Friday, March 27, 2015

Caught Up In The Rush

     Things have been crazy busy here lately and it’s just going to get busier over the next few weeks so I have a lot of exciting stuff to write about. A couple of weeks ago we had a party. There were tons of expats there and it seemed like the later it got, the more people showed up. I’ve never been to any party quite like a Sierra Leonean party filled with expat NGO workers in the middle of an Ebola outbreak. Work hard, play hard definitely applies here. We all need a break every now and then. It still bothers me that when expats get together everyone hugs each other as if the “no touch” rules don’t apply to them, but even I’ve started to become more relaxed about that now. Anyway, there was a local band that used to play at a bar called O’Casey’s before all the bars were closed. I think they played ‘Happy Birthday’ about four times over the course of the night, but it was an interesting rendition. Conversation topics included the distinction between “expat” and “immigrant” and questioning why we call Europeans and Americans expats, but refer to Chinese laborers as immigrants. Naturally the night ended with a bunch of people either jumping or getting pushed into the pool. Many phones were destroyed that night. Thankfully I escaped and there was no repeat of the Thanksgiving Day debacle of 2013 in which my phone fell into the toilet because my 38 year old cousin and I were chasing each other around the house like children...

     Instead of the typical work filled weekend, last weekend was actually quite enjoyable. On Friday night we had a farewell barbeque for our Head of Programs (HoPs), Jonathan, at Annisha's house. Jonathan has been in Sierra Leone for over 3 years (and he was a CRS Fellow here back in the day) and is heading back to the US to be with his family. They had been living here with him, but Sierra Leone became an unaccompanied post soon after the Ebola outbreak began. His family had gone home for a few weeks and the decision to make the post unaccompanied was made while they were away so they weren’t allowed to come back. I’m sure that was difficult for all of them. We’ll all miss Jonathan, but I’m happy that he’ll get to be with his family again.
We had an awesome view of the lagoon from Annisha's back deck

     On Saturday morning I watched Jonathan and Sasha play tennis, something they do every weekend. Since it was Jonathan’s last day, I really wanted to see this match and it was a lot of fun. The weather has started to change though and it’s gotten very hot and humid so I was sweating just sitting there. Jonathan and I went for a quick swim afterwards to cool off. Later in the day, Annisha, Meredith and I went for lunch at a place called Brews and Bread (where I got a delicious chicken bacon melt and a milkshake!) and then fabric shopping at the outdoor market. I expected the market to be a lot crazier than it was. There were definitely a lot of people, but the people selling stuff were nowhere near as pushy as the Maasai mamas in Kimana. It helped that Annisha speaks Krio quite well and was able to negotiate for all of us. At one point, two little girls were showing us some fabric. It quickly became clear that they were sisters as they started fighting. As I was watching them I was struck by the fact that they were no different than my sister and me. That easily could have been Haley and me fighting on a dirt street in the middle of Freetown surrounded by trash and dirty water. Even the smallest things that we take for granted every day are probably luxuries that these kids will never have and that’s really sad. Anyway, when we left the market, Meredith had to pick up a shower head and fiberglass for Sasha. She wasn’t really sure where to get it so Annisha started yelling out the window to an old man working on the street and had him ask inside a building material store to see if they had what we needed. This old man was so helpful. He went and asked if they had what we needed and helped us park (which is an experience all in itself on the crowded streets of Freetown where there are no defined parking areas and you basically just park anywhere you want). When Meredith finally came out of the store we headed back to the compound.

     On Sunday Annisha came over and she and I went to Sasha’s house and worked on social mobilization stuff for most of the day. Sasha watched Mockingjay at one point and I was significantly less productive when it was on. After Annisha left, Sasha, Meredith and I went swimming for a couple of hours. We were joined by our German neighbor, Rudy. He manages our compound and this was the first time I had met him. I’m pretty sure I only understood approximately 4% of the words that came out of his mouth, but he was hilarious when I could make out what he was saying. He brought out sparkling red wine, some of which he randomly proceeded to pour on Sasha’s head. Honestly, the guy is crazy and I love him. After we got out of the pool, we decided to make brownies and relax for the rest of the night.
     Last week my supervisor had to go to Germany for the week so while she was gone and not looking over my shoulder incessantly, I seized the opportunity to spend more time working on the project I’m actually interested in (social mobilization) and less time focusing on the vehicle tracking database that I created and am now managing. On Tuesday I trained World Vision and CAFOD staff on how to use the database, but then I got to go to Port Loko and Makeni on Wednesday and Thursday to work on social mobilization. Annisha and I spent those two days at “Dialogue Days” with community and religious leaders, at least one of whom was an Ebola survivor. Shockingly, nobody has ever gotten all of these people together to discuss the issues they are seeing in their communities. They were thrilled to have a place to rant and share ideas about what steps should be taken to eliminate Ebola. I think the most interesting suggestion was to have religious leaders tell their congregations that Ebola is an “enemy of Islam” or an “enemy of Christianity” so that people will be more motivated to fight it. The sessions focused on key messages such as calling the ‘117’ hotline to report a sick person or death and not touching dead bodies. We then discussed effective communication techniques that these leaders can use to spread the messages in their communities. There was also a role playing activity and the people loved it! They got really into it…

