the other baby J.

**For some context, in November of 2014 the Ebola Treatment Unit (ETU) we worked in had the highest census of the entire time it was open; we were overwhelmed with patients from three different Ebola hotspots exacerbating the epidemic within about a 6 hour ambulance drive from our ETU.  Throughout the time IMC ran ETUs (and other organizations as well), there was a constant effort to improve treatment and quality of care.  But the limitations were extraordinary–very little was known about what treatments would be efficacious against Ebola, it was difficult to access or import needed medications and equipment, direct patient care time was limited by the short duration of time one could safely work in hot conditions while wearing PPE . . . it was hard.  In hindsight, we learned a lot, there are things we would change if given a chance to go back, and we hope that data that is being analyzed even now will shed more light on how to better treat Ebola next time it rears its ugly head.**

This month of stopping, of coming off the adrenaline-driven 14 months of working to fight Ebola in Liberia, has finally granted the space and time to process much of what happened during that time.  In the middle of sweating through a shift at the Ebola Treatment Unit or preparing for marathon Ministry of Health meetings or painstakingly reviewing budgets at midnight–there wasn’t time to process much of the emotions of any of it.  Those had to be pushed to the side, compartmentalized into a corner of our minds and hearts so we could just cope and keep going.  This is the reality of an emergency, but not a healthy long-term method of coping.  So I expected to begin to remember, to think, to feel in these weeks.  But nothing prepares you for loss and grief, no matter how professional and clinical and ‘used to it’ you are.

Journal Entry, November 2014

J. should not have died.  I’m convinced that ultimately it was not Ebola that killed him; rather it was the awful reality that no one had the time (or PPE endurance) to sit and hold him and coax fluids into his weak and tired body.  He lost so much, and my heart broke to hear his whimpers and see his floppy body on that bed all alone {baby J lost multiple family members to Ebola, several in our ETU}.  I wish I’d started sooner, I’d taken more time for him–I wish everyone had. 

But on the {ETU} ward there is precious little time to do what needs to be done, and the loudest voices (or vomiting) get the most attention.

In a crisis, there is little else you can do.

But it’s still so wrong.

I tried to block the memories for a long time, but I remember.

I remember picking up this precious child one afternoon on my shift in the ETU confirmed ward, from his mattress on the cement floor.  He was so weary, so sick, his body worn out from fighting and losing so much.  I held him, and he flopped his little head against my breast. Only, he couldn’t really feel me, through the layers of my heavy vinyl apron and my PPE suit and scrubs and three pairs of gloves.  And he couldn’t really hear me, through my hood and two masks.  And he couldn’t see me, through my sweaty and fogged up goggles.  I slowly squirted ORS from a syringe into his mouth, tried to patiently wait for him to swallow. Heard the calls of the clinical team needing help with other patients.  Knew he needed someone with him all the time, to give him more than a few cc’s of fluids, to hold and comfort him, to tell him he was beautiful and precious and worthy and so very loved.  And I couldn’t stay.  I couldn’t be that person–our time inside the unit for that round was almost up, measured by the amount of sweat filling our boots and how little we could see out of our goggles and our shallow breaths taken against sweat-soaked masks.  I prayed over him, sang over him, laid him on that forlorn mattress all alone on the floor.  I resolved to prioritize his care and ask a couple other clinical team members to do the same on our next shifts inside the unit.

Baby J. died that evening, alone, before I got a chance to go back into the Ebola confirmed ward.

 

 

 

On Leaving Liberia

When you are living the small, hard-fought, incremental changes it is often impossible to see the improvements, to recognize the significance of the work. These last few weeks of knowing we (Megan and I, along with many of our colleagues) were leaving Liberia we have felt the weight of this–we had not accomplished all we aimed to, we knew there was and is so much work left to be done in this fight to ensure that Liberia is prepared and ready to respond to Ebola when it next threatens and to deal with the repercussions of the EVD epidemic that will go on for many years.

