Ebola #2

For a large portion of my deployment I worked in Lofa County in the area where movement between Sierra Leone, Guinea, and Liberia is high and Ebola burden was the highest for a long while.  Currently only Monrovia has more cases. I really enjoyed my time in Lofa.  I was able to work closely with the leadership and field teams and accomplish quite a lot in the short time I was up there.  

Before I left Monrovia I learned that food was scarce in Lofa because of all the transportation limitations and loss of full capacity to support agricultural activities.  I ran by a grocery store right before leaving and picked up my 8 or 9 days of food - a bag of raisins, some crackers, 2 jars of peanut butter and a round of Laughing Cow cheese.  Jealous?   I ended up being able to each local food that was cooked by a woman who worked where I was staying.  Happily, my $10 daily contribution fed the entire compound of ~15 staff of security and others.

The drive up to Lofa was just beautiful.  The trip was all the more peaceful because I am so used to road trips in Bangladesh where roads are just teaming with buses, trucks, cars, motorcycles, rickshaws, auto rickshaws, cow, bikes, people, goats, markets, etc.  This time around, the roads were empty and the scenery was an aesthetic treat.  The bumpiness was effective at keeping my pedometer step count high. After my 8 hour drive I had 'taken' 12000 steps and climbed 97 flights of stairs!

Sometimes we passed through road blocks designed to allow an official to assess temperature of all passengers as one measure of Ebola screening. It's hard to see the road block but try to find the rope held across the road.

My driver wanted to stop for some sugar cane to snack on:

During the drive, I saw signs of closed health facilities.  At this time ALL health facilities across the country were closed...all of them.  There had just been too many health care staff who died of Ebola.

And finally we were in Voinjama
Heading in to town

 Looking back out

 And I thought this was interesting because it shows a typical rice farm which looked MUCH different from a rice farm in Bangladesh!

Once there I settled in

While there I worked a lot with the surveillance team to support them as they improved their activities.
Here's the data management team working hard at entering data which eventually makes it in to the numbers you see in the news:

One activity we did was improve the link between the county surveillance center and the MSF Ebola treatment center in Foya.  To do this we visited the center and copied all of their records to enter into the national system

I also helped with community-based trainings about Ebola. The training in the photos below focused on various genres of community leaders (tribal, police, government, youth) and their action plans to prevent the spread of Ebola in their community.

The team there organizes a few regular weekly meetings that gather representatives from a number of organizations participating in response activities. In this first photo we're heading to the meeting

At one point I went out with a colleague to visit the county hospital. This used to be a very busy hospital that has centers focused on tuberculosis, HIV/AIDs, etc but was completely empty.  One of the first outbreaks happened at this hospital resulting from someone traveling from Sierra Leone.

We always have to wash our hands when we enter a location.

 Main entrance

 Emergency room

Where an Ebola 'holding' center may be established

The second day I was there the burial team prepared for a burial on the office compound (vs preparing at the affected household as they usually do).  

Here is the man who receives all the calls (hands free) from the community and assigns response tasks as appropriate.  He receives a lot of calls requesting a burial.

The team of 6 prepares for a burial

Getting the final touches and ready to go

But then they realized the car didn't work (a common occurrence).

 And the team pushes them forward and lets go to fire up the car.

Two days later was my first full day in the field up in Lofa.  The response coordinator and I planned to observe a burial and visit a few hard hit towns. I ended up getting a tour of the history of Ebola in Lofa. It was an amazing day.  Each person I met had been heavily affected.

The death of a village leader and the first death in that village, here we are walking up and talking with the community members for the first time

 The same burial team that you saw above prepares for this burial

 Here you can see the burial team standing next to our response coordinator working with the family to complete the data record form

And, among a few others stops during the day, visiting Barkadu which, when I visited, had experienced more than 10% of ALL recorded Ebola deaths in all three countries.

 the ONLY vegetables or produce for that matter that was in the market - some peppers

 bananas, potatoes and peanuts (and there were a couple more items being sold)

 Here the response coordinator is speaking to many Barkadu town members

 and here my driver is asked to spray bleach water on hands and also on feet.  He was carrying around my spray bottle so that he could spray anything before he touched it.  I am very proud of him because at the beginning of this day he was too fearful to get out of the car at any location but after a few minutes of seeing me and the response coordinator walking around he would join us, with the spray bottle.

While I was up in Voinjama, CNN International visited to complete a story on the area.  They joined us when we visited the burial and catalyzed Alpha leading us on the tour of the history of the spread of Ebola in the Lofa, and on into Liberia.  If you have a few minutes, here's the clip and you'll know from the other photos I put on the blog, that I was hovering just outside of camera view the whole time.

CNN video clip from Lofa

Ebola response #1

In August I deployed to Liberia for 4 weeks to help with the Ebola response.  This is part 1 of photos from the field. I'm limiting my commentary but let me know if want any more details.

I spent about half of my time in Monrovia where there are Ebola related billboards, cars reassigned to Ebola tasks, and many more Ebola related visuals all over town.