Religious leaders got really into the role playing activity. This pair is acting out a message about
not touching dead bodies and calling the hotline for safe and dignified burials.
     When we were at dinner in Makeni, Annisha informed me that it smelled like it was going to rain. Suddenly it started to get really windy and we each ran to our rooms. I got ready for bed and was about to lay down when I got a call from Annisha. She didn’t have a blanket in her room (which was in a separate building) and she didn’t want to come to the main building to ask the manager for one. So I brought her my blanket because I’m always warm and didn’t need it. Naturally, as soon as I got to her room it started pouring. Since I wasn’t going to walk back to the other building in the rain, we ended up hanging out, watching tv and ranting about a certain person for a while and it ended up being a fun night. Then the power went out for a bit and the rain become monsoon-like. The rain finally stopped after a few hours (a long time for a rainstorm to last here) and I went back to my room and fell asleep in approximately 2 seconds.
     I was out in the field again this week. It’s so much better than being in Freetown. On Tuesday I led a training session for about 15 CRS field staff to teach them how to use the vehicle tracking database that I created. I think the database is great and the people I trained understand how to use it, but the real challenge will be in getting drivers, more than half of whom are illiterate, to fill in the logbook forms from which we need to collect data to enter into the database each week. I don’t really think it’s going to happen, but I guess we’ll just have to collect whatever data we can get. When we got back to the guest house that night I listened to Davor share some incredible stories from throughout his career. He worked in Afghanistan for a few years right after 9/11 and at one point his passport was taken and he had to sneak into Pakistan. Then when he was living in Pakistan for a few years, he lived almost right next to the compound where bin Laden was killed and he was there during that mission!! That’s pretty cool.
     Our social mobilization project is really picking up so I’ve gotten a chance to get more involved in that. The program has two components – Rapid Response and ongoing social mobilization. We are working with an organization that has used intergenerational dialogue to create behavior change surrounding FGM in a variety of countries and are hoping to adapt their method to apply it to Ebola. I’ve also been busy helping to create training manuals for our Rapid Response Teams who will be deployed to hotspot areas to reinforce key messages related to Ebola prevention and response. We will be training these teams next week and they will be deployed the week after that. When these teams are not deployed to an area where new cases have been reported, they will be stationed in high risk areas or rotated throughout the chiefdoms of the district within which they are operating. On Wednesday I had the opportunity to travel to Kabala in Koinadugu district to speak with the head of the social mobilization pillar there. Koinadugu is the largest district in the country and the region is so remote that it’s very difficult to travel from one community to another. Drivers often have to travel 100+ miles out of the way just to access a road that leads to another community. Koinadugu has active cases in only 1 of their 11 chiefdoms, but 6 of their chiefdoms border Guinea. Cross border activities pose an extremely high risk in this area, particularly with the high number of cases that are still occurring in Guinea, so part of our social mobilization program will focus on this area.

Tippy tap outside the CRS office in Kabala
CRS office in Kabala
Decontamination site for burial, ambulance and swabbing teams and vehicles in Kabala
     On Thursday we were in a mad rush to get back to Freetown before 6pm. In preparation for the “Stay-At-Home” they were being a lot stricter at the checkpoints so our trip home took a couple hours longer than it usually does due to the traffic and the fact that we had to stop at every checkpoint (normally our vehicle pass allows us to drive right through) and even had to walk across one checkpoint to have our temperatures taken. We finally made it back to Freetown only to discover that there was a dead rat on our kitchen floor and the internet wasn’t working again. Let the lockdown (erm…I mean…Stay-At-Home) begin!!

