"You're not stopping Ebola. You're just stopping fun!"

     A lot has happened in the past week. As I mentioned before, the Regional Director for West Africa visited our country program. Last Wednesday we had a big dinner at the CR's house where we discussed the possibility of creating a "Survivor Camp" where Ebola survivors can go after recovering to get support for a few months. We also talked about how the government wants to reopen schools soon. Yesterday I found out that the plan is to reopen on March 16th so that students who haven't been in school for 7 months can sit for the GCSE exams. I'm sure that'll go well. I do think that reopening schools fairly soon (definitely not mid-March though) may be feasible for older students, but not for younger students who can't keep their grubby little hands off each other. We'll see what happens.
     I also learned how they make coffee in Sierra Leone. This was not very enjoyable for me since the mere smell of coffee disgusts me, but it was actually a cool process. The woman making the coffee roasted the beans over fire, crushed them and then did a bunch of stuff that I can't really explain other than to say that she poured things, stirred things and lit incense. There are three separate rounds of coffee drinking so it's a time consuming ordeal. If you're visiting someone's home and you ask for tea, it will be taken as a sign that you are in a hurry to leave. If you ask for coffee, they'll know that you're not in a hurry and have time to stay and socialize.

     The following evening there was a reception in honor of the RD. It was a public health workers dream...free and delicious food, almost non-stop Ebola talk and a keynote speech by the Minister of Health. It's clear that some of the people who have been here for awhile are really ready for all the restrictions to be relaxed. My favorite quote of the night on this topic..."You're not stopping Ebola. You're just stopping fun!" If someone said that in the Suites back at PC, that would have been worthy of a spot on the quote board. Apparently Freetown's night life was pretty crazy before Ebola and people are ready to get back to normal. Apart from there being handwashing stations all over the place and having your temperature checked a lot, restaurants and stores are closed after 6pm, bars, clubs and schools are closed indefinitely and you're not allowed to have gatherings on Lumley Beach (the main beach in Freetown which used to be packed all the time). It doesn't leave very much to do and locals and expats alike are getting restless. But the restrictions are in place for a reason and seeing people, particularly expat NGO health workers, hugging or shaking hands all the time is stressful. I'll admit that I did shake someone's hand the other day, but it was just one time. Oops.
     There is, however, one gaping hole in the restrictions. While all the places I mentioned above are closed, churches are still open. And they've never been more full. In terms of faith, there are pretty much two responses people have in times of crisis -- they turn to God or they turn away from Him. In Sierra Leone, it would appear that the people have very much embraced faith in the face of Ebola. While it would be nice to think that people are flocking to churches for spiritual nourishment (and I'm sure plenty of people are going for that reason...religion has always been important in SL), I'm certain that the sudden increase in churchgoers is also tied to the fact that going to church is really the only way they can socialize in large groups. So basically the other restrictions are pointless if you're going to keep churches open. Either the churches need to be closed too or all the other restrictions (apart from closing clubs...grinding with a bunch of random, sweaty people seems like a bad idea) need to be lifted.
     On Sunday we spent the afternoon and evening at The Hub Hotel. Different hotels are bases for different NGO's...the Radisson (I finally got to go to the Radisson for dinner last night and it's seriously swanky. It was like being in a totally different country) is swarming with CDC employees and The Hub is primarily UN workers. The place was really nice. We had great food and I got to swim in this awesome pool. I was randomly told that I can't be a fiscal Republican and work for an NGO which made me laugh. I didn't tell the guy that I'm also quite conservative on many social issues...that would've just been too much for him. I also played squash for the first time ever. While I was waiting to play, multiple people walked past me off the court dripping with sweat which I desperately tried to avoid touching. Because Ebola. Obviously. But it was fun and I was glad to put my intense competitiveness back in action.