While in Monrovia I spent a lot of time at the Ministry of Health working on surveillance as well as health promotion / communication activities.  When I entered the Ministry of Health building, and about 99.9% of all buildings, I, along with everyone else, was required to wash my hands with a 0.05% bleach solution (if mixed properly) to kill any potential virus on my hands.

 I supported the surveillance team as they hosted a 2 day workshop to train officials from affected counties on surveillance systems and provide information about support offered by the Ministry. We had two exciting surprise guests: President Ellen Sirleaf, Liberia's president, and Keiji Fukuda, WHO Assistant Director General for Health Security.  Dr. Fukuda was in Monrovia at the same time Dr Tom Frieden and Dr. Rich Besser were there. It was a very busy week for hosting guests.

Part way through the workshop two folks lead us through the Ebola dance.  They asked everyone to use their hips to spell E B O L A. I think the request surprise everyone, but it also pulled some much needed laughs from the audience.

Here are some photos taken in the national data and surveillance center at the Ministry of Health.  These were taken on my last day. I wish I had photos from my first day because you would have seen these same people crammed into a room about 1/7th the size and all hovering around 1 computer.  It's amazing what a month can do!

 Here I am trying to convince the team to pose for my photo but they were just too dedicated, or maybe too shy, to get up and really pose.

Each yellow form represents one person with Ebola.  The team and the whole response effort is challenged by the fact that forms are submitted for only a fraction of the actual cases.

I worked with national medical centers and MSF to improve data communication between facilities and the national surveillance system.  Here are some photos from those facilities (let me know if you want to see more).
Here is the 'green' or 'cold' zone for only physicians and nurses, and no Ebola patients, that is at a government Ebola management facility.  The boots and other reusable items are drying after being washed in a 0.5% bleach solution.

I was able to visit the huge, 120 bed, MSF Ebola management center in Monrovia the day before it opened for patients.  Here is a tent to house suspected cases.  Yes, it does get hot in the tent during the day.

This time around as MSF built the clinic they decided to put in sockets to allow patients to charge their mobile phones.  Patients really appreciated this option.

Here is a break room for center staff with a row of backpacks that hold 0.5% bleach solution.  The 'hygienists' or 'environmental specialists' or 'sprayers' use these to, among other things, douse medical staff as they take off Personal Protective Equipment when they are leaving the facility after a shift.

This depicts someone measuring the driver's temperature and subsequently all of our temperatures before we entered the district health office in Grand Bassa County.  Periodically throughout the roadways and particularly at county and some district borders, there were road blocks where passenger temperatures were recorded.  The accuracy of the temperature checks is a matter of discussion, but at least there was movement to get protocols in place.

Here I am with one of my closest colleagues there. 

Weekends with friends

Here are a few photos from the past 2 weekends during which we enjoyed time with friends, including amphibious ones.

Henry has had many of the same friends in his class since he started at his school in the summer of 2013.  We were finally able to enjoy some time together outside of school and Henry (and Elliot) had a blast.   After an hour or so when some of the kids turned to playing games indoors, Henry took advantage of time with a friend's dad who threw the ball with him, and then Elliot, for quite a long time.

The next day that weekend we went to the Botanical Gardens after a many-month spell when we didn't go.  We spent many hours exploring the grounds and certainly enjoyed the frog feeding session.  Henry and Elliot spent a good amount of time hunting down the quail that hangs out in the 'rain forrest' who Henry named "Quilder of the Wilderness".

 Looking for Quilder

Not only do Henry and Elliot like to dress the same sometimes, but when it comes to Teenage Mutant Ninja Turtles, if one has the shirt on the other one needs to follow. By the way, in case you should ask, Henry's favorite Turtle is Raphael and Elliot's is Leonardo.

The other wardrobe preference update happened one morning when Henry said "I stand for Yasir (his best friend at school) and Yasir wears soccer socks to school." Therefore, Henry felt he should wear them and now tries to all the time.  Too bad we have only 3 pairs.  Interestingly, it turns out Yasir and Henry were on the same soccer team last year and now just started being classmates.

Last Saturday we participated as a family in the Winship Cancer Institute annual 5K to support cancer research.  It was fun to be back at Emory of this event.  The boys enjoyed our first family race and cheered us on as we ran the course - all the while pushing 115 lbs of boys and stroller.  Scott pushed most of the way but since I had the stroller the last ~1 mile I got all the glory at the finish line :)

Note: Henry is wearing bright orange soccer socks.

Randomness

Here are a few photos of the boys from the last few months.  

Breakfast time

Dada and Gigi came to visit and brought with them dry ice to keep some food cold during the drive.  The boys were so curious watching the bubble they blew hover over the 'fog'

 A morning walk to the bagel shop and then on to the park to play.

 Ice cream with Gamps

 An evening picnic at the nearby park

 Elliot is OBSESSED with corn!  It was wonderful to discover this through our weekly CSA supply of fresh cobs.

 Backyard time

 Baseball practice

 Going for a bike ride