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.

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.

What Doesn’t Kill You…

One of the best lessons I learned from my time in the Peace Corps is that it’s really good for people to be miserable. Good and miserable. For quite some time.

You learn you can tolerate not being comfortable or having amenities. You learn to sit patiently for hours (and you learn to always have a book on you). You learn that time passes the same every day whether you are miserable or not. You just get tougher.

That was over ten years ago for me. I’m trying to channel that toughness at the moment.

I just arrived in Koidu which is in Kono District in Sierra Leone. This is a major diamond mining area with several international mining companies who set off explosions about once a week making the buildings shake. It’s pretty bare bones here.

It’s the hottest time of the year and I am feeling it. I am laying on a mattress that is both foam and hard as a rock (seems odd but trust me on this). I have a fan about 6 inches away from my face. I’m relishing in the air as we only have a couple of hours of power and then the generator gets switched off. It will be a long sweaty night ahead with mosquitos buzzing around. The worst news? There’s no kettle. I have several days here and I am seriously concerned with how I’ll be able to function without coffee. I WILL figure something out in the morning! Even if that means I have to pay a child on the street to run home and boil some water for me.

I will be oh so grateful for Freetown again, just 24 hours after saying how I was ready to get out of Freetown (how ungrateful I was for the air con and omelets).

It’s somehow comforting to recall all of those really miserable days and nights in Turkmenistan, and then Chad, oh and that night in Sudan…yeah, I can do this.

Confinement Yoga

I’m not one who exercises-at least not in the gym rat sort of way. But I do practice yoga fairly often. My yoga practice ebbs and flows according to how much time and extra cash I have, since I’m terrible at motivating to get out my mat at home. When I’m living abroad, it’s another story. In most of the places I’ve lived, I’ve had little freedom of movement because of the security or context of the place. Taking walks is limited and there certainly aren’t any yoga classes around. So, I get into a routine of doing yoga regularly on my own. (Below is a photo of me with my mat in the deserts of Chad.)tamam My all time favorite video series is with Bryan Kest. You just have to watch a minute or two of his video to see why. The hair, the white suits, the oh-so hands on pose assists. I guarantee it will keep you on your mat for the entire 53 minutes. Enjoy!

Culture of Aid

There’s definitely a certain type of person that chooses to do aid work. It requires a lot of travel to difficult environments, leaving your loved ones for extended periods of time and often with very little notice. The work seems to attract wanderlusts and misfits. The cadre of responders to the Ebola outbreak are a slightly different group of recruits than in my past aid work, which recruited the typical humanitarian aid worker assigned to protracted crises. The expats here in Sierra Leone comprise a mix of humanitarian aid workers (like myself), many clinicians with varying experience in these contexts, those with military backgrounds for the logistic response, and emergency responders who thrive on the chaos of the immediate aftermath. It’s a strange mix and I have to say I don’t connect with most. This is the first post I’ve had where I am spending most of my time in the capital and while I appreciate the amenities, it’s such a surreal experience going to the Radisson after work sitting amongst a patio full of white people looking like they came from their DC office and begin their evening of alcohol and smokes.

There’s always an expat economy when we flood an area for a humanitarian response, but here it is stark. Usually, there’s some shopping at local markets, only a couple of restaurants available, and one or two hotels that journalists stay in. Because of the enormity of the response, many of us are staying at hotels, there a quite a few restaurants to eat at (and without a kitchen, we only eat out), and then there are the swimming pools.

I have to say that I do appreciate having a place to go outside of the hotel and office. Freetown is reasonably safe, but I’ve found the harassment to be far greater here than I’ve experienced elsewhere. It certainly isn’t relaxing to take a walk in town.

I think the adjective that best describes my feelings about the mission (external to the job itself) is disappointing.

I’ve seen a couple of episodes of prostitution-white male expats escorting Sierra Leonean women. Exploitation of this sort is absolutely not tolerated by the major agencies, which have strict policies about such behavior. It violates humanitarian principles and reflects on all of us. Unfortunately, I haven’t known who these men are or whom they work for or I would absolutely call their heads of office.

That sort of behavior also poses risk of transmission to others. We are under a strict no touch policy, those who are directly exposed to infected or suspected patients and those that work solely in the office. Those men obviously don’t care too much.

I feel disappointment that the environment here isn’t one of a team working together for a common cause-even though that’s surely what everyone is doing. Instead, it’s a bunch of misfits with habits that I don’t share or with dubious characters.

I keep mostly to myself and just try and concentrate on my job. May can’t come soon enough.

Kenema Isolation Kenema Clinic

Above (top) is an isolation unit for people who come to the community health clinic (below) and who are suspected Ebola cases. They wait until an “ambulance” comes to take them to a treatment unit. These were taken in Kenema District.

Oatmeal Please

I’ve been in Sierra Leone three weeks now and I’m really starting miss good food. Sierra Leone is a much easier post than my previous aid work in terms of amenities and availability of food. But I’m still missing really good meals. I’ve had an omelet for breakfast for the past 21 days. It felt like a real perk for the first, say, 19 days. Now, I could just go for some oatmeal.

I’m lucky to live in a farming community back in New York where I have access to fresh organic vegetables, grass fed meats, and raw milk. I may smell like a cow most days, but I eat like a Queen!

I can’t wait for the day when I’m back and can choose to whip up whatever I fancy.

Thanks Pinterest!