     I'll also give you a quick update about work because I know my public health friends are more interested in that than in anything else. Last week we had a meeting with World Vision, during which I was given the task of creating all the forms (vehicle log, maintenance and accident report forms, decontamination forms, etc.) that will be kept in every vehicle in our fleet. Now that I've done that, I'm working with a guy from World Vision to create a database containing all the information relevant to our indicators. Once it's finished, I'll be going out into the field to train everyone on how to use it. I'm also getting involved in our Social Mobilization program which is a collaboration with IsraAid and Caritas. The aim of the program is to change behavior so that people stop unsafe burial practices. I'll be working to create something like an instructional manual for behavior change. We don't want our workers to have to follow a script when they go into the field and lead discussions or other sessions, but they need to have an idea of what kinds of things to talk about and how to handle certain situations. Once the manual is done, I'll be going out into the field to help oversee implementation. I may also be going into the field on Friday to deal with the logistics of where each pair of workers is going and when which is essentially exactly what I did in Kenya.
     For those of you not checking the NERC website religiously, there were 62 new confirmed cases in the 7 days prior to February 21st. I thought we might come in just under 60 new cases, but close enough. It's better than the 74 new cases from the week before! Unfortunately we're already at 48 new cases over the past four days so we will likely see an increase this week which will be pretty disappointing. Apparently there has been a big increase in the number of cases in Bombali so hopefully we can help get that under control soon!
     Overall, I finally feel like I'm really settling in. Work is busy, but good. I'm excited to get involved in the Social Mobilization program even though I know it's going to make me super busy. It's a good thing I don't stress easily. At least not about things like this. I also really love our fun, relaxing weekends. I sometimes have to work on weekends, but now that I know I may have to do that I'm less annoyed about it than I was when it first happened. Honestly, you really need the weekends to recover because the work week is intense (although I'd probably feel the same way even if I wasn't working in a country with active Ebola transmission). I think we're going to the beach this weekend and it's going to be great!

The People We Serve

     Something happened today that really put the Ebola outbreak into perspective for me. Today I was handed a list of the dead whose bodies had been collected by CRS burial teams. I know that many people in the US have had a hard time relating to people in West Africa and to what’s going on here, but if you want a way to put the number of deaths into perspective really quickly all you would need to do would be to look at that list. It was pages and pages long. And these were only the people that had been collected by CRS and not by any other organizations. CRS burial teams only work in 4 districts. There are 14 districts in Sierra Leone. The names and ages of all the people were listed and it was pretty upsetting to see “14 years” and “22 months” typed on there. A colleague also told me that a lot of the kids were likely orphans who had died because there was simply nobody to look after them or call for help for them when they got sick. I've heard some misplaced criticism of the Ebola response in terms of how much it's costing in proportion to how many people have actually died. Ebola in West Africa certainly hasn't killed even remotely close to as many people as diseases like malaria or HIV, but when you see the names and ages of the people who have died, you're quickly able to recognize that it doesn't matter how many people have died. Whether 5 people or 50,000 people had died in this outbreak, it wouldn't diminish the pain felt by those who have lost loved ones. The Regional Director for West Africa has been here visiting for a few days and when I looked at this list, I couldn't help but think of something she said in our staff meeting the other day. She said, "The people we serve are not as lucky as we are." She's right. I'm incredibly lucky. I have been given so much. In one of the first papers I wrote as an MPH student, I quoted Luke 12:48 which says, "...Everyone to whom much was given, of him much will be required, and from him to whom they entrusted much, they will demand the more." That's something that I've always believed deeply. I'm so grateful that this experience allows me to give back while also doing work about which I'm extremely passionate. That's not something that everyone can say about their job and sometimes I can't even believe I've been given this incredible opportunity. It's an absolute privilege to be here and to serve the people of this country. 

