Countdown

Tomorrow will start my final full week in Sierra Leone.  My replacement arrived on Thursday and I have the rare luxury of being able to do an in-person handover.  Now that I'm going and I've told everyone, each day I find myself fielding local colleague's comments about how they'll miss me and asking when I'll come back and my international colleague's asking me how it feels to be leaving.

Since I've arrived here, I've watched colleagues leave one after the other.  Emergency response is by its nature a very transient world.  Even though you only get to know people for a few months the intensity of our lives here and the constant contact in both our professional and personal lives forges bonds that are surprisingly strong.

My feelings about leaving are extremely mixed, for both professional and personal reasons.  Although the OICCs that I was hired to manage have now closed and I've finished all of my work on those, my work as Freetown Health Manager is far from over.  I've been able to accomplish a lot a work I had planned, but it never ends up being quite enough, but I don't think it ever really is.  When I came, the Ebola epidemic was already starting to end and I really believed that I would be here to see an Ebola-free Salone.  Unfortunately, getting to zero is a long process and we're seeing a resurgence of cases, especially in Freetown.  I know that I won't be able to see us get to zero, but I feel confident that it will happen.

Personally, I just feel sad about leaving the people that I've met here.  I know that with other expats, there's a strong possibility that we'll cross paths again some day.  The development world is small and I've already seen that it's less accurate to say goodbye and more accurate to say until we meet again.  However, it's different with national staff.  I know that with most of the Sierra Leoneans I've met here, I'll only see them again if I come back to Sierra Leone, and maybe not even then.  This isn't the first time I've come to feel at home in a new country and then had to leave its people behind, but it's one of the parts of this world that never really gets easier for me.

I think that all of those feelings are amplified by knowing that when I head back to the US I'll be starting over again in a new city with only a few existing connections.  Don't get me wrong, I'm really excited to be starting my DrPH and I think that I will really enjoy the program and living in New Orleans, but my stamina for making new friends yet one more time is starting to wane.

I know that those of you who have read my blog throughout my seven months here and who have kept in touch with me during that time know that this has been far from an easy experience.  Even so, I don't regret my decision to come here.  I think that in whatever small way, I've been able to contribute to a response that I think is very important.  All of the challenges that I've faced along that way have been learning experiences and I'll leave Sierra Leone having grown a lot.

Music saves the day

I'm now more than a week into my temporary escape from Freetown and I've seen and done some pretty great things, like....:

-Walk to a castle nestled in hills full of vineyard and enjoy a glass of wine while taking in the view
-Float along the River Rhine while mentally deciding which castle I would choose for my own
-Visit a 1000 year old cathedral surrounded by a quaint gothic village
-Walk along the remains of the Berlin wall
-Drink beer by the half liter
-Walk through the Brandenburg Gate

However, yesterday was a bit of a difficult one.  I woke up in the morning with plans to go out to brunch with the friend I met in Berlin.  I didn't have many euros so I was hoping to find somewhere to change money.  In Freetown, you can change money almost anywhere, and even if you don't have leones you can basically always pay with dollars.  Germany is not so dollar friendly, unfortunately.  The hotel wouldn't change money, but gave me information for a place that would.  I went there, but it was closed.  I decided I would go meet my friend and figure it out there.

We decided getting money changed wouldn't be too easy, but we could surely get money out with an ATM (which I had done only a few days before).  We were very, very wrong.  We tried probably a dozen ATMs throughout the city with no luck.  As each ATM refused to cooperate, I became more and more sure that someone had cleaned out my account.  This happened to several of my colleagues in Sierra Leone and it seemed strange that my card had worked only days before.  I was seized by an unshakeable need to check my bank statement.  Unfortunately, I couldn't remember my password so we ended up returning to the hotel to get my password and check.  My fears were, of course, unfounded.  I had plenty of money in my account, I just couldn't access it.

So, one problem was solved, but the mystery of why I couldn't access my money was still pending.  We went back into town and managed to find a place that would take credit cards and had our brunch, at 1 pm.  My friend had to leave to go back to his town so I was left by myself.  I went to go try to find somewhere to change money.  The first person I went to try to give me 60 euros for 100 dollars, which I didn't accept but I eventually found someone.

I sat in the train station feeling a little shell-shocked from how the day had gone so far, but not feeling like it was a good idea to go to the hotel and call it a day.  My feet were also still aching from the 10 or 15 kilometers we had walked the day before, exploring the city in full.  I convinced myself to go back to an area I had particularly liked the day before and was rewarded greatly for my pluck.  It turns out the June 21 is the 'Fete de la Musique' throughout Europe.  It is the first day of summer and at one time, a French king (or equivalent to a king) designated that this date would be known as the Fete de la Musique and would be marked by concerts throughout the city.  As I walked around Berlin, I couldn't help but run into small concert after small concert.

In the end, it may not have been exactly the day I had in mind, but it was still a good one.  I saw that my friend here in Berlin is truly someone you can count on as he helped ease my panic and trekked with me to the hotel and back into the city.  And since I was wandering aimlessly in the city rather than on a mission of some kind, I ran into the street concerts and felt free to sit and enjoy them.

Escape From Freetown

I’m writing this post from inside a high speed train on my way from Frankfurt to the Black Forest in Germany.  I left Freetown on Friday night to start a two week vacation, which will be my last before I finish my contract in August.

Leaving Freetown on Friday was typical.  Although my flight left at 5 am, I needed to catch the boat to cross the bay at 1:00 AM, so I needed to be there by 12:30 and needed a car to pick me up at 12:00.  I spoke with our fleet manager to arrange to have the car there at 12:00.  This, of course, didn’t happen.  I ended up getting a driver who wasn’t on duty to take me to the boat and paid him out of pocket.  Then I waited for the boat to leave for 30 minutes, had a 45-50 minute trip across the bay, another 20 minutes or so from the boat to the airport, 10 minutes getting through the first security check, 20 for the next, and then an hour standing in line to check in.  I didn’t realize this, but at Freetown airport there are actually no computers so you’re supposed to print out your ticket, which I didn’t do.  In any case, they worked it out.  15 or 20 minutes to make it through immigration and security and then and hour or so waiting for the plane to take off.  Typical Freetown life.

