Quarantine

Well, we finally made it out of quarantine.

Our repatriation flight landed us in Dulles at 3AM. We went to the hotel and had an amazing hot shower and 2 hours of sleep before we went back to the airport to catch a plane to Detroit, then Atlanta, then Chattanooga. My parents drove to the airport with two cars and met us at the airport with a car loaded with food. We drove home by ourselves, waved to my sister who stayed on the porch with her 4 week old, picked up the dog, and drove to a cabin in the woods with no cell service or internet.

It was a both a blessing and difficult to be so isolated. Alone in the woods, in a beautiful cabin, with wonderful food, and a loving spouse is quite wonderful. But even though we are thousands of miles closer to home, we were even more isolated from our family than when in Africa.

COVID makes it easy to be paranoid. On our arrival we started to have worsening runny nose, small cough, but no fever. We stayed cooped up for a week and a half, during which time Rachel read 8 books. We called the health department, which is now doing screening for all who want it, and got tested. It felt like I was getting my brain tickled by that swab. After a few days, our tests both came back negative. All our symptoms were just allergies and we praise God for that.

It's wonderful to be back home and reunited with family. But after only 7 months, it still seems like we left some of our heart back in Salone.

Repatriation Flight

It’s been a chaotic week both emotionally and for our plans. After our decision to leave, we went to Freetown and paid $7000 cash to a travel agency. Less than 4 days later, the embassy says that there’s another flight that is completely different. They recommend we go and get a refund. “Money business” is always hard in Sierra Leone and I expected quite a fuss to get a refund. After all, this business had at least $315,000 come in and they were about to lose it all because the embassy changed its mind. However, it was surprisingly easy! I walked in, my hand written ticket was sufficient, and they took me to a small back room to count out the cash. The only thing they tried to pull on me was giving me some 20 dollar bills and not all 100 dollar bills. There is quite a drop in exchange rate between the bills, but I put up a fuss. After he acquiesced, I said “Thank you.” In the African style of directness he responded, “Why are you thanking me? You’re not helping me at all.”

We do all the paperwork to sign up for the flight and then begins the preparations to leave. Decide who to give our office keys to, increase security to 24/7, arrange for someone to intermittently sleep in our guest room, put all the important items under bed sheets to protect from dust, eat everything in fridge and freezer, and leave money with the appropriate people in case we need to arrange for something.

Friday comes along and we had arranged for the driver to pick us up at 6 AM. He arrives at 5:30. While driving to the airport there were multiple checkpoints where everyone was forced to either use hand sanitizer or to disembark to wash hands. The airport had 2x mandatory hand washing stations and temperature checks. We were literally the first passengers to arrive. I’ve never been so early for a flight before: 8:30 AM for a 1 PM departure.

During the check in process I spoke with a woman from the Embassy. She described the logistical nightmare of a repatriation flight as there are never direct flights from Freetown to the US. So the Sierra Leonean government had to discuss with the US Government, who had to get specific FAA approval. After lots of paperwork we arrived at the departure terminal and hunkered down with the Herreras and their 3 boys. We played cards, Minecraft, group games, ate lunch, shared our homemade snacks. The hours ticked by to 1 PM, no plane. 2 PM no plane. The plane had two other stops prior to us to pick up other Americans from other West African countries and it finally arrived by 3 PM. No one was allowed to disembark and they began fueling. Over many hours we would queue to board, then a delay; sit down for a few hours then queue again.

Based on rumors from staff overhead in the bathroom, initially there wasn’t enough fuel. After the fuel situation resolved, then the fuel door couldn’t be properly closed. It was decided that the plane was unsafe and that the local staff couldn’t be trusted to verify the repair was done properly. An announcement was made that we were stuck for several more hours while another plane was sent. Less than 10 minutes after this announcement, at roughly 8pm, it was announced that the plane was safe and we were leaving.

Our waiting time in the airport far exceeded our flight time to cross the Atlantic.

We arrived in Washington DC slightly before 3 AM. Everyone was wearing masks, but there were no handwashing stations and no temperature check. Just driving in Sierra Leone had more hand wash check stations than the major transit hub of the US capital. Due to our late hour, we didn’t see anyone from customs. The man at immigration asked us, “Have you been in contact with anyone with fever and cough?”
I replied, “Well, I’m a doctor.”
We stared at each other for a few seconds before he inquired, “Anyone in the last two weeks?”
I stared silently back as both of our discomfort was become more and more visible. I offered, “We’ve been screening people for Coronavirus and we never had any cases that needed testing.”
He looked relieved, shrugged and quickly waived us on without another word.

We arrived in our hotel with enough time for a shower and 2 hours of sleep before needing to return.

Due to being underpopulated, our original flight from DC to Atlanta to Chattanooga was canceled. Our trip now is DC, to Detroit, to Atlanta, to Chatt. All the airports are like ghost towns. It’s quiet and peaceful. Currently we’re sitting in Detroit and we’re happy to be back in the US. But we keep thinking about the welfare of Sierra Leone and we’re going to be very happy when our 36 hours of travel is over.




The Fernandos and Herreras in Freetown's Lungi International Airport

Travel Agents

We slept well last night, even without electricity. This morning the flood of messages brought us both comfort and more confidence in our direction. We prayed and discussed some more and then went to Freetown to book with the travel agent.

