The importance of a fart joke

Before getting back to work and start studying the benefits of long lasting social bonds in chimpanzees, I want to understand my own behaviour in a social environment. Arriving in a new place, I always find it difficult to choose bonding partners and weigh up costs and benefits of investing in new social contacts. I can engage in small talk, but it bores me to death so I usually stay quiet and observe members of the group for a while. Then pick out my grooming partner later. I am getting good at it as last time someone only noticed me after 2 days being in the same group work.

Female-friends require more investment than males; evaluating how big the competition is they will accept you or not. Fortunately I am already in my 30’s and don’t have the body of a sun tanned model (working on that is a continuous process) so in women’s eyes less likely to run off with their mates. However, bonding with males is much easier. I get along very well with men who are a bit older, slightly taller, know what they want in life and are more up on the hierarchy level. It creates a ‘Me Tarzan, you Jane’ situation, which is comfortable for both parties and avoids awkward situations. Perfect for short term bonding, before the question ‘shall we have a drink at my place’ comes, you are packing your bags again.

Every human being should have a few special long-lasting friends, to invest in and who invest in you equally. It is vital for your mental health and definitely increases your happiness index. I am lucky to have a few, who I can ask to pull my finger and who smile if I then laugh with my own fart joke.

I am ready to start that PhD now.

Young Couple in the village Malen V (Cameroon, 2013)

Rejected on Valentine’s Day

Those engaged in scientific writing might recognize what I am about to say...

You spent months in the field, digging in the mud, collecting poo samples of gorillas, or puzzling on transmission chains of Ebola patients, with the mourning and crying family next to your investigation tent as another loved one has passed away. Running through the forest, falling in mud holes elephants left for you, or driving hours on a motorbike with a cramp in your left buttocks, all in order to get the data, the information you need to understand the world around you better. And when you think you start to get answers for your question marks, you want to share it with the world, sometimes forgetting that not everyone is as excited as you are about gorilla faeces.

Once you get home, an enormous pile of data awaits you to be analyzed. It will take you weeks – preferably hidden in a wooden cabin, next to a beautiful lake in Canada with the occasional moose or bear strolling by. Because nobody will understand how much time (for God’s sake!) you can spend looking at numbers on a data sheet. I am a disaster in statistics, as a child I didn’t understand the difference between ‘half’ and ‘double’… fortunately, my highly intelligent family accepted me as I am and often appreciate me for my developed social skills. I got over it eventually, but still can’t get my head around what exactly an ANOVA means if I don’t calculate it myself.

By the time you have your paper ready for publication, people have moved on with their life, they’ve travelled, children were born, and careers have been made. You have aged, probably grown a beard, but you are proud of your work! You managed to narrow down months of work to 7 pages maximum, where the discussion concludes that more research is needed.

Three months later, reviewers have done their work and you click hopeful on the email blinking ‘your submission’.

“I am afraid that we have decided to reject your paper”

I hope this friendly moose and bear are still around to keep me some more company.

Male Gelada, or "bleeding-heart monkey", Simian Mountains, Ethiopia - 2015

Word of the year 2015: “Seriously?”

Leave the new year’s resolutions for what they are, you won’t be able to lose that weight, the handsome man you would fall for on Tinder won’t have that much hair as he shows on his picture, you won’t find the job of your dreams and after one week of intense jogging you will find your couch much more interesting than the training program you downloaded on your smartphone. 

Much nicer is to reflect a bit on the good things that have happened in the past year!

Personal 2015 moments to remember

Family

Brother: “So you donated a 100 dollars to the Virunga National Park and send us a post card that that was our Christmas gift for this year? Where did I deserve a sister like that! But it’s ok, the gorillas need it more”.

Job

Boss : “Veerle, tu as tutoyé le Ministre!”

Love

Y: “I don’t care if I need to come to Ethiopia to see you.  I’ll be there in 2 days, might need to bribe someone to get the visa sorted out though”

Friends

The Ladies: “Even after months of not seeing you, it seems like it was last week. Give me a hug you Ebola-fighter!”

The Boys: “Who are you again? Doesn’t matter, let’s have some beers and an excessive amount of rosé and discuss life, love and world problems.”

Honest Mistake

Veerle: “did they really choose ‘I wanna be your dog’ by The Stooges as their weddings’ first dance? That is so cool!” 

Family: "No V, it's ‘I wanna be adored' by the Stone Roses!"

V: "Oh ok, ...still very cool!"

Seriously!

Daily life in the Democratic Republic of the Congo (DRC, 2008)

Smengel

Back in Kinshasa after 5 weeks of cholera intervention, and wondering …

What will I wear for my sister’s wedding?

