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Ebola in Uganda: November 30 - December 17, 2007

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Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Fatal Ebola Infections in Three Health Care Workers in Uganda
Recombinomics Commentary
December 4, 2007

"The sad news is that our doctor who was admitted in Mulago died last night and a senior clinic officer who had been in critical condition died this morning," said Samuel Kazinga, district commissioner for Bundibugyo, the epicentre of the new outbreak.

Joshua Kule, the senior clinical officer, and the head nurse of the hospital (Peluce) also died this morning, so with Jonah that brings 3 of 6 health care workers admitted dying within 12 hours of each other.

The above comments describe the deaths of three health care workers in the past 12 hours. One had been admitted to the hospital in Kampala, while two were admitted locally. The high fatality rate for the health care workers as well as clusters of cases, raise additional transmission concerns.

One group was linked to attendance at a funeral, raising concerns of transmission by casual contact. The CDC is setting up a local lab for testing, so the number of confirmed cases should rise shortly, which will help determine the spread of the infections..

The sequence of the virus from patients is said to represent a new species, which is almost certainly a recombinant.

Details on the sequence would be useful.



.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

The report, date December 3, 2007 states:

"4 B'gyo hospitak health care workers quarantined 1/12/07, following complaints of fever (Med Sup Bundibugyo, Dr Sesana, Dr (Joshua) Kule, Clincal officer, and 1 Nurse. So far all improving. Dr (Jonah) Kule in Mulago Isolation unit"

As of this morning, three of the four have died, both Dr Kules (and nurse?).
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

I thought I read somewhere it was the clinical officer. I'll look for it.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

I thought I read somewhere it was the clinical officer. I'll look for it.
The most up to date info is in the blog:

http://paradoxuganda.blogspot.com/2007/12/ebola-bundibugyo-mid-wednesday.html

Scott said it was very disturbing and poignant to be given the key to Dr. Sessanga’s office and told to use it . . . And to find the top paper on his administrative stack was a request by Joshua Kule for his month of annual leave to begin today. I know that Dr. Jonah was also planning an annual leave beginning this week.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Thanks! I'm a bit confused. I'll follow the blog.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

From the blog:
http://paradoxuganda.blogspot.com/2007/12/grief-and-fear.html
..We had not heard of any bleeding, just vomiting and diarrhea and unusual deaths. We wondered if it was a cholera outbreak. I remember him slinging his backpack on, and getting on his motorcycle, saying ?If I die, I die.? When he came back he guessed typhoid fever, due to the prominent abdominal pain and even what seemed to be two cases with intestinal perforation.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

New Ebola strain may be milder, which presents new challenges

The Associated Press

Published: December 5, 2007

LONDON: The new type of Ebola in Uganda might be less deadly than others — but that's not necessarily good news.

The World Health Organization said last week that an ongoing Ebola outbreak in Uganda was caused by a new subtype, the fifth to be detected since the virus was first identified in 1976 in Sudan and Congo. While information about the outbreak was still limited, it appeared to be killing fewer of its victims than other strains typically do.

Dr. Tom Ksiazek, chief of the special pathogens branch at the United States' Centers for Disease Control and Prevention, said Tuesday it was premature to conclude whether the new Ebola strain was milder.

If it were, its victims could be less contagious, Ksiazek said.

A less lethal version of Ebola, though, might spread unnoticed and be confused with other diseases, making it "a more difficult challenge," Asiya Odugleh-Kolev, a WHO communications expert who has worked on numerous Ebola outbreaks, said Wednesday.


Ending previous Ebola outbreaks in Africa has largely depended on Odugleh-Kolev's specialty: teaching people to spot the disease early and to reduce behaviors that could spread it. She said people might not take a less dangerous form of Ebola seriously, or fail to take the proper precautions because they think they have measles or some other disease.

- snip -

In Uganda, WHO said the classic Ebola symptoms were not always present, and that in the current outbreak, there were more reports of vomiting than usual. That slowed diagnosis, according to Ugandan health authorities who said that the outbreak might have begun in August.

The Ebola viruses from Uganda examined so far appear to be up to 25 percent different genetically from previously known Ebola strains. Ksiazek was unsure whether this difference might be significant for patients and doctors.

"What we know from previous Ebola outbreaks is still going to apply," he said. "We now have to figure out if the mortality might be any different."

