BOOK: Transatlantic: A Novel by Colum McCann who also wrote Let The Big Worl Spin which I have put on the top ten best reads ever
THOUGHT FOR THE DAY: People praying jubilantly to God and Allah (perhaps less jubilantly, but with equal intention and fervor) might be one of the best arms of Health Promotion that we have. Note to self…contact religious leaders for intense training. Some may have missed the last one! From my balcony, the sound of fervor is deafening in a very good way. Can you hear them, Big Guy?
SONG: Yes We Can Can by the 17th Avenue Allstars
So the week has come to an end and the sun has risen on my second Sunday in Sierra Leone. It was just rising when I arrived last week, but I was sound asleep as it rose this morning, in my huge clean bed. No alarm to get me up for the early breakfast and departure for the office…loved opening my curtains to a day more or less belonging to me. Went out onto the terrace for my first cup of coffee and later snuck down to get my breakfast and bring it back up to the room. Breakfast is not a social meal for me! The abundance of fruit makes my GI tract a little over enthusiastic, but it will come into balance as everything eventually does. I ate it at my proper not-plastic table, in my soft upholstered chair. Is there still evidence of glee!?
I have actually gotten hand off training from 2 people as MSF is merging the work at many levels to trim things back from the Rapid Response mode to a sort of normalization of activity that will become the transitional and sustaining way we will hand over to the National staff. There have been 4 phones, 2 computers, 1 cash box and various other bits of hard and software. This is presently my 2 back pack system, in place again, and it presents as a sort of mule-load transport when I need to move from place to place. Fortunately the bulky cash box goes on my first morning stop, into the hands of my first team. This is the Survivor follow up group. The MD sees all survivors to monitor them for the list of after effects of their survival. Most conditions seem at this point, to be resolve-able including medical intervention within the existing health structure. Within this visit, each person and often a family member or 2, has a contact with the mental health component to work them thru the stress and stigmatization issues. HP speaks to them about any presence of community stigmatization or adaptation issues. If it is needed, we go out individually with them to do a community education followups that is most often just a supportive reassurance session.
There is also a team within this team that goes daily out into the communities for general, non-specific intervention and interaction. The challenge is in getting the staff to shift themselves from a teaching modality to a dialogue. We already know that almost everyone can recite the list we intitially went out to provide (along with multiple other players) for transition and prevention guidelines. The problem is that the message is surface and the gut connection to disease prevention has not yet been worked out in the individuals and groups in many of the city sections and rural areas. For me it is the “Yes, yes” factor. Like when you tell your mother or your boss “yes, yes” because you know that will shut them up whether you know what you are doing or even remotely plan to consider doing it at all.
I think it is in this context that I want to do training with the staff for community dialogue. One group has done the training and the other has not. Integrating them to broaden the teaching so there will not be boring replay or new info overload will be interesting. It is not in the West African nature or culture to “dialogue” in the way we need. Usually one person tells his/her very circuitous story and the the other person does the same. They might have exactly the same focus, but that is irrelevant. It is always simply the telling and retelling..and Ebola has become a boring story even tho it is still a very big threat. And this prevails from the simplest village construct right up to the president. I am beginning to wonder if it is not a part of the NGO mode now as well.
Moving forward in a sea of well intentioned, very differently funded groups with more so less specific goals, does not come easily into accord. And it does not move quickly either. It occured to one of my handover people that I should consider a plan to invite one of the top dogs in the latter group to come to my team of 50’s groups meetings. I will do that first thing Monday, once I figure out how to use the Nokia phone…was this ever an effective device????? I am getting a lesson on it today. Right after I figure out how to get to my email. Sigh
Yesterday I met for the first time with the 50 member outreach team and have gotten to know (over 2 days) the national supervisors for these 5 different field teams. Everyone in these teams is young and enthusiastic and very hard working. They work the slums of Freetown on a daily basis. They leave early and come back late. They still have some strong training needs but are willing to rise to the occasion in whatever way they can or are asked to do so. All I need to do is show up with what they need for that.
There is a measles outbreak as well that has not reached catastrophic proportions. Fortunately the vaccine campaigns prior to the Ebola outbreak have not left the population totally defenseless. Over a year’s time however no further vaccines have been done for updates or initial vaccines for the newly born. And yes many have been born! For the vaccine deniers among you, I have a really big rant. The absurdity of what is being perpetuated in this effete, supposedly intelligent group, has failed so deeply to look with any world view at the realities. The tunnel vision (or head burying behaviors) rival the group of science deniers who are trying to place Creationism into school science curriculum!! And that is not even the tip of my rant.
And after all else, it appears that I will inherit the Mental health team as well as the 2 HP teams, bring the resounding total of those on my team to about 70. I am sorting out how we can shuffle some national supervision into all of this. I have 2 identified already and they too need leadership training. My shuffling skills are challenged…but it will sort itself out as long as I keep breathing in between each event…and probably during the events also. The psychologist leaves next weekend and says her team is autonomous. We will talk more about this…her and me.
AND then, there is a “lockdown” set in place for this week by the President of Sierra Leone, who claims that the last one was very effective, hence, this one is necessary. Think of being told that for 3 days you will NOT leave your house and the military will assure this…the effectiveness of this idea is just incredibly awful in the real world anywhere. The NGO’s are working on their plans, but ebola response teams were given passes last time this was in place and it will be likely the same this time. They are all able to move in the communities to assure that drinking water and food are in place. The military does house to house checks during this period, “extracting” the sick. There is not much addressing of human rights in these situations on the part of the government and they do not want us rattling their cages. Of course that is one of the primary components of an MSF intervention….I will keep you posted. And as looming as it sounds, every measure of security is on the ground and well-known to our staff. It is just very unlikely that it will be an issue other than complaints and local grumblings. The president told people that is is not a “lockdown” but rather for the people to consider it a “stay at home”. Wasn’t there that period of economic slump in the US that families were told that perhaps it was time for Staycations? But this is definitely not that!
Week one…check…Current goal/get to zero cases…indicators for success/zero cases.
Action points for today
1. post blog
2. work on needlepoint started in Cambodia about this time last year
3. Review most recent handover along with other handover and reflect
3. eat supper with team and sip a surprisingly good Sierra Leone beer called STAR.