Do the new born babies of my best friends look like the fathers, because its nature’s way of telling them it really is their offspring?

Why can’t I ask him to go for a beer and a rock concert anymore?

Why did the parents of my Congolese colleague gave him the name ‘Bienfait’? And more, why not?

How is my friend doing after the hospital in Kunduz was bombed?

All of a sudden I get scared that my friends and family will forget about me. That they will remember me as ‘that crazy girl who worked with primates, spent some time in the forest and then decided to chase epidemics in Africa’ but we lost track of her somewhere between ebola and cholera. 

My Norwegian friend invented a word for this feeling, and it’s the weirdest (but very beautiful) word I heard in years: “Smengel” (to be pronounced with Scandinavian accent). It’s the feeling of not being missed anymore. To feel annoyed not to find the words to express what situation you are in and to feel even more annoyed when nobody understands you.

One day I would love to write a book, not because I think my story is more interesting than anyone else’s, but I am scared that I (and others) will forget everything that is happening and has happened. Being alone in the forest of Cameroon I read a book about an anthropologist and his work in the same area. Everything sounded familiar, and I felt like someone understood. I was not imagining things! Absurd situations, difficult to explain, and to believe can become daily business before you know it.

Entre loup et chien?

Checking water sources during the Cholera outbreak, Kindu, RDC. (Sept, 2015)

Ali Baba and the 7 "enquêteurs"

Piles of burning plastic in the middle of the road, you get stuck in the mud every 3 steps and a strong smell burns your nostril hairs on the way to the ‘centre de santé’. Bikenge is not really the most charming village in Eastern Congo. Young men come here to look for gold but find themselves lonely and far away from home. Daily life is dominated by promiscuity, prostitution, sexual transmittable diseases, excessive alcohol and drug abuse. When I think about it, it sounds a bit like 3 days of Tomorrowland, but with nice weather!

I put together a team of 8 motivated researchers to cross the whole ‘Zone de Santé’ to do a survey on health indicators in the area. It was meant to be as one of the candidates presented himself: “Je m’appelle Ali Baba et je serai ton chef des enquêteurs”. Hired!

Inaccessible roads guided us to the most isolated villages where you find amazingly friendly people but living in difficult circumstances. Households up to 20 people living under the same roof, having no access to health care, women are obliged to deliver at home putting themselves and their babies at risk. Family planning? Non non, il faut mettre au monde! When it is survival of the fittest this is the way life goes.

Congo is a fascinating place. Not only I had the honour to meet Ali Baba, but I can add Khadaffi, Beoncé, Bob Marley, Julius César, Nicolas Sarkozy and the twins César 1 en César 2 (as they were born with a caesarian section) to that list. 

 

Mother with child, village Riseri, Maniema Province, DRC (July 2015)

Hands Free

Besides running, or rather, dragging myself up to the 8th floor to go back to my room (this altitude is killing me!) we didn't get much excercice during the 2 weeks course in Addis. Elevators are tricky, can't risk to be in a box like that when there is a powercut, which is quite often, hence my claustrophobia is resulting in an increased red blood cell count. 

Every night after classes we have been storming into a cosy local bar for a cold Ethiopian beer, right next to the hotel where we were staying (Bole area). We only needed some good old P-Square songs to get us dancing the daily research questions away: 'Personally' and 'Chop My Money' always works! It didn't matter that everyone was watching and laughing at our crazy moves, because it resulted in free shots (at least for the women) from the barman and a lesson in Ethiopian shoulder dislocation movements.

I think I was getting the hang of it, because when I now pass by the bar the guards are always smiling, showing some brown, but happy teeth. Yesterday he even stopped me and wanted to shake my hand. All of a sudden I froze and didn't know how to react. This kind man with twinkling eyes wanted to shake my hand, probably to congratulate me on my great dance moves, and the first thing I thought was: 'no, don't touch me, ebola is real!'

But I pulled myself together, took his both hands in mine and stood there for a good 2 minutes, enjoying the normal human friendly contact and smiling back, white and happy teeth. 

*thx Django

Addis Ababa, March 2015

Operational in Ethiopia

origin of mankind
origin of the Rastafari
never been colonized (although the man remind me of Italians)
intriguing traditional dances
different types of beer
delicious food
wonderful coffee
beautiful women (and men)
familiar churches

and

a crazy team with researchers originally from: Ethiopia, Italy, Belgium, Rwanda, Guinea, Swaziland, Zimbabwe, Ivory Coast, Kenya, India, Bolivia.

Trying to finding the energy again to write scientifically about Ebola, but often drifting off to what has happened the last months and what is still happening in West-Africa.

