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.

A tree is the limit

On the road to Kenema, the 3th largest city in Sierra Leone: It’s nice to escape Bo for a day, certainly if you are in the good company of two beautiful women from DRC and Malawi, another Belgian and my good friend from Ivory Coast. Seeing the Gola forest passing by, I immediately think of the chimpanzees that (just like the people) are trying to survive in harsh circumstances. It must be nice to be able to go look for them and see how the populations are doing in Sierra Leone.

Being a ‘first missioner’ I have to get used to all the aspects of living the MSF life. Before coming to Sierra Leone I was working in complete different circumstances, i.e. tracking chimpanzees and gorillas in the forest of Eastern Cameroon. It has been the most interesting, but also most disturbing working experience so far. It is amazing to live in the forest, never knowing what to expect the next day. But there is one thing you need to be able to do your job, regardless of where you are. You need the support of the organization in all its aspects. There will always be unforeseen circumstances, but if you are abandoned in the forest by your drunken field guides and you are planning to climb a tree to spend the night to avoid the risk of being trampled by elephants, you realize that as flexible you want to be, everyone has a limit. It is not always easy now to deal with all the security rules and protocols that we have to respect in our professional and personal life with MSF, but I understand more than ever that you need this to be actual able to do your job without being distracted and always switching to survival mode to make it through the day.

I miss the forest, the pollution in the city is difficult for me, but I love the fact that I can be much more productive and actually contribute to the well-functioning of the hospital. They warned us during our training before departure that working for MSF is like a marriage: some days you just want to run away from it as fast as you can, but most of the days you feel how much you love this lifestyle and would do anything to make it work.

An average working day in Dja Faunal Reserve, Cameroon [2013]

Small Small

A paediatric mortality rate of 6% for the first quarter of 2014 was one of the results we presented this week in the hospital. The target of staying under an 8% mortality rate was achieved. Just looking at the numbers you want to clap in your hands and congratulate each other on the good work. 

But when I was walking back to the office, I saw a young father carrying his deceased child out of the hospital. For a second I thought he was holding a small gift, trying to show it to the people around him. Wrapped in a beautiful blue-yellow lappa, he was holding the child in front of him and with a certain grace he walked out of the hospital. 

At the exit, the paper put on the small bundle said that it was indeed his child and that he would appear in my statistics as ‘exit outcome: death diagnosed as severe malaria’.

All of a sudden you feel that this 6% is nothing to congratulate each other on.

Attempt to play tennis in Bo Club, Sierra Leone [2014]

New York Kisses

She was supposed to celebrate her 30^th birthday today. It would have been our perfect excuse to organize a crazy party, to dress up as we did when we were 16 and drink (a bit) too much of that home-made cocktail.

So I promised her to get out of this life as much as I can for the both of us.

a birthday kiss [New York, 2006]