Ebola update

Two days ago we received an email from the CDC Chief - Tom Frieden stating that we have moved to EOC Level 1. This is the highest level of activation, reserved for the largest-scale responses, which often require substantial agency-wide effort.The Emergency Operations Center (EOC) moving to a Level 1 means that "all hands are on deck" for the Ebola response. Level 1 is the highest on a scale of 1-6 and it means that increased staff and resources will be devoted to the outbreak. It enables CDC to pull resources from across the organization to use in the response efforts. Since I cannot post the email here, I will post a link to the accompanying news article, which you can read here. 

In addition to the announcement about Level 1, Dr. Frieden's email also included a call for volunteers to help the CDC response in the region, particularly French speakers. I don't know how I feel about volunteering at the moment...it is something I have to talk to Michael about. On one hand, having worked and lived there, I know Liberia and its health system like the back of my hand; on the other hand I am not going to put my family at risk and add to their worry. Something to think about...

Regardless of volunteering, I will monitor the situation closely from my post in Dar es Salaam.

Ebola shows no signs of fading away in Liberia

The Ebola scare in Liberia and neighboring Sierra Leone and Guinea is getting worse every day. There are now two Americans that have been infected with the virus. One of the popular doctors in Monrovia - Dr. Brisbane - passed away over the weekend. Another popular doctor in Sierra Leone is currently infected. If you live in that part of the world it feels like perhaps this is the "big one".

Over the weekend I have come to know from my ex-staff in Liberia that Dr. Samuel Brisbane passed away from Ebola. Liberians are grief-stricken by the loss of the Chief Medical Officer of the most famous referral hospital in Liberia - JFK Hospital. I had the privilege of meeting Dr. Brisbane during one of the many meetings at the Ministry of Health and Social Welfare (MOHSW) when I worked in Liberia. I did not know him outside professional interactions, but he always brought a good spirit to the JFK hospital whenever I visited for work. And, most importantly, he was respected as an authority in medicine. I can only imagine the morale of JFK staff at the moment, after their beloved leader passed away. 

There are numerous mainstream media reports on Ebola in West Africa. However, I feel that most of them are not comprehensive. While I have known for a while - through my ex staff in Liberia - that the situation on the ground is not entirely reflective of what is being reported in the media, most of the my friends and family back in the US are not being told the complete story. Only recently are we hearing reports of communities refusing access to Médecins sans Frontières (MSF) in Sierra Leone and Guinea. Some of us have been hearing these reports from almost three months ago. This animosity towards MSF is important to notice because MSF is one of the few organizations that has consistently been at the forefront of the outbreak response. If MSF is denied entry into communities and cannot provide care, the crisis will undoubtedly get worse. My ex staff in Liberia tell a similar story of family members threatening clinic staff with physical violence and taking away their infected family members from the hospitals to care for them at home. The communities do not trust the medical care and believe that quarantine is a way of "controlling" the locals. In fact, the situation in Liberia has gotten so bad with families hiding their infected family members that President Ellen Johnson-Sirleaf had to issue a government order stating that hiding Ebola-infected members from medical care is a punishable offense. 

We are now hearing of a suspected Ebola death in Nigeria that may have come from Liberia. If Ebola has spread from Liberia to Nigeria, I am afraid it has spread to the countries in between - Côte d'Ivoire, Ghana, Benin, and Togo - because of porous borders. As of a few days ago, President Johnson-Sirleaf has restricted movements in and out of Liberia. The land borders are to remain closed but the Roberts International Airport remains open with possible testing for passengers who are entering and leaving the airport. Considering my past experience in Liberia, I do not put much stock in how or if this testing will be conducted. However, it is a important step in disease surveillance. 

So far all my ex staff are safe and sound, in spite of working in the infected areas. I pray for their safety and hope that the outbreak subsides. This is one event we need to closely monitor and take measures to contain the infection. As we used to say during our work meetings at the MOHSW - "God bless Liberia!". Even though I do not live or work there anymore, Liberia will always be in my heart and well wishes. Liberians always believe God will save Liberia and its people...this is one time that God may want to step in and give hope to the Liberians. 

Lone Star Forever!

Nigeria brings back Liberian memories

It has been a hectic past few months, and I realize I have not posted anything since last August, spare for the one entry last week about Ebola in Liberia. Since August 2013 I have been traveling like a mad man. I may have spent 6 weeks at my home base (Nairobi) between August and end of 2013. No wonder I haven't posted anything. Since my last trip to Myanmar, I have been to Washington DC, Cambodia, Myanmar (again), South Africa, Nigeria, Boston, DC again, Chicago, and NYC. All except NYC were work travel. Good times!

I was in Abuja, Nigeria for two weeks back in October. This blog post has been lingering in my drafts since then. What made me go back to my drafts and finish the post is my latest visit to Abuja few weeks ago. If you have ever been to Nigeria you know that it plays a major influence in African affairs, particularly West African affairs. Nigerian music, food, and style is emulated all over Africa. Nigerians are friendly people who are proud to showcase their culture, heritage, and they love welcoming foreigners to their country. The hospitality I encounter every time I am in Abuja is warm and welcoming.

