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.

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“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.

Half Way

I’m exactly half way through my time in Sierra Leone.

There were a number of reasons I chose to re-immerse myself in humanitarian aid work. If I am to be brutally honest with myself (and you), I came to Sierra Leone because I needed to feel purposeful again. I was in a place without meaningful work, feeling rejection and a loss of confidence from an abrupt fall out of a business start up, and generally feeling direction-less and unsure of where to find purpose.

I turned to what I have known in the past, what I spent years preparing for, for the issues I still feel compelled by (in this case the health consequences of the ebola outbreak). I was nervous and excited about returning to the field. I came with an open mind – and the question of whether this could be the beginning of a new chapter of global health work. I really thought it could be.

The answers have been loud and clear. I am grateful for such clarity and for the affirmation that the life of land and family that I dream of is just as valuable as any other pursuit.

When I’m not straining my eyesight with spreadsheets and feeling the ills of sitting 9+ hours a day, I am dreaming of settling into a place, the daily work of chores of home and farm, and starting a family.

I am very grateful I have had the opportunity to take this job. I hope the extremely small accomplishments I leave behind will be beneficial to the efforts. But I just don’t have the all consuming passion for it-to live this life of constant travel, of hours and hours of computer work sitting at a desk, the conversations with colleagues knowing that even the friendships made will never have the time to flourish.

It reminds me of the quote by Lawrence LeShan:

Don’t worry about what the world wants from you, worry about what makes you come alive. Because what the world really needs is people who are alive.

I know what makes me come alive.

I look forward to returning home with a new appreciation for the small things, for relationships, for a place in community, for work that I love (even if it doesn’t require a degree), for family.

The countdown begins.

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.

The Battle to Zero

Matter magazine published an article on the loss of one of Sierra Leone’s most talented physicians, Dr. Sheik Hummar Khan. The Ebola outbreak has taken an enormous toll on the health system, with the death of hundreds of skilled clinicians who became infected whilst caring for Ebola patients.

Ebola has terrified communities, with its devastating case fatality rate and rapid onset. While we’ve seen the incidence rate decline dramatically over the past two months, new cases ARE still being confirmed. Where one case equates to an outbreak, the on going confirmation of new cases is frustrating efforts to eradicate the virus.

I’m currently working in Sierra Leone on health programming with an international organization. It’s very evident that the outbreak has and will continue to have long term effects on social and economic recovery. Schools have closed, businesses have shut down, movement is restricted, hundreds of children have been orphaned and the stigma survivors face leaves them with an uncertain future.

The road to recovery won’t end with zero cases, but first we just have to get to ZERO.