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Friday, January 09, 2015

On the Unexpected Difficulty of Volunteering to fight Ebola

For the last 21 years, we have been on the receiving end of volunteers, praying for help and appealing for colleagues, managing emails and work permits and scheduling and flights, thinking about housing and resources and correspondence and logistics.

So it has been a sobering and frustrating experience over the last five months as we have struggled on the "trying-to-go" end.

In the summer of 2014, the Ebola epidemic that had been building momentum in West Africa grabbed headlines as the rest of the world finally woke up to the gravity of the situation.  Mostly because a few Americans got sick, which was probably the most heroic thing they could have done to finally get the emergency response of the world in gear.  We were in the USA in August plugging kids into school, reading the news with pits in our stomachs.  Having lived through an Ebola epidemic in 2007-8 in Uganda (though on a much smaller, local, contained scale) our hearts were drawn to the doctors and health care workers affected, both African and missionary.

So I was not surprised in September, as we returned to Kijabe, when Scott sat me down only a few days after we got home, and said he wanted to go to Liberia to join in the fight against Ebola.

We had lost our best Ugandan friend to the disease on December 4, 2007.  Scott had treated the one other doctor in our district, who survived.  We had worked closely with MSF and other organizations at that time.  It was familiar territory. Scott is an activist, and the type of person who does not step down from danger or challenge.  He felt a strong sense of conviction that this was one of the defining crises of our lifetimes, and he should respond.  It reminded me of the time he decided to go back into Bundibugyo in the middle of a rebel insurgency.  I wasn't sure he would survive, but I knew he had to do it.

He cleared his plan with our Serge supervisors and our Kijabe Medical Director, and began sending applications to the agencies active on the front lines.  By mid-September he had applied to five organizations, and expected to deploy by the first of October.  He could work for two months in an Ebola Treatment Unit (ETU), we hoped, then have 21 days of quarantine in December before starting our Kilimanjaro climb with our kids.  They had already bought tickets, and we had booked our climb and made a deposit.  He was exploring flight options.  We were edgy, distracted, feeling the closeness of departure and the uncertainty of outcome.  Hundreds of health care workers had died.  We waited to say anything publicly, expecting any hour for plans to become concrete.

And that's where the unexpected delays began.

Incredibly, even though news reports constantly appealed for help, he could not find any organization actually treating Ebola patients that had the capacity to take him.  Some never answered calls or emails.  Others gave a polite standard form-letter response.  As a doctor with Ebola experience, two decades in Africa, ICU experience, and solid general medical and surgical skills, ready to go at the drop of a hat ... we thought he'd be exactly what was needed.  In retrospect, the treatment units took longer to construct, everyone was so overwhelmed, and probably missionaries are not assumed to be as qualified as infectious disease experts living in America.  Who knows...

October came, and he was still re-sending emails, trying to get responses.  That month a nurse friend suggested AmeriCares, and he sent in one more application.  This time he got a very welcoming response; they were ready to make him an ETU Medical Director if he could commit to six months from January to June.  We decided he would be more useful as a clinician and for a 3-month time period, since we had a major Serge regional training and retreat to run in April.  The AmeriCares group was to send an advance team in November and not begin clinical care until mid-December, so Scott agreed to deploy on Jan 2 for three months. He talked to the doctors who went in November, and kept in touch through December, getting ready to go.

But he was watching the numbers as well.  While September projections for what the epidemic might look like in January ranged from a 20,000 to a million cases, it became clear in December that the epidemic was tapering down.  GREAT news.  The response which took all Fall to mobilize was finally having an effect, contact tracing and public health messages were halting transmission chains.  The epidemic is not over, but when he talked to AmeriCares on December 29 about his departure, they told him to "hold on" for another week, as they were "reevaluating their staffing needs".  Hmm.

So another week went by, and we kept thinking and praying and discussing.  By the time the AmeriCares ETU finally opened a couple weeks ago, and the Liberia-based decision-makers finally approved Scott's deployment (they suggested Jan 16th), the area they are working in south of Monrovia was down to only a handful of cases.  The unit is functional, but mostly empty, and will soon shift gears into rebuilding the decimated health system.  The epidemic is still raging in Sierra Leone, but this organization does not work there.