Doctors also worry that the presence of other diseases in Uganda could complicate the effort to contain Ebola. Because the symptoms for diseases like malaria and typhoid are sometimes similar to those for Ebola, doctors and nurses will need to be careful not to mix Ebola patients with other patients, which could spread the virus in health care centers.

http://www.iht.com/articles/ap/2007/12/05/africa/AF-GEN-Uganda-New-Ebola.php#end_main
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

<TABLE cellSpacing=0 cellPadding=1 width=478 border=0><TBODY><TR><TD>UGANDA: Ebola kills two doctors as death toll rises to 21

<TABLE style="BORDER-RIGHT: #bbbbbb 1px solid; PADDING-RIGHT: 5px; BORDER-TOP: #cccccc 1px solid; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; MARGIN: 2px 5px 8px 0px; BORDER-LEFT: #cccccc 1px solid; WIDTH: 120px; PADDING-TOP: 5px; BORDER-BOTTOM: #bbbbbb 1px solid; BACKGROUND-COLOR: #eeeeee" cellSpacing=0 cellPadding=0 align=left border=0><TBODY><TR><TD style="PADDING-TOP: 3px" align=right>
2088.JPG

Photo: WHO </TD></TR><TR><TD class=ImgCreditCaption style="FONT-SIZE: 7pt; FONT-FAMILY: Tahoma">An isolation ward for Ebola sufferers in Uganda</TD></TR></TBODY></TABLE>KAMPALA, 5 December 2007 (IRIN) - Two Ugandan doctors who had been helping in the fight against an outbreak of the deadly Ebola virus have died, bringing the death toll to 21, officials said on 5 December.

"The sad news today is that our doctor who was admitted to Mulago Hospital [in the capital, Kampala] died last night and a senior clinical officer who had been in a critical condition also died this morning," said Samuel Kazinga, resident district commissioner for Bundibugyo, the epicentre of the outbreak.

The doctor who died at Mulago had come from Bundibugyo to the city to collect one of his children, only to fall sick, and had been put in an isolation ward at the hospital, the largest in the country.

Some health officials have said a lack of appropriate equipment in Mulago and other hospitals allowed the virus to spread, but the government announced on 4 December that it had sent 400 packages of protective gear to the affected region to help ensure medical workers were adequately protected.

The UN Children's Fund (UNICEF) has announced its intervention in the outbreak, including offering funds for the medical workers working in isolation centres.

Keith McKenzie, the UNICEF representative in Uganda, told reporters on 5 December the priority was "to ensure safety of the community and the health workers supporting them?, before announcing other forms of interventions, including tents, plastic sheeting, drums of chlorine and emergency health kits for 1,000 persons for three months.

Eight pathogen specialists from the Atlanta-based Centers for Disease Control arrived in Uganda on 4 December to help battle the disease that has infected at least 64 people. Five of the experts left Kampala for Bundibugyo on 5 December.

Efforts to isolate suspected patients in Bundibugyo, a rural district neighbouring the Democratic Republic of Congo (DRC), have failed as many residents fear hospitals are unsafe, authorities have said.

The rare disease, named after a small DRC river, killed at least 170 people in northern Uganda in 2000, with specialists blaming poor sanitation and hygiene.

It was first discovered in the DRC in 1976, but other outbreaks have been recorded in Ivory Coast and Gabon.

vm/mw

</TD></TR><TR><TD colSpan=2>http://www.irinnews.org/Report.aspx?ReportId=75702
</TD></TR></TBODY></TABLE>
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

hat-tip Exodia

Latest numbers from paradoxuganda blog:

OK the numbers:

Cumulative cases 93 (controversial actually. Now that we have MSF, WHO, something like African Epidemiology something or another, Ministry of Health, and CDC all wanting a say in who is a case and who isn?t, they don?t totally agree on this . . .also as wise Dr. Yoti pointed out, if numbers shoot up this week it can be a reflection of good surveillance, of contact tracing, not of a spike in the epidemic.)

New admissions to isolation units today: 4. Two were in Bundi and two in Kikyo.

Deaths: 21. But they decided not to include Jonah?s death in that number because he died in Kampala not Bundibugyo. Clearly he got his disease in Bundibugyo, so in my opinion 22 more accurately reflects the toll of the disease to date. Again one must bear in mind that there may have been others that were missed in the community.

Deaths in the last 24 hours: 3, all medical workers, Dr. Jonah Kule, clinical officer Joshua Kule, and nurse matron Peluce Rose.

Money the task force budget wishes for: 400 millions shillings . . . (about 250,000 dollars, for a major epidemic. Luke told me today that Virginia has budgeted 80 million dollars to remove the centimeter or two of snow that was supposed to fall today).
The government agencies involved don?t seem to have much in the way of funds . . . But UNICEF has already provided some, and clearly MSF and CDC are bringing in lots of resources. There were calls for transparency from people whom I personally know to be opaque and slippery. Maybe a bit of scrutiny of spending patterns would be one of the good things to come out of this tragedy.