I returned to Liberia from my last R&R on November 18th, and less than 24 hours later a confirmed Ebola case was identified. My team and I spent the next 21 days heavily involved in responding to what ended up being three EVD cases by supporting infection prevention and control and screening at multiple health facilities, providing intensive daily monitoring at high priority health facilities, having ambulances on standby to transport of suspect Ebola cases to the ETU, attending multiple daily coordination meetings . . . it was a tiring three weeks and came at a time we had planned to focus on wrapping up our program and phasing out projects. Instead we had to ramp up our activities for the 21 day Ebola follow up period which left us with very little time in the end to wrap up 11 months of work.

Over our last few days, we have been in a hectic, sleep-deprived rush to finish up projects and handover programs, to file documents and write reports and deliver last-minute supplies, to say goodbye to friends and colleagues in our own organization, in the Ministry of Health and county health offices and health facilities, in other INGOs. There has been a constant reminder that there is SO much we set out to accomplish but weren’t able to do because of limited time or money or manpower or delayed decisions and management–it has felt defeating.

But.

Our perspective is small and while it’s not untrue that there is much we did not get done and much work still to do, it’s important to see the good of the current reality in Liberia. This past Monday I (Sara) was privileged to sit in a room with 80+ members of the staff team I have worked with in the SRU Program for the past 11 months. We gathered to discuss what we learned, what we could have done better. But also, we remembered what we did accomplish–the training and mentoring, the hundreds of thousands of people screened at health facilities, the supplies and PPE we provided, the construction and improvements we put in place, all with the goal of making health facilities safe for patients to seek care in and health care workers to work in–and while it was all a drop in the bucket of the needs and gaps, it was our drop to make and I am proud of our team for the work they have done.

It was poignant that Megan’s and my last night in Liberia was on New Year’s Eve. We packed and worked frantically all evening but left to join friends before midnight, gathering under the stars close enough to hear the ocean waves rolling in. Our cheers and obnoxious horn-blowing at the stroke of midnight was a declaration that 2015 with all its challenges is DONE, lived, behind us.

Our two favorite drivers picked us up at 2am to take us to the airport and as we drove along the same roads by dark that we drove in on on November 8, 2014, I was overwhelmed with the differences. Then, it was pitch black and the whole country was under a nighttime Ebola-driven curfew–no one was in sight other than military and police officers at checkpoints ensuring that the only people out on the roads were government or humanitarian aid workers. It was eery, like a ghost town, a place under great fear and distress.

This time, a New Year had dawned. There were colorful Christmas lights stretched over trees and fences and buildings, parties going on and churches open for late-night services,  and children running along the roads beating drums made of jugs and pots and sticks, jubilant in the New Year. I want to leave with this Liberia in my mind, the one that has survived, has revived, is alive and pulsing with resilient hope and expectation for the future. The mourning has turned to dancing, there is light where there was once darkness. And we are grateful.

A Year Ago Today

  

Today is exactly one year from when Sara and I embarked upon our journey to Liberia to be apart of the Ebola mission. As if to underscore the personal, national, and international events of the last year, yesterday we held the official closing ceremony for our first ETU. This is a part of the national strategy to close ETUs and integrate Ebola care into the existing healthcare system. Looking back over the last year I cannot help but feel so many things: sadness, anxiety, thankfulness, anger, exhaustion, frustration, satisfaction, blessing, disappointment, hope, fear … the list is long. The emotional response is not straightforward, nor is the way ahead for Liberia.

Our ETU in Bong served as a beacon of hope in the middle of Liberia during the worst outbreak of Ebola the world has ever known. We cared for sick and dying patients inside of those walls, we comforted colleagues and family members over the loss of life, and sometimes we were fortunate to be able to dance and sing with those who were discharged, free of Ebola.   Faces, voices, and songs come to memory, reminding of a time that was very dark and at once very light. There is no way to express all that was experienced in that place. The ETU changed me, as it changed all of us. And now, it is empty of workers, clinicians, and staff. Our ETU has closed.

