health care

Life in the time of Ebola

Patience was going to have a baby.

It was to be her very first baby. She and her boyfriend Momolu were excited. They wanted a baby, they were ready for it. They have been waiting for it.

Finally!

They knew each other since high school. But the war separated them and sent them running for their lives. Patience ended up in a refugee camp in Cote d’Ivoire and Momolu found himself on the ruthless streets of Conakry, Guinea. They have lost contact for many long devastating years, not knowing whether the other is still alive. But they survived. And found each other again after it was all over. Now they were going to have a baby. And they were well prepared.

Patience’s restaurant business was doing great. She found the right location to serve her Liberian delicacies. It was a small, but neat place on Bye-Pass where the major routes come together and streets are bustling with people. So many customers. During the lunch time it was always packed. Her pepper soup was the best in the area. Check rice and palm butter were selling well too, but nothing like her pepper soup.

Momolu’s plumbing contracts brought in a decent income as well. He had several plumbing and other maintenance contracts with private residences and businesses around town. Maintenance was a good business. There is always a plumbing problem somewhere.

They saved up and were able to find a nice place in Paynesville. A two bedroom house, so that the baby could have its own room. A luxury, indeed. The house had charming surroundings with banana and mango trees casting an afternoon shade that moderated incessant heat of the tropical city. There was even space for a kitchen garden. Patience really wanted a kitchen garden. She already had an outline sketched in her mind. Now she could grow her on cassava and collard greens and not have to buy overpriced vegetables at the local market anymore. Life in the city was expensive. But Patience and Momolu were doing well.

The baby made them wait. They have been trying for a couple of  years now. And finally in December she got pregnant. What a joyous day that was when she discovered it.

Few months later, in March, Ebola has reached Liberia. Patience heard about this horrible disease on the radio. But there was no reason for concern. There were only a few people ill far away in Lofa county. It will be stopped soon. It will never reach Monrovia.

Over the coming months Patience and Momolu have painted the house. Patience bought some baby clothes. In white and yellow, as she didn’t know whether it will be a girl or a boy. And she had planted her kitchen garden. She had gone to her prenatal visits to the clinic regularly. She was in good health and in an even better spirit. She was going to have a baby.

She was seven months pregnant when Ebola crisis broke out in Monrovia, as if from hell. Where did it come from? How? What happened? What went wrong?

Ebola descended onto Monrovia, spiraling out of control. Health workers started dying in numbers. Hospitals got infected. And were closed down. Clinics closed down too. Health workers were afraid to come to work. Ebola kills. Quickly and silently.

Patience could no longer find a health facility where she could do her prenatal examinations. She tried. She has been all over town. “OK”, she thought. “I’m in good health and things will get better by the time I am due. Hospitals will re-open.”

Little did she know that the crisis was to escalate. It was not getting better, it was getting worse by the day. That it will take far too long to provide safe health care services again.

It was early August. She didn’t feel well that morning. She was tired and stressed. Things were not going well. Many people from her village in Kakata district have died. Fourteen of them, to be precise. One after the other. Ebola kills. She knew them all. They were her neighbors, her friends. But she knew better than to attend any funeral. She knew that this is how Ebola is transmitted. People touching dead bodies at funeral rituals. But people in the village didn’t listen, they refused that Ebola burial teams collect the dead bodies. They were burying them in secret, at night.

Her business was not going well either. People didn’t want to come. They were scared of Ebola. Many lost their jobs. Ebola. Also, they didn’t want to spend money like that anymore. They didn’t know what is coming. Better to keep the money. Momolu’s contract jobs also became few and far in between. Many people left the country, so there wasn’t much work to be done. And the baby was on the way.

She left the restaurant early. She needed a rest. She was having a stomach pain and that wasn’t good. While walking towards a taxi stand her stomach pain became unbearable. Piercing and burning. Contractions followed. Blood started gushing down her legs. She was horrified. She hurried. She needed to get to a health facility quickly.

One after the other they were closed. Or have turned her down. All too afraid of Ebola.

She was getting weaker. But she kept on moving. She was determined to find an open hospital or a clinic. She kept on going.

Finally, after hours of desperate attempts to find a health facility willing to assist her, she had reached her last resort. The last clinic. She knew she couldn’t go any further. She lost too much blood. Her head was light. She couldn’t stand on her feet anymore. She was losing consciousness.

Her entry was denied.

She sat down on the dirt floor. She tried to call Momolu. To let him know that she had tried. With all her energy drained she was unable to dial his number on the cell phone.

She laid down on the ground.

There is no more patience for losing Patience.