Ebola Stops With Me

     Remember how for the first few days I was here you all thought I was just on a really nice six month vacation and maybe I'd do some Ebola response work every now and then? Yeah well that's over. I'll admit that I did spend my entire weekend lounging on the couch on the balcony and alternating my time between reading, doing sudoku and crossword puzzles (special thanks to the Pavys for the awesome care package they sent before I left RI), listening to music and just staring at the ocean, but the work week is a different story. I've been here for just under two weeks now and I'm really getting into things After arriving on the 4th, I spent my two full work days that week just reading documents and catching up on everything that CRS is doing here. Last week I got thrown right into the fire (I was going to say I was thrown into the hot zone, but I thought that might give you the wrong idea). I spent quite a bit of time organizing a master list of all the Ebola response vehicles that CRS manages -- almost 400 vehicles across four different districts (Port Loko, Kenema, Bombali and Koinadugu). Trying to pull all the data together into one spreadsheet was a nightmare. The information was spread out across about eight different spreadsheets and there were twenty different categories of information that I needed for each vehicle. Naturally a lot of the information was completely missing. Doing logistics work in Kenya was nothing compared to this.
     On Tuesday night I went out to dinner with some colleagues and learned more about our social mobilization program which I hope to get involved in soon. I'm writing my final paper for school on that very topic so I got a lot of great information. That paper is going to write itself! Or I'm going to write it. At the very last possible second. Per usual. Anyway, there's still a 6pm curfew in place for stores and regular restaurants. Only hotel restaurants are allowed to remain open later than that. So we went to dinner at Country Lodge which is situated at the top of a massive hill. One really great aspect of Freetown is its geography -- flat coastal areas that are surrounded by (mountainous) hills. It's got everything! So we enjoyed dinner overlooking the ocean and watching the sunset. I got a burger with a fried egg on top which I was quite sure I'd never have in Freetown.

View from the restaurant at Country Lodge

While we were at dinner I also saw BU's very own Ebola doc, Dr. Bhadelia, but I wasn't certain it was her so I didn't say hi. After texting her later to ask if she had been there earlier that night, I found out that it was indeed her. We were supposed to get together while she was here, but it's just been too chaotic and she headed back to Boston on Wednesday. Hopefully we'll be able to meet up back in Boston once I'm home. Anyway, on our way back to the apartment we saw the president's motorcade. On our way to the restaurant we had almost almost accidentally gone through a military road block on the road to his house. That would have been interesting.
     On Wednesday morning we had a staff meeting. Our country representative, Michael, gave a great presentation and told us "Ebola is not over. I must emphasize that. Ebola is not over so don't let your guards down. Let's be rigorous until this country is declared Ebola free." As I was sitting in that meeting I realized just how grateful I am to be here. There's only a handful of non-African staff so the fact that I get the opportunity to be here and help is just amazing to me. I'm especially excited that in just a few days of being here I already feel like I'm making a real contribution. There's a possibility of me going into the field for a couple of days next week. I think it would be so awesome to get up to Port Loko and see what's happening up there. We'll see how things go.
     Something that's been really interesting to see are the Ebola response signs all over the city. They're everywhere. Unfortunately, it now seems like people are starting to get back into their old habits which could be why we're seeing a slight increase in cases in the Western Area Urban. I've seen a lot of people holding hands (it's common for people of the same gender to hold hands as a sign of friendship while they walk) or high fiving on the streets over the past couple of days. We have to make sure that people understand that Ebola could still spread quickly if old practices are resumed. At least all these signs are still up as a reminder...

This is my personal favorite...very empowering

I have no idea what these say...

A reminder of cancelled Christmas celebrations. People were heftily fined
for even stepping foot on the beach between Christmas and New Year's

 

Initially, many people thought Ebola was just a big government conspiracy

     On Thursday night the power went out for the first time. It's gone out a few more times since then. I just kind of assumed that the generator would be running constantly at night so we'd never experience any power outages, but that's not the case. I was totally caught off guard the first time. I looked outside and everything was pitch black. Literally I would not have been able to see my hand in front of my face if I hadn't had my computer on to give off some light. If you're wondering why a two minute power outage is blog worthy, it's because I absolutely hate the dark. So these surprise power outages are not pleasant. They only last for a minute or two until the generator kicks on and I've started to get used to them now, but I still don't like them. Last night we had a crazy storm. I'm so excited for the summertime storms that will start when the rainy season begins in May. It's going to be amazing to sit on the balcony and watch the lighting strikes out over the water. In terms of the Ebola response efforts, however, the rainy season is likely to bring immense difficulties. As the rains come, roads will become impassable and it will be more difficult both for us to get people where they need to be and for the sick to get to hospitals or holding centers. The rains will also bring an increase in cases of other diseases, such as malaria, which produce a fever that would need to be considered to be an indicator of Ebola. Sierra Leone has set a goal of zero new cases by May, the start of the rainy season. Let's pray we can reach that goal so that none of the progress that's been made is lost.

