Thursday, May 21, 2015

Water, Water, Everywhere

     The rainy season has officially begun in Freetown!! Before I get to that, let me update you on some things that have happened since the last time I wrote. Almost two weeks ago now, I went with Sasha and Meredith to Zsolt’s house to watch the guys attempt to make mango brandy. Zsolt had been fermenting his mangoes for more than a week and when we got there he had already started. I absolutely despised chemistry when I took it, both in high school and the four ridiculous semesters I was forced to take in college, but when I saw this machine set up and different distillation fractions, I started geeking out a little bit. I remembered how in orgo we had learned how wine and vodka and are made because it’s all chemical processes, ergo relevant to orgo. And let's be honest, there's probably nothing in the entire field of chemistry that's more interesting to a bunch of college kids than learning how to make alcohol. Anyway, I still hate chem, but it was a lot of fun to watch the process, even though it was pretty slow going. Ultimately, the mango brandy was a bust as it apparently just turned to vinegar. There was a lengthy, pseudo-scientific dinner discussion (interspersed with a brief, very random conversation about the Great Schism and whether the guards gave Jesus water or vinegar to drink when He was on the cross…) about why it had failed and the guys decided to try again with other fruits like pineapple and, at my suggestion, watermelon.

 
Zsolt adding water...
I thought the coil was really cool
Sasha was really excited for his mango brandy
Look at those fractions!! SCIENCE.

      The next day we had a pretty lazy pool day. Early in the day, I watched random Youtube videos about Turkey with Sasha and Meredith because Sasha was trying to decide if he wanted to take a job in Antakya. He may also do a TDY there which is a little funny because we think he wants a relaxing TDY, but Antakya, which is very close to the Syrian border, is anything but relaxing right now thanks to ISIS. Last Monday I went to dinner at Lagoonda with Nancy, Annisha and Amy because it was Amy’s last night in Freetown. We ran into Sasha, Meredith, Zsolt and one of their other friends there as well. The highlights of the evening included Amy using “quagmire” in a sentence and being quite proud of it and, my favorite quote of the evening (likely a quoteboard quote if the quoteboard was still going), was when Amy, upon being asked if she wanted to go to the Radisson for dessert, said, “It’s a Monday! Let’s live it up in Freetown! One gin and tonic AND dessert!” Clearly, Freetown is not the most happening place in the world right now.
     Last Tuesday morning we learned that the Swiss Ambassador would be coming the next day. The compound we stay is for the Swiss government and the ambassador just happens to stay in our apartment, specifically my bedroom, when he visits so we had to move out for this guy’s Wednesday-Sunday visit. I was pretty annoyed about this for several reasons. First, why couldn’t the ambassador just stay somewhere else for the few nights he’s here? Second, if I’m being forced out of my apartment, it would have been nice to have a little more warning than 24 hours. What na├»ve little me didn’t realize was that the Swiss pay for the apartment year round, not just when the ambassador comes, so Rudy, the (sneaky German) property manager, is secretly making extra money off of us when the ambassador is away. When I first heard that the ambassador was coming I assumed I could just take my clothes and anything that would be in his way out and leave things like my wall calendar and food. WRONG. We had to make it look like nobody else had been living there at all. The whole thing is ridiculous and to make matters worse, I’m not sure our CR knows what’s going on. When I told him we were being forced out for a few days he said, “Oh. That’s not right. Rudy should have the ambassador stay somewhere else.” Face palm. Anyway, one good thing did come out of it. I got to move to the third bedroom at Sasha and Meredith’s and Nancy went to a different apartment so my stress level decreased significantly. However, it's now been more than a week since we were forced out and we've discovered that the ambassador still hasn't even arrived. Who knows if or when he's even coming.
     Last Wednesday night, I went to Martin’s house (Martin is a Toyota dealer here and we get a lot of our cars from him) for the weekly Wednesday night dinner. I’ve been trying to go for ages, but I’m usually in the field so this was the first time I was actually able to go. It was a blast. I got to watch the RM vs. Juventus match, we ate delicious food (bruschetta, meatballs, stuffed peppers and more), listened to some great music, stood on the porch so that the mist, which was being blown at us like it was coming from a mister in Disney, would hit us when it started to rain (we hadn’t had running water in a while so we all felt pretty gross) and just hung out. I've never seen more people in one kitchen in my entire life. It was really funny to watch a bunch of European guys get so into cooking this meal for everyone. We also had a bit of a dance party because Martin has a machine that flashes cool lights across the room in tune with the music. We didn’t get home until about 1:30am so that was a little late for me (because I’m an old person) and I was so tired for the next couple of days, but it was a lot of fun. I hope to go again soon because the theme next week is Pizza Night. Everyone will be given dough and will get to make their own personal pizza and, despite the fact that I don't particularly enjoy cooking, I am PUMPED for this pizza night.