Saturday, March 21, 2015

Learning Empathy

     When I was in Makeni at the beginning of March, I received news that a very close family friend – Benny – had passed away. Benny, who always reminded me of my own grandfather, was 93 years old and I had visited him in the hospital before I left for Sierra Leone so the news wasn’t unexpected, but it was still a shock.  Two days after receiving this news, I returned to Freetown only to hear more bad news. My Uncle Ernie was in hospice. That was a complete shock to me. He too had been in and out of the hospital and I had visited with him several times before I left for Sierra Leone, but this was totally unexpected. He passed away the next day.
     You’re probably wondering why I’m telling you all of this so let me get to the point. After receiving all this bad news at the same time and losing two people that I loved very much, I was pretty upset. I was upset that they were both gone, but I was also upset that I wasn’t there in Rhode Island. There are two main reasons I wanted to be in RI and not Sierra Leone when I heard all this bad news. First, when things like this happen, you want to be there to have the chance to see your loved ones one last time. Yes, I had visited both Benny and Uncle Ernie before I left, but I wish I could have been there in the hospital with each of them before they died. Some of you may feel differently, but when my grandfather was in the hospital before he died, I spent every possible second there that I could. That’s just how I react in situations such as these. So I wanted to be there to see Benny and my uncle one more time. I also wanted to be in RI for another reason – to be able to comfort my family and friends who were suffering far more than I was from the loss. It was crushing me that I couldn’t be there. I didn’t take the news of these deaths particularly well (I spent the next three days in my room alternating between crying and watching Netflix), but the reason why isn’t what you might expect. Obviously I was saddened by the news of the loss, but that’s something I’ve unfortunately dealt with multiple times before. What I’ve never dealt with before is being apart from my family when a loved one has died. A couple of years ago when I was living in DC, my 101 year old friend, Virginia, died. When I heard she wasn’t doing well, I jumped in my car and made the 7+ hour drive home after working all day just so I could be with her before she died. Not being there is just NOT an option for me. Until now.
     I had to try to find some positive from a situation that was so overwhelmingly upsetting. So I thought about why I’m here in Sierra Leone. At first I started questioning whether I had made the right decision in coming here. Was this even really where God wanted me to be? If it was, why would all of this happen right now while I’m here, separated from my family? There had to be a reason. As I thought about it, the answer hit me like a ton of bricks. Yes, this is exactly where I’m supposed to be. I’ve always known that. I knew that from the moment I first heard that there was an Ebola outbreak. With that question answered, I moved on to trying to figure out why all of this was happening right now. And I think I found the answer.
     I spend my days working on projects which have been designed to encourage people to seek treatment if they have a fever or to not touch dead bodies/perform traditional burials. These things seem so obvious to me and I’ve gotten frustrated more than a few times at the fact that there are still people not following these simple guidelines. But the loss of Benny and my uncle and the fact that I’m not able to be there with my family during this time has taught me a valuable lesson in empathy. Straight from the mouth of Wikipedia, empathy is “the capacity to understand what another person is experiencing from within the other person’s frame of reference, i.e. the capacity to place oneself in another’s shoes.” I’ve begun to empathize with and feel more compassion than I ever imagined I could for the people who are doing all the things they aren’t supposed to be doing during an Ebola outbreak. One of the main reasons that people don’t call the Ebola hotline when a loved one has a fever is that they are afraid (for good reasons) that they will never see that loved one again. When a person is taken to an Ebola Treatment Unit (ETU), their family members will not be able to see them again until they recover. If the patient dies, it is unlikely that the family will ever see the patient’s face again as safe burial requires them to be buried in a body bag that has already been disinfected. If the treatment unit is far from where the patient and his family live, it is unlikely that the family will even be able to go stand outside the ETU (safely outside the buffer zone) to await news about their loved one. They still have work to do and children to take care of every day. They may be unable to afford transport to the ETU if it is far away. There are many reasons for not calling for a safe medical burial (if you’re really interested, you can read all about them in my CE). The most prominent reason for not calling is because people want to perform traditional burial rituals which have great spiritual significance and which provide comfort and closure for the family of the deceased. For both Muslims and Christians, these burial practices involve some type of washing of the body. Various ethnic groups have differing practices, but often times many people will touch or sleep next to dead bodies. This might sound somewhat shocking to you, but it really shouldn’t. We have rituals of our own, but we just don’t think of them in the same way. Have you ever attended a wake and kissed the forehead or touched the hand of the person who had died? I have. And I’m sure plenty of you have as well. We do something physical to feel a connection to the person we have lost even though we know they aren’t there in that body anymore. This really isn’t fundamentally different from what happens here. We even wash and prepare the body just like Sierra Leoneans do…we just happen to have specialized people who we have assigned the task of carrying out this process.
     As I was feeling upset about not being with my family, I realized that families all over Sierra Leone are facing the same struggle every single day. I didn’t have the option to go home to be with my family or to visit Benny or my uncle right before they died. The people here do have an option. They can choose not to knowingly separate themselves from an ill family member. They can choose to hold the hand of or hug a recently deceased family member just like we do. Obviously these are not wise decisions during an Ebola outbreak and I don’t condone them in any way, but I do understand them now. Not having the opportunity to be part of the traditions that we have surrounding death for our loved ones, I’ve come to realize just how important these traditions really are, both to us in America and to the people of Sierra Leone.
This video by United Methodist Communications nicely highlights the struggle faced by both Ebola patients and their families. It's very well done and we've actually been using it as part of our dialogue sessions with community and religious leaders.

