Quarantine Blues

Week number 2 of quarantine is almost over, and I will be glad when the 3rd is over. It is quite difficult to be back home, and yet not to get the usual hugs from my children and son and daughter in laws, and friends as they welcome you back after 3 months away. Alabama seems to have their act together in checking the post Ebola exposure doctor; in that they require me to check my temperature twice a day, with one of them being directly observed by a health department employee. At least they come out to the house every day to accomplish that, and so I am not forced to travel. I can't really say the same about the Atlanta airport--they seemed to be sort of making up their approach as they went along. It was quite an adventure getting through airport in Atlanta. I figured with the CDC there, they would have the procedure down as to what they do with people coming from West Africa, and maybe they do, although if they do, they hide it quite well. I waited in incredibly long lines just to get the privilege of filling out your custom forms, and getting pictures taken, and then we still had to fill out the regular form and get a picture taken at the custom desk. Of course, that is the same for everyone, but I think they could have it much more efficient and streamlined. ( I spent about an hour in line, and I had a connecting flight 3 hours after touchdown. So anyway, I had on my form that I had been to Sierra Leone as well as Holland. The customs officer asked, "You came from Holland?" I figured that I would only answer questions that were asked, so I said yes. Then he asked, "what was the purpose?" and I replied, "for vacation." So everything was fine, until he said at the very end of the interview, "did you visit any other countries?", and I replied Sierra Leone for 3 months. I wasn't trying to be smart or hide anything, as my form clearly stated where I had been. But, suddenly, I was public pariah number 1. He handed me a mask, told me to put it on, and called for "special transport." So I was stuck there in the line, with a mask on, and I am sure that everyone behind me in the line was saying "what did this poor fellow do?" But, unfortunately, special transport never showed up. So he called for someone else to come, and they took me to a side room where there were returning CDC workers, all with masks on as well. So, I thought to myself, "At least I have company." And then they took my temperature, and asked all the appropriate questions. But saying that you had been working in an Ebola Treatment Center was not the right answer. That landed me in a separate room, more private, and then a doctor and a helper came in, and again took my temperature, and asked me all the same questions. Except that they very busily wrote down all the answers. So that took quite a while. The doctor explained that I was only the 2nd person that had worked at an ETC to come through Atlanta? Hard to believe, but maybe true. She then consulted someone else on the phone, and they decided that I could go on. But then it was on to another room, where they gave me a cell phone so they could call me (I get to keep the cell phone, but it is not a smart phone, sigh!), and a packet. Only then, I was allowed to leave to go to my next flight. But as I got to the carousel to pick up my baggage, my investigators came running and made me come back. Apparently someone had decided I shouldn't fly, but then as I waited there in limbo, they must have been overruled, and they let me go back again and get my luggage. By this time, I had used about 2 1/2 hours of my 3 hours layover, and I still had to go through security again. So there were a few tense moments, as they picked my backpack to do an intense search on. So I ran through the airport, taking the train between terminals, getting to my flight as the last people were boarding, and I slipped on. So, for 1 more week, (I have already served 1 week in Holland and 1 here in quarantine) I will be taking my temperature twice a day, morning and evening, and the evening one will be personally observed by a nurse who comes out to the house...so I should be well taken care of. I am allowed to travel, but only in private car--no public transportation....which works out well here, since there is not a whole lot! Glad to be back though, and look forward to getting out of quarantine and getting back to normal! I will be doing work here but personal things like taxes, sending out wedding invitations, :) etc. It is so nice and warm here, and green! And such a nice time to get back...And purple martins galore, and the bluebirds are nesting, so it is quite nice. I quite see why people hide symptoms! If you say something, you get a penalty. I woke up one morning this week with some hiccups that lasted for 10 minutes or so, but then went away. So when the nurse that comes out to check me once a day came, he asked if I had any symptoms. I told him about the hiccups, and later in the day he called me back to tell me that I need to self-isolate for the rest of the weekend, even though they vanished and I have absolutely no other symptoms. Next time if I have hiccups, you won't hear it from me.

