Below will be a transcript of the Dr. Jonah Kule Memorial Lecture, delivered by Scott to the Federation of Uganda Medical Students Association on 31 March 2018 at 10:30am at the Makerere University Main Campus.
(This specific was a 45 minute lecture so be warned, This specific's a long read...)
not bad morning. Thank you very much for the invitation to deliver the Dr. Jonah Kule Memorial Lecture to the Federation of Ugandan Medical Students Association.
I would certainly like to acknowledge the presence of Masika Constance, the firstborn daughter of Jonah Kule. She will be a graduate of the Uganda Christian University, along with was 15 years old when her father died coming from Ebola. Her younger sister, Birra Phiona, who will be studying Law at Uganda Christian University will be also here.
This specific will be fitting that will I am delivering a lecture memorializing the life of Dr. Jonah Kule on the weekend of the Celebration of Easter. Easter will be the climax of the Christian calendar in which we remember the resurrection of Jesus Christ. Easter weekend begins with the observance of Passover. Christians call This specific Maundy Thursday. Jews hold a traditional meal called the Seder during which there will be a reading of the Haggadah, a Jewish text which means “the telling”. During the Passover Meal, the story of the Passover will be recounted. This specific will be a story of God’s deliverance of the Jewish people coming from slavery at the hands of the Egyptians. I am here for a re-telling of the story of our friend, our colleague, Dr. Jonah Kule. I have two objectives because of This specific re-tellling. The first will be to honor the memory of our friend along with colleague who gave his life serving the sick. The second will be to challenge you, a group of future doctors, to consider how you will live along with work – along with whether the life of Dr. Jonah Kule will be one to which you might aspire.
Our part inside the story began with our arrival in Bundibugyo District in 1993. We came as part of a Team, trying to bring life along with redemption to a remote along with forgotten district with efforts in health, education, church planting along with Bible translation. When we arrived, there were 49 Districts in Uganda. inside the education sector, the brand new Vision always published a list of the District Performance for senior secondary O-level results --which will be a proxy I think of development – along with Bundibugyo was always dead last. My wife along with I are physicians so our piece was in promoting health along with healing the sick—preventive along with curative health. As we moved into needy communities with immunization campaigns along with health messages we met a young energetic Clinical Officer named Jonah Kule. Jonah was a Mukonjo, a person of the mountains. We learned very quickly that will This specific young man had a gift for shepherding communities. He could teach, persuade, correct, encourage, guide—along with all the while lead community groups on a path of self-discovery along with mobilization towards healthier lives--idn a way that will we as outsiders could not…
We got to know Jonah along with his family very well. He eventually had 5 daughters—Masika, Biira, Maga, Keren, along with Serah—who were inside the same age range as our own four children. We shared holiday meals together in each additional’s homes. We traveled together. We were professional colleagues working for health in Bundibugyo. After a few years, Jonah shared his dream of going to medical school with us. We decided This specific was a worthy investment of time along with money, so we gave him the green light to pursue a medical admission. Jonah was over 30 years old so he took the Makerere University “Mature Age Entry” exam. He scored in near the top of all who took the exam. He was called in along with asked how he cheated. He must have cheated—because This specific was not possible that will a student coming from Bundibugyo District could have performed so well. So, they deleted his result along with sent him away. He was determined, however, along with came back the next year along with again scored inside the top three of all who sat. This specific time they accepted his result along with he was admitted to the Makerere University Medical School.
Jonah was a smart guy, however biochemistry almost did him in. I think he passed by 1%. however he was very experienced seeing patients as a hardworking clinical officer. So, he did well at MUMed during the clinical rotations. however he was always singled out in class by the professors. No matter which subject whether This specific was surgery or obstetrics—they would certainly look at Jonah along with say, “along with if you are practicing way out inside the bush with few resources—like, in Bundibugyo, This specific will be how you need to think about This specific.” This specific was a slight humiliation. Calling out Bundibugyo as the least developed along with most backward place in Uganda.
Nevertheless, Jonah persevered along with graduated in 2005 coming from Makerere—along with was the first to graduate as a native born coming from Bundibugyo in 29 years. The last previous Bundibugyo-born graduate was William Sikyewunda who went on to be a member of Parliament along with the District Health Officer. The brand new Vision’s headline on 31 March 2005 said “Bundibugyo’s Reason to Smile”. He went on to do his Internship Year in 2006 at Rubaga Hospital where he was much loved along with appreciated for his serious work ethic.