As my friends know, my travels revolve around work and food. I was glad to be back in the land of spicy goat pepper soup, jollof rice, egusi soup, and eba. I was in heaven when I tasted goat pepper soup after a gap of almost one year. I haven't had goat soup since leaving Liberia. Since I pray at the temples of street food, I had to venture out and try Suya, which is meat marinated in a lot of spice and grilled on coal. Let's just say my mouth and insides were on fire after eating a few skewers of beef suya. Delicious!

Suya

The typical West African escargot is a must try if you are adventurous. I used to eat a lot of escargot in Liberia and Coté d'Ivoire, but I haven't found the same ever since I moved to Kenya. East Africans do not appreciate giant snails like the West Africans do. Imagine my joy when I took my first bite of Nigerian escargot after a gap of almost one year.

Escargot

Spicy yam cakes

Egusi soup

Besides eating my way through half of Abuja, work was productive. I trained a lot of people on conducting research in malaria so we can use the information to strengthen access to antimalarial medicines in Nigeria. But enough of that...who wants to read about boring work anyway!

Some of the trainees

In between the training sessions I took a short break to walk around the hotel where we were delivering the training. I went to inspect the pool area and heard some familiar sounds. I turned around and noticed a bird cage with two African Grey Parrots. The sight released a flood of memories. Some of my friends remember Isaiah, the African Grey we had in our Liberian home. He was our child and he lived a good life until the day he passed away. I used to take Isaiah on a walk in our garden....that's right folks, I walked a bird! Watching these two African Greys reminded me of Isaiah and his shenanigans. A teary eyed moment....

Isaiah's family

I also visited the Arts and Crafts Village in Abuja. Wonderful gift ideas and some interesting items. While the beads, leather items, and jewelry were beautiful, there are some items at the market that left me feeling uneasy, sad, and angry. I saw merchants openly selling ivory items, whole elephant tusks, lion teeth, and a variety of endangered animal skins. I almost cried when I saw a group of Chinese tourists bargaining for ivory chopsticks. I wanted to bring an elephant to the market and let it trample all the merchants and buyers. It was quite disturbing! I bought some beads, two pairs of leather sandals, and left the arts and crafts village in anger.

Arts and Crafts Village

I am not sure when I will be back in Nigeria again, but I look forward to eating some good food and experiencing the wonderful Nigerian hospitality.

Ebola in my beloved Liberia

The past few weeks have been very nerve-racking due the Ebola outbreak in Guinea that has now spread to Liberia. As many of you know, there is an outbreak of Ebola in Guinea at the moment that has reached crisis levels with over 60 deaths attributed to the disease. You can read more about the outbreak here and here.

Like most countries with porous borders, Ebola outbreak in Guinea means Liberia and Sierra Leone are next in line. Senegal has already shut its border with Guinea to prevent spread of Ebola. Reports have emerged about deaths in northern Liberia from Ebola, particularly in the Foya and Zorzor districts of Lofa County. I fondly remember the time I spent working in the Foya and Zorzor hospitals when I was working in Liberia. Lofa County was my favorite to visit because I could stay at the United Nations battalion stationed in Voinjama. The battalion was Pakistani and it had the best chicken curry and nan I had in West Africa.

Needless to say I was worried about my ex-team members who work in Lofa county. I called/ emailed them and they are all safe as of today. They are disappointed by the response from international community towards containing the disease. Being health care workers, they are worried about the fact that they still do not have adequate personal protective equipment. However, that does not stop them from providing health care for the needy. No matter where I've been in the world I always encounter health care workers who spring in to action regardless of their safety. It is what makes the clinicians a unique class of people. I am proud to be one of them.

I would like to share one of my favorite pictures from Liberia, which was taken in a clinic in Lofa County...which is now the seat of Ebola scare. I am showing one of the nurses how to enter antenatal care data in to the ledger. I miss my staff...

This Ebola scare has brought back so many fond memories of Liberia and concern towards my staff. I will be closely monitoring the developments and pray that the disease is contained and the Guineans/ Liberians/ Sierra Leoneans do not suffer any further.

Mere piya gaye Rangoon...

Anyone who knows their classic Bollywood music will know the song "Mere piya gaye Rangoon". It is from the film Patanga released in 1949. The song has been remixed in recent years because it seems to be the trend in India to remix oldies.

I remember listening to it as a child when my mother used to play classics in the house, so we could learn our native culture while living in a foreign country. For my non-Hindi speaking friends, it is a song about a man that leaves his wife to go work in Rangoon and she sings this song when he calls her all the way from Rangoon. You will notice the traditional Myanmar outfits in the video. I am wearing the same traditional longyi in one of the pictures.

Mere piya gaye Rangoon, kiya hai wahaan se telephone = my lover went to Rangoon, he is calling from there. 

That song always stuck with me because it kinda resonates with my life. I have been traveling across continents since I was 11 months old and I wish I could take my family and friends to the places I visit. When I was young I wished that I could take my friends, now that I am an adult and happily married I wish I could take my partner with me.