Sunday, March 15, 2015

Notes From The Field: Makeni and Port Loko

     On my last day in Makeni, we went on an all day road trip out to some of the more remote chiefdoms. I was stuffed into the back seat of our Land Cruiser with Aminata and Compson and Davor was up front with our driver. I spent the majority of the trip trying to not touch Aminata. It was a futile effort. The road was so bumpy and we were already so crammed in that there was no way I was going to avoid it. The drive was almost as nauseating as the boat ride over from the airport. Anyway, I think it took about an hour or an hour and a half to get out to the first place where we had to pay burial teams and caterers (we supply breakfast and lunch for the burial teams). When we arrived, we pulled into what I think used to be (and hopefully will be again soon) a school. The burial teams came over and Davor and I were instructed by Compson to stay in the car. I knew that this was a serious instruction meant for our safety because Davor is Compson's boss and yet Compson was telling him what to do. So Davor (safely seated in the front of the car) called the name of each team member and once their identity was verified by their ID, Compson reached into a giant bag and handed each of them cash. Then we met with the caterer and had her sign a contract and I had to take a picture of her ID card. We repeated this process in each of the other two chiefdoms we visited. After the first stop, it took another hour and a half to get to the next area and then another hour after that to get to the final chiefdom.
Hearse at the first payment site
     At the second stop, something happened that upset me very much. The burial team was lining up to get paid, but some people were missing so, without telling anyone what she was doing, Aminata went over to another building and started talking to two men in PPE. This is bad enough in itself as she should not have gone anywhere near them while they were wearing PPE, but the worst part was yet to come. The men, obviously eager to get paid, ran over to the decontamination area, presumably to decontaminate themselves. I was watching them the entire time to make sure they followed the proper procedures and I was appalled by what I saw. They simply pulled off the PPE, left it on the ground in front of them and ran over to our car to collect their money!! THIS IS NOT OKAY!! They were touching the PPE with their bare hands. They left it out in the open instead of burning it immediately. They didn’t wash their hands. I’m pretty sure they didn’t spray down their boots. Davor was furious. I was too. And I wasn’t just furious because their actions put Aminata, Compson and Davor at risk (I stayed safely on the opposite side of the car from where Compson was passing out money and kept my window closed), but because that’s just so wrong, especially this far into the outbreak. They should know better. That’s not how you behave after putting a dead body in an ambulance. It’s absolutely unacceptable.

Men in PPE running to decontaminate after loading a body into a hearse. This is probably
my favorite picture that I've taken since I arrived in Sierra Leone.
       After that debacle there was a bit of a stony silence in the car, but when we arrived at the last chiefdom, everybody’s spirits rose. This chiefdom is right on a river and it’s a beautiful spot. If you have to live in rural Sierra Leone, this is the place to be. This was the first time I was able to get out of the car all day because the teams had not yet arrived so it was safe. We walked down a hill to the rivers’ edge and took some photos of our group (which we hope might end up in the CRS yearbook) and waited for the burial teams. Initially we had thought that we would cross the river in one of the canoes they have reserved for such things. The water level is low now since it’s the dry season so it would have been quite safe and I was really excited for it. We also had the option of staying in the car and getting taken across the river on a sketchy looking barge. That option got booted very quickly for safety reasons. There were other vehicles on the opposite bank though so they must have taken the barge across. In the end it was decided that the burial teams would need to come to us so we wouldn’t be crossing the river at all. I was pretty disappointed. Anyway, while we waited for the burial teams we took more pictures and Davor and I played in one of the canoes. It reminded me very much of a punt which probably makes sense since Sierra Leone was a British colony. Knowing how bad I was at punting in Cambridge, it's probably a good thing that I didn't actually try to go anywhere in the canoe. Just to spice things up, Compson decided to buy a chicken. A live chicken. I thought he was kidding when he said he was going to buy it. He wasn't. So this live chicken sat (and squawked a lot) behind me in the car for the entire 3 hour ride back to Makeni (Sriya, I couldn’t help thinking back to when you got “attacked” by the chicken in Kenya…I think you would have been very unhappy if you were in the car).
Walking down to the river in Tambaka

Davor and me
Punting Sierra Leone style
     I think my favorite part of this road trip was just getting to see the people. It was very evident that these were poor, undeveloped areas. The poverty was a lot more evident to me than it is in Freetown. There were a lot of signs promoting various NGO’s and the programs (mainly food security) they were running in the area. The houses were very simple. I was shocked to see people riding around on motorbikes with heavy winter jackets on. It’s way hotter here than anywhere I’ve been in Africa. I was in an air conditioned car and I still felt like I was melting. Yet here they were with down jackets on. When we drove by houses, there were usually kids outside and it was SO MUCH FUN waving to all of them. When they first saw us most of them would be stony faced so I was hesitant to attract too much attention at first, but as soon as I decided to just start waving to them it became evident that they were all just waiting for me to make the first move. I think I need to remember that I’m the adult (but not a REAL adult) in the situation and they’re the kid. Anyway, when I waved they would burst out into big smiles and start waving back frantically and it was fantastic. Seeing their reaction would make anyone smile. It was also fun when adults would wave and seem just as excited as the kids. Seriously, can you imagine doing that in Boston? People would think you were insane. I think we should start being a little more friendly to random strangers. Actually, it’s not like this in Freetown, either. Add that to the growing list of reasons that I like Makeni significantly more than I like Freetown (despite the fact that it’s way hotter than Freetown). 