This brings with it a certain level of accomplishment for us as expat staff, but much more so for the national staff who took up their own cause and fought for their family members, neighbors, and country. But just as there was the terrifying unknown of live Ebola virus during an active outbreak, the same daunting uncertainty applies once the transmission has stopped. No one knows if and when it will return. We can hope and pray that the systems that have been built and left in place will respond appropriately in the next outbreak. But, I have become more cynical in the last year as I have been apart of laying the foundation for those systems and have watched others build onto it. As I participate in the closing down of our ETU, I fear that those systems and protocols may not hold. Without adequate and sustainable supplies, supervision, and human resources; the high vigilance needed cannot be maintained. From where I stand, it would not take much for the levee to break and for Ebola to flood the country or region once again.   It wouldn’t be as bad as before, but even a minor repeat of history would be devastating.

So I pray and hope. I pray that the decommissioned grounds of the our ETU, and the several others that have already closed, will remain signposts for Liberia, reminding this nation from where they’ve come and an encouragement to keep crawling, walking, and hopefully running towards a healthier and safer future. I pray that we can continue to honor the dead, those who had Ebola and survived, and those communities and families that were decimated by the disease. I pray that my Liberian sisters and brothers will remain diligent and not fall asleep at the post, but instead continue to build on the knowledge that has been learned and ensure that it is cemented into the foundation of their country.

And I pray for myself and my expat colleagues, that we won’t forget this time and simply stuff into our humanitarian backpack, letting it sink out of sight and out of mind. Instead, I hope that this global experience of fighting Ebola will impact the way in which we provide aid, whether on the international or personal level. I hope that we will respond swiftly, and with integrity and accountability to the beneficiaries, during the next disaster.   Better yet, before the next disaster starts, I hope we continue to build into the infrastructures that can prevent such wide spread devastation.

Personally, I am exhausted from this fight and from this mission; emotionally, spiritually, physically, and mentally. Blessings and many thanks to Sara in sticking this out with me, but she feels the same. And yet, we know it is not yet time to leave. We have 2 months to go, utilizing the support and funding prompted by the Ebola emergency to build up the health care systems as much as we can prior to our own discharge. Some NGOs will stay for future development, but the big push, the big money, and the big outcomes are here and must be used now. So here we remain, running towards the finish line in this race that, for some divine reason, has been carefully marked out for us. Please pray that we can lay aside every obstacle and hindrance, and keep running with endurance, grace, peace, and hope. Thank you to all who have supported us thus far: expat and national colleagues, friends, and family. We could not continue to do this without you.

Much love,

#TeamStopEbola

Thank You Too

And so I’ve returned to Liberia. I was home in the DC for the last couple of weeks; seeing family and friends, packing up my belongings, and processing the last few months of work and life. And now I’m transitioning back into life as an expat and back into this other home.

My last homecoming to the states in December felt vastly different then this most recent trip. Previously I came from fatigue, exhaustion, and disease. However, when I left for my break a few weeks ago, the epidemic was over for Liberia, we fought Ebola and, by God’s good grace, we had won.

Yet, the epidemic is far from over. Unfortunately, there have been 5 positive cases in Liberia in the last 2 weeks. Thankfully the outbreak is actively being contained by county health teams and our own program’s teams. However, in Guinea and Sierra Leone there are still discoveries of new hot spots and unexplained transmission. While we have worked hard to set up border control check-points and screening units within the communities and clinics, the borders are essentially porous. The stories from both countries are reminiscent of those from almost a year ago: fear, stigma, harsh government edicts/action, and a minimal health behavior change. The epidemic in Liberia was fought through education, adherence to protocols, and communities banding together to spread the truth about Ebola. One of the many reasons the epidemic did not hit its predicted potential, was because of this massive change in health beliefs and health behavior. In a matter of mere months, Liberians participated in a public health miracle that I believe traces back to their resilience and faith. The war may have left scars, but it bound them together in the end; with a deep current of several faiths propelling them forward.

