Saturday, September 5, 2015

Sierra Leone at the End* of an Epidemic

Sierra Leone is so BEAUTIFUL. Perched on the edge of the sea. Every restaurant or hotel has an ocean view.  Honestly pretty much wherever you go in Freetown there is a stunning ocean view. Beauty and inequity in large quantities as far as the eye can sea.

What can I tell you? I got to see Sierra Leone at the end of an epidemic. All the aid and solutions got here too late and are staying here too long.

I was driving down a highway from Kenema towards Freetown (near Bo) when it came on the radio that there were no new cases of Ebola (Monday August 17) . Zero for the first time in more than a year. I thought there would be more jubilation about no new cases. The response from the nationals around me was muted. It's as if they were thinking, "It’s one more thing… when will all these organizations and their bossy money and protocols leave? What will be the next scourge? Shrugs. "

(*Since then another case has been found, and contacts are being traced. Hopefully this is near the end.)

I had a great trip and learned a lot. I saw actual contact tracers doing their job in Northern Port Loko. It’s hard. Really hard, Imagine your mom just died of a strange and terrible disease. And imagine some foreigners came and told you not to bury her. And that they were taking the body. And also that you were now quarantined, (whether you have any food at home or not) and you have stay in your house under armed guard. And your crops in the field? They will fail. And others in the village that know you are trapped? They will kill and eat your goats. You are helpless and angry. And grieving.
Ebola Treatment Unit in Port Loko
For a while people were starving in quarantine. Naturally, they would run, and break quarantine, and spread Ebola. Now the CDC supplies live chickens and pineapples and there are reports of people touching the dead to GET INTO QUARANTINE for the food. So god help us, you just cannot win. It makes sense to me why some who were supposed to be quarantined ran away to avoid starving and being trapped with sicker people. And it makes sense to me why someone with nothing might choose to get into quarantine to have enough to eat for a few days. And it makes sense to me why this epidemic is hard to contain. It is all mind numbing and also makes so much sense.

Back to the contact tracer. It’s their job to walk up to this angry, grieving household every day and ask them how they are, and if they have a fever or vomiting and take their temperatures. And they try to not get Ebola themselves. And the people they are asking are maybe not that excited to see this stranger asking all these questions (Do you have diarrhea? How bad?). And maybe they call you a ‘busybody’ and tell you to get lost. And you need to get the data and report it and identify if anyone is symptomatic and have them sent to the ETU if they are. Everyone lies to you and distrusts you. And it’s your job. Good luck!

On the trip I also got to visit some schools. ‘Schools’ really. Don’t get me wrong. They are doing their best, I met wonderful dedicated teachers and head teachers doing their job the best they can in very difficult situations. I spent a few hours at this school:

We were there to help them automate how they take attendance and also report other indicators to the school donors (Plan, Save the Children, and International Rescue Committee). These groups fund the schools and want to know, quickly and accurately, about attendance, and reading and math scores, and number of minutes of the day dedicated to reading and math, and number of teachers trained on their methods. All of this can be reported electronically and help the donor if the programmatic funds are being directed as they expect.

This school has one big open room for two first grades and two second grades. Can you imagine if your first graders were subjected to distraction like that? There are no benches or desks so the students sit on the floor. The school is a primary school for about 400 students in the morning from 7:30 – 12:30, at 1:00 PM the school becomes a secondary school and older kids come until 5 PM. There’s no power in the school and when the rains come it’s quite dark inside.

The teachers carefully take attendance in registers for the donors:

I hope that some of the aid money to fight Ebola will help to strengthen local systems to provide better general health care going forward. This will require an effectively planning government. And coordination among agencies that did not exist prior to the outbreak. It's a tall order.

The way money swirls all around but somehow doesn't seem to wet the parched areas at all feels familiar. While I was there the government was tearing down the slum residences and shops that are around my hotel. The government wants to improve the area for tourists and development. The residents have nowhere else to go and are angry. This was meters from my hotel:

“The U.S. Embassy has received reports that the Government of Sierra Leone has initiated “Operation Take Control” in the Aberdeen area of Freetown as part of continuing efforts to fight crime. This operation entails the demolition of unlicensed shops, businesses and dwellings in Aberdeen and is expected to last for at least one week.

So far it appears that the displaced people in Aberdeen are remaining peaceful but there is a visible police presence in the area. The U.S. Embassy in Freetown advises U.S. citizens to be cautious when going to Aberdeen in the coming days and avoid any public gatherings. Due to the extent of the demolition there is a possibility of spontaneous demonstrations breaking out in Aberdeen and the surrounding environs. ”

“Operation Take Control” is actually operation piss off hundreds of poor, desperate people with nothing to lose. Their slum homes were demolished in the height of the rainy season. They are angry and marching, and throwing things at cars that go in and out of the hotel. They don't have much, but they now find themselves with ample debris. I can sympathize. I can see why the government wants to develop this area for tourists. With Ebola gone maybe the tourist dollars will return. That would be a boon for industry. But for hundreds of squatters, they are homeless in the rainy season and lost their small shops and cobbled together tarp tents. Now they sit among the ruins of their slums and don't have anywhere else to go.

The CDC spent so much money here. Flying in doctors for four or six weeks rotations. That’s a week to learn what is going on, two weeks to do your job and a week to get ready to go home. Those flights are expensive. Everyone stayed in the Radisson Blu for $300 (or more) a night. Everyone has a car and a driver. It is big aid at its ugliest. I keep meeting amazing organizations doing special difficult work, and when I think what they could have done with small crumbs of this budget.

Check out Anna from World Hope International, she’s almost the only service provider of any kind for more than 400 disabled children in Freetown. Her budget is minuscule and she raises her own salary from emailing friends. Imagine what her thrift and skill could do with the kind of funds CDC and UNFPA and UNICEF are dropping on this place.