     Another thing that was interesting to me was how many people I saw just laying around doing nothing. Now, that's how I spend a significant portion of my free time, but I do it because I'm probably the laziest person I know. They aren't laying around because they're lazy. They were laying around because they'd probably been working all day in the heat doing things that would take us a matter of seconds (collecting water) or which we don't even need to think about. They have to do all this work just to survive. How much work do we need to do to survive? Walking from my bedroom to my refrigerator and then heating up a pre-made meal in a few minutes doesn't exactly strike me as hard labor. I readily admit that I'm ridiculously lazy, but I'd challenge the most industrious people I know to do the work these people do and then be able to spend their afternoon doing anything other than laying around. If you can do the work that they do in this heat and not have to take a nap by mid afternoon then you can say something. I was so tired just from sitting in the car because the heat is so overwhelming, even with the air conditioning on. I think many people have this misconception that Africans are lazy or want to get something for nothing and that's just not true. They work a lot to get a little. I can't speak for everyone, but I think Americans work a little to get a lot. I'm not saying that Americans don't work long hours. In fact, I think Americans work too much and don't enjoy life enough. I'm also not saying that there aren't any Americans that do work that is equally physically demanding as some of the work that needs to be done here on a daily basis. And I'm also not arguing that all Americans can work a little and then have extra cash to spend on luxuries. This is definitely not true for all Americans. But the point is that I don't know any American who has to spend any time whatsoever boiling their water so it's safe to drink. Everything that we need (and too many things we don't need) is at our fingertips and we don't really have to do very much for it. Most people that I know (admittedly, my sample is a little skewed since I primarily know highly educated, upper middle class white people) have extra money to spare for Netflix subscriptions, gym memberships, dinners at nice restaurants and North Face jackets. Sometimes we think of ourselves as deserving of these luxuries because we work hard, but really we're just incredibly lucky. We usually only realize this when something terrible happens and then we try to make ourselves feel good by doing something like giving $10 to support Earthquake victims in Haiti...but only if we can do it via text because otherwise it would take too much effort. Usually we do these things with good intentions, but I think we're missing the bigger picture. Every single day people all over the world struggle to survive and we're too busy binge watching Friends on Netflix (I'm on season 8...) to notice. Or worse yet, we notice and don't bother to do anything about it. I recently came across this quote by Saint Teresa of Avila:
Christ has no body now but yours. No hands, no feet on earth but yours. Yours are the eyes through which he looks compassion on this world. Yours are the feet with which he walks to do good. Yours are the hands through which he blesses all the world. Yours are the hands, yours are the feet, yours are the eyes, you are his body. Christ has no body now on earth but yours.
Are we really living like this is true? Personally, I could certainly do a lot better. If we feel like we're being compelled to give of our money, time or talents to anyone then we probably shouldn't be giving anything at all (2 Corinthians 9:7). The reason the quote above is so powerful is because of the freedom it implies. Christ didn't have to give anything to anyone, but He ultimately gave His life for all of us. If we are His body now, we should be willing to give so much more than we actually do, not because we have to, but because we realize what He gave for us. If we are His body, we should be his hands and feet, but we should also be His heart. He freely gave us everything because He loves us. As His body on earth, shouldn't we be willing to do the same for our brothers and sisters simply because we love them as He does? I really like what Proverbs 11:24 says on the topic: "One gives freely, yet grows all the richer; another withholds what he should give and suffers only want." When I was younger, I hated giving gifts to other people, but I really liked receiving them (which is why I once bought myself a $7 soccer ball at the Rudolph Gift Shop at school and then bought $0.50 presents for everyone else). That's totally normal for a kid, but I probably carried on with this attitude a little longer than is socially acceptable. Although I was always excited to receive gifts, I probably flustered a lot of people since I was never overly enthused with any one present I opened because I was always looking for something even better. No toy or video game was ever going to be enough, not because I didn't get some amazing gifts (I absolutely did), but because the gifts aren't what's really important. But that's not something you understand as a kid. Eventually, however, I came to LOVE giving gifts. I'm still absolutely terrible at picking them out, but I love seeing other people happy at something that I was able to give them. It really does make you grow all the richer. And that's part of the reason I'm so glad to be here in Sierra Leone. Gift giving isn't just something that involves money or something that can be wrapped. All of our skills and talents are gifts from God so being here and working in an environment that literally could not be more perfectly suited to me is a way in which I can both show my thanks for the gifts I've received and also give back to others and nothing could make me happier.