Mr. Prime Minister, Please Explain – October 5, 2014

Most people hate it when foreigners criticize their countries. I won’t do that. I’ll criticize my own. It’s about time to provide a mirror to Slovenia.

Make no mistake. I’m angry. No, that’s not it. I’m furious. And more than that, I’m disappointed. Yet again.

It is by no means the first time I am frustrated with my country. Being a Slovenian expat is no fun when it comes to dealing with various administrative issues that are painfully complicated and make you want to pull all your hair out of the scalp. But this one is just unacceptable.

This all came about last week. We are in the midst of Ebola crisis. I work for a Dutch NGO that is intensifying its Ebola response. Last week the Dutch Embassy in Accra, Ghana has sent a delegate to Liberia to assess the state of affairs, to determine how the Netherlands can best support the response and to encourage its remaining citizens and offer them support. I was invited for a cocktail party organized for the Dutch nationals. I have been in contact with the Dutch Embassy when the crisis broke out and our country director was not in Liberia. I didn’t really want to go. I felt it to be an intimate national affair. But I was encouraged to go. Perhaps I’d be less angry at my country if I didn’t.

It was more than heart-warming. The Dutch were thanked for the work they are doing, in one way or another assisting in Ebola response. They were told that their country appreciates it. That they are thinking of them. And that they will be supported in their endeavors.

The relief on people’s faces. The gratitude for the gesture. It was eye-watering. I wanted to cry and I’m not even Dutch! (We live in a biohazardous environment so emotions tend to run on the high side. So I just drank more beer to mellow my emotions.) It doesn’t take a lot to encourage people. To make them feel appreciated. To have them know that their country cares about them.

The burning question at hand was Medevac, of course. The Netherlands has signed a contract with Phoenix Air, the only organization that is equipped to Medevac Ebola patients. Mind you, that does not mean that the Dutch government is paying the bill per se. But at least there are options.

In the days to follow, my government advised me to reconsider my stay in Liberia. Slovenia cannot assist with my potential Medevac.

Mr. Prime Minister, please explain. Please explain why you believe that advising humanitarian aid workers to leave Liberia in the middle of Ebola crisis sounds like a good strategic choice? When humanitarian aid workers are most needed. I’d really like to know. This is the time to take pride in the fact that 3 of your nationals have not left the country, like so many have done. This is the time to demonstrate Slovenia’s commitment to ending the crisis that has potential devastating effects of global proportions. This is the time to have the balls and show some support. This is the time for action.

Within the same week Slovenian government announced that it will provide 30,000 Euro to the WHO, earmarked for Ebola response. Slovenia, please! My organization got 5 times more than that from the Dutch public alone! This isn’t something to brag about, it’s rather something to be ashamed of. Don’t advertise your shame. We’ve got enough of that to go around. If that’s the best you can do, do it quietly, don’t tell anyone and pray that no one ever finds out. You are making all of us look stupid.

This is not to downplay the contribution. Every cent is needed. It is rather to point out poor consideration and even poorer contribution of a nation-state that can do better. If it wants to.

But then, this isn’t the only thing that is making us all look stupid. We are a country that allows convicted criminals to remain in politics. Who despite serving a prison sentence are allowed to leave the prison to attend parliamentary sessions. And at the same time believing that we are a worldly citizenry and a country of significance.

A nation of serfs. Has been said a long time ago. I refuse to accept it!

Your pretty ties and fancy suits jumping around Brussels mean nothing. Your eloquent words are useless when no action follows. We aren’t judged by our oratory skills, but by our deeds. You don’t walk your talk. Your trample on your walk. And you are drifting into insignificance.

And still you wonder, Slovenia, why your daughters and sons are leaving the country en masse. And why they are not returning. I give you the answer to this one. It’s because you don’t care about us.

Find a mirror and take a good long look.

Those Who Stayed – October 4, 2014

This post is not only about the foreign aid workers, but also about entrepreneurs and other individuals who decided to stay in Ebola affected countries, and those who are still arriving to provide needed services. This post is also not about singing any of us here a praise, nor it is about complaints about the situation we find ourselves in. It is to describe the environment we are operating in and the kind of personal and professional concerns and decisions we are challenged with every day.

The psychological stress of living with an invisible killer may be the most obvious one. Every daily routine is aligned with infection prevention. We keep a distance from one another, our lives have become a touch-less operation. We are suspicious about exchanging documents, goods and other items. We bleach-wash our hands obsessively. The threat of Ebola seems far more real than skin cancer. One day we will have to consider it too. The skin on our hands shiny and smooth from excessive bleaching, often with incorrect bleach solutions. Not everyone knows the standard bleach solution for hand washing and others just like to exaggerate, operating on “the more the better” principle. And we are obliged to wash our hands everywhere we go. There is no entry without hand washing.

