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.

St John's Hospital, or Mabesseneh, as most people call it, is an important link in the health of people here in the Lunsar and Makeni area of northern Sierra Leone.  Run by the Catholic order St. John's of God, and sponsored by Spain, it was quite well known in this area for quality health care with a more loving approach than is sometimes characteristic of health care in West Africa.  So, people came from far away to seek treatments here, even from the neighboring country of Guinea.  Their usual census was from 60-80 patients, and they did a large maternity business and a full array of surgery.  But in fact, it was this very fame which became an Achilles heel, as a patient from Guinea came there for treatment of an ill defined fever, diarrhea, and headache in September.  Unfortunately, he turned out to have Ebola, and before the plague was stopped, Dr. Manuel, a Spanish priest and the beloved surgeon here for many years had died, and about 9 nurses who had treated the patient ended up dying as well.  So the hospital was shut down in September, and has been closed for the past 5 months.  With the help of IMC (my parent organization), St John's built a very nice triage center where every patient checking into the outpatient clinic would be screened by people in protective equipment, and if they have no suspicion for Ebola, they are referred on to the outpatient treatment center where the patient can see the doctor.  It started about the 2nd week of January, and has rapidly grown to now seeing about 35 patients a day or so.  

After training the staff at St John's in donning PPE--ready to go

  So this next week, the hospital will open once again, with the triage center functioning as well for screening all the inpatients as well.  If a patient does show some suspicion of Ebola, then they are referred over to our ETC for testing.  Of course, we pick up many cases of malaria, acute gastroenteritis, and other issues that are not Ebola, but that is okay.  So far in the 4 weeks, only 7 or 8 patients have had to be referred to the ETC, and I am happy to report  that all of them have ultimately been negative for Ebola.  So that reflects more the fact that Ebola incidence is falling here in West Africa than necessarily anything else, but I do think the screening process works.  So that is why we feel pretty good about the process of opening one more of the cogs in the health care system here in West Africa.  There are plans to assist with the opening of up to 6 or 7 other local health care facilities with the help of IMC, but that process has been a bit slower, so I suspect that many of them are a good 2 months off.

One of the buses used for transport of staff at the hospital

Sign over top of the entrance at St. John's

   I have spent a great deal of time there over the 6 weeks that I have been here.  And, although not as exciting or risk taking as working in the ETC, it is probably the more important role here in Africa for the long term.  So it is good to be part of the whole recovery of the health care system here.  It is not enough just to stem the tide of the Ebola outbreak, but the future is important too.  I hope that organizations can see the need for ongoing work.  They have recruited doctors and staff from Nigeria to help run the hospital, and as far as I can see, it looks like we will be good to start up the week after Valentine's Day.  We do have a surgeon who is here from Italy for 1 month, and after that, it looks like other volunteers will be coming as well. Perhaps in the near future,  St. Johns will once again become a powerful force in the health care system of Sierra Leone.

Dr. Manuel, the surgeon who died

The new entrance to St. John's hospital, with triage area to the right Doctors helping with the training from IMC head towards the main hospital

Consider the Lilies...

“Consider the lilies of the field…”

I (Heleen) love this Scripture, as it seems to tell me that Jesus – while travelling long distances by foot and tending to the needs of the crowds – did not get so distracted by his work that he no longer saw the beauty of creation around him. And he didn’t just look at it; he let it speak to his heart. The flowers and the birds were to him a reminder of the love and care of his Father in heaven.

