My journey home

My journey home to the US was uneventful. I miss the heat, the colors, and the sounds of Africa already. I was warned that Africa gets  into your blood and it is true! I was sitting in the airport in Geneva. It was rainy, dark and gloomy. I looked around at the 100 odd travelers and noticed that every single one was wearing black! It seemed surreal after the vivid patterns and rich colors in Sierra Leone.

I flew into Detroit which is not on the list of “approved’ airports. I was somewhat concerned about this but the travel agency assured me that it would not be an issue. Not only had they purchased my ticket well before the restrictions on travel, but my flight  originated from Geneva where I had spent time debriefing.

I came armed with a printed copy of the  CDC “Guidance for monitoring and movement of persons with potential Ebola virus exposure” document. They have done a great job with it and have stratified the risk into the following categories: ‘high’, ‘some risk’,  ‘low but not zero’ risk, and ‘ no identifiable risk’ category. They have added recommendations for specific groups and settings. Each category describes the clinical criteria and public health actions required. I fall into the “low (but not zero) risk’ category. Since I have no symptoms of Ebola, I should not have any restrictions on travel, work, public conveyances or congregate settings.

I made it quite far through the customs process before anyone thought to ask me about the countries that I had visited. My customs official actually took a step back when I told him ‘West Africa’. He carefully handed my passport back to me and told me to follow the blue line. As I continued on, I could see him speaking urgently into his walkie-talkie (and using hand sanitizer!). The blue line seemed to stretch for miles. There was no one else on the blue line. I finally reached the end of the blue line where several other agents were waiting for me anxiously. They had contacted the CDC official that was assigned to the airport and were waiting for her arrival. As you can imagine, there was pages and pages of paperwork that had to be completed. Yes, my temperature was taken (again). I was offered an Ebola Care Kit which included lots of basic info on Ebola, a thermometer, a symptom card and symptom log, a “Check and Report Ebola Card” or C.A.R.E card, and a list of state health department phone numbers.  The CDC has assigned a number to me for tracking purposes.

Since I was traveling on to North Caroline for a few days before returning to Kentucky, the local health departments in each state were notified.

Once I arrived in NC, I was immediately contacted by the Forsyth County health department. They came out to the house to speak with me and of course, fill out MORE paperwork. I was the second person from West Africa that they have had to follow and apparently the first was extremely uncooperative, refused to answer questions and moved in and out of the county several times. They were very grateful that I cooperated! For the duration of my stay, they phoned me daily to check on my temps and health.

I am now being followed by the Fayette County health dept. Yes, they too had to come to the house and fill out the exact same paperwork that was filled out in Detroit and in NC. I am the only person from West Africa that  they are checking. Each state has different regulations about monitoring for EVD; KY requires that the health department call me twice daily for temp and health checks. Rather inconvenient for all of us but easy enough to do. I am to notify them and must receive approval before I leave the county.

Almost everyone has been very glad to see me.  One lady at my gym backed away from me and sniffed “I am surprised that you are not in quarantine!” I had to laugh. This is the same lady that told me her husband would not fly for work any more because they were worried about catching Ebola from someone on the plane.

I am still not used to the casual touching, it catches me off guard. Will I ever get used to it ever again?

My journey and blog has come to an end. Thank you for sharing it with me. If I can make it back over the West Africa, you will be the first to know!

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One last story

I received a garbled message about a new Community Care Center in the Western District. I called the District Nurse (the Matron) and set up a time to meet with her. The location was a small village called Kontolloh on the outskirts of Freetown in the Western District. The village was perched on a very steep hillside with an outstanding view of the Atlantic. It was very difficult to transverse the rutted paths in our 4×4 vehicle and I was afraid that we would turn over. Street signs are non-existent in Sierra Leone and we had to find out way by consulting various random strangers, all whom were happy to help.

We had intended to visit the Community Care Center but instead ended up at the community health clinic by accident. Hannah, a friendly and welcoming nurse who runs the clinic, greeted me. She called the Matron to let her know where I was and while I was waiting for Matron to come collect me, she gave me a tour of her clinic. This clinic is one of the few in the country to continue to provide preventative care during the Ebola crisis. It was immaculately clean and well cared for. The employee running the screening triage table actually had on the correct PPE, had a laminated copy of the screening algorithm to determine who was at high risk for Ebola, and conducted the screening appropriately. It was amazing since these basic things were lacking at many of the treatment facilities that I had visited. All of the chlorine hand wash buckets were neatly labeled with its contents. The clinic had originally been set up by a nonprofit organization that had pulled out financially after it was established. They had a brand new fridge for storing vaccines and medicine. Although the clinic itself did not have electricity, the fridge was connected to a generator for a 24/7 power supply. In addition to providing immunizations, they treated routine health issues such as malaria, STDs, respiratory infections and the like. The medication room was sparkling clean and everything neatly labeled with the name of the medicine and expiry dates. On the wall were handwritten posters clearly outlining the hand washing procedures as well as how to mix the chlorine solutions appropriately. The next building was used for labor and delivery. Maternity services are almost nonexistent in SL as it is such a high-risk procedure involving vast quantities of body fluids. I meet the 5 dedicated midwives that worked there. The conditions in this part of the clinic are appalling. The staff lacks proper PPE. The L&D room is tiny and dark with 2 metal rusty VERY narrow beds on either side. It is inadequate for their needs. They average 10-15 deliveries per week; often 4 or 5 women will be in labor at the same time. The other side of the clinic has a small two-bed room that provides post-natal care for 24 hours. Unbelievably, there is no running water. If water is needed, they must buy it from a vendor down the street and carry it back to the clinic in buckets. They have no budget for water. They are short on delivery kits. They have 2 sets of instruments but need 4 or 5. They meticulously clean and wash their dirty instruments after a delivery and then autoclave them in what looks like a pressure cooker. It is heated over a charcoal fire. They have a tremendous need for used clothing and diapers. They have no blankets to swaddle the infants or clothes to send the babies and mothers home. They realize that they are at high risk for contracting Ebola. Women in labor share many of the same signs and symptoms as Ebola patients and it is difficult to differentiate one from another. They have tried to make accommodations for potential Ebola positive mothers in labor. They have a cholera bed (bed with a hole in the center for body fluids to leak into a bucket below) in between the 2 buildings but it is not covered. They have received training and have the procedures carefully written down.