After a layover in Casablanca for a few hours, I finally arrived to Frankfurt.  I was really anxious about arriving to a place that was completely new to me, where I didn’t speak the language, and trying to figure out how to get to the place I was staying.  My fears, however, were completely unfounded.  After a few missteps, I found myself at my destination.  Frankfurt has an amazing public transit system that would put even DC to shame.  It’s hard to explain how liberating it feels to be able to decide where I want to go and what I want to do without having to deal with calling multiple drivers, dealing with other people calling and wanting the car at the same time, and knowing that everyone knows exactly what I’m doing all the time.  Despite its name, Freetown is the place where I’ve felt less free than ever before in my life.

I don’t want to make you all think that I hate living in Freetown, because that definitely isn’t true.  There are absolutely great things about it like my friends, without whom I would have had a nervous breakdown long, long ago.  And to be honest it’s definitely one of the most beautiful places I’ve ever lived.  But it’s not easy.  Although I guess it’s not supposed to be.

Although life in Salone can be hard, the time that I’ve spent there has flown by.  When I get back from my vacation on the 27^th of this month, I’ll only have a little over a month left before I come back to the US.  The overwhelming feeling I’ve been having at work these days is that there just won’t  be enough time to accomplish everything I wanted to before I leave.  When I started in my new job as the Freetown Health Manager, I took on the management of a huge project with a team of 21 people and a gigantic budget.  My job was to get it restarted and get it all organized.  I’ve made a lot of headway, but there are still miles to go until I could say that my job is done.  The hard truth is that in the end, I’ll probably have to just do my best to control my inner perfectionist/control freak and accept that someone else can pick up where I left off and it simply will not be the end of the world.

Highs and Lows

In the field of global health, as in a lot of fields, there are a lot of highs and lows.  There are days where you find yourself so fulfilled with the work that you're doing that you couldn't imagine doing anything else and days where you find yourself wondering if anything you're doing makes any difference at all.  And some days you even have both of those intense feelings within a period of hours.

This week I had one day that has exemplified a lot of my experience here and the highs and lows that have gone along with it.  As I've talked about before, I've now moved on from my position as OICC Programme Manager focusing on Ebola response and have transitioned into a position as Freetown Health Manager where my job is implementing our long term health projects in the capital.  Just to give you a sense of the scope of our project in Freetown, we have at least 70 project activities that have to be completed during the next six months.  Although I manage a team of about 20 people, I had been finding that the responsibility for getting things done was all falling on the shoulders of the three of us at the top of the pyramid.

After discussing this with my boss (who is amazing, by the way), we decided to plan a one-day planning workshop with the team to increase understanding of the whole project and create detailed workplans for each of the project activities.  I was really excited about this idea and threw myself into planning.  I chose a great location that is close to the office but very pretty and sure to be a relaxing place for everyone to get to know each other and attack the task at hand.

I came into work on the day of the event and was told that the place we wanted had not been booked, but an alternative had been found.  Not ideal, but ok.  The alternative was further away, so we had to find a way to get the whole group there.  However, our fleet manager told my colleague there was no fuel in the cars.  I went to the Fleet Manager and managed to convince him that this was not an option and got us a car.  At this point, it was 9:10.  The event was meant to start at 9:00.

We got into cars and started moving.  For about 5 minutes until we hit a massive traffic jam where we sat until 10:00.  We finally arrived to the location, which was of course not as nice as the one I had originally requested.  And, as it turned out, had also been double booked.  My boss told me he would handle the double-booking issue and I started to set up.  Of course, only one outlet in the hall worked, so we had to re-arrange the entire room set up.  Finally by 10:30 or 10:45, we began.

I managed to shake off my frustration and found myself commanding the room as I started my presentation.  The team was responsive and engaged and everything seemed to be coming together.  I honestly had serious doubts about whether this exercise would work.  We were asking our team to do relatively high level planning for a large number of activities and there was a definite possibility that they wouldn't be able to do it.  I had set aside about 3 hours of the day for group work, so if we found that the team couldn't handle it, disaster would have been inevitable.  As we put them to work, there were some challenges, but between myself and my boss, we worked with everyone and people caught on.  Before long, I found that I didn't even need to assist the team with the work and I just left them to do it.

By the end of the day, our team had taken every activity in our program and had developed a detailed plan for its completion.  For those of you who have worked in development and with large groups of varied experience and capacity, this is the kind of result that you can scarcely dream of.  I was on cloud 9, feeling like I'd gotten to know my team better, built team solidarity, increased capacity, and saved myself a ton of work all in one fell swoop.  My boss said to me 'we've made tremendous progress today,' and I couldn't help but agree.

And then I stood outside the training hall with my colleagues and waited an entire for a car to come pick us up, calling our Fleet Manager about every 15 minutes trying to understand why I found myself waiting for a car, once again.  It finally arrived and I made it back to the office and went out to a bar overlooking the ocean for drinks with my colleagues, ending the day on not necessarily a high, but with the warm feeling of sitting with people who you have become your family and sharing the highs and lows of your days.

And that, my friends, is more or less a typical day in my life here.  A roller coaster from being on the verge of tears to feeling unstoppable to feeling incredibly proud of your colleagues to feeling like your colleagues are completely useless to feeling awed by the beauty of this place and finally feeling so exhausted that all you can do is fall into bed and do it all again the next day.

The beginning of the end

There are funny things here that I use to keep tabs on how long I've been here...  While I'm here, I have to take a malaria prophylaxis every day.  I was advised to bring down enough pills for my whole six month contract, so I came down with about 175 pills.  And as I watch my supply dwindle, it's like a visual representation of my time here.  I also decided to leave my external hard drive at home, so every thirty days or so my MacBook will remind me how many days it's been since I last updated... another reminder of how long I've been away.  At this point, it's been over four months and I have less than three left.  My final day will be August 5 and I'll start orientation at Tulane on August 19.  Just one more whirlwind transition with a cross-country move involved.