Beach Bungalows and Ebola

     I spent the weekend hanging out on a beautiful, remote beach outside of Freetown, but lest you think I’m just on a six month vacation, I want to share some Ebola related stories before I write about a weekend getaway to the beach. I live in the King Tom area of Freetown, right near the King Tom cemetery which is now known as the “Ebola Graveyard.” I knew a lot about the cemetery prior to arriving here, but I didn’t know I’d be living next to it and I honestly didn’t give it much thought until I’d been here for a couple of days. The cemetery has been burial central for Ebola victims with over 4,400 bodies being buried there since August. Of course, it’s impossible to tell how many of those people actually had Ebola as anyone who dies is being buried as if they were an Ebola victim. Apparently it was almost impossible to directly access our street for many months because there were nonstop funeral processions. The elderly who know they’re close to death continuously pray that they won’t die until after the Ebola outbreak is over so that they won’t have to be buried in a way that violates many customs which they believe to be extremely spiritually significant. I try to catch a glimpse of what’s happening inside every time we pass by, but apart from the graves directly in front, it’s difficult to see anything other than smoke rising, presumably from the burning trash heap inside the cemetery. If you want to read more about the cemetery and what working there is like, this is a great article.

     In other Ebola related news, a driver based in Makeni came down with a fever on Friday. He wanted to be sent home to Kenema! It’s not good when people working in the response efforts who know that they should go to a holding center ask to be transported home instead. Of course, it’s easy to tell other people to go to a holding center, but it’s hard to know what you would do if it was you. If I was in the US, the answer would be easy, but it’s very different here, especially now that I’ve seen my first Ebola Emergency Holding Center which was essentially a bunch of makeshift tent buildings that I’m thankful I only observed from the car as we drove to the beach. Anyways, the driver did not have Ebola, but had malaria and typhoid and the last I heard he is responding to treatment so all is well.  

     The Ebola Emergency Holding Center wasn't the only Ebola related thing I experienced on our drive to the beach. We made a pit stop at the supermarket before we left and before we could go inside we had to wash our hands in chlorine water and have our temperatures taken. It’s interesting how quickly this becomes routine (although my temperature was higher today than it's been since I got here and it's stressing me out despite the fact that my temperature was exactly what it's supposed to be - 98.6 F) and it’s fantastic that this added safety measure is in place. After the supermarket we drove down a ridiculously bumpy road and crossed bridges with no rails that were barely wide enough for our car until we finally arrived at the Bahamut at Black Johnson Beach about an hour or so later. When we got there we met the owner, Martin, and the four other weekend guests. Martin actually lived in Cambridge for a few years so we bonded over that and talked about going to Grantchester. While I think Grantchester is interesting because people like Stephen Hawking, James Watson, Francis Crick, Ernest Rutherford and Ludwig Wittgenstein spent a great deal of time there, Martin thinks Grantchester is interesting because Pink Floyd used to go to the meadows to do acid. Needless to say that conversation ended fairly quickly. But Martin has put together a great little property. There are four bungalows and people can also bring tents or hammocks and sleep on the beach. We spent most of Saturday eating. I ate barracuda for the first time and thought it was actually pretty good. We hung out on the beach, enjoyed the warm water and we even saw some dolphins!