Our mission, World Harvest Mission, sponsored Jonah that has a Bond Agreement that will he would certainly return to serve in Bundibugyo District for at least 5 years. For Jonah that will was not a burden – he desired to return to Bundibugyo. Immediately upon finishing his internship at the end of 2006, he did return to Bundibugyo. He was immediately posted to the District Hospital. This specific was a place he knew like the back of his hand since he had worked there for many years as a Clinical Officer prior to attending medical school. however there was still a requirement that will he have an Official Tour at the time of his posting. On that will tour, he was shown the Operating Theatre where he found a pregnant woman lying on the operating table. He asked why she was lying there along with was told that will she was waiting for the family to come up with the money for the surgeon before he was willing to do the surgery. Jonah was annoyed along with immediately terminated the tour. He said, “Get me theatre scrubs along with boots…I will operate on This specific mother—for no money.” that will story spread like wildfire inside the ensuing days. “Dr. Jonah will be here… along with he will be not charging money to do surgery!!”
Jonah came back not just to be a doctor however to stand up to the rampant corruption. that will action shook up the District. however life became hard for him. Not everyone was happy that will he came back to serve. There were those who feared him along with were jealous. Everybody knew that will Dr. Sikyewunda came coming from Makerere Medical School along with became a member of Parliament. People began to talk already that will Dr. Jonah would certainly be the first Mukonjo Parliament Member coming from Bundibugyo. that will was a radical idea. I don’t think Jonah was entirely opposed to the talk. He knew that will corruption was rampant along with might need to be cleaned out coming from within. however I think he thought that will would certainly be some years down the road.
So, he began to serve his people…
So, when there were a rash of deaths in Kikyo Sub-County (a mountainous area on the slopes of the Rwenzoris) in August of 2007 (six months after he began his posting), he took an interest. He went up along with treated people along with investigated. There were a cluster of deaths in one family – about 5. The father along with all of the sons of one family—along with then soon many more coming from that will clan. So, the pattern seemed to be infectious. In retrospect, This specific will be thought that will these men were involved in butchering monkeys hunted inside the mountains along with then many more died who were involved with the burials. however that will was covered up because This specific was an illegal practice. Jonah brought inside the District Surveillance Officer who sent off samples for testing for Hemorrhagic Fevers to UVRI. The tests were negative. There were no hemorrhagic features clinically. Malaria tests were also negative. This specific was mostly a picture of fever, vomiting along with diarrhea. At the time -we thought This specific might be typhoid.
Jonah passed by our house one day on his way up to the Kikyo Health Center. Jennifer went into our stores along with gave Jonah all of the Ciprofloxacin, gloves along with alcohol hand sanitizer that will we had. He was in a hurry, however we insisted that will he wait until we get these supplies together. He did wait however as he pulled out on his dilapidated motorcycle he laughed along with said, “I must serve my people. If I die, then I die.”
along with so This specific went. Things smoldered along with flared through September, October along with into November. Finally, on Thursday 29 November 2007, we got a call informing us that will the CDC figured out that will This specific disease was due to a brand new strain, the fifth identified, of the Ebola virus. Much later in 2008, This specific was given the name Ebola bundibugyo. Nobody in Bundibugyo or Uganda was happy about the fact that will This specific was named for a place in Uganda.
So, This specific was the 17th documented outbreak of Ebola since 1976. All of the significant clinical outbreaks had occurred in Africa except for some of laboratory contaminations in additional parts of the entire world. The last previous Ugandan outbreak prior to This specific was in Gulu in 2000. Uganda lost another hero due to that will outbreak, Dr. Matthew Lukwiya, who died while caring for Ebola patients at the St. Mary’s Hospital in Lacor on 5 December 2000 – almost exactly 7 years prior to Dr. Jonah’s death.
As soon as the diagnosis was announced, Uganda MOH epidemiologists visited Bundibugyo along with reviewed the records of many of the cases as they could find along with decided that will officially speaking (during that will early period of the epidemic) there were 79 cases that has a 43% death rate. My own opinion will be that will This specific will be a significant underestimate. They used extremely strict case definitions along with had no medical records for many patient deaths which made This specific impossible for them to be categorized as Ebola-related deaths.
