New Life

There is so much to catch up on…leaving Sierra Leone, a road trip from Texas to New York, moving onto a new farm, bees, chickens…so much change in a few months.

But I’m skipping ahead of all those stories and introducing you to a new little life…a heifer calf from my most favorite cow. Honey calved yesterday morning in a brushy patch hidden away in the pasture. I found her laboring around 8am and stayed to watch her through it. It’s a really amazing thing to watch such a large animal give birth. She passed the calf just two hours later and immediately went to the business of licking her clean. Honey loves babies and is an exceptional mama. I was hoping for a heifer calf with horns, but it doesn’t look like this little girl has any horn buds. I may keep her anyway…calf

Her name is Pecan. I visited them hours later and they were both laying down in the same spot she gave birth. I let them be and came back to see them two hours later. Honey hadn’t cleared her afterbirth yet and I wasn’t convinced the calf had figured out how to nurse. Honey is older and has a somewhat misshapen udder, not the easiest for calves to figure out.

I went back an hour later knowing I had to get the calf to drink colostrum before nightfall. Fortunately, Honey cleared her afterbirth but was looking very uncomfortable with such a full udder. I cleaned her up (she likes to be a very clean cow) and milked about a gallon out of her to relieve her pain. I tried coaxing the calf onto her, but she just wasn’t getting it. I decided to pour Honey’s colostrum into a calf bottle and see if she would nurse. She is a strong little girl! Fighting being held with everything she had, she also sucked down about a half gallon of Honey’s milk. So, I left them for the night with a  full belly and a little relief. As I was leaving, they were finally making their way out to pasture.

I will have to work with them today to get the calf to nurse from her mama, but hopefully she now has the energy and will to do just that.



Ebola and Secret Societies

Always talk to the drivers.

Today, when the driver picked me up from the guesthouse to take me to the UN helicopter where I was to wait for a lift to Freetown, he immediately asked me if I was a born again Christian who believes in Jesus.

Good morning to you too.

After he gave me his testimony and he felt that I adequately appreciated his conviction, we arrived at the “helipad” (field), he turned the car off and the sweating began. And some good conversation.

I asked him about mining, the civil war, and ebola. We covered a lot of territory.

I had recently learned of secret societies in Sierra Leone and their role in coming of age ceremonies. It was previously described to me as teenagers who are kidnapped and taken to the bush for a month or so of initiation. The driver told me that this is still widely done and that members of the secret society have the most influence in politics and status in the country.

There is a separate society for men, called the Poro, and one for women, the Bondo. Young men are given a special marking on their back made with knife scarring. The driver, although he said it was forbidden to talk about or to show the markings, said he would do so because he has forsaken it as he is now a Christian pastor. He turned his back to me and unbuttoned his shirt enough to loosen it down his back so I could see the start of it. The markings are a series of a pair of downward slanted lines about one inch apart going from the back of the neck down the spine. He said the marks are given during the month long initiation where other “traditional things” are done.

Although it was clear he thought it was all evil doing now, his eyes became wide when he said the political power it gives one is the most important aspect. You cannot be anyone without such marking in this country, he told me. You have the protection of the society and the Paramount Chief (the leader) has much power.

He said the Bondo society for women is completely separate. He didn’t want to talk much about it, but did say this is when “they take the female genitals”. Female genital mutilation is very widespread in Sierra Leone. It’s done “in the bush” with crude instruments, no anesthetics, and no infection prevention. The driver proudly said that he and his wife (who underwent FGM) did not have this done to their three girls, but he said it was done everywhere “even in Freetown”.

Then he said something really interesting.

He said that he thinks both of these initiations will stop with Ebola because “much blood is spilled” during the process.

Let’s hope.

Shocking Inequity

(These women are Traditional Birth Attendants in Kenema District, Sierra Leone. They are greeting me with a traditional welcome.)

Much of my work here in Sierra Leone is centered around reproductive health care and child health care. Public health programs in the “developing world” provide services to women of reproductive age such as family planning, antenatal care, assisted births and postnatal care, as well as for children under the age of five for malnutrition, malaria, pneumonia and diarrhea (the leading causes of death). There is a wealth of evidence that health interventions in these areas for these two demographics have the greatest impact on the population’s health.

Simply put, they are life saving.

The figures comparing mortality rates for Sierra Leone to the United States are shocking.

The under five mortality rate, which tells us how many children under five die within a timeframe, is expressed per 1,000 live births. It answers the question: for every 1,000 births that occur, how many children under the age of five perish?