In reflecting on my experience so far, I find myself shocked at how transformative of an experience it's been.  I think back on how I dealt with different situations in my first few weeks and how I deal with them now and it's hard to believe I'm the same person.  Things that would have brought me to tears when I first arrived now barely even register.  My obsessive need to be the smartest person in the room and my somewhat unhealthy level of ambition have both mellowed a bit.  I've found that it's not so important to have the highest level position, but rather to have a position that allows you to have somewhat of a work-life balance and that you find interesting.  And that's what I have now and I'm happy with it.

In my last post I wrote about how monotonous life can be here.  The situation is still the same, but I decided to take the reins and make some changes.  I'm working on organizing a pub quiz night at one of the local bars, I arranged a GOAL potluck this weekend, and I'm planning a karaoke night this week.  Sometimes you just have to decide that you're going to get out of your rut and drag other people out with you.

Sadly, there are some changes coming that I'm not looking forward to.  My French roommate got a job with another NGO and she's leaving at the end of the month.  She'll still be in country, but not in Freetown.  The dynamic that we have in our flat is one of my favourite things about my life here and it will be really hard to do without.  It can be hard to trust people in an aid context because aside from drinking, gossip is probably the number one pastime.  But I do trust my flatmates, and it will be really hard to watch her go.  Our Assistant Country Director, who is absolutely fabulous, is also leaving at the end of the month... and then our Financial Controller at the end of June.  One by one, my social circle is deserting.  I realize that I'm deserting, too, but it doesn't make it much easier.

I know that it will be alright and that the time will fly by, even as I start to miss the people who have gone.  It's just strange to realize that somehow, without me really noticing, my time here has started slipping away.  However, I'm hoping that we're finally starting to get to the beginning of the end of Ebola.  In order to be declared Ebola-free, a country has to pass 42 days (twice the incubation period of the disease) without any new cases.  Although cases have been reducing steadily, we continue to have small surges of 4 or 5 cases at a time that have been stalling our progress.  As of today, Sierra Leone has had 5 days with zero new cases.  This is a big milestone for us and we're really hoping this could be the start of our 42 days.  My big hope is that I'll be able to be here to see the end of Ebola, but it's hard to say whether or not that will happen.  Ojala...

The Last Mile

It's almost the end of my fourth month in Sierra Leone and I'm finding that things are changing, but even more so they're staying the same.  The Ebola epidemic was already beginning it's downward trend when I arrived, but now four months later, we still haven't managed to get to zero.  We're now stuck in a tricky middle ground where we have to be constantly prepared for a surge of cases, but at the same time have to turn our attention towards recovery projects.

For me, this means dividing my time between my original role of managing the OICCs  and my additional responsibilities as Freetown Health Manager.  With the OICCs, every month requires me to try to anticipate the future and determine whether or not we can get funds to keep it open, what to do with the staff employed there, and what our long term plan is.  At this point, I think we're all comfortable with it remaining open through May, but it's April 26 and I don't yet have the funding secured for May 1.  This kind of constant uncertainty and narrow focus is a sharp contrast with Freetown Health, which is a long term health project with a broad array of activities.  Trying to juggle the two, along with new projects that will likely be thrown my way, is proving to be more difficult than I had anticipated.

As things change and stay the same at work, the same thing is happening in the rest of my life.  Since we're still in the midst of an epidemic, albeit one that is losing steam, our options for a social life in Freetown are still limited.  There are still only four restaurants open after 6 pm, and every Friday night inevitably means going to the only one with a DJ: Country Lodge.  Our lives have reached a level of monotony that can become quite depressing.  Our Sunday escape the beach, though, is now no longer a possibility.  The official stance of the President is that beaches are off limits, although the authorities had become lax on that issue and we were able to go the beach with no problem.  Until Easter weekend when a group of staff from the Ebola Treatment Centre in Port Loko were arrested for going to the beach.  Since then, the beaches have been off limits for all staff.  As far as we can tell, we're the only NGO that has this restriction, so it's something that's really frustrating for all of us.  When you have such a limited option of things to do, having such a key one taken away is really no fun.

It's funny even the little things that grow monotonous.  I didn't bring a lot of clothing with me, just like everyone else.  We see each other so often and all have such limited wardrobes that we all wear essentially the same thing, week after week.  I open up my closet in the morning and internally sigh as I think about wearing the same thing I wore last week, and the week before, and for every week in the past four months.  Our office isn't exactly surrounded by restaurants and the streets are dusty and full of traffic, so going out to lunch isn't really a nice experience.  We have a woman at the office who cooks, but every single day it's rice with chicken and fried plantains.  Every. Day.  The chicken always has bones, but she only gives us a spoon, so I spend my lunch time desperately trying to get some meat off of the bone with a spoon and inevitably making a mess of the task.

In the midst of this monotony, though, things are changing all around me.  In crisis situations like this, people are usually given six month contracts.  Many people extend, but all around me, my social circle is deserting.  When I first arrived, I just took all of the people around me for granted because I saw them so often, but now people are leaving left and right and I'm finding the my social circle was somewhat fragile.  Luckily, though, my flatmates aren't going anywhere.  It makes me sad when my friends start leaving, but if any of my flatmates left I think I would be in really bad shape.

I think that the way that I'm feeling is just part of the stages of living abroad.  At first it's all new and exciting, but as the new wears off and the small frustrations start to seem bigger, you find yourself feeling dissatisfied with your life.  I've been through it before, so I know that this feeling will pass with time.  And I know that when I have to board that plane to head back home, that it will be hard to go.  And also, there are of course some ways to break up the monotony.

Last weekend, my flatmates and I went to a chimpanzee reserve just outside of Freetown.  It had been closed for months because of the outbreak, and had just reopened.  We stayed in an ecolodge in the heart of the jungle where we could hear the sounds of the chimpanzees and other jungle animals all around us.  As soon as we arrived, I felt this wave of calm wash over me and I continued to feel that way for the entire weekend.  We didn't do much, went to see the chimpanzees, went on a hike, and ate food and drank wine and just relaxed.