  

 

     After dinner things got interesting. Martin turned on the generator so we'd have some light and music and we lit a bonfire. The other guests were a group of four middle aged people, two of whom were British, one of whom was Irish and one of whom was South African. The South African, whose name was Skhool (pronounced something like “skull”), was fairly reserved, but the other three, two of whom were married, were insane. The married couple, Chris and Allison, have been living in Sierra Leone for thirty years. They didn’t even leave during the war, the effects of which didn’t really reach Freetown. The other Brit, Andrew, works for Brussels Air. Anyway, I proceeded to spend the night watching them get completely hammered (read that in the British accent I have in my head and your life will be better) and listening to them tell me that I’ll love Sierra Leone. They also chatted with Martin about England, Ireland and Spain (Chris and Allison have a house in Malaga) and where they and their children went to boarding school. I was a little jealous of their cool European lives and their accents, of course. We finally went to bed and I slept in a charming bungalow with a fantastic view. 

My bungalow

Inside the bungalow

View from the bungalow

     The next day we hung out on the beach all day, ate more delicious food and explored the neighboring beach which is also owned by Martin. For my four beach meals and lodging, I spent a grand total of 250,000 Leones, or about $55 (In other news, I paid $11 for a box of Fruit Loops today. Not cool, Freetown. Not cool. But I also found out that I'm getting a danger pay bonus which makes me feel less stupid for spending $11 on a box of cereal). The currency here is a little ridiculous. The largest bill is 10,000 Leones so paying 250,000 Leones requires you to count out a lot of bills. One of the girls who came to the beach, Meredith, commented that it’s difficult to function in a cash economy when the largest bill is worth $2 and it’s very true.

     We left the beach around 5:30pm on Sunday and drove back to Freetown. Along the way there were kids that would sit along the road and start chasing our car as we drove by. I assume this is just because they have nothing better to do. There are some really nice houses along the road to the beach. They’ve fallen into disrepair, but it’s obvious that they were once either really nice houses or they were meant to be nice houses and were just never completed. As we drove home we heard the daily Ebola update on the radio. If you want an accurate daily update on the number of new confirmed cases, go to nerc.sl which is the website for the National Ebola Response Centre. We’ve partnered with them for some of our programs and they keep a good record of what’s going on here in Sierra Leone. We finally arrived at the compound and I settled in for a relaxing evening. Overall, it was a great beach weekend, but I’m still really hoping they fix the pool in our compound so I can go for a quick swim after I play tennis.  

Arrival Adventures

     After traveling for almost two full days and through the US, Germany, Belgium, Senegal and Guinea, I finally arrived in Sierra Leone last night at around 7:20pm. While traveling from Brussels to Sierra Leone, I realized that Africans travel in style. Most of the Africans were in suits or dresses or at least nice jeans and shirts. I felt particularly shabby in my hiking pants and Yankees sweatshirt, but I was comfortable so I didn’t really care. After stops in Dakar and Conakry to refuel and drop off/pick up passengers, we finally arrived in Freetown. As I was waiting to get off the plane, I started chatting with two British (yay!) women, one of whom actually showed up in our office today to schedule a meeting with my supervisor (it was particularly funny because we had discussed how the world of aid work is really small while we were waiting in line to go through immigration last night). As we walked off the plane I prepped myself for a blast of heat that never came. I was immediately struck by the fact that it was humid, but it wasn’t terribly hot (Hanna, if you’re reading this, I’m sorry I broke my promise since the heat wasn’t the very first thing I mentioned, but it's close enough)! It was fantastic! I definitely got a blast of humidity as I walked off the plane, but it’s not super hot (yet). 

     The impact of Ebola was evident immediately as we all washed our hands in chlorine water before we even got into the terminal. After going through immigration I went through my first ever Ebola screening! 

