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.

African Exclusive

There are some experiences that almost solely happen in Africa. People think about wildlife, poverty, malaria, safaris, clicking languages, polygamy, etc. There are other experiences that are just so outside the imagination, it’s hard to even predict.

With all the Coronavirus talk, the government officials came to the hospital for an impromptu “sensitization” lecture. Of course, they came at 4:30 right as everyone is supposed to be going home. Then it takes 30 minutes to set up and is just a bunch of people reading directly from slides. Regardless of how boring it is, I’m a bit nervous. Things aren’t finalized with all our paperwork, government officials always pick out the white people, and all the staff is also at the meeting. It’s a packed house. In the middle of all this, Ami comes over and starts tapping me on the shoulder quite insistently.

Before I go on, let me describe her a little bit. Ami has a fiery personality and with her things are either great or terrible. She’s either dancing or sulking. She speaks such deep Krio that even after 6 months here, I still can’t understand her most of the time. She insists on speaking to me in Temne, even though it’s clear I have no idea what either she or I am saying. Here’s a picture of Ami with Rachel last Sabbath. I’ve never seen her wear such a great hat.

 

So Ami is insistently tapping my shoulder. I try to brush her off, but she won’t be deterred. She whispers something into my ear, that I have no idea what she’s saying. Then she shoves something into my hands. At this point, whatever is going on with Ami seems super important. I turn towards her and open what is in my hands.

It’s my underwear.

Ami is our laundry lady and it was laundry day. She must have found them and she decided that an all staff meeting with all the government officials was the best time to bring back my lost unmentionables. That evening I walked home with a conspicuous bulge in my pants pocket while trying to imagine any situation on any other continent, where a woman would hand me my underwear in the most important meeting of the week. I decided that I’ve had a once in a lifetime experience.

Strange Encounters

Things that would be strange in the US are totally normal here. I notice it daily, but thought I would jot down a few instances.

I'm walking through the hospital and a nurse pulls me over, "I need you to meet someone." I think it's a patient's family or one of her friends. Instead, she leads me to a white person (a rarity). She says, "Hello I'm Paula. I'm a cardiologist from Italy." She asks if I mind if she gives some recommendations about one of our admitted patients: a 50 year old woman who came in with blood pressure of 240/120 who had been on IV antihypertensives combined with triple oral antihypertensive therapy for 3 days without any effect. What a perfect consult for a roaming cardiologist!
"I hear a mitral valve regurgitation murmur, have you considered lasix?" Firstly, I have no idea how she heard that with the nurse's stethoscope. Secondly, in this country I'm always happy to have a second opinion from any non-witchdoctor. Because I frequently want to have a cardiologist around, I ask "How long are you in Waterloo for?" She casually replies, "Oh, probably another 4 hours." I wonder if she could see the disappointment on my face. Unfortunately I didn't have another consult for her within 4 hours, but I certainly did within 12. Either way, both me and the patient were blessed by the roaming cardiologist.



A few weeks ago, right as the coronavirus fears were really picking up, we had a Chinese man walk into our hospital. He asked how many masks he would be allowed to buy. Now normally we don't sell medical supplies. But we have thousands of masks that it'll take us years to use and since we struggle to make payroll, for the right price you can have almost anything. After he made the purchase and left, Dr. Kabba noted, "I hope he doesn't know a coronavirus patient."
The next day he came back, wanting several hundred more masks. Then rumors started flying around the hospital. Is he hiding a coronavirus patient from the government? Is he trying to protect himself and his compound without telling anyone? Well, we're desperate for money so we sold him the masks. But when he arrived back on the 3rd day in a row, enough was enough.

Dr. Kabba notified the Ministry of Health, who called Immigration, who requested backup from local police. Soon the hospital was swarming with uniforms. Any man in a uniform is instantly interested by an Apoto (white person), and it's not always for good reasons. So Dr. Kabba recommended that Rachel and I make ourselves scarce. In the end, they discovered that he was just a shrewd businessman making a pretty profit in China. There was no risk of exposure. But with all the police around, they needed something to do. So they accused the hospital of selling government supplies. Dr. Kabba, Mr. Fobbie the business manager, Augustine the clinical supervisor, and Danquah the chaplain all got hauled to the police station. For several hours they were held and asked multiple times about exactly which staff member did the selling and where the masks came from. Once they learned it wasn't government cheese being sold, they still wanted to arrest a staff member. Dr. Kabba said, "If you want to arrest someone for alerting the Ministry of Health for the good of the country, you can arrest me. I was the one who gave the ok to sell the masks. I'm sure the news will find this story interesting." Needless to say, nobody was arrested. But I saw a lot fewer patients visiting the hospital that afternoon. I'm starting to believe the local version of "No good deed goes unpunished" is actually translated: "No one who calls the police in Africa goes un-harassed."