I'm also distracting myself with making plans.  I've worked out my schedule for the future and I'll be leaving Sierra Leone at the end of the first week in August.  And I'll be taking a trip to a few countries in Europe in June.  For right now I think it will be Germany, the UK, and Ireland but I'm still working out the details.  And on August 19, I'll be starting my DrPH program at Tulane!  It feels great to have made a decision and I'm really excited about new challenges in a new city.  Onward and upward!

Coming Home

I've had many homes that I've loved in my life, and now I can add Sierra Leone to that list.  You never really realize that a place has become home until you leave it and come back.  I returned from Ghana on Wednesday and found myself breathing a sigh of relief as I stepped out of the airport into the cool air.  I enjoyed being away and having some time to myself, but I was happy to see the ocean stretching out before me on the ride home and was excited to see my friends in Freetown.

As I started to unpack, I had another great surprise.  My room doesn't have a dresser or any shelves in the closet, so for the past three months I've been keeping things that don't need to be put on hangers in my suitcase.  But when I came home, I finally had shelves!  So after three months of living out of a suitcase, I was finally able to unpack properly.

My time in Ghana was really refreshing.  I spent one day in Accra and then went to the coast to spend a few days.  The town I stayed in was small and the coastline was dominated by Cape Coast Castle (http://en.wikipedia.org/wiki/Cape_Coast_Castle).  This is one of the several castles that were built on the Gold Coast of Ghana for the slave trade.  It's hard to describe how I felt as I was touring it.  The disconnect between the beautiful building and the stunning views of the coast and the ugly things that had happened there was hard to stomach.  The most striking contrast was the entrance to the church in the castle.  Just outside the door of the church was a spy hole for the men's dungeons where over 200 men at a time were trapped with only a tiny window at the top for light and ventilation.  It's hard to imagine how the people working at the castle were able to walk into their church service past the cries from below.

My time in the Cape Coast wasn't completely heavy, though.  I made new friends and learned how to play a ngony and managed to commission one to be made and sent to my Mom.  I spent a lot of time sitting on the beach, sipping a beer, and just relaxing.  Here in Sierra Leone we generally work 10-12 hour days and are expected to work at least one day of the weekend.  Since it's the norm, you get used to it and start to forget what it's like to have a proper work-life balance.  While I was away, I didn't check my email at all and I was able to just focus on myself for the first time in a long time.  It was definitely a needed break.

This weekend in Sierra Leone we're having a 'stay-at-home' period, also known as a lockdown.  The cases had been reducing, but getting to zero is proving to be much more of a challenge.  We've had case surges in certain areas and it seems that our progress is starting to stall.  So the government declared this lockdown for three days.  No one is allowed to leave the house for three days to try to reduce cases.  It's quite boring, but at least I have my roommates.  The house we live in has three floors of people, so we've been taking turns cooking dinner for each other and hanging out.  In addition to that, I've also been making great use of my Netflix account.  I think if they ever need a spokeswoman, I could absolutely do it.

R and R in Ghana

Getting Back to Normal

After about a month of everything going wrong that could go wrong, I’m back in my normal room, in my own flat, and with my roommates.  I’ve returned to the office and now instead of alternatively working and napping to get through the day, I’m running back and forth from meetings and starting to figure out my new position.  In short, I’m trying to get my normal Sierra Leonean life back.

I came out of quarantine last Thursday.  I had to ‘released’ from quarantine, which essentially consisted of some guy coming by my apartment and reminding me not to touch people.  Then it was back to the office.  I honestly felt a little anxious as we started to drive through our gates and out into the world.  After having had such limited contact with the world for so long, I just felt out of practice.  But, like riding a bicycle, you don’t forget how to live your life.

On Friday, I found myself at a district health planning meeting where I was the only person who wasn’t from Sierra Leone.  The meeting was extremely chaotic and took place almost entirely in Krio, the native language here.  Krio is similar to English, but it’s different enough that it was hard to catch everything.  The meeting was supposed to start at 9:00, but didn’t start until 10:30.  I’m not sure how long the whole meeting went on in the end, but I had to leave at 3:30.  It was a truly bizarre experience. 

That night, we threw a party to celebrate my release.  Since it was a Friday night, it was a little smaller than the last party we threw, where we had to throw people out at 6 AM because we were ready for things to wrap up.  All in all, it went well, though.  I then spent Saturday doing all of the things I had been thinking about doing while I was trapped in quarantine: getting a pedicure, going to a restaurant and ordering lobster thermidor, laying around all day by a pool.  It was glorious.  And then Sunday, as per usual, was a beach day with my rommates.  So, back to life as usual I think.

I left this Friday for Accra, Ghana.  One of the perks of working during and emergency is that we can use the UN flight system, so I can get free flights to Ghana, Senegal, Liberia, and Guinea.  The downside is that you have to get a medical check every time you want to fly, which is a bit of a pain.  I have to say though, walking on the tarmac to the World Food Programme plane made me feel pretty cool.  At this point, there are so few flights coming in and out of Sierra Leone that there are no commercial flights on Fridays.  The only people in the airport were those of us going on the UN flight and a group of Chinese military people with their own plane.  The arrival and departure boards were blank and the airport was nearly deserted.  Just one more bizarre experience to add to the list.

I’m spent yesterday in Accra and I’m heading to the Cape Coast later today.  I haven’t travelled on my own for a long time, so I’m a little out of practice at figuring things out myself without any drivers or other resources.  But hey, I’m a resourceful girl and I’m sure I can figure it out.  I’ve managed to not check my work email since I left the office at 6 on Thursday and I’m hoping I can stay strong and avoid it until my return on Thursday. 