In the United States it is 7. In Sierra Leone it is 156.

Another significant indicator is the maternal mortality ratio, which tells us how many women die from pregnancy, childbirth, or in the postpartum period (42 days). This indicator is expressed per 100,000 live births. It answers the question: for every 100,000 births that occur, how many women are dying from pregnancy or childbirth?

In the United States it is 28. In Sierra Leone it is 1,165.

Globally, having children is one of the most dangerous experiences a woman encounters. It is the second leading cause of death in women of reproductive age (ages 14 to 44) (HIV/AIDS is the number one cause of death).

99% of ALL maternal deaths worldwide occur in “developing” countries.

This is shocking inequity.

*Mortality data is from DHS and UNICEF.

Coconut-the local ORS

coconut seller2

(ORS is Oral Rehydration Salts, which are used commonly in community health programs as treatment for children with diarrhea, cholera patients, and now Ebola patients. When I told one of our Sierra Leonean drivers that I am loving the coconuts here, he said “It is good for ‘d’ body, it is our ORS!”)

The expat world in Sierra Leone is very surreal. You have a driver, you live in a place far above local purchasing power, you eat at restaurants that cater to expats. It’s very insular and it exists entirely parallel to life as a national. I’ve found it very hard to have any authentic experiences here.

Coconuts are my one exception.

I sneak out of the office compound and take a walk down one of the busiest roads in Freetown, cross the street and hope not to die (I try and wait for a local to dart into the traffic so I can cross at the same time-safety in numbers, right?), and stop at the petrol station where several people are selling items to passers by.

I go and ask the gentleman for a coconut, who has a wheelbarrow full of them. He asks me which one I want (sometimes, sometimes he just chooses for me) and proceeds to use his machete to whack off the outer layer, tap on it (to hear how much liquid is inside?), and cut a round hole at the top. I say thank you, take it from him and stand there to drink the contents and then hand it back. He whacks it open and scrapes out the meat and hands it to me. I pay him 2,000 leones (about 40 cents) and remain standing there eating the meat and then toss the husk into the back of the wheelbarrow with all the others.

And then I dart back across the street, feeling really proud of myself.

It is my one activity that makes me feel like I’m actually experiencing something of Sierra Leone.

I’ve never had fresh coconut before coming here and now I swear by it. I’m sure going to miss it. It just wouldn’t be the same buying it from a grocery store (nor do I have the machete skills for such a task).

“Ebola Stops With Me”

(a slogan that’s ubiquitous around Freetown-painted on walls and printed on t-shirts worn by locals manning checkpoints, armed with thermometers and hand sanitizers)

I was joined by an American doctor working for WHO (World Health Organization) for dinner the other night. He’d clearly had a brutal day.

His job is to trace contacts of Ebola patients. He goes to the homes of patients and tries to find everyone the patient would have come into contact with whilst infected. That day, he’d gone to the slums near the beach looking for a certain contact. He was asking people where the man lived and the neighbors pointed to a shelter made of tin that was about 4′ X 4′. They named four different people, including the contact in question. The doctor said “no, no, four men can’t possibly live in there”. They all said yes, they live here. “Surely there’s a misunderstanding”, the doctor repeated, “four men can’t possibly live in there and I need to know specifically where this man lived and who lived with him”.

One of the neighbors turned to him and said “this is Africa, doctor”.

It was one of those moments that hits you like a ton of bricks.

Of course, four adult men live in a space unfit for shelter the size of a toilet room. Just like another recent case that came from an area where more than 80 people were sharing one latrine.

“This is Africa, doctor”.

He continued with the visit and uncovered some frustrating information.

When a person dies at home, the number 117 should be called immediately for a safe burial team to arrive and take the corpse. What we’re finding is that transmission is still occurring for unsafe burials despite widespread messaging on 117 and safe burial teams. What the doctor found out was that people are delaying the 117 call in order to complete the traditional preparation of bodies (washing) before their loved ones are taken away and never seen again.

Washing dead bodies is the number one cause of Ebola transmission.

This is so frustrating to learn as it feels like a major step backwards after all of the sensitization around burials. There are signs all over Freetown that say “Save Yourself Do Not Touch or Wash Dead Bodies”.

And yet here we are, 11 months since the index case in Sierra Leone, and we are still battling this. It shows just how difficult it is to change behavior especially with regards to such sensitive traditions and beliefs.