Hello!

Every day as we walk to the hospital, there is a 4 y/o boy who lives across the street. He loves to yell “Hello!” to see our reactions. Usually I wave; if he persists I use two hands; if he perseverates I even try to wave with my feet and hands simultaneously. It doesn’t matter the circumstances: rain, sun, big trucks, weekends, he always greets us.

Last week the mother called me over and told me that he was sick. I walked across the street and they pulled up a chair for me. I sat in their front ‘yard’ (really more dirt) while they tried to find him. I looked him over and he wasn’t dying. So I didn’t commit to free consultations or medications like they wanted, but they also didn’t ask outright. I noticed a deep dimple on his tongue at the same place I’d expect his frenulum to attach from underneath. I asked about it and it’s been there since birth. I asked if he talks ok and the mother gave him a firm nudge (that in the US would be ‘hitting’) and commanded him: “Talk!” Under those circumstances, nobody would have anything to say. So I squatted down, shushed his mother, and said “What’s your name?” He responded, “Ishmael.” Sounded good to me, so time to have a little fun. “What’s my name?” I asked with a smirk. I honestly didn’t expect any response at all. He smiled back at me, waved his hand, and said “Hello!”

The small crowd that had been gathering laughed, as it was obvious I’d been out played by a 4 year old.

Spiritual Battles

The longer we stay in Sierra Leone, the easier it is to see the spiritual warfare.

Every time that someone moves into a new office in our hospital, the staff gather for a prayer of dedication. It didn’t seem unusual to me, until the office prayer was delayed for several days due to busy schedules. The staff member refused to move into the new office until the prayer. I asked around and learned that it is often dangerous to be promoted. Jobs are so rare, everything is seen as a zero-sum game. So, if someone is promoted they become a target: threats, poison, curses, etc.  Spiritual attacks are so common the phrase, “I’m going to Waterloo for you” means that you’re headed to Waterloo to find one of the many witchdoctors to order a curse on someone. One of the reasons people are so happy to work at a Christian institution is they feel some safety from these attacks. Prayer is protection.

I had another case where a young Muslim man (maybe in his 20s) came in unconscious. Nobody from his family could provide any conclusive history. On physical exam, it was clear that he wasn’t completely unconscious. I would lift his leg and after letting go, it would slowly return to the bed. I told the CHOs, “I don’t know what this is, but you need to be thinking beyond just physical. In the States, this would be a psychiatric issue.” I ordered a bunch of labs, all normal. I ran some IV fluids and just waited.

Oh, I did have to tell the family I didn’t want them rubbing raw garlic all over his body. Who knows what else they did at home.

After several hours the nurse came to me and told me that the family wanted discharge. “What‽ Do they want to take him home unconscious?” The nurse responded like I should somehow know without being told, “No, he woke up and feels fine.” I pulled the patient into Mr. Abu’s office, because I didn’t trust my Krio enough to dive into psychosocial issues alone. Without the family present, I delved into all the sensitive issues: Sex, HIV, Drugs, Anxiety, Abuse, Depression. All negative. As I dug into psychosis, I got an unexpected answer: “Does your mind ever play tricks on you? Do you see and hear things other people don’t see or hear?” “Well, no. But 7 nights ago a Devil came to me in my bedroom.”

He told me that more than a week ago, he went to the ocean. He was swimming while wearing a hat, and he lost his hat into the waves. With fear in his eyes, he described how he was unable to retrieve the cap. (Demons and beliefs relating to water are very common here). Then after a few nights he was asleep and a Devil woke him up and presented him with two identical caps. “One of these caps is yours, one is mine. Pick the correct one or you will be sorry.” The man grabbed the one on the left. “Wrong!” the Demon shouted, as he started to cackle and dance around the room. Then he vanished.

For several nights, the Demon visited to ‘torment’ the man: ‘You’re going to die’ ‘I still have your cap’. Then the next few nights he slept well. Later he was in town, walking down the road and the Demon appeared. “Give me my cap right now! I need it!!” The man pleaded, “I don’t have it! I’ll go home and get it right now.” “Too late” screamed the Demon and the man went unconscious.

It was at this point that I realized my mouth was hanging open a bit. I asked him, ‘Have you told your family about this?’ He hadn’t. I asked him if he would benefit from a Christian prayer and he declined. Mr. Abu and I encouraged him to tell his family so they could provide ‘Muslim Prayers.’ He left and I never saw him again.

In the States, Demons and spiritual battles are the last thing anyone thinks about. Here, even rashes can be attributed to spiritual curses. I’m learning more and more that the truth lies somewhere in the middle. I need to keep an eye on the Great Controversy, while also leaving room for a contact dermatitis of unknown origin.