Over the many years in Sierra Leone I have had moments when I made myself look away from the brokenness, the dirt, the dust, the darkness, and instead search for beauty: large white clouds against a blue sky, the leaves of a palm tree rustling in the breeze, a sunbird dancing over a flower…

Yesterday I didn’t have to look far: in the little patch of garden right outside my veranda I found this beautiful double hibiscus…

“Therefore I tell you, do not be anxious…”

Worker PTSD

It would be crazy to say that being here in Ebola land does nothing to your psyche.  I think of the hundreds of workers who have been here for some months, trying to make a difference in a terrible disease.  But most of us are not used to having 60-70% of our patients die, the statistic that seems to be relatively steady in our treatment center.  The only thing that gives us the impression that we are making any difference is by looking at the total number of patients, and factoring those into our psyche.  For example, the other day, we discharged 6 patients from the center in 1 day, but all of them were Ebola negative from the beginning, so they never had the disease.  So although it seems like some progress is being made, it is a false mirage, one that promises water without delivering any.  The disease itself continues its terrible rampage, and the benefit of our treatment center may be in getting those with Ebola out of the community, more so than actual benefit to those patients.  

So far, in this blog, I have avoided giving much personal introspection, and have made it more of a travelogue.  However, the individual cases eat at your insides, and linger long after the patients die.  Yesterday, we admitted the husband of “Fatimata” (not her real name).  She died last week, after the battle was lost. We thought that she might be the very first pregnant lady to survive the disease in our clinic, and for a couple of days, it looked like that she would make it.  But then, she rapidly deteriorated and died over the course of a couple of more days.  And so now, here comes the husband.  What about the 4 children who are at home, wondering if they will get to see Dad again?  One of his symptoms is hiccups and bloody diarrhea, and both of these are not good signs….I am certain that he will be positive, (he was) and the question is--will he make it home and return to his family?  ...This randomness of death and destruction plays with your mind.  I think of one doctor who was a pediatrician here who stated that he had certified more deaths here in 6 weeks than he had in his entire career up until now.  In Family Practice and ER work over the years, I cannot say the same, but the degree of deaths and percentage are like no other disease that I have seen. And so all of us are weary in a way that defies compartmentalization. We absorb all of this into our psyche and it wears you out emotionally.

We discharged “Mamood” earlier this month….Mamood’s mother had died in our center, and it appeared that the disease might escape the rest of the family, when a week went by with no problems...but I remember the day that Mamood and his father were both admitted to the unit.  Both of them walked in, but only one walked out--the orphan Mamood, at age 8 facing an uncertain future.  Will his village take him under their wing? It certainly seemed that way when they returned him to his village.  We hope that they will take over for his absent parents.  But what really will happen?  These are the questions that haunt, and we know that this same scenario has happened so many times over the past months here in Sierra Leone, Liberia, and Guinea.  

These are the questions rolling around in the back of the mind, as I trudge through the Ebola ward tonight.  The questions roll back and forth, and do not go quietly into the night..

Here are photos from the ETC.  Here is the main street in the compound

The Probable Ward across the red fence

Inside the medical tent, where charting and computer work is done

Looking towards the psycho-social department from the medical tent

The doffing station, where we take off our Personal Protective Equipment

This is the Suspect Ward in the background, and on this side of the fence, the donning station, where we put on our PPEs

Boots drying in the sun, ready for reuse

Pharmacy tent

On the road...

Over the past week I (Heleen) travelled across Sierra Leone. First to Pujehun, in the far south, then to Kailahun in the east. It was nice to get away from Freetown, the always busy city, where the Ebola messages are right in your face, non-stop: posters, paintings, radio messages, etc. etc.

Now I looked out of the window and saw beautiful wide rivers, birds dancing in the air, a mother playing with her baby, holding him high over her head, a child smiling and calling out “Pumwuy!” (white person), a little boy holding a goat (upside down) under his arm. Despite the dryness of this season, I spotted some beautiful flowers: bright red, purple, yellow… The Ebola crisis seemed far away.

But when taking a closer look, I noticed the differences with earlier visits: schools are locked up, playing fields deserted. In the markets all the stalls are empty. There is not much activity around the clinics and hospitals. We passed several Community Care Centers for (suspected) Ebola patients and one of the MSF Ebola Treatment Centers. Then there were the frequent checkpoints where we had to come down from our vehicle, wash our hands with a chlorine solution and have our temperatures checked. And anytime I looked out of the window my view got partly blocked by a sticker saying “Stop Ebola. Prevention is your best protection.” Ebola is real, also outside Freetown. In fact, Kailahun was the district where it all started.

