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.