We were given an Ebola screening form on the plane

I have to admit that as I stood in line waiting I was pretty convinced I was going to have a temperature of about 107 degrees and have to be put in quarantine. It’s a little nerve-wracking to have people in masks and gloves take your temperature as you stand there helplessly just hoping you (and any of the people around you) don’t have a fever that could be indicative of a very deadly disease. After having my temperature taken multiple times today (the first one today was a little scary too…I had been prepared for the one at the airport, but I forgot they’d be taking my temperature every day before I’m allowed to go into the office), however, I’m convinced the thermometers are pretty much useless considering my temperature at one point today was 96.6 which is almost low enough to be hypothermia. Anyways, after passing through the Ebola screening, I became convinced my bags had been lost until they finally showed up after what seemed like years and then I was approached by my facilitator, Bai Bai, who got me my ticket for the boat across the harbor to Freetown. As Bai Bai was asking me to relinquish my passport to him (I know, I know…) so that he could get my ticket, another guy that Bai Bai was supposed to help, Robert, came up to us so I got to tag along with him for the rest of the journey. He’s a cartographer from DC and works for a small organization calls ACAPS and does GIS stuff. We waited for the bus together after hesitantly handing over our bags to the random men taking them in a separate bus down to the dock. We finally got down to the dock (it probably would have been quicker to have walked there than wait for the bus) and miraculously, even though we were on the second bus and thought we would have to wait a long time, got on the first boat. As soon as I stepped onto the floating dock I knew it was going to be an unpleasant ride. I don’t typically get seasick, but as we sat on the boat waiting for it to depart, I felt nauseous immediately. Robert and I got separated on the boat. I felt particularly bad about that after the guy he was sitting next to started throwing up over the side of the boat. Eventually we made it across and back onto land where I was picked up and driven to the CRS housing compound. When I arrived I met Sasha who is the acting Country Respresentative, Nancy who is my supervisor, Davor who retired from CRS but is back as a consultant and Meredith who used to work for CRS, but works for the Ministry of Health now. We hung out at Sasha’s house for a while and then I finally went to see the apartment Nancy and I are sharing. Before I arrived I was told that it was “basic,” but it’s actually pretty great. It’s a big place and we have wifi, running water (hot water when there’s power which is basically only when the generator is on at night) and there's air conditioning in my bedroom!! 

Balcony

Living/dining room

Dining room/kitchen

My bedroom...check out that beautiful air conditioner!

We also have an awesome balcony which overlooks the water. Since I arrived at night I had no idea that we had such a great view until this morning. I knew we were near the water, but I didn't realize we were this close...

The sun sets right over the water and I got to experience this beautiful scene tonight…

Over the next few days I’ll put together a post about my first day at work and my first impressions of Freetown, but I wouldn’t even know where to begin right now. Let’s just say we’re not in Kimana anymore.

A Day in Munich

     I had hoped to have close to 12 hours to explore Munich, but thanks to snowstorm Linus, my flight got delayed and I arrived in Munich about two hours later than planned. I still had plenty of time to check out the city though. After getting out of the airport, I hopped on the S-bahn (the MBTA could learn a thing or two about efficiency from the Germans) and headed into the city center. On the way, I overheard a woman who appeared to be a nun say something about Dar es Salaam. After awkwardly staring at her for a few minutes and eyeing her pin of a Tanzanian and German flag, I ended up asking if she was from Tanzania and she was! She lives in Moshi and climbed Kilimanjaro in the 80’s so we had fun talking about out Kili climbing experiences. As it turns out, she’s actually part of a Lutheran order of sisters (which I didn’t even know existed) and was in Germany for a meeting. We chatted about Africa for a bit and what I’ll be doing in Sierra Leone. Eventually we parted ways and I headed off to my tour.

     I took the Sandeman’s Free Tour of Munich which was pretty good. I’ve done a few of their tours in other cities and have loved them so I knew it’d be a good option especially since I had limited time to waste trying to find everything I wanted to see on my own. We started our tour in Marienplatz and learned about how Munich got its name (from the term “Munichen” or “by the monks” because monks maintained a monastery there). 