The Quarantine Chronicles: Volume 4

I ended up officially going into quarantine on day 6 of the 21 day observation period, so I ended up remaining there for 15 days.  For a little over two weeks, I could only go as far as my front porch.  I was still in the building where most of the staff live, so I would see normal life going on around me as people went to work, went out, went to the beach.  I just couldn’t really be a part of it.  Don’t get me wrong, people came to visit me pretty often, but it still felt like life was pretty much passing me by.

I know that some of you may be wondering whether I was scared about whether or not I had Ebola or not, but that honestly very rarely crossed my mind.  I had to check my temperature three times a day to make sure that I didn’t have a fever, but I knew that my contact had been so minimal that it would be next to impossible for me to positive. 

As I think about the experience now, the most striking thing was the endless monotony of it all.  People who know me well, know that I like to keep my schedule full.  I love planning everything, to the detail, in advance.  If my calendar isn’t full, I feel like I don’t have anything to look forward to and I start to get bored.  Well, for two full weeks I didn’t look at my planner at all, because every day was the same.  Some days I dealt with that alright and some days I didn’t.

On good days, I’d get up around 7:30 or 8:00, make coffee, and do work through the morning.  Then I’d usually eat lunch, take a shower, and work until the late afternoon.  At that point, I’d usually pop in a quick nap, then make dinner and watch Netflix until I went to bed.  Unless someone was coming to see me, in which case wine and chatting would be added to the Netflix portion of the evening.  On bad days, I would bring my computer to bed and make sure I didn’t have any pressing emails, then snooze/watch Netflix throughout the morning and maybe get a little work done in the afternoon… followed by more Netflix at night.  I managed to stay pretty positive throughout, but I would be lying if I didn’t admit that it was a very long two weeks.

Spending two weeks in such a confined space and seeing the same things, day after day, I began to get joy from very small things.  There was a particular mug in the apartment that I used for my coffee every day.  There was nothing particularly special about it, just a normal coffee house kind of mug, but there was something about it that I liked.  Even though there were probably 15 mugs in the kitchen, I would choose to wash out and reuse the same one throughout the day.  I became absolutely uncompromising about my showers.  Although we have pretty consistent hot water here, there are days when either the water has run out in the tanks or there’s no electricity to heat it.  Usually, I would just grit my teeth and deal with a cold bucket shower.  But nope.  Not in quarantine.  I would turn on my water heater about an hour in advance, then I would spend some time picking out music for my rock out shower.  And then I would have a rock out shower, singing along of course.  I also learned to appreciate my front porch.  The view on the ground floor is of course pathetic compared to the others, but there’s a beautiful hibiscus plant in front of it.  I made it a point every day around sundown to sit outside for a while and just sit.

I think perhaps the most surprising part of the experience was the last night.  Even though I was going back to the same job and desk and office I’d spent way too many hours in over the past two months, I found myself with the same jitters I’d had before my first day.  It felt like it had been so long since I’d left the apartment that I was anxious about going into work.  I knew logically that my anxiety was unfounded, but viscerally I just couldn’t shake it.

The 21 days between the day I found out my colleague was positive for Ebola and the day I was released from quarantine are ones that I don’t think I’ll ever forget… although a lot of them do blur together.  My colleague passed away less than a week after being diagnosed.  A week after that, his wife also passed away.  Although I didn’t get to work with him for very long, it still affected me.  In this kind of work, it’s easy to think of yourself as isolated from the world around you.  These things just don’t happen to us… until they do.

I know that this has been some very heavy stuff, so I want to end these chronicles with some of the my quarantine accomplishments:

1) Finally finished the book ‘Lonesome Dove’

2) Started watching the ‘Lonesome Dove’ miniseries, but then gave up because it was too horrible

3) Finished all of the Law & Order: SVU available on Netflix

4) Finished all of the Psych available on Netflix

5) Watched the latest season of Archer in one day

6) Bought a bottle of champagne to celebrate my release day and drank it after 3 days

7) Cooked every day (not that I had a choice, exactly)

8) Showered (almost) every day

9) Remembered to take my malaria meds every day

10) Stayed sane (or at least as sane as I was when I started)

The Quarantine Chronicles: Visual Aids

Here are some photos of my quarantine apartment 

The Quarantine Chronicles: Volume 3

As often happens in Sierra Leone, things change quickly and without warning.  Life was far from normal as we struggled to deal with the implications of having a staff member test positive for Ebola, but some things hadn’t changed.  I still got up each morning and headed to work and was free to move about as I pleased.  Within the space of about an hour, that all changed.

I was sitting in our Country Director’s office strategizing our response to the situation when she received a call that the Quarantine Security team was in our lobby.  We all looked at each other and she said, “Well, they’re probably here for you, mate, so I would suggest you make yourself scarce.”

The use of quarantine in Sierra Leone has been under considerable criticism over the past month or so.  The view of most people, myself included, is that it is used far too liberally.  As a result, there have been instances of people fleeing quarantine and actually causing the virus to spread more quickly than it would have otherwise.  A big part of the problem is when you have someone like myself, who had very limited contact, undergoing the same quarantine procedures as someone who was a close contact with the patient.  The level of risk for someone who had casual contact with a victim is extremely low, and since an Ebola patient is only dangerous to others after becoming symptomatic, the quarantine of low risk contacts is a considerable waste of resources.  However, as we struggle to make it through the last mile of this epidemic, the pressure to be seen as taking a strong long against complacency is intense.  As a result, we are seeing mass quarantines.

It turns out that our Country Director was indeed correct and they were looking for me.  In no uncertain terms, they said that I needed to be quarantined and if I didn’t do it voluntarily, they would take actions to make sure I did so.  So I came out of hiding and went to the ground floor apartment, which would be my home for the remainder of my 21 day observation period.

As I arrived home, I found myself somewhat in shock over everything that had happened over the past week or two.  Life in Sierra Leone is nothing like life in Boston, but up until all of this started, it had still been a normal life, albeit with its own quirks.  Now, somehow, within the space of two weeks I had watched my friend be carted off in an ambulance by people in space suits, learned that I colleague had Ebola, and been threatened with forcible quarantine.  The level of normalcy that I had started to feel here had been completely shattered.  I knew that my level of risk was very low and didn’t find myself worried about actually having Ebola, but I could just hardly believe how quickly the life I had built since January could be dismantled so quickly.  I had been displaced from my home, my freedom had been taken away, and I felt like I was losing control of my own life.

