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, naïve 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!!

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