All operational in Ethiopia.

Holy Trinity Church, Addis Ababa, Ethiopia (March 2015)

Temperature is rising

I like Belgium for its diverse population, wandering around in Antwerp reveals a glimpse of what the rest of the world might look like. At the same time the intolerance towards this diversity is increasing. I thought it was a joke until I actually saw the military standing guard in the Jewish quarter in Antwerp!

Imagine the surreal feeling I had during a meeting with Liberian ministers about quarantine measures taken for families of confirmed ebola patients. They started comparing with the military presence in Belgium, so how could we be against coercive measures taken in Liberia? High time to come out of my ebola bubble and see what is happening in the rest of the world!

The 2 months in Liberia were interesting, there was hope the last chains of transmission could be stopped and the outbreak could finally be declared as over. Unfortunately this was not the case and until the day I left the country there was still a lot of work to be done. So many children lost their parents, so many parents lost their children, the economical and social consequences of this outbreak only start to reveal now.

But I am back home, packing again to continue to Ethiopia next week. First making a stop in a western corner of Belgium, enjoying voluntary isolation, peace, quiet, silence and red wine (yes, I am a village girl!). 

The temperature monitoring sheet has some blanks here and there, it seems these months of working in ebola context are slowly fading.

Vébola, over and out.

Elwa 3, MSF Ebola Treatment Centre, Monrovia, Liberia (January, 2015)

2015 Wishlist

A new year, a new mission, no big plans besides eradicating ebola...starting in Liberia.

It is a strange situation in Monrovia. I don't want to say it is the end of the outbreak yet, but numbers are numbers and they say that we have 1 patient in the treatment centre as we speak. I can't even imagine what the centre must have looked like when I go back in the data and see that there were weeks with more than 150 admissions in one week!

I was a bit worried to come here because when I was struggling in Sierra Leone good friends told me the stories they lived through some weeks ago of refusing patients at the gate, the 200 bed treatment centre was not big enough and dead body management was more necessary than anything else. I can't express the respect I have for them, attending to the patients as good as possible and trying not to get infected themselves. Definitely worth to be the people of the year 2014!

When they come back here, they will see a different Monrovia and Elwa: number of beds is down to 30 and dismantling and desludging (worth googling) has started!

Besides running around from meetings to the clinic and back again, changing from regular clothes to the strangest scrubs and boots, it is not bad to end the day with a beer and some crazy attempt to play beach volleyball with the ebola team! FYI, gloves can be the perfect excuse to touch another human being without breaking any rules...

500th Survivor at Elwa 3, Monrovia, Liberia (Jan 2015)

Always go on a second mission

I look outside the window, it's pitch black with only the comforting orange light on the wing flickering in a distance...showing the world down there that people cramped in uncomfortable positions in a small Airbus are flying over their houses. On our way to a next adventure. 

We are 5 people from Médecins Sans Frontières flying to Monrovia, Liberia. Next to me a young couple who are going to spend their end of the year in Morocco and I want to ask them if I can go with them instead of going to an ebola epidemic. I feel kind of connected to this woman because she also grasps the armchairs while flying through a heavy zone of turbulence....oh God, I still hate flying and the Xanax is not working properly!

Getting out of the plane and being hit by the instant heat, humidity and sweet smell of Africa is usually one of my favorite moments since I started working here. But I didn't smell it this time, something was different.

Outside there were no enthusiastic men trying to get your attention to offer you a taxi or to carry your luggage, the streets were empty and dark. When the epidemic hit the capital some weeks ago, a curfew was put in place and although the daily number of new cases has gone down, there are still new patients every day. This epidemic is far from over.

Arriving at the hotel we realized we forgot to give each other a last big hug before entering Liberia! No touch policy back in place and a new day at work tomorrow.

First day at work: epi team Monrovia, Liberia 2014

Business as usual

It's nice to put on again my shoes, after months of running around on sandals and wearing the same clothes every day (proudly showing a dusty mustache during the dry season) you feel like a new person walking on heels, trying to look elegant ... probably failing in every way but I couldn't care less because I just came back from an ebola mission!

Life continues as usual and I am trying my best to smoothly fit in again. Now that my 21 days of incubation period (no quarantine!) have passed I feel more relaxed and don't think too much damage was done to my mental and physical state. Besides the unforeseen and difficult circumstances I feel kind of good about my first experience as an aid worker and the curiosity of 'what else is there' is slowly making its way again to my head and heart. I knew the moment I signed my contract that this would change my life (again) and now I realize that there is no way back...I have become one of these strange expats, giving friends and family the impression to be a bit lost in life but actually knowing very well which direction to go. 