In one of the villages I chatted with two teenagers, a boy and a girl selling oranges and sweets. They told me they have no idea when their school will reopen, but “If school opens tomorrow, I will go back,” the boy said determined.

In Pujehun I met with the Save the Children staff. We brought out large sheets of paper and started describing the Ebola crisis through the eyes of a child: no school to attend, not being allowed to touch your friends, hearing non-stop Ebola messages on the radio, seeing graphic pictures displaying the symptoms of Ebola, hearing people talk and use unknown language: quarantine, contact tracing, swab taking… As farming activities were restricted, many families faced hunger and malnutrition. Children saw the ambulances come and go. An SCI staff commented: “they will say, ‘that ambulance took my mother and she never came back’…” People in strange suits came to the village to remove the dead in plastic bags. Some children survived Ebola but were no longer welcome in their communities.

The next step was to think: how would children feel about all these things? Another long list was made: sad, afraid, confused, abandoned, stigmatized… And then the last step: how may children behave when they feel like this? Some withdraw, some cry, some wet their beds, others struggle with concentration, while there are also children who become irritable and start fighting a lot.

It was a very helpful exercise which opened our eyes to the psychosocial impact of the Ebola crisis on children. We can’t change what has happened to the children, and may not be able to change what is happing to them today. But together we can make efforts to help children come to terms with the stressful events they have experienced. That’s what I hope to be doing over the next few weeks…

My visit to the Kailahun Field Office was cut short when I came down with food poisoning. Never a great experience, but worse in the era of Ebola. I was not allowed to work and had to spend most of Thursday in the staff guest house, resting and drinking lots of ORS. Thankfully my temperature remained within the normal range and today I was able to travel back to Freetown. Please keep me in your prayers as I further recuperate…

On the road...

Beautiful rivers...

This is the road to Kailahun - a district with a population of 465,000!

Temperature check

The dusty town of Kailahun, a district capital without paved roads...

Put to shame...

We have so much, so much, so much

We have so much, so much, so much

We have so much, so much, so much

To be thankful for!

We have our nurses, to be thankful for…

We have our doctors, to be thankful for…

We have our children, to be thankful for…

Etc.

Everyone was dancing as they were led in the song by a nurse preparing to work in an Observational Interim Care Centre (OICC).

I was at the world’s first ever Unicef training on OICCs. I’m not sure that’s something I would naturally feel thankful for… OICCs are places where children are kept who have been in touch with Ebola patients (for example parents, brothers, sisters) and who have no other place to stay. For 21 days they are kept apart as much as possible, and cared for by women dressed up in plastic suits… If one of the children becomes sick with Ebola, the 21 days start all over again for the rest of the group.

Among the trainees were several survivors of Ebola. Since they most likely have developed immunity from Ebola, they are much sought after as carers in OICCs.

We started the day with sharing our experiences as child caregivers. I always feel slightly self-aware in an exercise like this. In Sierra Leone, to be my age and not have given birth to children is highly unusual, and for local women an area of great concern and stigma. But the slight uneasiness I felt soon vanished when a sweet-looking lady told us: “I used to be a mother of two, but I lost them both to Ebola…” And another woman: “I used to have eight children, but I lost them all to Ebola…”

And yet, these women were there, singing: “I have so much to be thankful for…”

We rush to emergency areas around the world to tell people how to cope with loss and grief. And are put to shame…

Together - at a safe distance :)

So today Jon was able to swap a shift with a colleague and come to Freetown for the weekend! We were very happy to see each other again - although we have to keep a safe distance, which means: no touch! We are having a good time talking through the experiences of our first 10 days here, drinking good coffee, eating good food, and planning our wedding! 

So here's a picture of "happy us"- maybe pushing the distance a little, but still no touch! :)

We'll be going out for dinner this evening (in one of the few places that are still open) with some friends and are hoping to attend church in the morning before Jon leaves again for Lunsar.