And we have to think about whether the staff working in our houses (no need to point out the luxury of it, we are aware of it and we immensely appreciate it) are healthy. Whether they have considered the instructions provided, whether they believe the existence of Ebola, whether or not they will show up to work with a fever. And there is little control over it. For the most part they have the same working hours as we do, so we rarely meet in person. Should they still cook our food, prepare the raw food, take our dog out?

We are also suspicious of our own pets, dogs in particular. Dogs can get Ebola too and can pass it on. Who is touching the dog when you are at work, what is he/she licking? Well, don’t lick me, it’s Ebola time! They don’t seem to respond to this Ebola command. Probably some have considered and reconsidered the affection they have for their loving pets. Everyone is a suspect. Everyone is a potential Ebola carrier, even your cute dog.

We look at our colleagues and friends for visual assessment of their well-being. Does he/ she look well? Could this one have Ebola? Who has this person touched? Who did I touch?! Everyone looks a bit strange, everyone is tired. And we are starting to know the people who are infected. It is spreading and it is coming ever closer. We are all in the same boat and we think we know how to keep safe. For now at least.

More complicated issues are those of health care. There are very few safe health care facilities available. Most got infected at one point or another. People are in general scared of health facilities and avoid them as much as possible, some paying for that with their lives. And if you do get Ebola, access to the ETU (Ebola Treatment Unit) is not guaranteed. You will get in if there is an empty bed. No preferences, no priorities. Well, why should there be any, we are all the same people.

Our commercial health insurances have washed their hands over us. They will certainly not Medevac (medical evacuation) us in case of Ebola. They claim to still be willing to come for non-Ebola cases, but it will require a negative Ebola test. As if we are talking about malaria tests here. There seems to currently be only one commercial establishment equipped to Medevac Ebola patients. They only sign contracts with governments. So of course, several months into the crisis there is still no concerted action on that. The EU support is fragmented. It’s individual members states’ choice to take care of their citizens. Some EU member states have signed the agreements. Others are still thinking about it and others will just not sign. And forget about the EU consular protection agreements and treaties- Ebola doesn’t seem to qualify.

Some of us have been told by our representations to leave or bear the consequences at our own risk. What a great idea, asking aid workers to leave the country. As if it isn’t everyone’s problem! We get politically correct statements such as “we have no logistical or financial means to provide required support”. That actually translates as “we aren’t picking up the bill for your Medevac”. It’s costly, indeed. I heard it’s about US$ 1,000,000 to Medevac an Ebola patient. No small money.

But this crisis is everyone’s concern and everyone has responsibility to respond to it, to end it. And it will require people on the ground. You haven’t solved the problem by throwing a couple of hundred thousand euros or dollars at the WHO! That does not absolve you from responsibility! Not to mention our African expat colleagues. Their embassies rarely even offer any statements. And when they do they are just as politically correct, but empty of any support. Soon we will all be signing waivers (those who haven’t signed them yet) that we are here at our own risk.

This isn’t all. Many among us are not allowed to go home, not for a break (we actually need it sometimes), not to visit families without 21 days quarantine. Many countries just don’t accept us to enter at all, with or without quarantine. The popular opinion in many countries that allow us to enter is negative too. They don’t want us to come. They don’t need us to be importing Ebola to their safe beautiful places.

When we are actually allowed to enter a country, many face problems with families and friends. Some of them don’t want to be in the same room with us, touch us or want us to stay under the same roof. Others are trying to be brave, but are probably horrified and must be reconsidering their attachment to us and wondering why they are exposing themselves like that. You’d be surprised how common this is. Fear prevails. And we are feared by our closest. There are of course those who are well informed and ask us questions and have no problems with us.

You should know that we are also scared. We don’t want to put you in any danger. We love you. And we do know how to keep you safe. We are aware of the risks and we are (for the most part) a responsible bunch. Ask us questions. It is allowed and it is completely understandable. You should know that we know what to do to keep you safe.

The commercial airlines aren’t helping us either (appreciation is extended here to Brussels Air and Air Maroc who are still operating regular flights to Liberia). With so many cancellations of operations they have created an ever worse connectivity environment that has already existed before. Some people have to travel absurd distances to come in and go out. It is delaying the response. FYI.