Going Home

    Here in Lunsar, the time has passed rapidly.  The rainy season is still a couple of months away.   The three months that I have been here has not seen more than a whisper of rain, and so water is becoming more of a scarce commodity.  There is dust married to the leaves everywhere, as they say here in Sierra Leone.  The river down from Bai Suba which was the local gathering place for all things, washing cars, trucks, clothes, and bodies, usually all at the same time, has long since dried up.  I don't know where the new place for those activities would be, but it must be harder for everyone now.  I saw a water truck the other day delivering water up and down the street, since many wells are less and less supplied, unless they are very deep.  
    The bustle and excitement of having 12-15 doctors and that many nurses as well has decreased to where the center will be down to 5 doctors when I leave.  It will be harder to fill the shifts, and if someone is sick or unable to work, it will be impossible.  But with the census down, it doesn't make a lot of sense to recruit a lot of doctors for the time being.  So the Ebola treatment center will get along with only 1 doctor per shift.  There are many observations that one could make after a time here.  You certainly have to change your mindset from "do everything immediately" to do things in an order that keeps you safe.  So many things that you have to learn are now just second nature.  From donning and doffing the personal protective suits, automatically starting in the suspect ward, moving down to probable, and then finally to the confirmed ward--none of those things require a lot of thought any more.  I sometimes wonder about the good that we did here.  After crunching the numbers, I found that the death rate when we treated more aggressively with IV rehydration and more aggressive fluid resuscitation was not that much different then it was when things were done less aggressively.  But as I stated before the main work of the ETC is to get people that have the disease in an environment where they can be taken care of and helped with the pain, and other discomforts, and to protect the community.
     And so, we wonder, what sort of time frame is there until Ebola is done?  At one point, it looked like April 1st might be a possibility, but now the rate of fall has decreased and more likely plateaued in the country.  However, in our center, we are pleased that the number of confirmed cases has fallen dramatically however.  Only 3 deaths from Ebola this month, compared to 16 or so per month for the first 2 months I was here...
    But we keep plugging away, and won't stop, even though I will not be personally involved, until all Ebola is don don. (meaning finished).  God willing, that will happen sooner than later.  I leave you with some photos from my last couple of days.

Colleagues right before I left--Some great friends here

Sign out front of Ebola Treatment Center--says thanks for coming, but misspelled kam--should be that instead of cam

IMC vehicles lined up before the beginning of the days activities

Dust "married to leaves"--the leaves are really quite green

Ambulance bringing a patient on my last night in the ETC

Last time to put on PPE--quite a sober look there...

Selfie after getting out of the PPE--again for the last time

Glimpses of the Kingdom

In several ways this weekend was a hard one. Jon had quite a few very sick little patients, one of which did not survive. One of my colleagues suddenly lost her 14-year-old child. I knew the boy, as he often was around at the office. He was a smart-looking boy, quite small for his age. I learnt his name and tried to make sure to greet him by name whenever he was around. He seemed to like that and I felt we bonded a little. The last time I saw him was when I came from Bo and he came back from a visit upcountry. For several hours we shared the back seat of the Save the Children’s vehicle. He seemed alright then, although he was coughing a bit. And now he is already gone. He didn’t die from Ebola, but I wonder if he might have survived if there had been better care. And that is simply not available at the moment. So many hospitals are closed and people don’t have access to good treatment.

This morning in church the tears came. I tried to stop them, but it was hard. After a while I was calm and able to concentrate on the service. When it came to the Intercession, we had a single prayer today: “Lord, have mercy on this country; let the Ebola epidemic come to an end…” At some parts, the man who prayed stammered: how do you express the deepness, the vastness of this crisis…

But the prayer was framed by stanzas of an old hymn: Amazing Grace. I listened to the strong voices of the people around me, Sierra Leoneans who have been through the war, through years of poverty, and now through an Ebola crisis. And we are not even talking about the personal tragedies of sickness, death, betrayal, unemployment…

Through many dangers, toils and snares,
I have already come;
'Tis grace hath brought me safe thus far,
And grace will lead me home.

This is what gives us hope. His grace is sufficient, even in the hardest of times. The church in Sierra Leone is holding on to this, and in doing so have been a great example and inspiration to us.