This dinner was serious business
    
     On Friday Francisco came to Sasha's and we spent the evening eating, listening to music and just hanging out on Sasha’s veranda per usual. It was a fun night. We talked about what’s become lovingly known as “The Yugoslav Mafia” which is comprised of Sasha and his group of Eastern European friends here. It’s so random that there are so many of them here in Freetown, but we’ve agreed that if he can say my name is “Corleone” and that we just changed it when we arrived in America because we didn’t want anyone to know we’re in the mafia (I promise we’re not!), then we can say he’s part of the Yugoslav Mafia. We also discussed the rain a bit and Francisco said it makes him think of the quote from “Forrest Gump” when he’s in Vietnam and says, One day it started raining, and it didn't quit for four months. We been through every kind of rain there is. Little bitty stingin' rain... and big ol' fat rain. Rain that flew in sideways. And sometimes rain even seemed to come straight up from underneath. Shoot, it even rained at night...” We’re not quite at that point yet here, but it has started raining a lot more and hopefully we'll be at that point soon. It’s so fantastic. Apart from crisp, cool, sunny fall days, rainy days are my absolute favorite. The rain is so loud because all the roofs are metal. It’s deafening sometimes. It typically rains overnight, but Monday was the first day that it was still raining when we left for work. It was so cool out and Nancy said that once the rainy season really kicks in, it will be like that for good. Apparently we can go for weeks without seeing the sun which makes me super excited because no sun means no heat which means no grumpy, tired Nicole. Yay!! I'm just so much more energized when it's rainy. I didn't even have the air on in the office on Monday because it was so cool. Normally I drag my feet the whole way from the car, up all the steps and into my office, but I had such a spring in my step thanks to the rain on Monday. I'm really going to enjoy these next couple of months. And another added perk of the rainy season picking up is that, because Freetown is mainly on hydroelectric power, we are on city power a lot more so we don’t have the ridiculously loud generator on in the background all the time at the compound.
     Also, this is totally random, but one day when we were driving home a traffic cop hit a guy driving a motorbike on the head with a stick. It was done playfully because the driver was trying to sneak through even though the cop had told him to stop. It was pretty funny. In the US someone would probably claim it was police brutality or something stupid like that. But here everyone was just laughing and kept driving without any semblance of order, as usual. There are no real traffic rules here and motorbikes get away with everything. They even drive on the wrong side of the road. So I guess the cop decided she was justified in giving this driver a playful little tap on the head and I loved everything about it. Here's one more random bit of info. There is a school right down the road from our office and when we drive by in the morning I always think of LSA because there are cars lined up, blocking traffic and dropping kids off and, apart from the fact that it's on a dirt road and there's trash and stray dogs everywhere, it's basically just like being on Smith St. around 8am on a school day.         
     Anyway, last weekend was pretty lazy. Oh, except I graduated on Saturday!! I wasn't there, obviously, but it made me so happy to see everyone's picture and how happy they were. I'm lucky to have met so many amazing people during my time at BUSPH. It was a great experience and was obviously the right place for me. Now I'm officially Nicole M. Carloni MS, MPH. And I'm already thinking about what other letters I want after my name in the future. Anyway, Sasha and Meredith left on Sunday. Sasha is on R&R in the south of France where he is visiting his son, Alex, who’s at a tennis academy there. Meredith is in Massachusetts. It’s so upsetting. It’s not necessarily that I was to leave here. It’s more just that she gets to be there and I don’t. So now I’m staying at Sasha’s house by myself which is pretty nice. I do miss the both of them though and I hope Sasha decides not to go on TDY to Turkey because I want to have someone with whom I can watch the French Open!! Anyway, this is a long enough post and nothing much has really happened this week anyway other than me analyzing burial data literally nonstop at the office every single day. We haven’t had a single day with zero cases since the end of our eight days Ebola free which ended last week. In fact, cases have quadrupled (from 2 new cases two weeks ago to 8 new cases last week) as the rains have started and that is not a good sign. It’s very depressing. In order for Sierra Leone to be declared Ebola free by the time I leave, they have to have the first of 42 days with no new cases by June 20th at the absolute latest. If Day 1 is on June 20th, Day 42 will be on August 2nd, the day I leave. June 20th is only a month away though and I'm getting nervous that it won't happen.