Things seem to be getting a little better with the Ebola crisis. We hope that this will continue and that we can soon call this crisis history. 

Much love from both of us - we are grateful for your prayers!

FEAR

   I sit here on the backside of another day here in Sierra Leone, after working during the early shift at the Ebola treatment center.  I enjoy the sunlight, which here at this time of year lasts until close to 7 pm.  The harmattan season has been nice here in Sierra Leone to bring refreshing breezes and cool weather at night, making the night shift almost cold at times in the medical tent.  A jacket is advisable, that is for sure.  And I contemplate that emotion called Fear.  
   I think that I will capitalize it during this blog, because Fear is a hard taskmaster.  It is like a many headed monster that once you get one part beaten down, another rears its head and attacks with just as much ferocity.  I am guessing a bit like fighting an octopus, or playing that video game where you bop things on the head with hammers....Fear will change behavior and inhibit a person.  The Bible talks about ‘Perfect love casts out fear’ and yet we struggle with it in our lives over and over.  We tend to fear the unknown, or fear what we do not understand, or even in cases of those with panic disorder, fear Fear itself.  None of us are immune to Fear.  Right now, in America, people are very fearful of the Ebola Virus, even though only 4 Americans have been infected, and only 1, a Liberian with US citizenship, has died.  It is natural for Americans to fear a disease that seems to be hard or impossible to control, and so many laws have been put into place by fearful people, trying to control that Fear.  But in coming to Africa, I felt that I was somewhat immune to that myself.  My familiarity with Sierra Leone and West Africa might allow me to skip some of the elements of fear that would normally beset a newcomer..

  But welcome to the real world.  I found that traveling throughout Sierra Leone actually made me feel more secure, because it seemed as if people were going about life as normal.  People on the streets, hawking their wares, Okada (motorcycle) drivers still driving insanely, and shops and markets continuing to sell.  So, I was quite surprised at several of the fears that I had, as I worked at the Ebola Treatment Center.  The first time back on the ‘hot’ side of an Ebola treatment center, even though my involvement was limited, I could feel the fear creeping up into my throat.  How will I survive?  Or will I even pass out, not being able to breathe, protected by a full body suit, goggles, and apron, and no exposed skin anywhere?  The fear was palpable, a presence that threatened to strangle, even to throttle you.

  A different type of Fear for me here this time is an insane worry about every little symptom, something that often goes completely ignored in another context.  I don’t worry about symptoms of my body, particularly in America, but here I go down through my mental checklist of what is normal, and what is not normal with Ebola.   It is common to get loose stools in this environment with different foods, but now, “Is this the first sign of Ebola?” Or waking up at night sweating on a hot night, and wondering, “Was that from a fever?” Or a bit of dizziness--is that the first sign of illness?  Even though none of these things are rational thoughts, there they are, particularly in the middle of the night, when all fears seem to be worse.  Or for the first couple of days, due to decreased coffee intake (2 early cups only per day), I started with headaches in the afternoon.  Well, headache is a symptom that we ask every day in the clinic of each patient, “Yu ed, de at?”  (your head, does it hurt?), and so is that an early symptom.  So, another worry..

   As with all irrational fears, it doesn’t help to use reason, because they are of course irrational.  So reasoning will not help to quell the anxiety that you feel, or the tightening of your throat muscles.  But time and experience do help.  I know now how protective the suit is of any virus getting through.  And I know that there have been no cases of illness after 4 months of work in Liberia and Sierra Leone in the staff of IMC.  And it does help to calm things down, to rest, to sleep…”He leadeth me beside the still water”.  I don’t think God wants us to worry, but he also brings peace.  He doesn’t deliberately lead us to the areas that are very troubling.  He is able to quiet us down, even if the circumstances are not quieting.  So, God becomes the stabilizer, the Rock, or the Anchor to which we hold.  Thanks be to God..