     Anyways, the next day we headed to Port Loko for the day. The best part of the day was probably meeting a British guy who lives in Cambridge and who told me that he wants to sail to Newport and then live in RI for a year. So we decided that one day we will do a year long house exchange so that he can live in RI and I can live in Cambridge again. Unfortunately, I don't actually own a house in RI so if any of you Rhode Islanders out there want to let me use your house for the exchange then you can come live with me in Cambridge. Anyway, the reason we were in Port Loko was because we had to pay the burial teams and gravediggers there as well. Naturally I thought I would safely sit in the car like I had the day before. I was very, very wrong. I was put in charge of coordinating payments. This meant that I had to call out the names of the members of every team, have them get in a line and check their ID’s before allowing them to proceed inside for payment. This seems like a fairly easy task, right? WRONG. You can try to keep the teams back all you want, but they are still going to get as close to you as possible without actually touching you. When I asked to see their ID they would typically hold their ID and bend down so that their face was close to mine. It’s hard to be comfortable in a situation like that. We quickly put a stop to their tomfoolery and I went into a small office so that they would come in one by one and I could check their ID’s and cross them off the list. I spent probably about an hour after the whole process was complete being really uncomfortable and nervous about the possibility of having contracted Ebola, but then I came to my senses. While this was certainly the most at risk I’ve been since arriving in SL, it’s still highly unlikely that anything will happen. In order to have been allowed into the CCC in Port Loko the workers couldn’t have been showing any symptoms which means they can’t transmit Ebola to me and it’s unlikely that they have it anyway. I still washed my hands like a thousand times while in Port Loko and will be obsessively checking my temperature until the end of the 21 day incubation period. In reality though, I could have been exposed to Ebola at any point in time since arriving here. Every single day is the start of a new 21 day monitoring period. But I never think about that. I just stay as safe as I possibly can in every situation.

Working at the Port Loko Command and Control Center

We had to make a detour to Lunsar before heading back to Freetown.

Wednesday, March 11, 2015

Notes From The Field: Makeni Part II

     The morning after I arrived in Makeni we left the hotel to head to the CCC and when I arrived, I met with Aminata who is responsible for monitoring the burial teams and gravediggers. She’s an amazing person. She’s from the area and has been doing community work with NGO’s for eleven years. I was 14 years old when she started doing this work. She told me how when she first started in this response effort she was afraid of Ebola, but once her predecessor explained how to be safe she felt a lot better. Aminata provided me with a lot of information about both the technical challenges the workers face (the app they use to send in data is glitchy, they don’t have enough credits to send reports in, teams are being forced to work at night by the military, lack of action taken by the appropriate authorities when an unsafe burial has been conducted, etc.) and the psychosocial issues that come with working in this situation. Many members of the burial teams have started to have nightmares. Both burial team members and grave diggers have been stigmatized and many have been kicked out of their homes by their families. After speaking with Aminata, I had the opportunity to meet both the burial teams and the gravediggers in person. I had known that I might have the opportunity to witness a burial (I didn’t actually get to see one though), but I was still surprised when Aminata asked if I wanted to go meet the burial teams. The teams are headquartered across the street from the CCC so we just walked over and spent a little time talking with them. They reiterated many of the concerns Aminata had raised. Being so close to people who spend their days burying Ebola victims was a bit unnerving. It was definitely the closest I had been to Ebola (especially since there has been a big increase in cases in this area recently) up to that point and it made me pay a lot more attention to handwashing and the no touching rules. I was quite close to the burial team members, but obviously I never touched any of them. In retrospect, I probably shouldn’t have been so close, but Aminata was just as close so I’m sure it was fine. They wear PPE when they do burials anyway.

     After meeting with the burial teams, Aminata shocked me again by asking if I wanted to go meet the gravediggers AT THE CEMETERY. Um. Okay. I had absolutely no idea that was something I’d be doing, but I’m so glad I went. As we were getting ready to leave, one of my colleagues, John, came over to me and started giving me some very serious instructions. He said to be sure to keep my distance from the workers and told me that if they look me in the face while talking that I should quickly turn away to ensure that no spit gets anywhere near my face. Then he asked if I had a long sleeved shirt I could put on so I had less exposed skin. It’s like a million degrees here in Makeni so no, John, I don’t have any long sleeved shirts with me (apart from one or two in Freetown), but thanks for scaring the crap out of me for about 2 minutes. Sometimes I forget that most of the people I work with are not public health people. They’re development people or emergency response people, but they’re not necessarily involved in public health activities regularly. I think that makes them more likely to be concerned about things that aren’t really going to get you infected. A healthy level of concern and respect for Ebola is necessary, but to be unnecessarily fearful just makes people nervous. Anyway, the gravediggers are some of the most amazing people I have ever met. When we arrived, every single one of them started walking towards us from where they were digging, stopped about 15-20 feet away from us and waited for us to explain what we needed. 