Main discussion points: should public gatherings be banned, even weddings? Is it a mixed message to ban public gatherings and then travel in a film van to show an educational film about Ebola, if that attracts hundreds of people? The decision was: yes. Bag the film for now and educate in small groups. Should community educators be paid for their mobilization efforts? I bit my tongue when it was mentioned that would be too expensive, yet the lab plan is to fly samples every other day from Bundibugyo to Entebbe (at $600/flight??).

Specimens collected for testing and sent today on MAF: 28: the CDC has set up a lab in Entebbe at the Uganda Viral Research Institute. They have a few people in Bundi, not sure what all they do, but the main lab will be off site. They will try to leave behind a sophisticated lab that Uganda can then use to find answers on outbreaks like this much faster. They said that the PCR (test for presence of virus by detecting the genetic material of the virus) has not been fully developed for this new strain, so we?ll have to rely on antigen detection (looking for various proteins the virus makes) which has ?very good? sensitivity (read: we think it should work for this strain like it has for others to find all the cases but we don?t know the real numbers yet, so it is hard to feel too secure about a negative test) and 99% specificity (read, if you get a positive test, it really means you have the disease). They will tests all samples for the antigens (presence of the virus) plus antibodies (evidence of a person?s immune response, therefore indirect evidence of the virus). Unfortunately not all the lab equipment arrived, so the first batch won?t be run until Friday.

http://www.paradoxuganda.blogspot.com/
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

I thought I read somewhere it was the clinical officer. I'll look for it.

Deaths in the last 24 hours: 3, all medical workers, Dr. Jonah Kule, clinical officer Joshua Kule, and nurse matron Peluce Rose.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

<TABLE cellSpacing=0 cellPadding=4 width=480 border=0><TBODY><TR><TD class=headline1 colSpan=2>Doctor dies of Ebola in Mulago Hospital</TD></TR><TR><TD>Wednesday, 5th December, 2007</TD><TD align=right><!-- E-mail and Print Article --><TABLE style="MARGIN-LEFT: auto; MARGIN-RIGHT: 0px; BORDER-COLLAPSE: collapse"><TBODY><TR><TD style="VERTICAL-ALIGN: middle"></TD><TD style="VERTICAL-ALIGN: middle">E-mail article</TD><TD style="VERTICAL-ALIGN: middle"> </TD><TD style="VERTICAL-ALIGN: middle"></TD><TD style="VERTICAL-ALIGN: middle">Print article</TD></TR></TBODY></TABLE></TD></TR><TR><TD colSpan=2><TABLE align=center><TBODY><TR><TD align=middle>
1196885855ZZZZ.jpg
</TD><TR><TD>Tabiita, the Nursing Assistant of Bundibugyo Hospital, who was admitted on Sunday, passed away yesterday. Inset, is Bulimpikya and Dr Kule who also passed away
</TD></TR></TBODY></TABLE>By Vision Reporters

A medical doctor and four health workers, who treated the first Ebola patients in Bundibugyo, have died of the disease. Dr. Jonah Kule, the medical superintendent of Kikyo Health Centre, succumbed on Tuesday night. He had been quarantined at Mulago Hospital.

Senior clinical officer Joshua Kule, senior nursing officer Rose Bulimpikya, matron Peluce Tabiita and another nurse not yet identified died yesterday in Bundibugyo Hospital, according to senior clinical officer James Agaba.

In a statement yesterday, the health ministry said the number of Ebola cases had shot up to 91, after seven new cases had been recorded. The death toll has risen to 24. This includes Bundibugyo businessman, Maipeni Muliwabyo, who died on Tuesday. Eight of the Ebola cases are health workers.

Contrary to guidelines by the health ministry to immediately bury the victims, Kule?s remains will be taken to his home in Bundibugyo today and buried there. The Director of Mulago Hospital, Dr. Edward Ddumba, said precautionary measures had been taken and there was no risk of infection from the body.

Bundibugyo chief administrative officer, Elias Byamungu, said Kule could have been infected when he went to investigate deaths which locals had attributed to witchcraft. The Bakonjo had accused the Bamba of bewitching them.
?I warned Dr. Kule, but he insisted saying: ?Let come what may. I must go down and investigate what is killing the people?. He investigated and he wrote a report. That report is helping the authorities,? said Byamungu, who sounded depressed.