New Town Hall and the Glockenspiel in Marienplatz 

Old Town Hall

     One particularly interesting story considering the work I’ll be doing in Sierra Leone, involves the Glockenspiel in the New Town Hall. The bottom half of the Glockenspiel tells the story of “The Coopers’ Dance”.  According to legend, after the end of the plague in 1517 in Munich, the coopers were losing money because people were fearful of going outside and, therefore, weren’t buying beer that was stored in barrels made by the coopers. In order to get people to buy their barrels full of beer, the coopers danced through the streets to tell the people that the plague had passed and it was safe to be out and about. I thought it was interesting considering how difficult it has been to get people to stay inside and away from other people during the Ebola epidemic. Anyway, the dance is still performed every seven years. The next one is in 2019 and our tour guide plans on being there. She told us that if anyone is there and finds her and says they took her tour once, she will buy their beer all night. I’d love to come back to see The Coopers’ Dance and explore the things outside of Munich that I missed this time like Dachau and Neuschwanstein. 
     Here are some other fun facts I learned on the tour today. First, Germany is ranked 3^rd (after the Czech Republic and Ireland) in beer consumed per person per year, but if you exclude beer consumed in Bavaria, Germany falls to 27^th.  If Bavaria were it’s own country, it would be ranked 1^st in beer consumed per person per year. I think Oktoberfest probably unfairly skews that ranking though. Speaking of Oktoberfest, the origin of the festival is pretty interesting. When Ludwig I got married, there were celebrations that lasted for days. The people had such a good time that when Ludwig’s one year anniversary rolled around they asked him to host another party just like his wedding celebrations. He agreed and they’ve been celebrating (mostly) every year since. It's probably not a shock to hear that people lose a lot of stuff at Oktoberfest. It's basically a given. The things people lose, however, are pretty strange. Apparently, the main things lost at Oktoberfest are Australian passports, artificial limbs (??) and wheelchairs (which could only be attributed to the “beer miracle”). Lastly, the Opera House was originally built with an inverted dome which was used to collect rainwater which would drain into pipes that became a sprinkler system for the building (that’s German engineering for you). Unfortunately, when there was a fire 5 years after the Opera House was built, the sprinkler system was useless because it was January and the water was all frozen. The river was also frozen so naturally they decided to use beer to put out the fire. As the beer drinking capital of the world though, it might not surprise you to know that as the buckets of beer were passed down a long line of people from Hofbrauhaus (a beer hall) to the Opera House, people decided to take sips and by the time the buckets got to the Opera House, they were empty. So the building burned down, but they rebuilt it using funds from a 1 cent increase on beer prices.

The Opera House

     I ended my day in Munich by going to Asamkirche which is one of the most beautiful churches I have even seen. Naturally I somehow managed to be that awkward person who walked in right as mass was starting and decided it was probably a bad idea to be the obnoxious American and take pictures during mass. So I grabbed a delicious (and expensive) hot chocolate from Starbucks (American Starbucks really need to step it up with their hot chocolate) and went back to the church after mass ended. After that I headed back to the airport and now I’m at my hotel in Brussels and I should really be sleeping since I need to be up in about 2 hours. I'm so tempted to stay in Europe and enjoy this really comfy bed and the cold weather for awhile. I can’t believe I’ll be in Sierra Leone tomorrow!! 

Asamkirche

Inside Asamkirche

Preparing for Sierra Leone

     When I was in Kenya I found it very easy to adjust to life there. I enjoyed the slower pace of life, the lack of distractions that came with having little internet access and no television, the friendly atmosphere and the culture. As I’ve been getting ready to leave for Sierra Leone, I’ve tried to remind myself that the next six months will be nothing like my time in Kenya. Life at Kilimanjaro Bush Camp was pretty sweet. We had delicious food cooked for us for every meal, we never had to worry that the water we were drinking might be unsafe, we had running water and flush toilets, we had staff all around us to help us if we needed them, we never had to worry that the power was going to go out (except for that one time when it did for about 10 minutes) and, most importantly, I was constantly surrounded by other BUSPH students. Oh, and there was no Ebola. The most difficult thing I can remember having to deal with was cold showers (which, though a painful experience on cold Kenyan mornings, I’m sure I will be extremely grateful for in the humid heat of Sierra Leone) and that’s not exactly a major hardship. I loved my time in Kenya, but I know my experience in Sierra Leone will be very different.