All of the above is unfortunately not part of the solution, but part of the problem. Not just for those of us here. We’ve made our decisions and we are staying. For now. But many have left due to the lack of protection and lack of support, and no one can blame anyone for leaving. It’s not a normal situation. In a lab setup the Ebola operations follow protocols of biosafety level 4 (the highest). What kind of a nut stays with no protection and support anyhow (it’s a rhetorical question, no need for anyone trying to define us).

But the problem is that due to many of the above considerations, people also cannot be deployed. And we need people in the field. At some point money, nice words and strategic plans aren’t useful, when they cannot be translated into real action on the ground. We need solutions. And everyone has to participate in finding them.

We need to be here. We need to stop Ebola before it gets worse. And if we are not here and we don’t stop it, it will come your way. So please, be on our side. We are not the enemy, we are the ones fighting it.

The Forgotten of Ebola Crisis – October 2, 2014

It’s one of those mornings. Crisp on the account of last night’s rains, sunshine peering through the deep greyness of the skies announcing a looming storm to descend on Monrovia any moment now. Waking up in the morning usually meant excitement for work, to be productive and contribute to ending the Ebola crisis. But for the past two weeks I have been dreading it. I fear waking up every morning and finding her dead body sprawled on the side of the road, while people continue walking by, paying little if any attention to her.

I don’t know her. Not her name or where she comes from or what her story is. I first saw her two weeks ago. She was there lying on the road on the main intersection close to where I live. And old granny in a torn green dress looking as old as she is, half her skinny naked body exposed and deep infected wounds marking both sides of her head. Lying on the road motionless and at risk of being run over by the first inattentive driver. That’s how she got her head wounds. She was a victim of hit and run.

Sights of poverty are not uncommon when living in developing countries. And those of us living and working here are not immune to them. Sometimes we can bear it, sometimes we can’t. Sometimes we can help and sometimes we can’t. This is one of those times when all you can be is outraged at the way this world is and at your own inadequacy.

We stopped, my colleague and I. Next to her were standing two young men from the nearby slum, themselves looking shabby indicating their own struggle to survive. They don’t know her either. She is nameless and abandoned. She has to be someone’s mother, grandmother, sister and aunty. The young men were appalled by her desperate condition. They tried to help. They bathed her a few times, claiming she does not look like she has Ebola. She doesn’t look like she has it, but they have not protected themselves for ‘just in case’ either. But they helped still. Many don’t. Scared of anyone not looking 100%. It could be Ebola. Indeed, it could. They moved her to a bus station so she can be sheltered from rain and sun.

The elderly in Liberia and many other parts of Africa are taken care of by their children. There are no adequate pension schemes to provide for one’s retirement, no decent social protection or elderly people’s homes. It’s a responsibility of your children to take care of you. Not everyone has this luxury though.

With my colleague we arrange food and water for her since the day we saw her there. We bought her a T-shirt. It’s still nothing close to dignifying the way she still lays there. We called upon what you would think are responsible authorities. They seem to be under too much pressure by Ebola crisis. No one is responsible for her, no one claims her, no one helps. We called the hospitals, but themselves struggling with devastating effects of Ebola, they currently do not provide any longer-term hospitalization (which was explained as being longer than a few hours). I didn’t even know that. They were supposed to have been fully reopened and this was praised as such an achievement. Both facilities were infected due to the lack of infection prevention and control and were closed down for disinfection and out of operation for some time.

We called the radios. Did we really think that it would create some kind of public outrage? That someone would come to her aid? In the time when people are dying in hundreds every day from Ebola and from all the other diseases?

Now we are at a loss. We don’t know what to do anymore. We’ve become useless.

A week ago she could still sit up to eat. But she is getting weaker by the day. Few days ago she could not sit up anymore and was eating while lying down on the bare ground. She has not been eating for two days now.

Some well-wishers come by and say “great job” or “thank you” for feeding her. But, it’s not great, not even a bit. Great would be something completely different, such as finding her more permanent care, health care, so she could recover and be well and continue living. She isn’t living, she is only existing.

And at the end of it, when she dies the Ebola burial team will come to collect her as now all the bodies are considered potential Ebola cases. Only then will someone care. But only enough to remove her lifeless body. And she will be buried in an unmarked grave or perhaps cremated, nameless and forgotten, gone without a claim, added to the statistics of deaths.

Worse of all… she is not the only one. Unofficial WHO estimates are 3,8 non-Ebola deaths for every Ebola death. And this figure could prove to be even higher.

This is the kind of world we have created for ourselves. A world that doesn’t care about its own. Where people are not considered our own, but rather yours or theirs and very rarely mine. She does have a name and even though we don’t know it, she is one of our own.

And we have failed.