Kule becomes the second medical doctor to die from Ebola in Uganda through contact with patients. The first, Dr. Matthew Lukwiya, died in Lacor Hospital in 2000 during the first ever outbreak of the disease in Uganda. In Kasese, a teacher who works in Bundibugyo, has been admitted at Bwera Hospital in Kasese with suspected Ebola.

?We have not yet confirmed if it is Ebola, but he complains of headache, joint pain, fever, chest pain and bleeding from the nostrils. We have isolated him,? the hospital?s medical superintendent, Dr. Yusuf Baseke, said.

He appealed for protective gear for the hospital staff to be able to handle Ebola cases.

Meanwhile, health ministry sources said yesterday experts from the US-based Centers for Disease Control and Prevention (CDC) and the Ministry of Health were assembling the Ebola-testing machine at the Uganda Virus Research Institute in Entebbe. Eight pathogen experts from the CDC also arrived in the country on Tuesday. The equipment was brought this week and is expected to be operational by the beginning of next week.

The machine will make testing for Ebola and other haemorrhagic viruses faster, and intervention quicker. Currently, samples have to be sent to laboratories in South Africa and the US, causing delays. The Ebola outbreak in Bundibugyo was only confirmed on November 29 after initial tests turned out to be negative, according to the health minister Dr. Stephen Mallinga.

The Bundibugyo Ebola strain is said to be different from any other known strain.
It is characterised by high fever, abdominal pain and diarrhoea and not so much internal and external bleeding.

Kabarole

The authorities at Buhinga Regional Hospital in Kabarole district said some patients had fled, fearing to contract Ebola. One of the patients who fled was a woman who had been put in isolation at the hospital after she vomited blood. She was classified as an alert case, though the results of her test had not yet come back. Radio stations in Fort Portal ran announcements for anybody who spots the woman to alert the authorities.

The Fort Portal Catholic Diocese, where a 13-year-old boy died from suspected Ebola on Sunday, has warned people to stop self-medication. The health coordinator, Sr. Euphrasia Masika, advised people to seek help from the nearest health units as soon as they suspect they may have contracted the disease. She warned that concealing the disease minimised their chances of getting cured.

Mbarara

Residents of Mbarara town have stopped their traditional culture of greeting with a hug and a handshake, fearing to contract Ebola. They have resorted to waving at each other.
This followed the death of a woman who was vomiting blood at Mbarara University Hospital. The woman was from areas near the hospital.

The Ministry of Health took samples of her blood for testing and buried her body immediately as a precautionary measure.
The management of all the banks in the town have instructed their staff to wear protective gloves before handling money from clients.

At Stanbic Bank, manager Enid Natukunda said it was the bank?s obligation to protect its staff. ?They are all supplied with gloves. We cannot take chances,? Natukunda said.

Make-shift eating places have been hit hardest by the scare as patrons abandoned them, fearing contact with other people. Two Ebola taskforces have been set up at Mbarara Hospital.

(Anne Mugisa, Bizimungu Kisakye, Kyomuhendo Muhanga, John Thawite and Matthias Mugisha)


http://www.newvision.co.ug/D/8/12/600646
</TD></TR></TBODY></TABLE>
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

WEDNESDAY, DECEMBER 05, 2007

Last Words of Dr. Jonah
Scott was speaking today to one of the World Health Organization visitors who related information from the MSF doctors who cared for Jonah at the end. It was spine-tingling to hear Jonah speak from beyond the veil....
Tuesday afternoon, he was still walking and talking, and said to them ?I have seen these patients die, and I know that I am dying?. I don?t think they believed him, and I wonder now if that is why he was determined to call us though his efforts were not successful. Moments before he died he said ?I am going to die now. And I pray that no one should ever have to die of this disease again.?

Right to his last moment he was thinking like the compassionate doctor he was, looking beyond himself to others.

Tomorrow his body will arrive, having been carefully decontaminated (as far as possible) and enclosed. His family was still en route when I last talked to them a couple of hours ago. 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, 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 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.

My mind keeps reaching back to some words of the Psalms which I can?t place, though a thousand have fallen at my side, yet I will trust.
We feel the falling of Jonah so acutely, we were both on the same front line of the same battle fighting side by side, yet he went down and we have not.
I know I can?t trust in anything other than God . . . Certainly not in not dying, which is not guaranteed, as Jonah shows. If we make it through this then what about the next tragedy? Safety is not the basis of trust. Instead our trust needs to be in God, inexplicable God, dangerous God, other-than-us God, who does not order this world according to our will, but knows more than we do and loves more deeply.