After the service, people didn’t want to go. They lingered around the altar and when the choir broke out in jubilant praises, they joined in: “I have no other God but You… You are the most high!” Soon many were dancing, singing, praising God. I noticed one of the directors of the National Ebola Response Centre, along with others in “high places”, dancing together with children who were delighted to get rid of some energy after sitting through a long service. I just stood there and watched and knew: this is a glimpse of the Kingdom… 

Top 10

Ten reasons why it’s time to go home…

10.  I actually have come to like the smell of chlorine.

9.  Three pieces of toast with either frozen butter or lukewarm jelly, but not both, tastes good every morning for breakfast.

8.   A bin los pan una.  (I have not been seen by anyone in the States for a long time)

7.  Wearing rubber boots all day long no longer hurts my feet terribly after a couple of hours due to huge calluses on my big toes. (BTW, does anyone who designs boots actually wear them?--inquiring minds want to know?)

6.  I never get tired of the waitress replying every night excitedly, as if it was a gourmet restaurant, in response to my question, "Well, what do you have tonight?  --"We have feesh, or we have chicken, with rice". (Well, that is not completely true--sometimes she says, "We have chicken, or we have feesh, with rice.")

5.  Small annoyances no longer bother me, such as having an inadequate supply of water or phone credit.  (Again, maybe not completely true, but at least I have learned to not stress about it)

4.  I have learned not to include the word 'maybe' in my sentences. In order to not appear callous when someone asks me to bring them a present back from my break, for example, I would say, 'Maybe I'll bring something back," meaning I probably won't.  However, I should have realized that anyone who desperately wants something does not have receptors in the brain for the word 'maybe'….

3.  I have learned how to make the clicking sound in the back of your throat that can express many different things--such as 'I hear you', 'I agree with you', 'I disagree with you', or 'I have a wad of something caught in the back of my throat.'

2.  I have read all the books that I have in my possession...

And, the number 1 reason that it is time to go home is.......

1.  Our wedding is only 9 weeks away!!!

So, what are you actually doing in Sierra Leone?

One of my (Heleen's) favorite starters for any training in Sierra Leone has been a simple exercise: I ask all participants to stand up and to slowly turn around… all the way around … and carefully notice their environment, which is usually a big room filled with tables, chairs, and other people, and some windows which allow you to look outside. Then I ask everyone to squat down and do the same thing: turn around… all the way around …. and carefully notice what you see. This usually evokes quite a bit of laughter as there are always some stiff-limbed or high-heeled participants who struggle to keep their balance or even actually roll over!

                                                              

When everybody has returned to their seats I ask them to share the differences between their first and second time of looking around the room. Participants share how the first time they are able to see far away, across the tables and chairs and even further away through the window. The second time their view was much more limited: the tables and chairs suddenly seemed a lot bigger and blocked their view of the “bigger world”.

The exercise is called “Seeing the World from a Child’s Perspective” and it helps adults to remember that the world looks quite different through the eyes of a child. The world of Ebola is confusing enough for us adults, but even more so for children. In an earlier blog I wrote about some of the experiences children are currently going through and how I was hoping to contribute to the work Save the Children is doing to help children cope with these stressful events.

So these are a few of the things I have been doing over the past weeks:

-          Spending days in the Save the Children’s office to develop relevant training materials for various groups

-          Training Save the Children staff from Freetown, Pujehun and Kailahun on how to recognise symptoms of distress in children, and how to provide basic psychosocial support

-          Training of 22 mental health nurses stationed across the country in the management of more severe mental health symptoms in children who are affected by the Ebola crisis

-          Participation in meetings with Unicef, the Minstry of Social Welfare and other NGOs to give input in the development of guidelines and strategies

-          We (Save the Children) took the lead in the adaptation and translation of the Child Psychosocial Distress Screener for use in Sierra Leone. This tool will help us identify children in need of advanced psychosocial services.

-          And a very exciting project which I am working on right now: the development of a curriculum for Child Survivor Groups for children who have recovered from Ebola. Many of these children have lost family members, and the admission in the ETC has been quite traumatic for many of them. They told me about a little boy who is afraid to go to sleep as he remembers how people in plastic suits would come around at night to take away the bodies of the people around him who had died. I am sure there are many stories similar to his. In the child survivor groups, the children will be able to share their experiences and – we hope – find strength and courage again.