 
 
 

Monday, May 11, 2015

Ups and Downs

      Last weekend (I guess it’s actually two weekends ago at this point because I never got a chance to post this…) was quite enjoyable. On May 2nd I hit the halfway point of my time here in Sierra Leone!! Everyone has been in a pretty miserable mood lately so initially I was upset at the thought of having to be here for another three full months, but today I realized that in three months I’ll have to leave and that made me sadder that I thought it would. It’s crazy to see how things have changed since I arrived. When I first got here there were almost 100 new Ebola cases per week and now we’re down to about 10 per week. It’s been such a stressful three months, but I know this is exactly where I’m supposed to be. It might be hard right now, but I know a lot of good will come out of it, hopefully both in terms of personal growth and for the people who I’m able to help while I’m here. Anyway, Saturday was a lot of fun. I spent a good amount of time swimming and sitting out by the pool. Matthew, a CONCERN employee from the other compound, came over at one point while I was outside and we chatted for a bit. He informed me of the real reason that we haven’t had running water. Apparently every year around this time the Giba Valley (or something like that) reservoir dries up. This year it happened earlier than expected and it’s drier than usual so the government has started rationing water. We’ve been getting pretty intense rainstorms (so intense that I’ve had to remind myself that God promised never to destroy the world by flood again and have then gone on to wonder if that promise extended to monsoons with raging winds) most nights now that we’re on the brink of the rainy season, but because it takes a long time for the reservoir to fill up we may see water rationing even in the middle of the rainy season. Matthew pointed out that rioting would be out of control if Freetown ran out of water and it would be crazy if the “Ebola riots” that everyone expected actually had nothing to do with Ebola, but were about water. It’s crazy that we have the ocean right next to us and a bunch of rivers and it’s raining a lot and there’s still no running water. Sometimes, if I'm sitting on Sasha's veranda on the weekend, I can hear people suddenly cheering as if Sierra Leone had just won the world cup. They're actually cheering because someone discovered running water. 
     Anyway, later in the day on Saturday I played tennis with Sewah and Meredith. Sewah is a semi-professional tennis player who trains Sasha and Meredith. It was a lot of fun, but I have never been more hot, sweaty or physically drained in my entire life. I was literally melting after just a few minutes and felt like I could barely move my arms or legs. A tennis raquet has never felt heavier. Davor made spaghetti carbonara for us for dinner that night and it was delightful! On Sunday, I was planning on sleeping super late since I was so tired from tennis the day before, but around 10:30am I heard a knock on our door. Nancy answered it, but I was too curious to stay in bed when I heard multiple people come up the stairs. Turns out it was Annisha and Amy! Annisha had just gotten back from R&R in London and Amsterdam so it was great to see her! Eventually Annisha and I made our way over to Sasha’s and hung out there. Amy, Nancy and Davor went for a work lunch at Country Lodge and Annisha, Ahmed (Annisha’s boyfriend), Meredith, Sasha and I had lunch on Sasha’s veranda. Sasha, Meredith and I have also started watching an amazing show called Orphan Black. Meredith has already seen it, but the third season just started so Sasha and I are catching up before we watch it. Literally we spent three nights in a row watching 3-4 hours of this show each night. So good. Check it out.

