6.4.2015

I am back with my family in Denver after an unforgettable 6 weeks.  My departure from Freetown was marked with a complex array of emotions – sad to leave so much work and many good friends behind, eager to be reunited with family.  I climbed the steps into the jumbo jet at Lumley airport without the expected sense of relief or joy.  I numbly moved through the transition from the heat, brilliance and dirt of Sierra Leone to the air conditioned, pastel-toned sterility of the West.

Back in the United States, I had dreams of Sierra Leone almost every night for the first month.  During the first 21 days home, I was visited daily by a public health nurse to check my temperature. Thankfully, I remained afebrile, and therefore managed to avoid the unwanted media attention that would have accompanied a trip to the hospital for an Ebola rule-out.

It has now been over a month since my departure from Freetown, and the frequency of dreams is steadily decreasing. 

But the memories are still there, clear and vivid, and at odd times they flash unbidden before my mind's eye. Picking up a weak patient to transfer from a stretcher to a rickety cot, her hand tugging at my Tyvek suit.  Holding a bottle of oral rehydration fluid to the cracked lips of a patient too weak to feed himself.  Grooving to the rhythmic, tinny Salone music blaring from cellphone speakers with other clinical staff in the green zone of the Ebola holding unit.  Walking through the dark hallway of the unit, stepping in chlorinated water and watching rats slink away.  The joy and relief etched on the face of an Ebola survivor coming back to the unit to receive his Survivor certificate.

But these memories tell only half of the story about my time in Sierra Leone.  Each day, I was surrounded by some of the most inspirational people I have ever met – both expatriate and Sierra Leonese.  Courageous, compassionate, and capable individuals who chose to work in a very challenging healthcare setting in one of the world’s poorest countries.  Most awe-inspiring were those people who weren't particularly trained for the positions that they willingly stepped into.  I had background training in medicine, infectious disease and public health – it was no stretch to volunteer to work in an outbreak of a viral hemorrhagic disease.  But in this epidemic there were many untrained individuals who saw a critical need and stepped up to the job, in many occasions crafting the solution with true ingenuity and perseverance in the face of a multitude of obstacles.

If there is one emotion that has been constant over this past month of transition, it is gratitude.  I am profoundly grateful to have had the opportunity to volunteer with King’s Sierra Leone Partnership.  Working with this group, I not only had a front row seat to witness and share in the response to this historic Ebola outbreak, but I also had the privilege of working alongside local and international healthcare workers in the trenches of a Sierra Leonese public hospital.  Had I volunteered with any number of NGOs who were in Sierra Leone expressly for Ebola relief efforts, I would have missed out on seeing patients in general healthcare settings and would have had a much more limited scope of understanding about the true issues which facilitated the deadly dissemination of Ebola in West Africa.

Today the epidemic is still far from over, although in Sierra Leone at least, the numbers are declining.  But last week there were 25 new cases of Ebola in the country, only two-thirds from registered contacts, indicating the virus continues to spread in the community without epidemiologic control.  In Guinea, cases are on the up-swing. Unsafe burials are reported in these countries every week.

However, Ebola is not the real threat anymore, and it hasn't been for many months.  The epidemic has shed light on the determinants of the much larger public health crisis: a broken healthcare system that does not - cannot - vaccinate susceptible children, provide consistent quality prenatal care, offer free and accessible care to the chronic infectious diseases HIV and TB, provide public potable water and garbage disposal, and ensure rapid access to good-value preventative healthcare as well as to medical and surgical treatment.  The needed human resources, coordination, money, and political willpower that are needed for an effective healthcare system are still largely lacking.

The public health challenges here at home are very small in comparison.  I tell myself that by continuing my work and training in this country of abundant resources, I will be able to offer better medical services to resource-limited settings in the future.  

But if there’s one thing I learned in Sierra Leone, it's that it isn't the best-trained or the best-educated who make the biggest impact.  It is the willing. 

I hope to have the will to return.