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.