The pit where personal protective equipment (PPE) is burned each night
Cemetery in Makeni
     As you might expect, a group of people who serve as gravediggers during an Ebola outbreak in Sierra Leone is not comprised of a bunch of people with PhD's. They are people who have been looked down on by society constantly since this outbreak began and probably beforehand as well. They should, however, be some of the most respected individuals taking part in this response. The heat in Makeni is intense (but I hate the heat so maybe some of you wouldn’t think it’s quite so bad) and these men work all day digging 8 feet deep graves so that every single person is buried properly and safely. I could see the sweat pouring off them (one guy was wringing out his shirt and I’m pretty certain you could have filled a pool with the amount of sweat that came out) which is probably why we stayed so far away. They articulated their concerns and the challenges they face clearly and respectfully. It was obvious that they thought I have far more power than I actually do, but I was happy to listen to the issues they presented and I will do my very best to make sure they are addressed. They also talked about how they were so grateful to God and to CRS for all the progress that has been made. After they finished and I thanked them for their hard work, someone began praying. I'm not actually sure if it was in English because it's sometimes hard for me to understand the accents here and because Krio has roots in Pidgin English I often can't tell if people are speaking Krio and I'm just catching some words that are the same in English or if they're speaking English and I just can't understand their accents. It was cool to be a part of it regardless of what language it was in.

     When I got back to the hotel after work, I took my temperature and it was 99.0 degrees which threw me into a panic for a few minutes. Logically I knew that it was likely just because I had been outside for a good portion of the day in hot weather while wearing long pants. I know there’s no way I would have symptoms if I had been exposed that day, but my temperature hadn’t been elevated once in my first month here and I had just spent a day with Ebola workers so my immediate conclusion was not a positive one. But thankfully my temperature was down just a few minutes later and all was well again. My next post will be up within the next couple of days. It will be the last (and most exciting) post about my week in the field and will feature some stories about my excursion to pay burial teams in some of the more rural chiefdoms, playing in a canoe, being trapped in a car with a chicken (aka Sriya's worst nightmare) and a day trip to Port Loko. 

Monday, March 09, 2015

Notes from the Field: Makeni, Bombali District

     March 4th was the one month anniversary of my arrival in Sierra Leone. I got to mark the occasion by finally spending some time in the field and I can tell you that getting out of Freetown was the best thing that has happened since I’ve been here. On Tuesday, I went to the office for a couple of hours before I headed off to Makeni. Now Google Maps will tell you that it takes about 2.5 hours to get from Freetown to Makeni. In Africa, however, nothing takes the amount of time that you think it’s going to take. I got a text from our Fleet Logistics Manager, Sahid, at 10:30am telling me that the car was back from refueling and we’d be departing soon. Being a foolish, na├»ve American I went downstairs about 5 minutes later thinking we were about the leave. But that’s not how things work. I waited for an hour and 15 minutes more before we actually left. Alusine was driving me to Makeni and then taking Robert and Nathaniel, both of whom work on our seed storage program, to Kabala which is about two hours further than Makeni. Nathaniel had to go to the bank before we left which meant that we drove to the bank, he went inside and we waited in the car for 45 minutes until he came out. I didn’t mind the wait because I got to people watch, something that I’m not particularly fond of doing in the US, but which is infinitely more fascinating to me here. Once we finally got on the road to Makeni I started to get pretty excited. The guys were all surprised at how calm I was about going somewhere new and how I wasn’t afraid of Ebola. Don’t get me wrong – Ebola is very serious and not something I take lightly, but if you're careful and diligent in observing the no touching rules then you should be fine. Plus, it’s a little silly to live in fear of an illness you’ll probably never have, isn’t it? 

     Before we even got out of Freetown, I was exposed to a part of the city I had never seen before – the slums. It was unlike anything I’ve ever seen. I’ve spent a lot of time thinking about poverty in Freetown and it’s bothered me that I haven’t been more effected by it. The parts of Freetown I’m usually in seem fairly well off. I don’t mean well off in the American sense, but well off for the 5th least developed country in the world. Sure, a lot of houses are just sheet metal or wood and there’s some trash on the sidewalks, but overall it hasn’t seemed like there’s overwhelming poverty. It’s just Africa. I know there is overwhelming poverty, of course, but the outward appearance of things doesn’t make it seem like that. But the slums are something entirely different. There were literally just fields full of trash and what seemed like one giant sheet metal roof that must really have just been hundreds of houses packed together.  This is where Ebola is in Freetown. I haven’t seen data on exactly where all the cases are, but I’d be willing to bet most of them are occurring in these crowded, unsanitary conditions in which nobody should ever have to live.

