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]