So, we received the news coming from the USA CDC along with immediately changed our approach to the way we handled patients, however by that will time This specific was too late….
So, let me try to walk through the timeline of the final ten days of Jonah…
Friday 23 November will be the day Jonah believed himself to have been infected. that will was the day he along with I examined Jeremiah Muhindo. Ebola experts call This specific type of patient a “super-infector”. Very sick patients with high viral loads along with lots of caregiver exposures. He was an important man inside the community – many people were involved in his care. There were 5 health care workers who died at Bundibugyo Hospital along with they all had contact with This specific patient:
--Rose Bulinpikya, nurse matron
--Joshua Kule, senior clinical officer
-- Asanasio Matte, ophthalmic assistant. (few of the patients in This specific epidemic had bleeding manifestations, however many did have conjunctivitis, so the ophthalmic assistant got involved – again, before we knew This specific was Ebola).
In between two of the times we saw the patient together, Jonah went in alone along with arranged a face mask of oxygen onto the dying man, hoping to provide some relief or comfort. He was not wearing gloves because he could not find any at the hospital at that will moment, along with he felt that will his friend needed the oxygen. that will was his greatest exposure.
Sunday 25 November Jonah traveled to Kampala to pick up Masika coming from school as they were breaking off later inside the week.
Wednesday 28 November he began to notice a headache, along with wondered if he was getting malaria. (5 days coming from last exposure, though of course he’d had earlier ones too).
Thursday 29 Nov the EBOLA epidemic was announced by the Ministry of Health. Jonah’s headache persisted in spite of first line malaria treatment, along with he vomited twice. He instructed his family to wash the floor with bleach, to not touch him, along with to not share his food or drink. He picked up his oldest daughter Masika coming from boarding school, along with by the time they came home he was feeling weaker along with worse, slumped over on his young brother’s shoulder. We talked to him on the phone about This specific time – our first time to talk since the announcement of the Ebola epidemic. I asked “How are you doing?” that has a sort of nervous laugh, he said “well, I’m not feeling so well.”
Friday 30 Nov he had two malaria smears at a private clinic up the road coming from his house, one positive along with one negative. Though he still hoped his illness was malaria, he talked to a doctor friend who encouraged him to be admitted, so they hired boda-bodas along with both rode to Mulago Hospital. There he was put in an isolation tent.
Saturday 1 Dec a blood sample was taken to test for the Ebola virus.
Sat to Monday he was mostly up along with talking during the days, still having fever, vomiting, along with some diarrhea. Then his urine output slowed down, so the staff began to give IV fluids, however in retrospect he was not dehydrated however rather in renal failure. He was thirsty, along with at times hungry. He remained optimistic until Monday that will he would certainly recover. His family would certainly come along with see him coming from outside the tent flap, talking loudly to communicate however not touching. The Mulago Hospital doctor assigned to his care had fled, however MSF Spain doctors checked him a couple of times a day. His young brother sometimes entered the tent to care for him when no nurse or additional medical person was available. He was alone much of the time.
Monday 3 Dec he began to have chest pain. He told his family This specific was a bad sign, that will he had seen patients along with when they had chest pain they were getting much worse. His brother describes finding him reading a medical text along with thinking through his symptoms along with what was happening. He read them some Bible verses.
Tuesday 4 Dec his chest pain became worse. He could not always talk because of breathlessness, taking several breaths to get words out, so his brother just kept quiet. He also felt a lot of abdominal pain along with weakness. His young brother was finishing A levels along with left to take his last exam. When he returned he found that will the MSF team was inside the tent along with they told him to wait somewhere else. Later he saw Jonah’s body. I think the hardest thing for the family was that will Jonah died without any of them around, alone in that will tent. that will’s hard for us too. His brother along with the Mulago staff decided that will This specific was best not to tell the family that will day, they should keep This specific under wraps until the morning. however Jennifer did inform the family due to direct information coming from MSF, for which his wife along with sister were very grateful.
The picture of Jonah in This specific situation will be somber however not desperate. He knew what was happening to him. He followed his own symptoms along with watched them unfold. He knew the choices he had made to care for patients might cost his life. This specific was 5 days coming from exposure to illness, along with six days coming from the illness to death.