The view from Sasha's veranda
     I was in the field for four days last week (and yes, I was slightly distressed that I’d be missing Orphan Black marathoning). That’s the longest I’ve been away from Freetown at one time and it was exactly what I needed to pull me out of the miserable mood I’ve been in. Things went well on the trip. Most importantly, Bombali hit 42 days with no new cases!! We walked into the Command Center that morning to find a sign on our office door congratulating the district. Everyone who walked into the office that morning had a smile on their face!! If the festive mood in the air was any indication, I can't wait for the joy and celebration that will come when the entire country hits 42 days!! Anyway, on my trip I visited Makeni, Kabala and Port Loko to get stuff sorted out with our burial data. We’ve done about 7000 burials, but we currently only have about 1000 records uploaded to a database being managed by the Red Cross. The plan was to have the burial teams upload their data directly onto an app on the smart phones we provided them, but that has turned out to be a disaster. They either claim that they don’t have phone credit so they can’t send the data (this is code for “We got the phone credit, but we used it to make personal phone calls”) or that the app is malfunctioning which actually is a real problem that’s been happening constantly. MHealth isn’t always the wonderful solution that we want it to be. So we’re ditching the phones and I now have the task of sorting through all the daily burial updates that are sent to us to see what’s made it into the Red Cross database and what hasn’t and to create our own Excel database of all 7000 burials (although I highly doubt I’ll actually be able to find hard copies of the data I need for all of these burials). Considering that some of the daily burial updates are in separate Word documents rather than Excel spreadsheets and that there will be new burials every single day, it’s going to be a tedious task. I could probably just assign it to data people in each district, but then it would probably never get done. It’s not that they wouldn’t do it. I’m sure they would postpone it for as long as possible, but they would eventually do it. The issue is primarily that they would be incredibly slow at doing it. I know that I need to be sensitive to the fact that even most of the people we have hired specifically for data entry didn’t grow up using computers. The same issue came up when they were entering data on the phones. It took them about ten minutes to do something that would take me two minutes, but I have to remember that they didn’t grow up texting. Sometimes I have just wanted to grab the computer or phone from them and do it myself, but nobody is going to learn that way and that’s not going to help this country in the long run. So I just have to learn some patience. I think this entire six months is pretty much an exercise in learning patience which is funny considering the fact that I’m typically super patient in other areas of life. Long line at the supermarket? No worries! I’ve arrived a little early and my room at the hotel isn’t quite ready yet? No problem! But when it comes to technological ineptitude or people who aren’t punctual, two things that are huge issues here, I get frustrated very easily. Here’s hoping I’m a little better about these things by the time I leave here.

CRS congratulating Bombali district on reaching 42 days Ebola free!!
          When I was in Makeni I got sick. Like really, really sick. I rarely get sick and when I do, I'm not typically a whiny baby about it. I suck it up and deal with it. But this time was different. For the first time since I arrived, I experienced that terrifying moment when you wake up in the middle of the night, sweaty and violently ill, and as you sit there thinking about how you'd rather be dead and debating if you should wake someone up to take you to the hospital, your mind goes to that place...the place where, based on your symptoms and the fact that you're in a country with active ebola transmission, you have to seriously consider the (still unlikely) possibility that you have somehow become infected with Ebola. For the next two hours, between bouts of sickness and as I fought to remember everything else it was more likely to be other than Ebola, my two main thoughts were "Oh my gosh. I could actually die" and "Oh no! If I have Ebola I will have just ruined Bombali's Ebola free status!! Thankfully I'm doing just fine and it was probably nothing more than food poisoning.
     Anyway, when I was in Port Loko, I heard something very upsetting that, for some reason, my non-public health, non-medical, non-science colleagues don't seem to think is a big deal. Vaccines were being stored in Port Loko and 25,000 more are set to be stored there soon, but it turns out that there's not actually enough storage space. That's not the bad part. The bad part is that while vaccines were being stored there, the generator was being turned off at night. Now I don't know how long the vaccines would stay at the proper temperature with the generator turned off, but I'm thinking losing vaccine efficacy by not keeping them at the proper temperature is not a risk you want to take. But of course it's "a huge cost implication" if we have to start requiring them to leave the generator on so nobody wants to hear it. Utter nonsense.
     On Friday I drove back to Freetown. The trip to like 5 hours longer than it should have and I still wasn't feeling well so I wasn't thrilled at being stuffed in the car with 5-6 other people (and one live chicken that I'm sure was someone's dinner later that night). We had a car take us from Makeni to Masiaka and then had to wait over and hour in the intense heat for the car from Freetown that would take us the rest of the way back. On the plus side, there were some cute kids who wanted to be friends with me which is always fun. When we got back to Freetown, I found out that we were doing a poolside BBQ and that Sasha and Patrick would be playing some live music. There were a good amount of people there, but it was pretty low-key. I met a CAFOD employee who was working with CRS on the Turkey/Syria border before coming here. She had some pretty incredible stories. When her driver would take her home from the work site each night, she could look across the border into Syria and see a sea of black, ISIS flags. It was pretty amazing to hear some of her stories and I can't imagine how stressful that post must be.
     Lastly, in an effort to quell the wretchedly miserable mood I and pretty much everyone else in this country program has been in lately, I’ve started listening to this song a lot. It’s a good one and it's a good reminder when just about every day at the office or in the field seems like an insurmountable obstacle.

