This summer, I participated in a trip to Sierra Leone where I
learned about the impact of Ebola and related efforts to recover from the
epidemic. I have worked in international affairs for over two decades. During
that time I have lived in and traveled to dozens of countries across Asia,
sub-Saharan Africa, and the Caribbean. None of those experiences prepared me
for my trip to Sierra Leone.
In discussing strategies for controlling the 2014 West Africa
Ebola epidemic and addressing its impacts, I have used the words “densely
populated urban areas” more times than I can count. The reality of what those
words meant hit me hard during this trip. I saw people traversing open sewers,
which could easily spread Ebola, and sharing cramped spaces, which would make
isolation virtually impossible. One evening we met three Ebola responders. I
was humbled listening to these people tearfully attest to bidding their
families good-bye on a daily basis, never certain how long it would be before
their own lives were claimed by Ebola. In my eyes, these people were heroes. Their
actions made me think: Would I risk my life without compensation to case my
neighborhood in search of those sickened with Ebola and shuttle them to the
nearest treatment center or isolation unit? And if I did, how many times could
I do that before quitting?
By the time the outbreak ended in June 2016, over
28,000 people had contracted Ebola, more than 11,000 of whom died.
Roughly half of the cases and about one-third of the deaths occurred in Sierra
Leone. Surviving Ebola has not been an easy task. I am very familiar with the
long-term health effects of Ebola, blindness, muscle weakness, and nerve
damage. It wasn’t until I was on the ground in Sierra Leone that I realized I’d
overlooked one of the most pressing long term effects of Ebola, orphanhood.
We visited a village where half of the population was killed by
Ebola. While standing, eyes blurred with tears, listening to a woman describe
her harrowing tale of isolation, loss of her family, and finally economic
recovery, I felt a little finger slip in between mine. I looked down to find
the sweetest distraction to this tale of misery: a chubby cheeked little girl
smiling up at me, completely oblivious of the tragedy into which she was born.
Before long, I felt another finger slip between mine and up popped another child.
Within seconds, I was out of fingers to hold. There were three children holding
onto each of my hands. I looked around and noticed for the first time how
severely the children outnumbered the adults, maybe by ten to one. Ebola had
robbed these children of their parents and for the surviving adults, members of
their support network. The remaining adults, who were already struggling to
make ends meet now had to figure out how to care for an additional three or
four children. They were visibly traumatized and exhausted but the children
were exuberant and joyful. If I was feeling overwhelmed during a brief visit, how
must it feel to live in such a reality?
The children soon became my focal point. Once I started to watch the children, I noticed another oversight of mine. Orphans, in my mind,
were like the little girl who soothed my spirits. I did not think about
teenagers. At one site, we met a 15-year old girl who lost both parents to
Ebola and now had to care for her 9-year old brother. I immediately thought of
my 16-year old daughter, for whom 90% of all conversation revolves around boys
and fashion, being made suddenly responsible for her siblings. I’m sure she’d rise to the challenge with the support of a
life insurance pay out, as well as aunts and uncles who are financially secure.
This girl had none of that, and most of those in her community were in the same
boat.
The loss of her parents was only the beginning. Barely able to
feed herself and her brother, this teenager suddenly needed a large sum of
money to pay for her brother’s surgery. This new caretaker described how she
benefited from a program where members of the community paid for the surgery
through a village savings and loan program (VSLA) that was designed to help
girls and women access capital for meeting their needs. Woman after woman
stepped up to share her story about how the members provided each other with
much needed comfort and support in a time of tribulation. One woman who lost
her husband to Ebola described how the program provided her not only financial
support but also emotional support. After she contracted Ebola, people avoided
her, feared touching her. After she finished retelling how the members of the VSLA provided her emotional
and financial support, she resumed her position next to me.
Instinctively, I hugged her. As soon as I hugged her the following thoughts ran through my mind: "Wait a minute, your hand is touching a woman who is an Ebola survivor. Her sweat and tears can carry the virus. You can be contracting Ebola right now." I was ashamed by these thoughts flooding my mind. My second group of thoughts went to the people in the community. I thought of the stories in the press of people chasing away foreign health workers, believing that they'd introduced the virus into their community; or other stories of how people with Ebola would hide in the forest to avoid stigma; or how relatives of those infected with Ebola would hide the illness from others and secretly bury their loved ones. I finally had some insight into the fear they must have felt of an unknown virus that was rapidly and visciously killing them and their loved ones. I also thought about the conundrum they must have faced: to care for your loved one could be your own demise.
