Sunday, January 25, 2015

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

Sunday, January 18, 2015

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 :)


Sunday, January 11, 2015

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!







Wednesday, January 7, 2015



OICC vs. ICC vs. ETC (AKA: what are you actually doing?)

When I explained to people what I would be doing in Sierra Leone, I was somewhat vague.  This was somewhat intentional since I wasn't entirely sure.  Now, with two days of experience I'll try to make it as clear to you all as it is to me (so, not all that clear really).

The Ebola response involves a number of different centers that all have their own acronym: OICC, ICC, and ETC.  There are probably other kinds of centers as well, but these are the ones I know about.

In the simplest possible terms:

1) At ETC (Ebola Treatment Center) is where they treat patients with Ebola
2) An ICC (Interim Care Center) is where they provide temporary care for children who do not have Ebola and who have not been exposed to Ebola as far as anyone knows, but also do not have another living situation available
3) And OICC (Observational Interim Care Center) is where children who have been exposed to Ebola but do not have any symptoms complete their 21 day quarantine if they are not able to do it at home because there is not a caregiver available

So, I am the OICC Programme Manager with GOAL, an Irish nonprofit.  GOAL itself runs one OICC and will be opening two more, but my job is a bit broader than that.  As these OICCs have been sprouting up throughout the country, there has been a steep learning curve for organizations.  In short, and OICC requires a combination of child protection, psychosocial, and infection control expertise that very few organizations have.  GOAL has put together a team of 6 nurses who specialize in OICCs and our job is to provide training and support to OICCs throughout the country and make sure they are running correctly.  My job, specifically, is to supervise this group of 6 nurses and be the focal point for OICCs for GOAL.  So, that's what I'm doing.  Well, what I'm supposed to be doing anyway.  I would say I still have a lot to learn.

While I'm here, I might as well give you a little glimpse into my day to day life as well.  I live in a 4 story house with other international staff.  Each floor is self-sufficient and I live on the 3rd floor with two of my colleagues.  We have a love balcony where we have our coffee in the morning and the house itself is pretty nice.  However, there have been some challenges like my search for a can opener, which ended today, and my search for a coffee maker/french press/something, which is ongoing.  And our mattresses, which have zero give and feel kind of like sleeping on a piece of wood.

The city itself is really quite nice and we have a great view.  I put some photos on Facebook already, but I'll try to put some more up soon.  The infection control here is really intense.  There are buckets full of chlorine water with little spigots where you have to wash your hands before you go in anywhere from grocery stores to restaurants to our office.  At the office, we have to have our temperature taken by an infrared thermometer before we can go in and if it's too high we aren't allowed in.

As GOAL staff, we aren't allowed to drive so we go everywhere with either a GOAL driver or a hired car.  The car comes to our house at 7:30 every morning so we all help make sure everyone is up and make our coffee (in a little crazy thing on the stove... not quite up to my standards I'm afraid) then we all go off together to the office.

Overall I'm really liking things so far.  It's been easy to jump into the job and I'm enjoying getting to know all of my colleagues.  I'm still fighting jet lag, which has had me waking up at all hours of the night so far.  I think I'm still on a bit of a high since I've just arrived and I know things will surely get more difficult with time, but so far, so good.


Monday, January 5, 2015

Serendipity

It's not often that one thinks, "Man, I'm really glad that I got Dengue," but I really am quite glad.  The following things happened because I came down with Dengue:

1) I had enough time to pack up my apartment
2) I got to spend New Year's Eve with my Boston loves and see some very impressive cross-dressing
3) I had time for a Cheesecake Factory trip where I discovered the best cheesecake I have ever eaten (Dulce de Leche, try it)
4) I got to have some cheese covered Mexican food with my fellow punching enthusiast
5) I watched an entire season of American Horror Story and also spent some quality time with Charlie Kelly
6) I ended up sitting in front of the girl who hired me on the flight to Sierra Leone so I had someone to guide me through the rather complicated process of getting to my new home

I don't have much to share yet, but I thought that there were enough people that are anxious to know how it's going that a little post was in order.

As some of you may know, the only phone I have is my work phone, so I had to leave it at my apartment when I left.  I was meeting my good friend Gina at a T station in Quincy so we could drive to the airport together and she could take my car.  As it happens, we were running late.  So you can picture me, sitting at at T station waiting for Gina with no phone and thinking I was going to miss the flight.  I was the picture of tranquility, or course.  And we made it with no problem, so my anxiety was unnecessary, as per usual.  I spent my last few moments with Gina ravenously devouring the last bits of my cheesecake from the night before.  As they say, a journey of a thousand miles starts with one bite of cheesecake.

In the first 12 hours of my trip, I only managed to make it to New Jersey, so that was rather frustrating but then things really got moving.  From New Jersey I was on a 6 or 7 hour flight to Brussels.  It was delayed for an hour or two on the tarmac, which I handled with much more patience than I thought I had.  I guess I've gotten used to these things, but I still usually lose it at least once in every journey.  Then after a short layover in Brussels, it was on to Sierra Leone.  Just as a note, the Brussels airport was much less impressive than I had expected.  Sadly, it was just like any other airport I'd ever been to.

On the flight to Sierra Leone, I thought that the girl behind me had a familiar voice and I found myself wondering if it was Erin, who was one of the girls who interviewed me for my job with GOAL.  However, I didn't want to be the creeper who eavesdrops and then jumps into a conversation, so I didn't say anything until we landed.  And, as it turns out, it was her along with a guy named Sam, who will also be working with GOAL and happens to be from Boston.  So, I had a lovely guide to help me through immigration, the health scan, waiting for bags, buying the ticket to the boat, waiting for the boat for an hour and a half or so, and putting me in the car that would take me to my home.  These are the things that you would never expect to have happen, but sometimes the universe is looking out for you.

I'm staying at a three story house in Freetown with a lovely view and huge balconies on every floor.  The first shower I had was hot, but I've been told not to always expect that.  I think that I have to move bedrooms later tonight, but the house seems like it will be a nice place to be based.  Today I've managed to try to stay awake at the times that I'm supposed to, despite the 6 hour time difference, changed money, and bought groceries.  Tomorrow I'll go into the office and have another GOAL induction (number 4, by my count) and hopefully start to figure out what the heck I'm supposed to be doing.  I'll keep you posted!

Ah, I also had my first Sierra Leone faux pas when I tried to shake hands with a new colleague and was gently reminded that "we don't shake hands here."  Ah, yes.  That one will take a bit to get used to.

Friday, January 2, 2015

One more last night

There's something disconcerting about sitting in a place that has been your home with all (or almost all) of the traces of your personality removed.  Exactly three years ago, I was unpacking my car and trying to make Boston feel like home.  And now, I'm trying to come to terms with leaving yet another home.

I find myself much less emotional than I had expected to be.  I think there may still be a part of me that can't come to terms with the idea that tomorrow at this point I'll be several hours into my trip to Sierra Leone.  Of course, having my departure delayed by a week may be part of that.  I was supposed to leave last Saturday, but I came down with a little case of dengue fever and my doctor told me that I would not be getting on a plane last week.  Luckily, I'm feeling fine now and I'm ready to go.  At least physically.

I'm afraid I don't really have too much deep thoughts to share on my last night in Boston.  I just feel thankful for the support I've had from family and friends over the last several weeks as I've prepared to make this leap.  I have no idea what to expect down there, but I know it will be an unforgettable experience.  So.... stay tuned!