The far side  of the clinic backs up to  a steep hill and is surrounded by a half-finished fence which the non-profit organization never completed. Hannah told me that the clinic was attacked by armed robbers the other night who crept down the hill in the dark. Shots were fired by the thieves who were then frightened away by the arrival of the police who have a station nearby.

The clinic has done so much with so little. They really need an outside organization to sponsor them. They need running water, new equipment and funds to purchase used clothing. They need diapers. They need PPE to protect themselves. The grim reality is that they will probably never receive any of this. I wish that I could change their situation, they deserve better

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Pics of “The Zero Star Hotel”

Believe me, the pics make it look much better than it was! Please note the lack of a toilet seat. Don’t be fooled by the presence of a sink (or the water tank for the toilet) —- it was not hooked up! While the pic of the bed makes the room look spacious, the room actually ended where I was standing. You can see that I have the mosquito net draped over the curtain rod since there was no hook available (as is usually customary). The fan was mounted on the ceiling above my bed but was useless anyway. I did not take a pic of the ants, wish I had.1111142215a1111142215

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Pics of my favorite kids!

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Scenes from Sierra Leone

Random pics from SL!

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Leaving Africa

I sadly depart for Geneva today. It has been one of the best experiences of my life. My colleagues are for the most part, brilliant, dedicated professionals doing a very difficult job under very stressful conditions. I was honored to be part of the team and I made many good lifelong friends. The country is very beautiful and the people are warm and welcoming. They are in desperate need of Infection Prevention Specialists as well as other professionals here, including nurses, doctors, epidemiologists, anthropologists, water sanitation engineers and logisticians, among others. The ranks are staring to thin as we head towards Thanksgiving and Christmas. Everyone fears that West Africa will be deserted over the holidays allowing the Ebola transmission to spiral out of control. I would urge all of you to consider coming. The need is tremendous. It is definitely a life changing experience to work in a developing country. I never felt to be in any danger here. I did not provide patient care and am at low risk for exposure to Ebola but the risk to healthcare workers is also low, assuming proper infection control procedures are followed. The training sessions are extensive and thorough. The outbreak will not end any time soon. Please come, take a chance , get out of your comfort zone. Please also consider making a donation to a charity of your choice that is involved in providing services to West Africa. There are many non-government organizations such as Unicef, Oxfam, World Food Program, to name just a few that provide essential services. I will definitely come back to  Sierra Leone if I have the opportunity.

I am worried about my reception in the US. Flying there is only the first hurdle. I will let you know how it goes.

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Last day in Sierra Leone

The road leading to the hotel is a rutted half-mile path lined with shanties filled with families. There is no electricity or running water. Meals are cooked outside on charcoal pots. I have become very fond of the families that live there. Isata sells fruit outside of her shack to the hotel guests. She is perhaps 35 and has 6 children of her own. She also looks after her brother’s 8-year -old twin daughters. Her brother and his wife are deceased but it is not clear whether they died of Ebola or not. Isata was a classical dancer pre-Ebola. She had a thriving business catering to ex-pats and international business travelers. Her dance studio was located in the business district and she would frequently travel to exotic locations to compete in dance competitions. Once Ebola hit, she was forced to close. Her family had previously owned this stand and she was lucky to be able to relocate there. She sits outside with her tray of fruit piled up. Behind it is a crude one-room shack in which they live. We stop to buy fruit from her every day, especially pineapple and coconuts. I buy even if I can’t eat it all just so they have something to eat.

The children are absolutely beautiful and are always so happy to see us. My daughter Molly (Molly, you are awesome!) made a bag of those oh-so-popular Rainbow loom bracelets and I was able to share them with Isata’s family. The girls were absolutely delighted and wear them with pride. Not to be left out, I handed out several soccer balls to the boys on the street. I had come home from work one day and had seen the young boys playing soccer with a rock. It broke my heart. All the boys want to be soccer stars.

I brought two large bags of lollipops from home (Dum-Dums of course) and I usually try to take a walk several times a week, handing out “sweets” to all of the children. They come running when they see me but they know not to touch. The children take baths every day in basins outside their homes. Like kids everywhere, they love to bath. They are so cute standing in the basins covered with bubbles and laughing. They are trying to continue learning despite schools being closed. One evening, I saw one of the 10 year olds standing in front of a line of young children ranging from 2 to 8 years of age teaching a lesson about letters, numbers and the days of the week. This week I purchased 25 composition books, crayons and pencils. I ransacked my backpack and came up with dozens of pens, highlighters and other random business supplies. They were so thankful. I had intended the school supplies for the children but so many teens crowded around asking for school supplies that I had to get a few more.

It was very sad to say goodbye to them today. Isata informed me that the hotel is intending to pave the road and they have been told to leave. They have nowhere to go. The children all crowded around to say goodbye and blow me kisses. Isata presented me with a necklace that she made for me. It is beautiful. I will miss them.

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