The Quarantine Chronicles: Volume 2

After our weekend scare, things went pretty much back to normal.  We were out of quarantine, back to work and all of us thought that the worst was over.  I boarded a helicopter on Thursday morning and headed out to Kenema to visit our OICC there without a care in the world, besides the normal crushing workload I was managing.

While in the air, I got a text message from a colleague that I supervise in Freetown telling me that he had gone into an Ebola Treatment Center for testing.  Ebola symptoms mirror those of a lot of other diseases like malaria and typhoid, so I didn’t find myself overly concerned.  With the number of cases dropping country-wide and the massive amounts of messages warning people to avoid touch and be extremely careful, it seemed unlikely that it could be Ebola.  So I put it out of my mind and went about my work.

On Thursday morning, as I was sitting in a training to observe staff and give feedback, I received a text message from another colleague telling me that our colleague was Ebola positive.  My heart dropped in my chest and my mind started racing, trying to think of what contact I had had with him.  I shoved my computer into my bag and left the training to try to find the Area Coordinator for Kenema.  I held it together until he closed the door of his office, and then burst into tears as I explained the situation.

The contact that I had had with this colleague had been very minimal, with the most extensive contact being when I let him use my phone to call some staff into work.  However, I was told that I would need to be quarantined, this time for the full 21 days.  It was decided that it would be best for me to return to Freetown for quarantine since I would be closer to a treatment center if anything happened and I would have my friends around.  So within the hour, I was in a car on my way back to Freetown.  However, I wasn’t to tell anyone about the situation.

Stigma around Ebola is still a very real issue in Sierra Leone and is fueled by misconceptions about risk.  Ebola, unlike many other diseases, is only contagious when a person is showing symptoms.  I had no fever and no symptoms, so I was not a danger to anyone.  However, we knew that if the details of why I was returning to Freetown were revealed, the drivers would probably refuse to take me.  So I sat in the car for the 7 hour journey, texting with everyone back in Freetown and trying to keep it together.

During the trip, there was a lot of back and forth about what exactly would happen to me when I arrived.  It was finally decided that I would stay in my house, but move down to an apartment on the ground floor where I could have the space to myself and be more easily isolated if anything happened.  When I did arrive, I spoke with our company doctor again, who had been speaking with our staff at the Ebola Treatment Centre.  It turned out that given how limited my contact had been, they didn’t recommend that I be quarantined, but just that I stay in the ground floor apartment for the 21 days.  I would be expected to monitor my temperature three times a day and promptly report any symptoms.

The situation had thrown everyone into a tailspin as we tried to trace any contacts of my colleague, so I was busy throughout the weekend dealing with that.  However, I was relieved that my contact was low enough to not warrant quarantine.  That was the day I took to calling myself the Queen of Quarantine, as to my knowledge I’m the only person on staff who had been quarantined twice within the space of one week.

The Quarantine Chronicles: Volume 1

My decision not to write over the past several weeks has been a conscious one.  I started off my time in Sierra Leone being surprised how little this felt like an emergency situation to me.  Yes, things were chaotic and the expectations on me were overwhelming at times, but it felt kind of like any other job. 

About a month ago, that suddenly changed.  I’m very conscious that my being here makes many of my friends and family members anxious, and for that reason I chose not to write about the things that have been going on for the last few weeks until they were all resolved.  So before you go any further, just keep in mind that I am completely fine and in no danger.  However, the experiences of the past few weeks have really had an impact on me so I want to share them with you.

I will begin when this all started, on February 15.  One of my housemates had been feeling poorly for a few days, but none of us were too worried.  We returned from a beach trip on that Sunday to find him in bed with chills and a fever.  After giving him some fever reducers and ORS for dehydration, we started the process of calling our company doctor.  It soon became clear that although his symptoms were not completely consistent with Ebola, they wanted him to go and get tested to be on the safe side.  Unfortunately, as we soon found out, that was not as easy as we might think.

The problem is not a lack of Ebola Treatment Centers (ETCs), but rather a lack of appropriate transportation.  A patient suspected of having Ebola can only travel in an ambulance that can be decontaminated and can only have contact with someone wearing full personal protective equipment (PPE), you know the stuff that looks like a spacesuit.  So we found ourselves waiting in limbo while our bosses were working to try to find transporation.  All the while, our housemate’s temperature was rising and he was becoming increasingly frustrated.

Finally, the ambulance came.  We stood watching from our balcony as a caravan of three vehicles came: one ambulance, one full of staff, and one full of PPE and chlorine.  The staff got out, sprayed the area with chlorine, and began the long process of putting on PPE.  If you’ve never seen anyone do it, you might realize that it takes almost a full 15 minutes to put on PPE and another full 15 to take it off.  The process involves multiple steps, almost all of which involve dousing everything in chlorine solution.

I had started to feel a combination of numbness and anxiety as I watched the men in yellow suits come into our apartment and then walk out with our friend, spraying down our apartment with chlorine as they went.  After he went out into the ambulance, we waited another 30 minutes or so as the staff took off their PPE and decontaminated the area.  As they finally drove away, we found ourselves sitting, somewhat shell-shocked in the living room.  I had never even had time to shower after coming back from the beach and could feel the beginnings of a sunburn coming on.

As per protocol, we were placed into quarantine until we could get the test results.  We tried to make the best of it, having dinner together and watching a movie.  Although we all knew logically that his symptoms were not consistent with Ebola and he had never had contact with an Ebola positive person, the entire experience left us all with our doubts.

The next day we waited, everyone finding their own way to pass the time.  Our apartment still reeked of chlorine, but in the light of day I found myself feeling less anxious.  We got news about the first test by about midday, and it was negative.  It turns out that the protocol is actually to have two tests done, so  we were told we would have to wait until the second test was back to have our freedom.  By the end of the day, the second test was back and we were free.