After my first deployment, I returned to a very different Liberia than the one I encountered in November, during the height of the virus, in Bong county, where Sara and I were stationed. My position shifted to oversee training instead of direct care and, around this time, transmission decreased drastically. By February we had no new confirmed cases in our ETU. While there was rejoicing, it was an oddly trying time. Disasters bring people together and provide purpose. As the emergency faded and we struggled to move ahead to rebuilding Liberia, angst and anxiety arose in both national and expat staff.

I was also questioning my place in Liberia. I didn’t feel useless, but I did feel purposeless. The work at the time was slow, a purgatory of sorts between the original response to the epidemic and starting new programs focused on post-Ebola preparedness.   I wasn’t sure I would come back after the next leave. It was a topic of conversation daily between myself and my colleagues who had been there since the beginning of the response.

Some people did leave. They had worked hard and well, their time was over and they could see clearly that another opportunity awaited them. I felt less clear and stayed in Liberia through the ambivalence. After going on leave for a week or so, I returned and found our program launching an entirely new training. It was tiring and unknown, but it felt good to look back at the end of a week and to have accomplished something. Maybe we didn’t save any patients, but we were teaching counties how to potentially save lives through appropriate response and isolation within communities if a hotspot were to occur.

During this time my professional skill set seemed to potentiate. I started working on budgets, pipelines, hiring requests, and organograms. While I enjoyed being in the field, I also had the opportunity to participate in and contribute to meetings linking the technical expertise and experience from the field to decisions being made on a national level. I could never have gained this experience in such a short time in a US based program. I have nothing but thankfulness for the opportunity.

So for a time, I forgot about my angst in the need to work. The questions of how much longer and is this right for me have started to surface again, but without the same desperation and exasperation attached to them. Time will tell. As I’ve waited through a few cycles of indecision I’m beginning to remember that my timeline is and always has been in God’s hands. At times I remember this more than others. Generally it’s the times of tears and frustration that I forget, but He is gracious and brings me back to His reality.

As a result, I’ve decided to return to Liberia and remain here for the next few months. Most likely staying out of the states until the New Year (maybe beyond?).   My most recent time home was invaluable. Physically being present with friends and family was needed and wonderful. It aided in processing the events of the last few months and settling me in the decision to return. I will miss so many things from home: bike rides with friends, Rock Creek Park (my personal natural refuge), intimate talks with girlfriends (and their husbands), cheese, etc… But, there is still a calling to Liberia, to Ebola, to be abroad. I am not sure when the door will close, but currently, it still seems very much open.

When you say thank you in Liberia, the response is thank you too. There have been many thanks given to the international community for our response to the epidemic. But, all I can say back is “thank you too,” Liberia. Thank you too for welcoming the NGOs, for responding as a nation to the crisis, and for staying Ebola free for 3 months. Thank you too for welcoming me into your lives, teaching me about perseverance and conviction, and allowing me to be your “bosslady.”

And thank you too, to friends and family that have prayed for me, encouraged me, hugged me, and cried with me in the last few weeks, months, and years. At the end of the day, I am simply returning to a job – but one that is currently requiring me to leave the home I love. I couldn’t do this without the tremendous support of loved ones both in the states, as well as my community in Liberia. For God has blessed has me there as well with support, for which I am most grateful.

I’ve been meditating on this quote from Frederick Buechner:

“In a world where there is so much drudgery, so much grief, so much emptiness and fear and pain, our gladness in our work is as much needed as we ourselves need to be glad. If we keep our eyes and ears open, our hearts open, we will find the place surely. The phone will ring and we will jump not so much out of our skin as into our skin. If we keep our lives open, the right place will find us.”

This describes both the encouragement that I feel in returning, but also the responsibility that I must still take in the venture. I feel as though my phone has rung and I am finally living in my skin. And my most heartfelt response to this calling and action is to jump up, look with my eyes and heart above, and say thank you too.

Sober Truth

Today, Elizabeth Elliot–I hero of my own faith journey–died.  Her life was not in vain.