     Sierra Leone is ranked 183^rd on the Human Development Index (a composite index measuring average achievement in three basic dimensions of human development—a long and healthy life, knowledge and a decent standard of living), coming in better than only four other countries – Chad, CAR, DRC and Niger. In comparison, the US is 5^th and Kenya is 147^th. Here’s a quick comparison of the US and Sierra Leone (Kenya falls pretty much in the middle of the two on all of these measures)…

	USA	Sierra Leone
Life expectancy at birth (years)	78.9	45.6
Mean years of schooling	12.9	2.9
Maternal mortality (per 100,000 live births)	21.0	890
Infant mortality (per 1000 live births)	6.71	73.3
Physicians per 100,000 people	242	2.0

     Despite these grim statistics, Sierra Leone has been one of the most rapidly growing economies in the world over the past few years and was expected to have the second most economic growth in the world in 2014. The Ebola outbreak has completely decimated that growth and has, in addition to destroying a fledgling tourism industry, likely set back development by a decade or more.

     It’s hard to picture what life will be like for the next 6 months because I still have very little information. I don’t know where I’ll be living in Freetown. I may or may not have air conditioning. If I do, I may or may not have a generator and power outages are frequent. It’s an extremely trivial concern in a country that’s facing so much hardship, but I hate the heat. Sierra Leone is ALWAYS hot. For example, when I first started checking the weather in Freetown on an almost daily basis, I checked at 4am Sierra Leone time and the feel-like temperature was 81 degrees with 89% humidity. At 4am. This is likely to be my most common source of complaint. I can get used to just about anything, but I always struggle with heat. I also don’t know what a typical day at the office will be like. I know that I’ll be based in Freetown, but I will spend time traveling to more rural regions as well. I guess I’ll just have to jump into things when I get there and hope for the best!

     Health is a major concern in Sierra Leone. If you’re thinking, “Well, obviously health is a concern…there’s an Ebola outbreak,” you’re missing the point. In a way, Ebola is the least of my concerns. We know how to protect ourselves from Ebola and CRS gave me a detailed health briefing on how to prepare for life in a country with active Ebola transmission, how to avoid being exposed to Ebola, what to do if you’re exposed to Ebola and more. I won’t be in contact with patients so my risk is low to begin with and there are a wide range of policies that have been implemented to protect aid workers. The first thing I’ll do upon arrival is go through immigration and then an Ebola screening checkpoint. I’m not supposed to shake hands with anyone ever. I’ll have ample supplies of gloves, masks (no, Ebola is NOT airborne...the masks are for other things) and hand sanitizer at my disposal. Ebola is worrisome, but it’s not the biggest concern. What’s more concerning to me are things that are far more common like Lassa fever, cholera, malaria and basically any illness that might cause a fever. If I’m sick at all, even with just a cough, I’m not allowed to go to the office. If I get a fever, I’m required to self-administer a rapid test for malaria and isolate myself immediately. While it’s likely that the fever will NOT be associated with Ebola, playing the waiting game while a sample is sent out for testing is not something I want to do. The plan is to stay as healthy as humanly possible so as to avoid this situation and the immense anxiety that I’m certain it would cause. If I were to get seriously ill with anything at all, I would immediately be medevac’d back to the US. While I’m obviously extremely grateful for this, it also upsets me a great deal to know that I’m afforded such a high level of care simply as a result of where I was born. There are 29 hospitals (including specialty care centers) in Boston alone. There are 5 hospitals in the entire country of Sierra Leone. It’s not uncommon for sick people in Sierra Leone to die from very treatable illnesses simply because they can’t get to a hospital. Knowing that I get to come back to world class care if I’m sick while they suffer like that is extremely difficult to face and motivates me to stay as healthy as I can in order to stay in Sierra Leone and complete the work that I’ll be doing there.