Does it matter that I don't manage to plan more than 3 days ahead since I got back? That I don't really care where we go for dinner or what the plan is for today, but want to leave all options open? Is it selfish that I can feel so close to someone for some precious moments and the next day want to be on my own again, planning my next biking holiday in Thailand? Or is this what it means to be an aid worker and finding ways to deal with the things you experience during life in a mission and the person you want/need to be in the outside world? 

No damage done...

Announcing that the paediatric and obstetric hospital was suspending activities due to the current ebola outbreak, Bo, Sierra Leone (Veerle Hermans, 2014)



              

The daily updates

Dear disease surveillance officers and CDC colleagues,

Included the daily update for the treatment centre in Bo:

- 4 new admissions:
      2 from Freetown (1 confirmed, 1 suspect*) + 2 from Port Loko (probable)

*1 baby came with its mother, who is confirmed. The baby is negative, but was breastfed by his mother for some days so we will keep him in the suspected tent for observation. He also has nowhere to go for now...

- 1 confirmed patient died last night > burial team alerted

- 2 patients cured and discharged! They will go back to their family today
    (if they will let them go back into the quarentined areas)

Any news on the outreach activities to the area of the new cluster today? Than I know if I need to chase the GIS officer to update the maps.

Thank you!

Kind regards,

Veerle Hermans

Epidemiologist, MSF

Bo, Sierra Leone

Staff member, wandering around the treatment centre while it was under construction, Sierra Leone, 2014

Winter is coming

It's nice to see the seasons changing in Africa. Until now I never spent enough time in one place to see this actually happening. In July the long rainy season started for which we were warned by several heavy storms...and when I say heavy, I really mean HEAVY - read as: your room is flooded the next morning. This was followed by long days of grey skies and soft, but long lasting rains. I will not elaborate on my frustration about the decision not to allow us cycling during this season. There is definitely a correlation between my mental health and the amount of kilometers done on my bike. 

This week the treatment centre in Bo opened and has already seen 32 patients passing, of which several died quickly. The team has also been faced with difficult social consequences of the disease. A baby of 1,5 years old was brought to the centre but turned out to be negative. You would say, she is lucky, but she has lost both her parents and has no one to return to. And how can you comfort a baby like that wearing a spaceman suit? We are doing what we can in Sierra Leone, Liberia and Guinea, but it is very sad to see that the worst is yet to come.

I used to write long emails to friends and family about strange situations in the forest, working for conservation organizations. It helped to get it of my chest and to have a reality check with what the outside world was like. It was a life saver as taking Lariam for too long resulted in completely becoming paranoid and accepting situations that turned out to be unacceptable: it seemed almost normal being held hostage in the village or having to climb a tree because it is not safe to spent the night alone on the ground in the middle of the forest after being abandoned by your, again drunken, guides.

I didn't do that this time in Sierra Leone...maybe I accept my way of living, and other people also don't email me weekly with their daily adventures. Thank God there is Facebook!

As I am writing this, a big storm is roaring outside and it is actually quite calming, a bit like a winter evening back home. I think I am ready for hibernation...

Construction of Bo Case Management Centre, Sierra Leone, 2014

Vébola on holiday

With a backpack full of chocolate and cheese, I boarded an almost empty plane flying back to Sierra Leone after 2 weeks of holiday in familiar Belgium. For the first time in my life I actually stayed at home for a holiday. It often felt like I could as well sleep my way through these 2 weeks: no generator in the background, night by night less dreaming about ebola following you around and enjoying seeing family and friends again.

The last 2 months in Bo were demanding for the whole team, to Ebola or not to Ebola...that was the big question. From one week to another we switched from long-term mode (enjoying a free weekend once in a while) to emergency mode in the Bo project, having no idea how long this outbreak will last. Normal activities have to continue in the hospital as good as possible, but at the same time Ebola is breathing down your neck and we have to offer our support in surveillance activities and case management with limited staff available.

So I wanted to get out for a moment, to clear my head and have normal conversations again. But this was wishful thinking, being back in Belgium I saw it was a hot topic in the daily news, creating a certain nervous athmosphere among people. As an epidemiologist I have quite a comfortable (and amazingly interesting) position in the field: surveillance, mapping, line listing,...and therefore I am not too worried about getting infected. On the contrary, other people are more worried about you being a risk than you consider it yourself. What they don't mention in the evening news is that someone carrying the virus is not infectious if he/she doesn't show symptoms and that it is NOT airborne. You have to practically vomit in someone's face to transmit it and this was not really my plan to do. I checked my temperature daily (being slightly paranoid is not always harmful) and no fever means free pass to hugs and kisses!