Our housemate was back by the evening, in much better shape.  It turned out that rather than Ebola, it had been E.coli.  I guess this just goes to show that when you’re in an epidemic, you better be very careful about the food you eat.

Daily sights

Finding Normal

I apologize to everyone that I took a little hiatus from writing.  My routine was disrupted by a few different things and my Sunday night blogging session took a bit of a hit.  Now that I’ve been here for nearly two months, I’m realizing that I’m starting to find my normal here.  Although my life here borders on the bizarre… taking UN helicopters and having my temperature checked 6 times a day or so, I suppose you really can get used to anything.  And, of course, not everything is so different.

In case anyone was wondering, Netflix actually does work here so Law and Order have been part of my weekly routine.  The workload here is heavy, but at least once or twice a week a make conscious decision to leave my work laptop closed when I get home and try to cook dinner and watch my Netflix.

Last weekend I was able to have a ‘treat yo’self’ weekend with a friend from work.  She’s lived here off and on for seven years so she knows where to find a good mani/pedi.  I usually work on Saturday, but I slept in and then met my friend for a mani/pedi followed by cappuccinos and pizza.  Then I went home and ate a really nice Valentine’s Day dinner that my roommate (who is French, mind you) made.  Then on Sunday, it was a beach day as per usual.  All in all, not a bad normal to have.

Some things, of course, are still harder to get used to.  Since the city is still on lockdown, we can only get groceries until 6 pm.  Since we all work a lot, it’s really hard to get to the grocery store before it closes, so that is a constant stressor.  And then when you do get to a grocery store, it’s basically a guarantee that you won’t find everything that you need.  They are all quite small and often lack basic things that we would consider a necessity.  I’ve started kind of picking up random things here and there that I know I would use for a recipe and then hoping that something will come together at some point.  I haven’t really found my cooking stride yet because it’s so hard to get ingredients, which is frustrating for me.

I’ve also been dealing with a lot of uncertainty around my job.  As I’ve talked about before, I’m the OICC (observational interim care centre) Manager, where children can complete their quarantine period if they don’t have an appropriate caregiver.  However, the number of cases is dropping quickly and as such, the need for OICCs is dropping as well.  For the past 3 or 4 weeks, there have been a lot of conversations about what to do with the OICC Training Team that I supervise as well as what to do with me.  For those who know me well, you’ll understand how hard it is for me to deal with uncertainty.  Finally this week, my role was decided and I’m quite happy with it.  I’m currently in a period of transition now to become the Freetown Health Manager.  I’ll be essentially supervising all of the health projects that are going on in the capital, which is great for me.  I will still have my OICC duties, but we expect those to start reducing quickly.

In the meantime, I’ve also been having a lot of things happening on the PhD/DrPH front.  I submitted applications for PhD/DrPH programs before I knew that I was going to have this job, so things have been moving forward with that since I’ve been here.  I applied to Washington University, Tulane, Johns Hopkins, and Boston University.  At this point, I’ve gotten interviews at all of the schools and already been accepted to Tulane.  I’m waiting now to see what happens with the other three schools as well as what the financial package will be at each.  Stay tuned!

Unsung Heroes

This week I was finally able to make it to Port Loko where we have our Ebola Treatment Center, which currently employs over 300 people.  This center has been the biggest piece of our Ebola response and has definitely gotten a lot of press.  However, I didn't even see the treatment center while I was there.  I was there to observe the OICC Training Unit that I supervise do a training at an OICC in the area.

I think in my earlier blog posts I talked about how OICCs started popping up all over the country with extremely varied levels of expertise and experience.  Not to mention the fact that everyone was figuring things out as they went along since no one had ever built and OICC before.  That situation was the catalyst for the creation of our training unit.  They travel around the country (often on a moment's notice due to the unpredictable nature of the ebola response) and do training and mentoring with OICC staff.

I arrived at the Lunsar OICC around one pm from Freetown and met two of my training staff at the OICC.  The staff were on lunch so we had a chance to chat a little bit about a training we are trying to schedule in a place called Kumala.  Unfortunately, this training has become a logistical nightmare due to the isolation of the town and a lot of inaccurate information passing back and forth.  I was at my wits end as I spoke with my team and said we may not even be able to do the training when one of them said, "Listen, this training needs to be done and we will find a way to do it.  If we have to go down there and sleep in the car, we will get it done.  Don't worry about it, boss."

After that little conversation, they gave me a tour of the OICC.  This is a follow up training, so they were telling me about the things they had addressed in the previous training like implementing a cohort system and handwashing stations.  I was feeling pretty pleased with the progress until I saw three caregivers working with the children without any gloves or PPE (personal protective equipment).  And then I watched as one of the caregivers walked out of the red zone where she had been working with the kids and into the green zone where I was standing and watching without watching her hands.  My heart dropped in my chest as I realized that I was at higher risk in that moment than I had been at any point during my three weeks in Sierra Leone.  The caregiver didn't come anywhere close to touching me and none of the kids were symptomatic (Ebola is only contagious during the symptomatic stage), so in reality it wasn't that much of a risk.

Anyway, my internal freak out isn't the point of this post.  What I realized from that experience is that the training unit that I work with is much braver than I had ever realized before.  They walk into these OICCs with no fear because they know that this training is essential to keep the kids there safe as well as prevent the spread of Ebola back into the communities.  You'll never hear about an OICC training team for a variety of reasons from politics here to the fact that it's just not as striking as an Ebola Treatment Center doctor in full PPE.  However after spending some time with this team and seeing their dedication and fearlessness, I wanted to share their story.

