of all the obstacles and potholes in the road as well as the places where it has been well-prepared for my travel.  I have that feeling that I know in general where I am going, but to be honest, I have no idea where I am along the way or exactly what my final destination will look like.  One thing I know, God is in the driver’s seat—He continues to show me that He is at work to get us there.

              

Within a few weeks of our arrival in Liberia, I was able to meet the leadership of the Liberia College of Physicians and Surgeons (LCPS)—the body that runs residency training for doctors here, and the body that will need to approve the program we are hoping to begin at ELWA.  I presented them with a proposal, expressing our desire to train Family Practice doctors for Liberia.  They agreed wholeheartedly with the need for post-graduate training for primary care physicians, so that meeting opened a dialogue that is continuing.  Soon after, at the beginning of November, I traveled to Abidjan, Côte d’Ivoire for the Annual General and Scientific Meeting of the West African College of Physicians (WACP)—the regional body we also hope to have accredit our program. The conference was an opportunity for me to network with trainers and faculty from Nigeria, Ghana, and Sierra Leone, as well the leaders of the LCPS.  On the flight home, I happened to be seated next to one of our WACP officers who is a psychiatrist, and we chatted about what a psychiatry rotation for our residents might look like.   

Last week, I would say we reached our first critical “milestone” on the journey.  On Tuesday, I spent the morning  with the LCPS President, Dr. Marshall, a Liberian woman who spent over 20 years practicing pediatrics at Johns Hopkins in Maryland, and is now heading up the Pediatrics Department at the Liberian medical college.  I visited her at JFK Medical Center, the main teaching hospital, and got a tour of the Peds Department including their Neonatal ICU.  There has been great progress at JFK—the hospital is clean, well-staffed, with many patients receiving care.  I was really impressed.  We had a good discussion about the future of Family Medicine in Liberia, and especially how a training program at ELWA might look.  The key result from this meeting was that I was given a “green light” to publicize our plans to start training family docs next year, so that prospective residents can prepare themselves for primary exams (which they will have to pass in order to enroll in the program). 

Later in the week, the Chairman of the local WACP Chapter Family Medicine Faculty visited ELWA hospital to thoroughly inspect our facility in preparation for an accreditation visit by the WACP sometime next year.  This visit resulted in a very long list of “things to do” to get the hospital itself in good shape.

Finally, we’ve recently been joined in this journey by two more traveling companions—Dr. Kent Brantly and Dr. John Fankhauser, family docs who’ve arrived from the USA in the past five weeks with their families. I’ll tell you more about them in our next update! 

As of this week, we have been here two months, and we are rejoicing in how quickly things are moving along.  Our primary prayer request as we departed was for FAVOR with those who would have to give the Residency Program approval and GOD IS ANSWERING those prayers in abundance.   Please CONTINUE to pray for every step we take with Jesus in charge! Specifically, pray for our medical and administrative team at the hospital to work together well as we tackle the list of upgrades and corrective measures that need to be made before we can be accredited to host a residency program.    

Happy Thanksgiving!  Our hearts are full of thanks for all that the Lord is doing already.

Yours in Christ,   Rick

Introductions...

I like doing introductions… Today I got to introduce a concept at the Liberia Medical and Dental Association (LMDA) meeting: the concept of starting Family Medicine Residency training in Liberia.  

I’ve been having some discussions with those in authority over physician training, and they encouraged me to speak on this topic at the LMDA. I reviewed the exciting history of the discipline in Nigeria, where thousands of Family Medicine residents have been trained since the early 1980s; reflected on some of my own experiences over the last 18 years; and wrapped up by asking the question “Is it the right time for Family Medicine in Liberia?” 

There was some pretty enthusiastic support for the concept, as well as some lively questions and discussion about the logistics and details. I was joined at the meeting by our newest arrival, Dr. Kent Brantly, a Family Physician from the US serving here through the Samaritans’ Purse/World Medical Mission 2-year Post-Residency Program. He’ll also be a part of developing this vision. We are anxious to see what God is going to do!