We want to avoid suffering, death, sin, ashes. But we live in a world crushed and broken and torn, a world God Himself visited to redeem. We receive his poured-out life, and being allowed the high privilege of suffering with Him, may then pour ourselves out for others.-EE

EBOLA FREE!

Earlier today I posted this BBC article regarding the BIG NEWS–today the World Health Organization declared Liberia officially “EBOLA FREE”!!  Read the full WHO statement along with an overview of the epidemic in Liberia–but the best part is here:

Interruption of (Ebola) transmission is a monumental achievement for a country that reported the highest number of deaths in the largest, longest, and most complex outbreak since Ebola first emerged in 1976 . . .

It is a tribute to the government and people of Liberia that determination to defeat Ebola never wavered, courage never faltered. Doctors and nurses continued to treat patients, even when supplies of personal protective equipment and training in its safe use were inadequate. Altogether, 375 health workers were infected and 189 lost their lives.

Local volunteers, who worked in treatment centres, on burial teams, or as ambulance drivers, were driven by a sense of community responsibility and patriotic duty to end Ebola and bring hope back to the country’s people. As the number of cases grew exponentially, international assistance began to pour in. All these efforts helped push the number of cases down to zero

Friends, supporters, random readers–thank you for joining us in this fight, for praying for us and encouraging us and spurring us on.  I am filled up to overflowing with joy today and am so honored to have stood alongside my Liberian brothers and sisters who truly bore the heaviest burden of this awful epidemic.  I am looking forward to hugging and high-fiving colleagues soon instead of having the elbow-bump be the substitute for all forms of physical touch.  I keep thinking, remembering–there are some awful scenes, yes, scenes I will never be able to banish of human misery and stifling heat and death.  But there are so many good memories– working in the Bong bush and hearing our staff start the day singing praises, sunsets bathing the ETU in a strange beauty, the relief to breath freely again after getting out of PPE, and mostly the patients– many did recover and we got to celebrate that, and we continue to rejoice in their LIVING.  (Remember baby J?  this photo of her mama on her discharge day is a perfect picture of the JOY in life!).

The battle, though, is not over.  Until all of West Africa is declared Ebola free, we must remain vigilant.  And we are many months away from that reality, as there are still new cases every week in Sierra Leone and Guinea.  We’ve been transitioning programming for awhile here in Liberia, but today’s declaration is all the more reason to focus hard on our efforts to prepare Liberia for any possible future Ebola cases–through training health care workers and county response teams (what Megan does), developing safe and effective screening and isolation at health facilities in the country (what Sara does), rapidly transporting suspected patients and specimens, and finally maintaining an open Ebola Treatment Unit until we are SURE that Liberia is prepared and West Africa has Ebola under control.

But today?  Today we celebrate!

Good News!

A couple of pieces of good news in an otherwise rather grinding week of proposals and meetings–

1) the Partners in Health staff member infected with Ebola last month in Sierra Leone has recovered!  Discharged today from NIH–such a relief!

2) last week there were the lowest number of cases of Ebola throughout the region since LAST MAY–that is fantastically encouraging news.  This battle is long and as we were eloquently reminded by a fellow humanitarian worker from Oxfam last night, often the last mile is the hardest and the longest, but the most critical to reaching the finish line.

Tomorrow (Friday) is a national holiday in Liberia, the Liberian Fast and Prayer Day.  So very glad that this day can be filled with much rejoicing as the last time dedicated to prayer and fasting in Liberia  in October was deep in the midst of a seemingly endless epidemic.

We are getting there!

What I do all day

Alongside a growing team, this is the program I (Sara) direct.  Since the end of January when we launched the first two sites at hospitals, we have screened over 64,000 people entering health facilities.  It’s tedious to implement and difficult for communities that just want to go back to pre-Ebola “normal”.  But normal wasn’t adequate to stop Ebola from spreading, and we can’t dare go back to normal.  It’s time for a new normal.