But why am I talking about a Bollywood song that majority of my non-Indian readers do not know? Because I was in Rangoon for the past two weeks. Now known as Yangon, it is quite the interesting city. I was in Yangon for work purposes, to learn more about Artemisinin resistance containment efforts, and meet with USAID to discuss how my project can help with malaria control in Burma...oops, Myanmar. I wish my piya/ partner came with me to Rangoon...oops, Yangon! 

So, Myanmar! It seems to have become the latest destination for tourists. I saw plenty of young American and European tourists on the streets of Yangon. They all seem to want the Myanma experience (people of Myanmar are called Myanma). I was there for work and luckily there happened to be a long weekend in the middle of my trip, which enabled me to get out and explore Yangon, Bagan, and Inle Lake. Yes, I am an efficient traveler when pressed with time. I covered Bagan and Inle Lake in three days/ two nights.

View of the Shwedagon pagoda from my office

There have been numerous travel articles written about Myanmar and some silly food network tv shows as well. I am not here to write about where to do and what to see, because that has been covered in various books and guides. However, I will say this... Bagan is a must visit. The moment when you climb upon one of the temples and see the panoramic view of thousands of ancient temples scattered across the plain will take your breath away. It is stunning, humbling, and enchanting at the same time. Words cannot express how I felt after watching the view... I just sat on top of the temple and stared. I have always been a sucker for ancient history and Bagan was paradise to me. Inle Lake, on the other hand, is the complete opposite of Bagan where there is not much to see or do. You rent a cottage on the lake and enjoy the views of the lake and mountains while recharging your batteries. You are pretty much dependent on the boats to travel anywhere outside your cottage, so your movement is limited. It is a good place for people who want to unwind and relax.

Shwedagon pagoda just before the rain

While Bagan and Inle were beautiful, the best part of Myanmar is the Myanma. The people are in a league of their own. I have not seen such levels of honesty and integrity among the general population in a long time. It gave me hope for humanity. I could leave my iPhone, wallet, cash, anything on the dining table at a restaurant and return after 15 minutes only to find everything untouched. The people are friendly and polite. They have a work ethic that is unseen in many countries. The Maynma are what makes Myanmar an interesting place to visit, more than the historic sights.

A monk enjoying his beer after a long hot and humid day

In addition to visiting Bagan and Inle, I went to Bilin in the Mon State for a work visit. I visited a few clinics and pharmacies that provide malaria treatments and other health care services. It was a wonderful visit where I got to see the health care delivery systems and countryside of Myanmar. I had to seek prior permission from the government to visit the clinics and I had to be escorted by an official through my site visit. The few clinics I visited seemed to be well-run with the limited resources they have. I spoke to doctors, pharmacists, and community health workers about febrile case management, malaria in pregnancy, and overall treatment guidelines. I was very impressed with their knowledge and adherence to internationally recommended guidelines. I also had the rare privilege to meet a "quack", someone who has no training in western medicine but dispenses treatments and advise. I was horrified to know the quack's practices and discussed them with the responsible people upon my return.

A villager is intrigued by my presence in his village

Besides the work stuff - which most of my friends find boring - I was able to witness the countryside of Myanmar. It is breathtakingly beautiful and seems like a land where the clock stopped moving 40 years ago. You have to experience to believe it.

At work, wearing the traditional Myanmar longyi 

In many ways, Myanmar and Myanma reminded me of the India I knew as a child. Myanmar now is what rural India used to be in the 80s. I remember when we traveled to India as children to visit our grandparents' in the village. I remember having to take an ox cart from the bus station to my grandparents' house and everyone in the village would stare at the newcomers who obviously looked like they are visiting. I also remember how friendly everyone was when they saw outsiders come in to the village. People just came up to the ox cart, stopped the oxen, and welcomed us to the village. Some even offered fresh coconuts to quench our thirst. I fondly remember those memories when it felt like the whole village was one big happy family, despite the clearly marked caste system. You do not see that anymore. As I grow older and somewhat wiser, I notice how the same bonds are not there anymore. I recently went back to my grandparents' village (they have passed away many years ago) to visit extended family and nobody bothered to even stop and say hello. My smiles were met with stares and indifference. Long gone are the days where people just came up and talked to you, regardless of your caste or creed. As India becomes more commercial and capitalistic, I feel like the poverty has reduced by a lot but it also took away the friendliness and niceties.

Myanmar reminds me of the friendliness of Indian villages when I was a child. I am now in my 30s and I have seen India change drastically over 30 years...from a poor but friendly country to a middle class but indifferent nation where people are more concerned about chasing the next Rupee. I hope Myanmar does not lose its charm because of the political and economic reforms and the Myanma continue to hold on to their values, integrity, and friendly attitude to outsiders. It would be a shame to lose the wonderful characteristics of the Myanma to commercial development.

I will write about Bagan and Inle in a separate post because they deserve a separate entry.

Resistance Park - the seat of many protests during the military regime