And what else have I done? I’ve sold or given away most of my belongings built up in 12 years in Sierra Leone, and am still in the process of deciding what of the leftovers will go into the three suitcases that Jon & I are hoping to take back. Initially it wasn’t easy to part with some of my “stuff”, but God has given me a real joy in seeing people go through my things and find just what they need - or like J. I have closed my bank account, sold my car, and am saying goodbyes to long-term friends. Although they may not be goodbyes forever – sometimes I think I am falling in love with this country all over again…. And having a fiancé who is eagerly studying Krio probably contributes to these feelings! J

Often my heart bleeds for the brokenness of this nation and sometimes I want to give up, go away and never come back. But the God of all grace continues to give strength. So we look up to Him who blesses us with guidance, strength and peace, and trust Him to direct us.

Save the Children Office in Freetown

Save the Children Office in Pujehun

Parebul den (Proverbs)

In reading over the teachings of Jesus, I have been struck by how often he used metaphor and parables in his teaching.  Often his teaching was of the kind where the people could understand every word that he said, because it was in their familiar language, but had absolutely no idea of what he actually meant.  Of all cultures I know, the West Africa region seems to be most blessed with proverbs.  They even call them  parebuls here and they are not unique to Sierra Leone, as Guinea Bissau had many of the same ones, just a different language.  I just love the way they condense a truth into a few words, and so I am going to give a few of them here, with the English interpretation. Keep in mind then that my explanation, might not even get down to deepest meaning of the proverb, of course. One word of explanation for those of you who actually know Krio....I don't have the two extra characters on my keyboard, so all backwards c sounds I have spelled with an o, and the small capital E I just changed to E.  So you know how the words are pronounced, so just do it.  Aw fo du?  ( What can you do?)

1. PeshEnt dog it fat bon.   (the patient dog eats a fat bone).  If you wait for something, you often will be rewarded more than if you try to grasp it right away.

2.  Kaw we no gEt tel, na God de dreb in flay.  (For the cow that has no tail, it is God who drives away the fly.)  A helpless individual has no option but to depend on God, as he can't help himself.

3.  Bad bush no de fo trowe bad pikin.  (A thorn bush is not a place to throw a bad child)  Even though a child is mischievous or bad, it is impossible to sever the relationship.  They are still your child (Do you hear echos of the prodigal son here?)

4.  Tek tem kil anch, yu go si in gut. (Broke my rule there, should be backwards c in gut--it means, take time to kill an ant because you will see its guts)  I am not exactly sure what this means, but I believe it means that sometimes the consequences of our actions are more than we bargained for.  

5.  Troki wan box, bot in an shot.  (The turtle wants to box, but his arms are too short)  Some people attempt things they have no business attempting, because they are impossible for them to begin with.

6.  Pikin we no mEn na os, na trit de mEn am. (A child that is not trained at home will be trained in the street.)  Someone will train your child, but hopefully that happens at home.

7.  Pikin we wan wEr in papa in trosis, na rop go it in wes.  (If a child wants to wear his father's trousers, the rope will eat his waist)  Assuming responsibility too big for you will be a burden, not a blessing..

8.  Fol we no yeri "shi", go yeri ston.  (The chicken that doesn't listen to 'shi', will hear a stone)  If you don't heed a little warning, you will be hit with something a lot more forceful and more painful.

9.  Doti wata sef kin ot faya.  (Dirty water will still put out fire).  I think this means that you don't always need the best of everything to accomplish the task--anyone else know different?  This is comforting for missionaries who often deal with work in less than ideal circumstances.

10.  An go, an kam.  (Literally, arm goes, arm comes)  This means that one good turn deserves another....

11.  Watasay ston no de fred ren.  (The stone in the river doesn't have to be afraid of rain)  Again, I think this means that if you already have your share of trouble, then a little more doesn't add that much? Someone may correct me on this.

12.  Ol kray du fo berin.  (All cries do for a funeral)  Maybe, any sympathetic act in a time of death will be appreciated.