Not Over

The past week has not brought good news on the Ebola front in West Africa.  An American health care worker in Sierra Leone working with Partners in Health was infected with Ebola and is gravely ill.  Several Sierra Leonean colleagues as well as a worker from the UK are also fighting to survive Ebola, and many of the American worker’s colleagues are being monitored due to their potential exposure.  While all of the Ebola response organizations have their differences, we deeply feel the weight of these new infections in our fellow responders–our communities are intertwined and I/we have many connections to these people and desperately hope for their survival.  Please pray for the sick ones and their families.

In Guinea, cases have been steadily increasing in 2015 and it is the most difficult country in the region to work in–there is much fear and skepticism and even violence in communities against Ebola responders.

And lastly, our hope that Liberia was on the way to being declared Ebola-free has been dashed again–Thursday was exactly two weeks since the last positive Ebola patient in Liberia was discharged cured and we were all counting–with some hope and a lot of hesitancy–towards 21 days (the halfway mark to the official 42 needed).  But instead, on Thursday a new Ebola patient was identified and admitted to an ETU in Monrovia.  Many partners are coordinating efforts to try identify contacts before Ebola spreads again, but it is not an easy job.

We must press on.

Reality and Good News

Sorry for the radio silence these last 6 weeks, friends.
We’ve been busy, for sure. Yet, the work is less concrete, more monotonous, frankly less ‘sexy’ (as evidenced by reduced media attention on Ebola and West Africa). Our days are filled not with patients and families and PPE but with meetings and paperwork and program development–so it can be hard not just to press on in this season of transition but also to report on what the practical reality really is. In many ways, it’s probably not much different than many of your days, it’s just that the context is different.
When we returned in January, Megan and I were both still in rural Bong County, Megan as Training Coordinator and me as ETU Director. As is wont to happen in an rapidly evolving emergency response, in early February staffing shuffled yet again to meet those changing needs. I transitioned to be the program director for IMC’s Screening and Referral Units (SRUs–fancy way of trying to describe setting up basic triage and isolation at health facilities) and Megan has spent a lot of time preparing for training non-ETU staff.
In many ways, this transition reflects really good news–it means progress has been made, and Liberia can begin moving towards recovery.  It means we fought Ebola–and the country celebrated as a whole last week when the LAST positive Ebola case was discharged from an ETU.  It means that Liberia is slowly returning to normal, though everyone must learn what post-Ebola normal looks like.  Schools have reopened, but there is still much (well-grounded) fear and it will take a long time for all schools to open and all students to feel and be safe to return to school.  Health facilities are reopening, but there aren’t enough staff to meet the needs–there were never enough to begin with, and many facilities lost tens of precious staff.  Plus, ETUs like ours still need to have staff on hand to be ready for a possible outbreak.  There is so much fear and danger in the facilities reopening and scaling back up to pre-Ebola capacity.  Just weeks ago the last Ebola cluster was spurred on by patients who presented to health facilities and were inadequately screened, thus exposing many health care workers to Ebola.  This is the reason we are working hard to expand the SRU program, and many other organizations are working alongside the Ministry of Health to help train, equip, build, and support health care staff to make facilities safe to practice in again.  There is still much work to be done–and it will continue to take a lot of effort, perseverance, funding, and support to reach the goal.  As we work, we will celebrate every day Liberia goes Ebola free until the grand day 42 is reached.

In the meantime, though, we must be vigilant.  In March cases of Ebola INCREASED in both Sierra Leone and Guinea.  Liberia shares a lot of border area with both of these countries, and at any moment a case crossing the border could ignite another cluster of cases.  It will not be over, truly, until all of West Africa is Ebola free.

In the last bit of good news to share, Megan and I have just returned from a lovely week+ break in Zanzibar.  Megan’s got the good photos, but I can’t begin to express how many shades of blue and green the ocean around Zanzibar is–surrounded by water and breeze and white sand and vibrant flowers and great food and drink was good for our bodies and souls.  We are so grateful.