On the personal front, things are going pretty well.  I've realized that it's very important for me to define my own social life rather than just going along with what other people are doing, which is really easy to do when you live in a house full of people.  I've also realized that when you work with a pack of workaholics (and have some workaholic tendencies yourself), it's pretty easy to get into unhealthy habits like skipping dinner a lot and eating shawarma every day for lunch.  I'm trying to get a handle on what things I can actually cook here so that I can eat better and also trying to set boundaries like limiting work talk at home.  I know that this is an emergency situation and my life here won't ever be quite normal, but I need to make it as normal as a I can or I won't be able to cope.  This weekend I was able to take up my favorite sport again: boxing!!!  I had no hope that I would be able to do that here, but someone had a number for a boxing coach in her phone from the last person who had owned it so she gave it to me and I set up a lesson for today.  It just takes place on the beach, which is kind of cool... except that people kind of gather around to watch you, which is mortifying.  I realized two things during my lesson: I'm in awful shape, but the team at South Shore Sportfighting taught me well because my fundamentals were spot on :)  Watch out for my left hook, y'all, it's a knock out punch.

Afternoon view

UN Helicopter, it's how we do

Mind the Gap

I'm sure many of you have seen the signs in the London Tube (subway) that say "Mind the Gap."  As Americans, we love this little turn of phrase that is so different from how we would say it.  The signs are there to warn passengers to be careful of the small gap between the subway cars and the platform.  However, once in a movie or something I saw someone apply it to the gap between expectations and reality.  I think that perhaps the thing I will come away from this experience is a more skill in that particular area.

Anyone who has lived in a developing country can tell you that there is always a gap between what you expect and what happens.  You expect a bus to arrive around a certain time and it never comes... you expect a scheduled meeting to occur and no one shows up... you expect to watch a little tv and the power goes out.  The combination of an extremely poor country, a raging epidemic, and staff that are stretched to their limits means that expectations are further from reality than I think they have ever been for me.  As some of you may know, I like to plan just a little bit.. and I don't much like not being in control so this week I found myself testing the limits of my patience.

As I mentioned in my previous post, I was supposed to go to my site visit in Kenema on the UN helicopter.  The tickets come the day before the flight, so although nothing was confirmed I wasn't worried.  I went to a meeting at UNICEF that I expected to last for 2 hours... but the reality was that it lasted for three.  I got back to the office after 5 and found no ticket... I called our Administrative person who just said she wasn't in the office, so that wasn't much help.  Turns out no ticket had been bought, but it was ok because someone was going to set up a car for me.  Expectations: 0, Reality: 2

I was told I would be leaving at 11, so I was in my office just trying to get a few things done when I get a call from my boss who tells me I need to be leaving right now.  The drivers didn't know this, so although I got in the car to leave at 10:15, we ended up running around to get gas and whatever else to prepare for the trip and I still left Freetown at 11.  Expectations: 0, Reality: 3

By this point, I was close to tears and so frustrated I could barely talk.  All along the way to Kenema, the police set up checkpoints where they make you wash your hands and they take your temperature.  About 3 hours and who knows how many checkpoints later, I met up with the colleague who was coming with me to Kenema.  This colleague had been slow on emails and I didn't expect to really get along with her, but she was great.  Expectations: 0, Reality: 4 (see, they aren't always bad)

In any case, I think get the idea.  Despite my difficulty in getting to Kenema, my visit there went really well.  The OICC that GOAL is running there is very impressive and it was really nice to get out of the office.  I did a good job strengthening my relationship with one of the nurses on my team as well as getting to know my colleague who will be in charge of another OICC that we a planning on opening soon.  I left Kenema feeling really happy with the visit.  And I left on the helicopter :)

So, the first 10 or 15 minutes of the trip you feel like perhaps one of the coolest people in the world.  Then you realize that the noise is nearly deafening and you can't really do much and it does get old kind of fast.  But still, it was pretty cool to ride on a UN helicopter!!  I'm going to post photos in another post :)

One week down... or is it one month?

So, I feel that I must correct some misperceptions about my Sierra Leonean life and my participation in the fight against Ebola.  The media has shown all kinds of pictures in people in full body suits with respirators and the whole bit working with patients.  That is not my life. At all.

On a daily basis, I wake up in the morning and head into my office.  I generally either stay there the whole day or run around to various meetings.  When I do have to go to the OICCs (quarantine units for kiddos), I won't be allowed to go into any "red zones," which are areas where there is a risk of infection.  So all in all, my risk of catching Ebola is very, very small and my life is very different from those people who are working on the front lines.

In some ways, my life here is easier than my life was in Boston.  We have someone who drives us around (although making the arrangements for drivers can be a pain), someone who cleans our apartment, and someone who does our laundry.  So in that sense, it's much easier than home.  However, this is still an emergency situation and there are some things that are definitely hard.  Everyone here is working full stop, so although it's not explicitly stated, that's kind of the expectation.  I've been here for a week and I'm already attending meetings with major partners (like UNICEF) on my own.  There is no time to get oriented, you really just have to jump in with both feet and hope that you don't sink entirely.

As I'm sitting here reflecting on the past week, the thing that I can't get over is how quickly I found my place in the office and started taking on responsibilities.  That's why it feels like I've been here for a month rather than a week.  My biggest fear here actually isn't Ebola, but rather it's making a big mistake or just not meeting the expectations of my colleagues.

One thing that I can say for sure is that this will be an experience unlike any other I've ever had.  I'm surrounded by really incredible colleagues that I've already developed a great deal of respect for and I look forward to learning from them.  I have no doubt that coming here was the right decision and I just hope that I can rise to the challenge

So, here are some highlights from the week:
-We have a giant TV that didn't work, so I made it my mission to figure out how to hook up a computer to it so we could make movies.  And I was successful :)
-My roommate made chocolate cake and it was lovely
-I went to one of the beautiful beaches near Freetown and fell in love with Sierra Leone a little bit
-I found out that one of my colleagues, who is Serbian, lived briefly in Topeka, Kansas
-I realized that wine here is cheaper than at home, although everything else in the supermarket is more expensive
-I put up pictures in my room so now I have the smiling faces of the folks I love to keep me cheerful

Next week so far on the docket I have a trip in the UN helicopter to see our OICC in Kenema, a meeting with UNICEF, and a meeting with the Minister of Health.  So ya know, I'm of course not at all intimidated.

Apartment Photos!