Freetown slums
      I had thought that the trip to Makeni would be over bumpy dirt roads, but it turns out that the road to Makeni is paved with more than good intentions…it’s paved with actual asphalt. The entire way to Makeni. Unreal. It was amazing. It’s the little things. There are three roads that can take you out of Freetown and they eventually all meet up. We took the road that goes over the mountains. As we were leaving Freetown, we had an incredible view of the city from the top of the mountains. As we got to the top of the mountains, we passed Fourah Bay College. I didn’t take any pictures, but I have a feeling some of you (Nicole DeSarro, I’m looking at you…) would be appalled by what this university looked like. Schools are still closed so there wasn’t anyone around, but the dorms look like they’ve been abandoned for a lot longer than seven months. Anyway, once we got a bit outside of Freetown, you might have thought we were in rural Florida. We were on this wide, beautifully paved road and there were lush, tropical plants and trees lining the side of the road. There was a lot more dirt than grass and most of the buildings were made of sheet metal or wood or cinderblocks, but there are some pockets of the south that really look pretty similar. We also passed the US Embassy which was a nice taste of home since it’s a behemoth of a building/fortress that looked like it was picked up from Embassy Row in DC and plopped in the middle of Sierra Leone.

     As we got over the mountains, we were driving along beautiful, lush green valleys which I can only imagine look even more beautiful in the rainy season. As we were driving by all this, I couldn’t help but think “Ebola, where are you hiding?” This country is absolutely beautiful and it’s crazy to think that this terrible disease just emerged from the bush one day and has decimated life here. Anyway, we drove for less than an hour before stopping again at a gas station that had a “mini mart” where I bought snacks and lamented the fact that I couldn’t play with the cute little girls hanging around outside. Then some adorable old man came over to the kids and picked up the baby and was trying to get her to wave at me and it was so much fun. This is what’s missing from life in Freetown…all we do is go to and from the office or hang out at nice hotels with other expats, but I don’t enjoy that. I want to interact with the locals. I know those opportunities are limited because of the circumstances, but just this small interaction with a couple of kids and an old man was enough to make me feel like I never want to go back to Freetown. After leaving the mini mart, we drove for maybe ten more minutes before stopping at a random side of the road “restaurant” (read: shack that served food) where I felt a little hesitant about eating what I was being served because the girl was preparing it with her hands and also because this is what I was served...

     After our delightful lunch, we got on the road and drove for a couple more hours before finally making it to Makeni. Along the way there were multiple roadblocks set up where military personnel or police take peoples temperatures as they go by. These roadblocks had all been taken down, but now that cases have been rising again they put them up again. All CRS vehicles have an “Allow to Pass” Ebola response permit so that we don’t have to stop at these roadblocks. Even so they made us stop at one, but only took Nathaniel’s temperature. It was really interesting to see the roadblocks because not only were they stopping vehicles, but they also stopped every single person that walked by and there were so many people that it looked like a stream of refugees fleeing from something. As we drove to Makeni, I was so happy. I saw children playing, people pumping water and numerous other things that are more like what I saw in Kenya than I could ever hope to see in Freetown. This is the Africa I know and love. Freetown is just a city. But the places we were driving by are more like the places I want to be. I don’t know how to explain it. The only bad thing about Makeni in comparison to Freetown is that it is so hot. I hate the heat and Freetown has been so pleasant because of the almost constant ocean breeze. There’s none of that in Makeni and it is hot. I do not like the heat. Although for some reason I haven’t been melting like I usually do in heat. Maybe I’m somehow getting used to heat? That would be fantastic especially considering that March and April are the hottest months here. If I can make it to May it'll be smooth sailing from there.

     We finally arrived in Makeni and I went straight to the office. What I didn’t know until I arrived is that we are based at the Command and Control Center (CCC) here. It’s an incredible place!! I mean, it’s just a warehouse that’s been filled with Ebola response workers, but what’s going on there is amazing. It’s exactly what I was hoping to be involved in when I came here. There are people manning the telephones where alerts are called in to report a sick or dead person. There’s an area for the people who are managing which villages are quarantined and making sure those villages get food supplied to them. There’s an area for all the social mobilization teams. There are maps everywhere. There are giant dry erase boards listing new cases, details of all burials, where each burial team is deployed to, total number of confirmed cases, deaths, new admissions, how many cases are awaiting lab results and more. There are British and Sierra Leonean military personnel all over the place. Think of basically every movie that’s ever been made that is about some catastrophe or the end of the world and think of what the command center usually looks like in those movies. Apart from all the fancy technology, that’s essentially what this place looks like and I absolutely love everything about it.

The CRS office within the Command and Control Center
Diagram of a village where 29 cases were recently discovered. All the
houses with red around them are now under quarantine.
The Command and Control Center (CCC). Out of frame to the right is where incoming alert calls
are received, the three people at the table are in charge of quarantine issues, the table in the center
is a giant map of the district with pins showing case locations and on the left in the back is the
 burial management team. The red board is a list of all cases in the district.
The CCC from another angle. Along the back wall is where WHO and
some CRS staff work. Upstairs is social mobilization headquarters.
Daily and weekly burial update boards
Map of Bombali district split into burial team zones. The map on the right
also shows where burials have taken place over the course of the week.
Case management board
Social mobilization activities
Daily contact tracing report
Keep an eye out for my next post where I'll write about meeting burial team members and gravediggers, going out into the chiefdoms to pay other workers and playing in a canoe in Tambakha!!