13.  Wetin de pan yams we nEf naw no. (Broke my rule there, but didn't want two no's together...There is nothing about yams that the knife doesn't know)  A man of experience has been through it all, just like a knife has cut through all parts of many yams in its lifetime...

Well, I could go on an on with parebuls, or proverbs from West Africa--there are so many.  And I haven't even got into all the idioms that need interpretation, such as you shot krab (you shot crab) meaning that you failed in your attempt...even if you hit it, there would be nothing left!

Another personal story

Heleen and I are together for a wonderful 9 day time of R and R in Freetown.  The stresses of a hectic work week have given way to a delightful time together and a time to visit some of her friends here in Freetown.  So, Sunday, we made our way down to the house of Abi, one of her friends whose husband died during the Ebola epidemic of last fall.  Her house was in a small waterfront area of Freetown.  Outside the breezes blew freely, but inside the heat of the closed in house and the intensity of her story made us sweat, as we sat, and listened, and listened..and she had much to say.... Her husband, Pastor Tholley, was a man of only 54 years, a pastor, and they had been married almost 34 years.  He got sick back in August of 2014, at the same time as the whole country of Sierra Leone was under a lock down ordered by the President.  So at that time, there was no facility to treat any sick people, plus people were not allowed on the streets anyway.  So his illness, which included symptoms of fever, abdominal pain, nausea, and vomiting, which are some of the cardinal signs of the Ebola virus.  She wanted to get some medicine for him but no pharmacists in town were treating any patient who wasn't there in person.  So she told them the medication was for her, and by giving his symptoms as her own, the pharmacist gave some medications that he thought might be helpful.  And then unfolded the saga that just literally makes you sick, as you realize that this scenario unfolded many times in Sierra Leone.

   No medical help was available, so she remained there at the house and tried to be his nurse.  Some pastor friends came over and spent the whole night in prayer for his life, but he continued getting sicker and sicker..as day 1 passed, then day 2, and finally day 3....until finally he lost his valiant struggle for life.  He died as she lay on the floor of their house outside his room.  This happened on Saturday...Since it was not clear what had killed him, they called the burial team as directed by the government.  But the burial teams were either busy or not responsive, so Saturday came and went, with the same response on Sunday.  By Monday, the smell was getting unbearable.  She tried to spray air freshener, but it did little good in the face of a dead body there in the small house. 
    Mercifully, and finally, the burial team arrived on Monday, and picked him up.  They did the test for Ebola, and took his body away..They grabbed the mattress, the blankets, and the body, and pulled everything out of the house, and then burned all the personal effects, mattress and all.  She was left to clean up the house by herself...as she grieved.

   In the meantime, the friends that they had were very reluctant to visit or even call, as everyone was scared of getting whatever it was, whether Ebola or not.  . One of the disappointments for her was the lack of response from her own church, but I believe everyone was just too scared to do anything. And, I don't blame them, as no one knew what to do.  It was pretty much every man for himself at that time.   Plus, travel was prohibited, so no one came to help..

   In the meantime, she wanted to get the result of the Ebola test.  But the person at the government office said she would need to pay 500,000 leones (100 dollars) to get the result...which she did not have.  (The report should have been free!) So the family did not have the result they needed to make decisions about anything...Eventually, at the graveside the next Saturday, they were to find out that his test was negative, but that did not take away the suspicion in the neighborhood.

  So now, 6 months later, she is slowly recovering..back to work, and slowly making headway on some of the bills.  Her main livelihood is not possible right now, as she is a distributor of palm oil in Freetown.  Travel is still restricted, so she is not able to do that business right now...The nightmare of the last months is slowly fading, but the scars still remain.  She no longer attends the same church, as the scars of desertion were too great for her.  But she still expresses a deep faith in God, the God who will continue to carry her through.  As I asked her permission to share this story, I sensed that she wanted to allow it to go forward to encourage, not to discourage. 

Here is a photo of Pastor Tholley and Abi, along with Heleen, when she lived with them back in 2005.  Heleen doesn't want this photo shared, but it is the best one of the two of them...so here it is.