POSTED BY DRSMYHRE AT 11:08 AM

http://www.paradoxuganda.blogspot.com/
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Post #94:

In Kasese, a teacher who works in Bundibugyo, has been admitted at Bwera Hospital in Kasese with suspected Ebola.
:(
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising


Testing Information From the Blog:

Specimens collected for testing and sent today on MAF: 28: the CDC has set up a lab in Entebbe at the Uganda Viral Research Institute. They have a few people in Bundi, not sure what all they do, but the main lab will be off site. They will try to leave behind a sophisticated lab that Uganda can then use to find answers on outbreaks like this much faster. They said that the PCR (test for presence of virus by detecting the genetic material of the virus) has not been fully developed for this new strain, so we?ll have to rely on antigen detection (looking for various proteins the virus makes) which has ?very good? sensitivity (read: we think it should work for this strain like it has for others to find all the cases but we don?t know the real numbers yet, so it is hard to feel too secure about a negative test) and 99% specificity (read, if you get a positive test, it really means you have the disease). They will tests all samples for the antigens (presence of the virus) plus antibodies (evidence of a person?s immune response, therefore indirect evidence of the virus). Unfortunately not all the lab equipment arrived, so the first batch won?t be run until Friday.
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Ebola virus kills doctors in Uganda<TABLE style="WIDTH: 405px; HEIGHT: 44px; BACKGROUND-COLOR: #ffffff" cellSpacing=0 cellPadding=0><TBODY><TR><TD class=caption style="WIDTH: 360px">
December 06 2007 at 01:01AM </TD></TR><TR><TD style="HEIGHT: 1px; BACKGROUND-COLOR: #cccccc" colSpan=2></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=23 border=0><TBODY><TR><TD class=svarticletext>[SIZE=+1][/SIZE]Kampala - The Ebola virus has killed two doctors in western Uganda, bringing the death toll to 21 of the 91 people infected since the strain first appeared in September, an official said on Wednesday.

"The sad news is that our doctor who was admitted in Mulago died last night and a senior clinic officer who had been in critical condition died this morning," said Samuel Kazinga, district commissioner for Bundibugyo, the epicentre of the new outbreak.

Kampala's Mulago hospital is the largest in the country. Some health officials have said that a lack of appropriate equipment in Mulago and other hospitals has allowed the virus to spread.

Ebola has infected 91 people so far, the health ministry announced in a statement.

Of those still alive, 36 remain in health centres in Bundibugyo and Kyikyo area, the statement said.

The health ministry confirmed the latest fatalities caused by the virulent local strain of Ebola, which kills up to 90 percent of its victims, mostly by puncturing blood vessels and triggering non-stop haemorrhage.

Eight pathogen experts from the Atlanta-based Centres for Disease Control (CDC) arrived in the country on Tuesday to help battle the mysterious strain with scant history.

Efforts to isolate suspected patients in the rural district neighbouring the Democratic Republic of Congo (DRC) have failed as many residents fear hospitals are unsafe, authorities have said.

Effectively, this has scuppered efforts to compile exact figures, officials said.

The rare disease, named after a small DRC river, killed at least 170 people in northern Uganda in 2000, with experts blaming poor sanitation and hygiene.

It was first discovered in the DRC in 1976, but other outbreaks have been recorded in Ivory Coast and Gabon.

At the same time the government had deployed health officials to the country's north-western and northern region to deal with fears of extremely contagious cholera, plague, meningitis and hepatitis outbreaks. - Sapa-AFP
</TD></TR></TBODY></TABLE>
http://www.int.iol.co.za/index.php?set_id=1&click_id=68&art_id=nw20071205225617382C714527
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

Re: New Ebola Strain in Uganda Spreading - Death toll rising

from Post # 95
My mind keeps reaching back to some words of the Psalms which I can?t place, though a thousand have fallen at my side, yet I will trust.
We feel the falling of Jonah so acutely, we were both on the same front line of the same battle fighting side by side, yet he went down and we have not.
I know I can?t trust in anything other than God . . . Certainly not in not dying, which is not guaranteed, as Jonah shows. If we make it through this then what about the next tragedy? Safety is not the basis of trust. Instead our trust needs to be in God, inexplicable God, dangerous God, other-than-us God, who does not order this world according to our will, but knows more than we do and loves more deeply.

Psalm 91 Verses 5- 8
You shall not fear the terror of the night nor the arrow that flies by day,
Nor the pestilence that roams in darkness, nor the plague that ravages at noon. Though a thousand fall at your side, ten thousand at your right hand, near you it shall not come.
http://www.nccbuscc.org/nab/bible/psalms/psalm91.htm

Song On Eagles? Wings composed by Michael Joncas in 1979
Lyrics and music http://www.mamarocks.com/on_eagles_wings.htm
 
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