 
P.S. Today (May 11th) is SIX STRAIGHT DAYS WITHOUT A NEW CASE!!!! If you can't tell, I am really excited :-)

Saturday, May 09, 2015

Reminders of War

     From 1991-2002, Sierra Leone was involved in a brutal civil war that was waged partly for control of the diamond mines that are in the eastern part of the country. Sierra Leoneans were used as pawns in the power struggle between the government and rebel forces and were forced to work in the diamond mines. The diamonds were then sold and the money was used to purchase weapons and finance the civil war. None of the workers ever reaped the benefits of finding a diamond themselves and many of them were killed or expelled from their homes in the process. As a result, diamonds from Sierra Leone became known as blood diamonds. As a nation, we don’t learn very much about Africa in school. When I read “King Leopold’s Ghost” last summer I thought it was fiction for quite some time, although the “Belgians in the Congo” line from “We Didn’t Start the Fire” probably should have clued me in to the fact that something terrible happened when the Belgians were in the Congo. The point is, only a very limited portion of African history is taught to us. We start with the Egyptians (because I don’t buy the nonsense that Egypt is part of the Middle East and not Africa…it’s on the African continent! It’s in Africa!) and end with Apartheid and get pretty much nothing in between. Actually, I’m not even sure I ever discussed Apartheid in school. I think my knowledge of Apartheid came mostly from that Disney Channel Original Movie "The Color of Friendship" which pretty much no kid (other than Nick because he's quite the oddball) liked...give me Brink or Zenon any day. So it's probably not too surprising that I had never heard about this war in Sierra Leone until it was immortalized in the movie “Blood Diamond” which, as I’m sure you know, features the somehow still Oscar-less Leonardo DiCaprio. I recently watched Blood Diamond again and it was a very strange experience. Oddly enough, the journalist in the movie mentions how she’d been in Sierra Leone for three months which is how long I’ve been here now as well. It was funny to hear the common Krio greeting “How di bodi?” and “Di bodi fine” as dialogue. It was odd to hear them talk about Port Loko and Waterloo which are places I go to or pass through quite often. It was a little too real to watch it while sitting in my room in the Sierra Leonean capital and to think that 15-20 years ago some of my national colleagues who are my age could have been child soldiers. I was ten years old in the waning years of the conflict and certainly wasn’t thinking about war, blood diamonds or kids my own age who were being brainwashed and ordered to kill innocent people at the command of the adults who should have been protecting them.
     Over the course of my first week or so in Sierra Leone, as I started to take in my surroundings, I began to notice something peculiar. I saw a lot of people without hands on the streets of Freetown. I’m not the most observant when it comes to physical appearances (there have been multiple instances of unnoticed haircuts in my life) and at first I didn’t think much of it. But pretty soon it started to dawn on me that I had seen quite a lot of people who were missing limbs, particularly hands. And then it hit me. These people couldn't ALL have been born like that or had some wound that required amputation. And I knew that they had most likely had their hands chopped off during the civil war. It was a shocking realization. This isn’t a movie. This is real life. There are people all around me who have witnessed such horrific things. Things that we can’t even begin to imagine or understand. There are people who have systematically had their hands cut off by their fellow countrymen. According to the movie, the rationale behind this cruel act perpetrated during the war was that because the government wanted the people to vote, the rebels would chop off peoples’ hands so that they couldn’t vote. In real life, I honestly don't know the exact motivations behind this act (and my internet is not working well enough for me to feel like looking it up), but what I do know is that there are no real provisions for people with disabilities here and all of the people that I have seen without hands have been begging on the street. Despite this fact, it’s actually incredible to see how far Sierra Leone has come in the past 15 years. I wish I had been able to visit here before Ebola because the country had really started to see economic growth. The people have learned from the war and it's something nobody ever wants to experience again. Pre-Ebola, Sierra Leone's future looked bright. Now the situation is grim. Poverty has dramatically increased. Ebola survivors face stigma and persecution. In a lot of places in the world, religion is the great divider. In a country in which a Muslims and Christians coexist so peacefully, it’s sad to see the people be separated and torn apart by the after effects of Ebola, something over which they have no control. The war they are fighting now isn’t one that can be won with guns or machetes. Fighting a disease is much different than fighting a person. But if Sierra Leoneans can come together, I know we can beat Ebola. It will happen eventually and when it does, it will be wonderful.