After Jonah’s death, we spoke with doctors coming from MSF who had cared for him. This specific was spine-tingling to hear Jonah speak coming from beyond the veil. Tuesday afternoon, he was still walking along with talking along with said to them, “I have seen these patients die along with I know that will I am dying.” I don’t think his doctors definitely believed him. Moments before he died he said, “I am going to die currently. along with I pray that will no one should ever have to die of This specific disease again.” Right to his last moment he was thinking like the compassionate doctor that will he was, looking beyond himself to others.
The final numbers of the Bundibugyo Ebola epidemic are not huge:
Case Fatality Rate (CFR): 25.2%
The CDC Team in Atlanta published a summary inside the journal, Emerging Infectious Diseases, along with they only officially recognized those Ebola patients who had laboratory confirmation of their infections:
This specific will be almost identical to the overall death rate of the massive Ebola epidemic in West Africa of 2015-16.
Ironically Jonah’s death was not included inside the official tally of deaths of the Bundibugyo Ebola epidemic because he died in Kampala.
These numbers are super tiny compared to the 2015-16 recent epidemic in West Africa where
Cases: 28,616 (200x bigger)
Deaths: 11,310 (300x more)
Bundibugyo was not the largest epidemic in history. however we did learn more about the disease as a result.
This specific was a tremendously organized effort. Large organizations came along with invested enormous amounts of manpower along with money: the Uganda MOH, Uganda Red Cross, Medicins sans Frontiers, the USA CDC, along with the WHO. There was one member of the WHO team who had been present at ALL of the previous Ebola epidemics. He was primarily interested in trying to understand where the Ebola virus was coming coming from.
The Ebola Task Force included all of these organizations along with was headed by the RDC along with the Uganda MOH.
This specific was composed of many sub-committees:
1. Clinical Care (MSF)– organizing the care of the sick
2. Social Mobilization (MOH/Red Cross)—the community educators putting out messages of prevention
3. Contact Tracing (WHO)– following up on those potentially exposed
5. Logistics/Finance – Ug MOH
We learned This specific about Ebola:
Incubation: 2-21 days (the larger the viral exposure, the shorter the incubation)
Transmission: contact (no evidence of airborne transmission – except perhaps droplet transmission when health care providers have been sprayed down along with blood has been aerosolized). One brief anecdote here…The Sunday after Jonah died, Jennifer along with I were home alone, having breakfast. This specific was eerily quiet. No kids (we sent them to Kampala so they wouldn't be at risk if we got sick). No visitors because people thought we might be infected…along with then I cell phone rang. The guy on the additional end of the line said, “Please hold for the President…” President Museveni then came on the line. We had a 10 minute conversation in which he asked lots of specific along with intelligent questions about Ebola. Specifically he wanted to know if Ebola could penetrate intact skin (my best answer: NO) because he was trying to make public health recommendations for his country. At the end of the conversation he asked, “will be there anything I can do for you?"
I always regretted that will I didn’t ask him for Ugandan citizenship for me along with Jennifer :(
Reservoir: to the best of my knowledge This specific was during This specific epidemic that will they made progress in understanding that will the long-term reservoir of the Ebola virus was Fruit bats.
Intermediate host: primates (This specific will be believed that will the first cases in Kikyo on the mountainside occurred in a family who were hunting along with butchering monkeys)
Those at risk: Health care workers along with family care givers along with especially those that will bury the dead.
This specific will be the insidious along with seemingly evil part of This specific virus.
Let me just say a little bit about Jonahs burial…
We lived in Bundibugyo for 17 years along with we attended dozens if not hundreds of burials. Jonah’s was unlike any additional we ever attended.
Since Jonah died in Kampala, his body had to be transported back to Bundibuygo. that will was done by the Doctors Without Borders – Spain team. The district leadership planned bury This specific with no ceremony, no attendants, not even his wife. We strongly objected. We knew there was no danger to standing a few feet away along with watching the MSF team put the coffin into the ground. We drove Melen, the three oldest girls, his sister Sophia, along with his mother, to Bundibugyo Hospital. When we arrived the additional two staff were just being buried. I called the DDHS thinking someone coming from the district should show the courtesy of attending the burial, along with he along with the LC5 came, as well as a handful of medical staff. We asked Melen what she wanted, she only wanted to be sure that will someone prayed. We circulated looking for someone who was willing to sing, along with thankfully found a Red Cross mobilizer who led hymns while the coffin was unloaded. Again people tried to keep Jonah’s family away, however there was no reason for that will. Because Jonah’s body was decontaminated along with enclosed in Kampala, the infection control protocol for his burial was less than for the two who died here. The team merely wore gloves, along with MSF allowed the girls along with relatives to stand by the side without touching anything. When the coffin had been lowered on ropes, Scott asked for a pause. He took out a Bible along with read. along with they stood at a distance. Quietly. While the MSF Burial team lowered the coffin into the ground.
