Returning in 2020

It’s time again to return to Sierra Leone.

The borders were reopened recently and the protocols have been put in place for us to return: Negative COVID PCR less than 72 hours before departure. On arrival we get two tests, both a rapid and a more time intensive test. If the rapid is negative, we leave the airport and are allowed to travel as long as public health can contact us at a moment’s notice. If we test positive on the rapid test, we are forced to stay at the airport hotel until the confirmatory test comes back. We booked tickets a few weeks ago and have had the dates and the times changed multiple times. But for now, we depart the US on the 13th. 

It was obviously emotional leaving home last time to move to Sierra Leone, but I’m surprised how complex the emotions are this time. 

There were two weeks this trip when all 3 of my parent’s biologic children were living in their house with their spouses. We joked that my mother had given us a checklist growing up (Get good grades, go to college, find and marry the right person, find careers you’re happy with), but now that all of us have completed these checklists we don’t know what to do! So we all came home and moved back in. Seriously though, with 3 children who each have a spouse, 4 out of 6 of us have driver’s licenses with Mom and Dad’s address on it.

It has been both wonderful and lacking all at the same time. Weddings we couldn’t attend. Trips we couldn’t take. Friends and colleagues we couldn’t see. All due to COVID.

It’s like we had something great and unique, but we still want more.

On the other hand, I am so anxious to get back to Sierra Leone. Apparently I’m not a classic workaholic day to day, but months without seeing patients just feels too long. Sometimes we feel like this has been the most selfish 3 months of our lives. We buy stuff. We see family. We eat fantastic food. All of our time is for us and family. Especially without church, it’s easy to misconstrue our necessary rejuvenation as selfish or bad.

I’ve also faced something I’ve not needed to put words to before: self worth. It’s been revealing to me how much of my self worth is wrapped up in my identity and work. The western ideologic framework easily ties ones ‘worth’ to their productivity. What’s my worth when I’m a missionary doctor who ‘abandoned’ their post during the worst pandemic in 100 years? What kind of missionary spends 3 months with all their time focused on themselves? I feel far from being the ‘perfect’ missionary.

It sounds so easy to say ‘Your identity should be in Christ.’ Or ‘It’s Jesus who gives you your worth.’ I’ve spent a lot of time recently thinking about these trite things we say as Christians. Honestly I have no answers. And I can only imagine the pain that others are going through. I still have a job; I have a loving family that can house me for 3 months. I can only imagine the existential crisis that people are going through during this coronavirus time. I worry that the usual and easy trite Christian reassurances are going to look even more inadequate to a hurting world.

And this is just about the US. As I have been communicating with Dr. Kabba (the medical director) and Mr. Fobbie (the business manager) things are even harder for the hospital than I expected. 

In late May and early June, the government of Sierra Leone approached the hospital and requested that we collaborate. They could use our facilities and they would provide salaries, supplies, and COVID patients. The Waterloo Adventist Hospital would become the local Community Treatment Center (CTC) for the coronavirus. 

But because the situation is so dire for the government, they are completely unable to adequately supply the hospital with enough PPE, medicines, fuel, or equipment to take care of the patients. There has been basically no money for salaries. And because all of the hospital was taken to treat coronavirus, there have been no facilities to see or treat the medical patients for revenues to pay the staff.

By mid July, there was only $500 in the bank which is no where near what’s needed to buy fuel, medicines, or even pay a portion of salaries. God always provides and we’ve received enough donations to pay the staff a fraction of their salary and provide a bag of rice. The SDA Mission has also offered the hospital a building to use as a small medical clinic in the interim. However, this building is so rudimentary it doesn’t even have electricity. God has continued to bless and a donor came forward to help us with partial renovations to at least make the space usable. And this is just a sampling of July's challenges.

Because things have been so difficult recently, we’ve updated the website to include a COVID donation section. If you’d like to donate please visit:

https://adventisthealthsystem.sl/donations/

Haiku 1619

Ideas rarely come to me fully formed. Even as I’m telling the patient what I'm thinking and recommending, the thoughts are still being born. Yesterday we drove through the Georgia countryside while listening to 1619 and arrived in my sister's friendly and kind neighborhood with 15 kids playing together on the street from different houses at 9:30 PM. Everyone we saw in this community on our evening 2 mile walk is black. It felt like home.

I woke up early this morning with a haiku fully formed in my head.

What is a human
Work, love, art, build. Robots can
How can we enslave?

Powerlessness and Power

We want to believe that we have control and autonomy over our lives.

I’m slowly learning the lessons of how little control we have over our lives. First we were evacuated from Sierra Leone by the Embassy. Then last weekend, I dove into some cold water to chase some sunglasses and came up with atrial fibrillation with RVR. This is a common disease, but only in old people. My heart rhythm didn’t return to normal for 2 hours, so I went to the hospital and was admitted overnight. No visitors allowed due to COVID.

Consistently, the podcast I listen to that most changes the way I view the world is Everything Happens for a reason by Kate Bowler. She’s a young woman and theologian who studied the Prosperity Gospel, has small children, and was diagnosed with Stage 4 cancer. Her podcast deals with how to find hope in desperate situations and how to provide strength to those in need. In her episode interviewing Ari Johnson, he discusses how pressing the need is for us to improve the lives of those around us. It’s a great episode, partly because he’s a doctor in Africa: https://katebowler.com/podcasts/ari-johnson-more-than-enough/

They wrestle with a topic that I think both individuals and our nation are struggling with. It’s so easy to feel like we have no control: heart arrhythmia, stage 4 cancer, systemic racism, crushing poverty, distrust of science and medicine, portrayal of Christianity as a right wing racist homophobic group. And this hopelessness is compounded by how invisible our individual power is. We have tremendous ability to influence the health and spiritual well being of those around us. Our individual actions form our communities and shape our society.

Ari Johnson said this:

“We vastly overestimate our own control over our own lives. We are not in control of our own lives. We can not control the outcome. I also believe that we vastly underestimate our power. We vastly underestimate our power. I believe we even hide from our power, because our own power is terrifying. We are terrified of how powerful we are, particularly our power in the lives of others. Our power to cause harm. Our power to cause harm and to hurt those around us.  And our power to heal. Both of those are terrifying.

The resonance of our actions both to hurt and to heal are so much bigger than we see and so much bigger than when we estimate, and it is terrifying for us to look at that because if we look at it… it takes so much courage to look at that because once we look at it, once we embrace how powerful we are, then we are responsible. And there’s no letting ourselves off the hook. We have to take action. There’s no other way.”

It's quite a dichotomy to feel our own powerlessness, but still be responsible for all those around us. But I believe it’s what Christ calls us to. Servants don’t have any control over their own lives, but are designed to benefit all those around them.

Now I don’t know exactly how to hold these ideals together: self powerlessness with power and responsibility over others. Regardless if it’s our global community, it’s the plight of the African American, my peers and community in Sierra Leone, people with different political beliefs, or my family and church family, I have a part to play either to heal or to harm. And I also know that regardless how little control I have in my life, in either health or geography, God will guide my next steps.

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.