As those groups of thought waned another one emerged: I am an American with access to health care, which was used to save the lives of Westerners who contracted Ebola. I reminded myself that my chances of survival were pretty high. These conflicting thoughts cycled through my mind as I forced myself to continue hugging this woman. I decided that I would not let the fear of contracting Ebola prevent me from demonstrating to this woman that she was not a periah.
Instinctively, I hugged her. As soon as I hugged her the following thoughts ran through my mind: "Wait a minute, your hand is touching a woman who is an Ebola survivor. Her sweat and tears can carry the virus. You can be contracting Ebola right now." I was ashamed by these thoughts flooding my mind. My second group of thoughts went to the people in the community. I thought of the stories in the press of people chasing away foreign health workers, believing that they'd introduced the virus into their community; or other stories of how people with Ebola would hide in the forest to avoid stigma; or how relatives of those infected with Ebola would hide the illness from others and secretly bury their loved ones. I finally had some insight into the fear they must have felt of an unknown virus that was rapidly and visciously killing them and their loved ones. I also thought about the conundrum they must have faced: to care for your loved one could be your own demise.
As those groups of thought waned another one emerged: I am an American with access to health care, which was used to save the lives of Westerners who contracted Ebola. I reminded myself that my chances of survival were pretty high. These conflicting thoughts cycled through my mind as I forced myself to continue hugging this woman. I decided that I would not let the fear of contracting Ebola prevent me from demonstrating to this woman that she was not a periah.
This trip was like an emotional rollercoaster. I would
vacillate within minutes between feeling despondent and hopeful. The tales of
death and further impoverishment would be counterbalanced with steely determination and incremental advancements.
Just before arriving, Sierra Leone’s health ministry announced that local scientists had detected a new Ebola species in healthy bats. I was giddy with excitement having met one of the Sierra Leonean epidemiologists who identified the new strain and peppered him with loads of questions. This was big news! As a partner country of the Global Health Security Agenda, the United States has been helping countries prevent, prepare, and respond to disease outbreaks with pandemic potential. Disease surveillance is a critical component of prevention. Discovery of a new strain before it causes mass animal casualties can protect humans if the information is used to create new vaccines or treatments against that strain.
In our interconnected world, disease that were once confined to the tropics are becoming increasingly endemic in the United States and other Western societies. Policy makers in industrialized countries are increasingly recognizing that bolstering disease surveillance and control capacity abroad provides mutual security for people in the tropics as well as those in their own societies. An important part of my work is explaining how diseases are transmitted, deliberating strategies for controlling and addressing their spread, and of course considering resource levels for such actions. Discussions in Washington about foreign aid programs can sometimes amount to a bland consideration of numbers, making it is easy to forget that behind those numbers are survivors (teenagers without parents, widows without any financial resources, and of course chubby cheeked toddlers) and people working for our mutual self preservation (Sierra Leoneon first responders and scientists).
Just before arriving, Sierra Leone’s health ministry announced that local scientists had detected a new Ebola species in healthy bats. I was giddy with excitement having met one of the Sierra Leonean epidemiologists who identified the new strain and peppered him with loads of questions. This was big news! As a partner country of the Global Health Security Agenda, the United States has been helping countries prevent, prepare, and respond to disease outbreaks with pandemic potential. Disease surveillance is a critical component of prevention. Discovery of a new strain before it causes mass animal casualties can protect humans if the information is used to create new vaccines or treatments against that strain.
In our interconnected world, disease that were once confined to the tropics are becoming increasingly endemic in the United States and other Western societies. Policy makers in industrialized countries are increasingly recognizing that bolstering disease surveillance and control capacity abroad provides mutual security for people in the tropics as well as those in their own societies. An important part of my work is explaining how diseases are transmitted, deliberating strategies for controlling and addressing their spread, and of course considering resource levels for such actions. Discussions in Washington about foreign aid programs can sometimes amount to a bland consideration of numbers, making it is easy to forget that behind those numbers are survivors (teenagers without parents, widows without any financial resources, and of course chubby cheeked toddlers) and people working for our mutual self preservation (Sierra Leoneon first responders and scientists).