Fear is a surviving mechanism, fight or flight reaction is to be expected. In this case the danger is not visible and very lethal, hence understandable that flight is a first choice. Presenting this in real life as people taking two steps back when they see you and will wait until the incubation period of 21 days is over before giving you a hug and a kiss. I didn't realize it would be like this coming back for holidays...having in my mind that I was advised to exchange as much bodily fluids as possible as it is not allowed in Sierra Leone, what a disillusion!

One of my African colleagues dryly made the note that even if a case ends up in Europe, it would not cause a lot of trouble: "Vous, les européens, se trouvent toujours dans des grandes maisons tous seuls,  une vie isolée et individuelle. L'Ebola n'aurait pas de la chance".

Normal activities ongoing, Bo, Sierra Leone [2014]

“Cordon” in real life setting?

After 3 weeks of being too tired to play tennis in the weekend I forced myself this morning and cycled over to Bo Club to meet the coach for another session on the court. On my way over there, I heard a woman shouting something at me in Kreo. I could pick up ‘ebola’ in her sentence so I stopped and asked someone to translate it for me: ‘you puwnis are well protected against ebola, but you will infect us and we will die’. As I continued my way I thought about what the women said. Maybe she has a point; we are protected in some way, because the last days a lot has been done to prepare ourselves for an outbreak in Bo. In the houses, chlorine buckets have been installed to wash our food and our ‘bodies’ to kill any virus trying to invade our system. The fact that you smell like a swimming pool the whole day is just a minor inconvenience.

However, it is sad to notice that a lot of people believe that the ‘white men’ are injecting the ebola virus in patients in the hospital. It shows again how important it is to really understand the cultural believes and ways of reasoning in the population, otherwise there is no way this outbreak will be contained soon. These believes and rumours result in people infected with ebola hiding and running away from the hospital, because they are scared. Soon all hospitals in Bo will be empty and all the children suffering from severe malaria will die at home, because their parents are too scared to come to the hospital. Off course they are scared! Everyone is very worried at the moment, puwni or not. 

Pharmaceutical companies don’t invest in finding treatment as it will not pay off the investment. Previous outbreaks have always been contained rather quickly and the number of people infected remained low compared to other diseases. Although there is a lack of treatment, the last months showed that people do fight the virus by themselves and walk out of the isolation ward in good health. Providing supportive treatment like fluids, malaria treatment and vitamins can help to make the body strong enough to fight the virus. That is why it is so important to come to the hospital and get this treatment, and above all, to prevent infecting other people. Too many have died already, this really needs to stop.

I didn’t manage to keep my eyes on the ball today…

Man climbing the waterfalls in Kenema, Sierra Leone, 2014

Love in the time of ebola

You hear people whispering it in the streets,…ebola….like saying it out loud would make it appear right in front of you. MSF plays an important role in the history of ebola, being one of the only organizations with hands-on experience in outbreaks. I wish I could be more of use, but besides explaining the role of primates in transmission of the virus, there is not a lot of expertise I can offer. I am still learning the basics of epidemiology and it was not really planned to get in the middle of all sorts of outbreaks.

In the meantime business goes on as usual, working long hours and reflecting on the things that happened during the day with a nice glass of marula. Since 7 years, I always try to hide somewhere on the 7th of June, not an easy thing to do in this setting. Some days I love it, when you learn new interesting things and you feel you get a very good bond with colleagues that become partners in crime. Other days I really wish to be back home in my nice comfort zone, so I could at least be with my family when my grandmother passed away last week or today with my friends, sharing memories about that special one we lost 7 years ago. I wish I could have told my grandmother that when working in Africa, I often take my second name ‘Clara’, her name, because no one can pronounce ‘Veerle’ (it becomes something like Veelie, Veurlie, Vierleu,...). She would have liked that.

Fortunately in crazy outbreak times like these, we got some good news! The gynaecology and obstetric ward of the hospital will stay functional until the new hospital closer to Bo is up and running and the expertise of handling complicated pregnancies and deliveries can safely be handed over to another hospital. The original plan was to close down the ward in June and continue the paediatric care, but as women often come from far away to safely deliver in the hospital and the maternal mortality is still high in the country it was decided to stay open. On moments like these it is great to be here: if the good news that no one would lose their job would be announced in a Belgian company, everyone would politely smile and quietly think, "yes, I still can redecorate my kitchen this summer", and then go back to work. But when the news was announced here, the midwifes got together, and danced in the rain around the hospital, laughing and singing. 

Midwifes dancing in the hospital after the good news, GRC, Sierra Leone.