We handed over $7,000 (almost all our cash) to a stranger in a small sweaty office off a side street who gave us a hand written receipt for “Air Ticket” without a flight number. He took our phone numbers and told us that the flight left at 8AM on the 10th, maybe…
This is probably how the rest of the world books flights, but man it was weird.

There’s still several opportunity for God to close doors to keep us in Sierra Leone.
Firstly, the flight needs 150 people to make it viable for the company. As of this morning the flight had 95 and rumor has it that the booking closes tonight, but it might be extended to Wednesday. However, the entire country is on lockdown Sunday through Tuesday. We might be stuck unless another 50 people get scared.

Secondly, if we show Coronavirus symptoms in the meantime, they won’t let us on the flight. It is peak dust season and we each sneeze about once per day. Maybe I should start taking Zyrtec as a ‘mental health drug.’

We feel like it’s in God’s hands now. We also feel immense gratitude and support from all the connections and people we’ve become close with over the years. Even some mentors to our mentors spoke up, which was a pleasant surprise. To hear from all of you in our time of doubt has certainly been a blessing.

Love you,
James and Rachel

Donning and Doffing

It’s official, COVID 19 is here. The air, land, and sea borders were all closed 3 weeks ago. But this week, on the 31st of March was the first confirmed case. A Sierra Leonean who had been in France, but then returned to Salone. He had been in quarantine and at the end of his time, still tested positive. Somehow he had 130 contacts during that time. There’s also rumor that he was actually discharged before testing positive. But rumors truly are vicious in this place.

The second positive case came a day later, completely unrelated. A Dr. Bell who is a pillar in the very small medical community of Sierra Leone. She’s a pediatrician who sees inpatients and clinics across both government and private hospitals. She lectures at university and medical school and also sits on all the most important health committees at the highest levels of government. She had no travel history, no exposure to the other case, and in the two weeks prior had interacted with literally thousands of people. In just 24 hours, it’s quite apparent how far the cat is out of the bag.

So in our hospital, our basic preparations were further escalated. We have a small amount of supplies left over from Ebola: Tyvek suits (picture big plastic onesie pajamas) and goggles. All the elastic on all the masks and gloves have been destroyed by the African heat. Regardless, we have pushed on ahead with re-training the staff on donning and doffing PPE. (Putting on and taking off personal protective equipment). I say ‘re-training’ because many of our staff continued to work at this hospital through Ebola. Taking off a suit incorrectly could literally end your life.

It’s amazing how physically mimicking something brings up so many stories from the past. Mr. Abu told me many stories about how terrible the fear was of the red zone. But after going in and out countless times, how life threatening became normal. Apparently when reaching for the zipper at the neck of the Tyvek suits, it was common to hear people shouting “Jesus! Jesus! Jesus!” If you reach too far and you touch your chin, it could all be over.

On the eve of another virus, far more contagious than the past, it’s hard to know how to move forward. What is faith? What is arrogance?

There’s one more flight home: a charter flight from the US Embassy. The emails tell us that if we don’t take this flight, we are here for the duration. Your home country shouldn’t have to come rescue you if you decided against repatriation and were warned. It’s a surprisingly difficult decision.

Pros – Run home to a country where there are actually ICUs. The government has the ability to intervene for its citizens. Your family won’t worry about you as much. Your life isn’t as much at stake. The entire administrative committee agrees we should go. Everyone we ever talk to says we should go. There’s only one shot left.

Cons – ‘Well Africans, we came to help you. But now that you need us we’re running away.’ There’s the guilt of abandonment. There’s the shame of not running towards trouble like so many missionaries before us. There’s only 4 ventilators in this entire country and the government officials are keeping the best hospital to themselves. If we contract the virus, Rachel and I will be admitted to different wards, unable to see each other for 2 weeks. All while being subjected to 3rd world medicine. We’ve been here for 7 months and homesickness and culture shock are a real thing. If we get trapped without flights home for another (potentially) 6-12 months, are we going to get so burned out we don’t want to return to Sierra Leone?

This is different from Ebola. During Ebola our hospital was overrun with support. Cuban doctors, British generators and infrastructure, Sierra Leonean government supplies and buildings erected. But now, every country is concerned about themselves. Foreign aid is unlikely. Even with confirmed cases, the government is yet to dispense any aid to hospitals.

There are just so many questions we can’t answer:

-       Did we come to Sierra Leone for such a time as this?

-       If there isn’t international support and the country runs out of medicines, do they even need doctors?

-       Is God asking us to risk our lives or did He give us unified counsel from everyone we ask and one last flight home?

-       Maybe we stay to help, then burnout and never return. Can that be a successful mission, even though we didn’t stay our 5 years? Is burnout a part of God’s plan?

-       If we become truly ill, is it even possible to medevac in the middle of global infectious pandemic?

-       How desperate will the people become when Sierra Leone is hit by the global economic downturn complicated by an already inadequate health system?

-       Once we leave, how long will the borders be closed? Will we even be able to return in the next year?

-       Are we any safer at home? Especially if the truth is that we’re just afraid and don’t have even a mustard seed of faith. Are we running away from God’s will?

Rachel and I want to do the right thing, but we don’t see any right answer. The chorus of advice is unified, but we’re not at peace. We have less than 24 hours to make our decision, all with the knowledge God will bless us regardless of which path we take.