Missive #9 – December 30, 2014

On the road again

Christmas was eventful. As I walked to the EMC for my December 25th morning shift, I heard our medical team leader (MTL) talking with our nursing activity manager (NAM) about a request from MSF-Geneva for assistance. Although Bo is operated by MSF-Amsterdam, all of the MSF operating centres (Belgium, Paris, Amsterdam, Geneva, and Barcelona) support each other logistically, medically and with human resources. I had already heard that OCG (Operating Centre Geneva) had just opened an EMC in Freetown, Sierra Leone’s capital, and that they had many patients and lots of work. This is not surprising because Freetown is a large Atlantic port city with over a million residents living primarily in slums. For a virus like Ebola, this is a perfect storm – poverty, poor sanitation, over-crowding, and constant, unavoidable human-to-human contact. Monrovia, Liberia’s capital, has only recently emerged from a devastating Ebola outbreak and Conakry, Guinea’s capital, is currently in the throws of an Ebola crisis. Although my time in Bo was stimulating and rewarding, I knew right away what I had to do. I volunteered to go to Freetown.

Later that day, the NAM took me aside and asked if I was okay drawing blood and placing intravenous cannulas in Ebola patients. The MTL then phoned me with the same query, because those skills were specifically mentioned in the OCG request. The issue in these procedures is not only the skill of doing them, but also the risk of a mishap because of the PPE. Since my internship, I have always been comfortable doing these kinds of interventions so I promptly said yes. And, that was that. The word spread quickly and, by the time our Christmas dinner and party got started that evening, almost everyone on the team had approached me to express their feelings about my transfer. I have to admit that I was touched by their encouragement mixed with twinges of sadness at my departure.

Christmas dinner was amazing! Two logisticians from OC Belgium, Pete and Chris, brought over their incredible western-style barbecue and expertly grilled-up beef kebobs and chicken breast. They’re Australian, of course. Other expats prepared vegetables, salads, plantains and cheese and onion pie (for the vegetarians) along with cheese, crackers, cranberry sauce, and dessert! My role was DJ because I was always playing my iPad/iPhone/MacBook music at the pool on my Jam-box speaker. My playlist for the event (“An Ebola Christmas”) included Motown, Doo-Wop, Arcade Fire, Beach Boys, Bob Seger, Bruce Springsteen, ZZ Top, and a few of my other favourites. I ended my last evening in Bo at Pete and Chris’ house playing their version of beer-Jenga. In the normal game, as all parents know, one tries to pull out rectangular Jenga pieces from a tower of Jenga without causing the edifice to collapse. In beer-Jenga, the home-made wooden Jenga pieces are inscribed on their side with tasks like ‘run to the gate and back in 10 seconds or take a drink of beer’ and ‘name the capital of Togo or take a drink of beer.’ Needless to say, a good time was had by all.

Next morning, I packed up my stuff and went for a haircut in Bo Town. The only barber recommended by MSF is an amicable Lebanese named Amigo. As I learned later, his real name is Salah but he is popularly called Amigo since he used to run a club in Bo named ‘Amigos’, the best club in the whole country according to Salah. As Amigo showed me into his haircutting parlour, I couldn’t help but notice that it was dusty and dirty with empty boxes and broken stuff littered all over. He sat me down in a squeaky barber chair that looked like it was left over from the Inquisition. But before I could change my mind and skedaddle home, he took out his box of pristine haircutting accoutrements and began patiently cleaning each and every one with Dettol. I immediately felt better. Salah is a second-generation Sierra Leonean whose father emigrated from Beirut along with many other countrymen. I guess they had positive experiences and told their relatives back home because Lebanese run many of the businesses here. We discussed his son in Washington, D.C., his recent return to Beirut, life in Bo, and the devastating effect of Ebola on his country, as he expertly clipped away at my mop with his scissors and comb. Towards the end of my very satisfactory haircut, Salah took out an old straight razor to trim around my ears. I told him that was too risky for me. Salah smiled and said ‘no problem’.

My ‘movement’ to Freetown was scheduled to leave Bo Base at 1 pm. When I arrived there with my luggage, I was glad to see that my Ebola training partner from Amsterdam was coming along to help out in Freetown. Doctor Greg is an Australian ICU physician who has lived and worked in London UK for more than 30 years. He was originally sent to the EMC in Kailahun but they were closing because the epidemic has subsided in that area. Like me, he volunteered to help out in Freetown. The 3-hour road trip went quickly. There were many Ebola checkpoints along the way but the MSF Land Cruisers are allowed to pass without delay or inspection. We saw a motionless body along the side of the road and turned back to inform the police at the previous checkpoint. We are not permitted to stop for accidents or become involved in incidents to avoid the risk of exposure to blood and body fluids. We arrived in Freetown at 4 pm, received a brief orientation and were escorted to our rooms at the Roy Hotel where the OCG staff have their rooms.

Freetown is under ‘Ebola lockdown’. Shops and businesses have a 6 pm curfew during the week, a noon curfew on Saturday, and everything is closed on Sunday. The Roy is a nice hotel on the Atlantic Ocean with a seaside restaurant where I had enjoyed fresh lobster 3 weeks ago on my way to Bo. Greg and I unpacked and went down to the restaurant for dinner and a beer. Around 9pm, the hotel manager (Lebanese, of course) informed us that the other MSF-ers were on the terrace. Greg and I went out and introduced ourselves as the reinforcements from OCA. Everyone pleasantly murmured hello but they looked really beat. When I enquired at what time we leave the hotel for the EMC, their answer was 6:15 am. Hmm. When I asked if they had all just returned from the EMC at 9 pm, their answer was yes. Without thinking, I blurted out “oh shit!”