Meanwhile Scott had been in touch several times over the last few months with missionary colleagues working at SIM's ELWA Hospital in Monrovia.  Their ETU had been handed over to others to run, and the hospital's general care severely scaled back.  But now that Liberia's transmission rate is rapidly falling, the ELWA hospital is resuming much-needed services.  This past week, just as we found out the AmeriCares placement would be delayed and much less urgent because of few patients and other available volunteers, he got an email from SIM asking if he could consider working there to fill a gap in surgical obstetric coverage.  Which is his favorite part of family medicine, and exactly what he does at Kijabe.

So, five months after embarking upon a path towards a trip that we thought would materialize in days, he finally has a clear(er) plan.  The first of February he plans to fly to Monrovia, Liberia, to volunteer until early March doing high-risk obstetrics at ELWA hospital, working under the Liberian leadership of Dr. Jerry Brown, relieving Ebola-survivor Dr. Rick Saccra who returns there this month to work temporarily, and giving a break to another family medicine missionary Dr. John Fankhauser who needs to see his family after a couple of months of intensive efforts.

 In our experience in Uganda, the direct Ebola deaths were the tip of the iceberg of Ebola impact.  Many more people died of preventable causes, of malaria and gastroenteritis, of labor and delivery difficulties, of birth asphyxia, because there was no functioning medical system.  We sensed God's call to serve in Liberia in this time of need, and thought it would be in order to care for Ebola patients.  Through long months of trying to get there, closed doors, and a changing situation, it looks like Scott's efforts will be redirected back towards the difficult task of rebuilding capacity for all the other things that kill the majority of people - a very real part of the war against Ebola.

This effort to volunteer has been draining, and he hasn't even gone yet.  I have to say that living for months with the expectation that one's spouse is about to deploy into a high-risk Hot Zone, but not knowing the actual dates or plans, has been hard on both of us.  It has been hard to watch a disaster unfold, to want to help, and to be paralyzed by bureaucracy.  It has made us appreciate the "administrative fee" overhead that keeps our own Serge organization running and responsive.  It has made us sympathetic to the people over the years whom we have not been able to accommodate.

Thanks for those who have been aware of this stuttering plan, and have prayed.  Please do continue to keep Scott in your prayers.  In many ways, seeing a handful of known Ebola patients in the Tyvex  HazMat suit in the controlled setting of an ETU seems safer to me than going back into one of the only functional hospitals in a devastated country and seeing all-comers without full-gear protection.   He could inadvertently be exposed to a patient with fever who has Ebola, but has not yet been diagnosed.  Obstetrics is a messy business with lots of blood and body fluids splashing all over the place.  This is exactly how Kent Brantley and Rick Saccra were infected with Ebola last summer. Scott will do the post-exposure 21-day quarantine in the month of March at his parents home in California when he leaves Liberia in order to assure that he's not infected before attending our regional retreat in Mombasa in April.   If (God forbid), he were to get infected with Ebola, being in the USA puts him within reach of the best medical care in the world - not available here in Kenya.

It has been a confusing road of obstacles and closed doors.  We trust that God honored his willingness to enter the fray earlier, but chose to close the doors in order to serve the vulnerable as well as to assist our missionary colleagues now.

Thanks for continuing to walk this uncertain road with us.  The good news is that we BOTH get to go to the Serge leadership meetings in Ireland this coming week (I thought I would be representing us all alone), and we have the rest of January together with Jack before Scott leaves.

We trust that God has been guiding our steps and prepared Scott "for such a time as this."


deborah said...

Praying for you both. Hugs.

Kelli Clifford said...

We have been wondering what the wait is like. Thank you for sharing your plans and heart. Dan and I care for you very much and will be praying constantly.

Daniel Morrison said...

Thanks for sharing. It seems like the more I hear about how God works, the less I know about how He works, except that He always works things out in the end.

Scott Will said...

Scott & Jennifer,

Thank you for persisting. I sent inquiries/applications to three different agencies in September as well. I heard back from one of the organizations, SIM, and at that time they were not placing people in ETUs, but instead looking for people to work at ELWA hospital, and they were not yet sure how they could best use physician assistants. So despite my willingness and readiness to go, the doors were closed.

Al said...

Jesus loves you. We love you. Jesus loves Monrovia by providing an amazing gift to patients there. Tricaricos praying.

Al said...
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