By our estimates only his youngest brother along with his mother had any potential exposure, touching him or cleaning up coming from his sickness. however the entire family was ostracized as dangerous along with put into quarantine for 21 days. This specific was harsh.
Jonah’s wife did receive a modest worker’s compensation lump sum coming from the government since he died while doing government work, however inexplicably they published that will fact along with the sum inside the brand new Vision. This specific was a horrible decision as every distant relative descended on Melen, trying to vie for a piece of the pie. along with Melen was pregnant with their sixth child at the time of Jonah’s death. A child he would certainly never meet. along with This specific turned out to be their first boy, currently named for his father.
At the graveside, as they lowered Jonah’s coffin into the ground I read
however Jesus answered them, saying: The hour has come that will the Son of Man should be glorified. Most assuredly, I say to you, unless a grain of wheat falls into the ground along with dies, This specific remains alone; however if This specific dies, This specific produces much grain. He who loves his life will lose This specific, along with he who hates his life in This specific world will keep This specific for eternal life. If anyone serves Me, let him follow Me; along with where I am, there My servant will be also. If anyone serves Me, him My Father will honor.
Jonah fulfilled This specific description as well as anyone we have ever known, not loving his life too much, being willing to die for the not bad of others.
I would certainly like to pause here for a moment before I move to my final points—to address the issue of how we deal with such a tragedy. How do we make sense of the death of a not bad man, one who we have poured so much into, who has just finished six years of medical training who has come back to serve his people, who will be the father to 5 children. This specific makes no sense, humanly speaking. I will say two things:
First, We cannot see the ways of God. God will be all-knowing along with all-loving along with all-powerful. We know these things coming from the ways he has revealed Himself in history. however sometimes we cannot understand His ways. We must accept that will God will be Mystery –that has a capital “M”. This specific will never make sense to us – however we cannot see all of history inside the same way that will God can. Look at This specific This specific way. If you wanted to understand the ocean, however you only had a cup of water coming from the ocean. You could say that will This specific will be salty, that will This specific might have some sand, along with some microorganisms in This specific. however that will cup of ocean water could never reveal the depths of the ocean along with the undersea world of creatures along with vegetation along with beauty. inside the same way, we only see dimly currently through a veil. God will be beyond our understanding…
Second, there will be some not bad that will has risen coming from the death of Jonah…we established the Dr. Jonah Kule Memorial Leadership Scholarship Fund to sponsor students in medicine along with additional health-related education. We have seen 6 doctors sponsored at Mbarara along with KIU; in nursing at UCU; in lab medicine at Mulago along with Mengo; in anesthesia at Mulago.
Those sponsored in medicine included Baluku Morris, Monday Julius, Katuramu Tadeo, Peter Kisembo, Isaiah Kule, Birungi Fred. along with they are all bonded to 5 years of service in Bundibugyo (though This specific seems unlikely at This specific time that will the District will possess the finances to hire them all).
So, what does This specific mean for us today?
We are here today remembering along with re-telling the story of the final days of Dr. Jonah Kule. will be his life a design for us?
As medical students, I used to presume that will you were motivated by a sense of service along with calling. that will there was some desire to heal the sick, to comfort the dying, to help your fellow humans. These last few years though I’ve run into more along with more young doctors who are motivated only by money. I have a Kenyan colleague who seems to be willing to do a Cesarean delivery on every woman possible to make as much money as possible. There will be a doctor in Bundibugyo recently who has been doing unnecessary hysterectomies in order to make as much money as possible.
I would certainly like to leave you today with one more verse coming from the Bible, Micah 6:8
He has told you, O man, what will be not bad:
along with what does the LORD require of you
along with to love kindness,
along with to walk humbly with your God.
I would certainly implore you as medical students to reexamine the reasons why you entered medicine. Of course, medicine will be a sure meal ticket along with potentially a lucrative career. I’ve heard so many intellectual justifications about why you DESERVE to be living comfortable along with convenient lives. You’ve worked hard. You’ve suffered. You’ve put yourself in harm’s way. You deserve to drive a nice car, own a big house, wear the best clothes, along with to send your kids to the best schools.
however let’s look at This specific verse coming from the Book of the prophet Micah…
WHAT DOES GOD REQUIRE OF YOU…
1 DO JUSTICE…God does not call us to lives of convenience however to lives of justice.
The Bible will be full of evidence of God’s concern for justice:
Cry loudly…raise your voice…declare to My people their transgression...on the day of your fast you find your desire, along with drive hard all your workers…will be This specific not the fast which I choose? To loosen the bonds of wickedness, to undo the bands of the yoke, along with to let the oppressed go free? will be This specific not to divide your bread with the hungry along with bring the homeless poor into the house?
If you remove the yoke coming from your midst, the pointing of the finger along with speaking wickedness, if you give yourself to the hungry along with satisfy the desire of the afflicted then your light will rise in darkness…You will be like a spring of water whose waters do not fail.
along with I would certainly like to make a distinction here between charity along with justice. Charity will be giving something to someone in need. Caring for the poor. This specific will be a not bad thing. however justice will be doing something in which there will be a structural change inside the system that will oppresses the poor along with those in need.
You see corruption along with deceit in your communities, in your hospital. People taking money coming from patients for dressing modifications along with placement of IVs. For services that will are declared free by the government. I daresay that will if we see This specific along with don’t speak up then we are complicit in promoting injustice. Injustice will be an oppression of the poor –who have no additional resources to access private care.
Jonah stood up to injustice when he rolled up his sleeves along with did the CS for the woman on the table who had no money. He stood up to the corruption, called This specific out, along with did the just along with right thing. He challenged the system of corruption along with publically condemned in This specific word along with deed.
Doing justice will be doing the right thing.
What will be that will for you today?
What does that will mean for you in your life?
How can you be working for justice in an unjust world?
Does that will require some sacrifice in your life – of course, This specific does.
2. LOVE KINDNESS…This specific will be about who we are as people. How we treat each additional.
Aristotle defines This specific as being "helpfulness towards someone in need, not in return for anything, nor for the advantage of the helper himself, however for that will of the person helped.
Kindness will be a comfort to those This specific touches. This specific makes their life easier, more pleasant.
Another way we can think about Kindness will be generosity. Giving. Some say This specific’s more blessed to give that will receive. To live generously will be to live that has a spirit of kindness. Always looking for opportunities to bless additional people.
Philippians 2:3 - count others more significant that will yourself…
There are so many organizations along with movements in our culture along with in social media extolling the virtue of kindness…
The Kindness Boomerang, the LifeVestInside, Random Acts of Kindness, Pay This specific Forward…
The common thread here will be doing something for someone else expecting nothing in return.
Usually these are modest acts.
Jonah was a kind man – one who thought always of others first. Of how he could serve, of how he could help…
What opportunities for showing kindness do you have in your life?
Are you touching others with unexpected, unmerited kindnesses?
3. Walk Humbly with your God.
What does that will mean to walk Humbly with God?
To be humble inside the Bible means literally to ‘submit yourself to the humbling process of God’
This specific means you submit control to God. You have faith that will He will be in control. that will he will be great along with we are not.
I remember one time Jonah along with I were traveling together. This specific was early in our friendship. He was still a Clinical Officer. We were staying in a guest house together. We had a modest room with two beds. I think we arrived late. We ate dinner along with I came back along with collapsed into bed. Jonah took a shower. By the time he got back I was almost asleep. He said, “Scott did you pray? We need to pray before we sleep.” I smiled along with nodded. He prayed, giving thanks for the day, for our safe travel, for our accommodation along with our meal. along with asked that will God would certainly protect us through the night along with give us rest.”
Jonah was a man who pursued justice, who practiced kindness, along with who walked humbly with his God.
He gave his life serving others.
He will be an example along that has a hero to his family, his friends, to Uganda, along with to the entire world.
|Masika, little Jonah, Mbusa, Melen, along with Biira