Rustling up some grub

     Some of the more interesting things that you see in the developing world are on the side of the road.  In the US, we drive along and don't really see what is on the side of the road unless it is something pretty unusual.  If there is an accident, a particularly garish sign or something that effects the flow of our traffic, we might pick it out.  But usually, we drive right past whatever is on the side of the road without giving it a second thought.  However, it can be different in the developing world, especially on your first or second trip to the developing world.

     Here, everything that you see is different from what you would expect in the US.  The buildings, often right on the road, are of an entirely different style.  Security is usually at a premium and there may be many abandoned or poorly repaired buildings.  The people will be carrying unusual loads, often on their heads.  You will pass wildly overloaded vehicles, often with people hanging on to the cargo area.  Yesterday, I even saw a small group of goats, tied up in sacks with their heads sticking out on the roof of a car, bleating as the car drove down the road.  Probably on the way to the market or dinner.

     In the cities, there are many areas of slow traffic and these usually turn into the developing world equivalent of a convienience market.  Anything that someone might need can usually be purchased while you wait at a traffic slowdown.  Recharge cards for your phone, cold drinks, grooming articles and street food are some of the more common items for sale.  The food can be interesting from a developing world perspective.  You can buy raw sugar cane cut up into foot long sticks that you can suck on and chew for the sugar.  There are various baked breads, fruits and meat pastries.  Yesterday we were approached by a person with bags of succulent grubs suspended in a clear liquid.  When I asked about them, I was told that they were harvested from the bark of palm trees and the liquid is some sort of sauce.  Usually they are served fried.  I know insects can be part of the diet in Uganda and I have had fried grasshoppers there.  However today, I didn't feel up to trying these grubs.  Maybe next time, or maybe not. 

Where the wild ones are

I receved a request to discuss what animals that we find in the jungles of Tappita.  I will take you on a photographic tour.  Many of the animals that you can find near the hospital are ones that you might guess.  

There are lions.

 

and elephants, 

and tigers.

We even have panda bears

and dalmations!

These are just some of the offerings at a whimsical 'petting zoo' that was created by a refugee two years ago.  He was a regionally famous artist and he was allowed to remain on the hospital grounds.  To show his gratitude, he created these sculptures for the children.  They are made of a heavily plastered paper mache and are really fun.  I am surprised that they have lasted so long given the conditions.  But there is a 'park ranger' who helps maintain the area and protect the statues.  It really demonstrates that the animals that we think of as 'African' are mostly confined to game reserves in an attempt to stop the poaching.  There really aren't that many exotic animals that we have run into around the hospital, that is except the green mambas.  That is another story.

The countryside

     When you spend most of your time in the ETU, the neighboring hospital and the housing, you can forget what the rest of the countryside looks like.  Of course you see what is along side of the road when you go to meetings.  But those are areas that have been influenced by the presence of the road.  These roads are conduits of the vehicles, pedestrian traffic and commerce of the region.  Farther away from the roads, you find a more baseline culture.  Small villages of maybe 100 people that often have only footpaths connecting them to anyplace else.  The consist of a group of small buildings of clay with either corrugated metal or thatch roofs.  Often, the livestock is kept in the compounds.  That is how the majority of the 750,000 people of Nimba county live.

     And the countryside is jungle.  Maybe not jungle is the way that we learned when we were children, but jungle nonetheless.  Certainly there are many clearings, both man made and natural, but the large majority of the land is green and densely vegetated.  Some of the land, but not as much as I was used to in Haiti where every potentially arable piece of land, was cultivated.  The land is held in common by the villages.  If you want to farm some land, you can get permission from the village leadership to farm there.  You can keep the crops but there is an expectation that the food is to be shared.  Since the land is held in common, that only makes sense.  Even if you have worked the land for years, you are still not the owner.  The land belongs to the village.  However, working the land helps you to maintain your claim for usage.  

     The countryside is a lush green wherever you look.  From the top of the hill where we sleep, the land is covered with large leafed trees and shrubs.  There is almost always a haze or fog that covers the low lying land which is much denser in the morning.  Sometimes there is so much haze that the helicopters can't  fly.  There must be a meteorologic factor involved, but there is also a lot of moisture coming up from the foliage which contributes.  I am not sure how much this haze varies throughout the year, but it has certainly been a constant the last two months.  I guess that I will have a few more months to find out.

Waiting for rain

     One of the things that we worry about in Tappita is the weather.  The temperature doesn't vary much, it is hot and muggy year round.  The main variable is the rain.  Rainy season usually arrives in late March or early April.  It has all the usual hassles of getting wet wherever you walk, the mud and the increase in mosquitos.   Those problems may seem obvious but the rainy season has one important additional consideration, the roads.  The road from Monrovia has a 3+ hour stretch from Ganta to Tappita that is not paved and is often impassible during significant parts of the rainy season.  Since the large majority of our supplies come in from Monrovia or Ganta, that can be a problem.  

     This year, the signs point to an early rainy season, possibly starting by the end of February.  That changes a lot of our plans.  It means that we need to push our district health survey forward so that it can be completed before the rains come.  It also means that we need to modify our cooking area to provide more drainage and cover.  Using some long ago learned civil engineering, we have submitted to our logistic support organization a plan to run a diverting drainage ditch to run the water coming down the hill away from the flat ETU area.  In the one big rainstorm that we had since I have been here, the ground water flooded back into the ETU latrines and caused to overflow.  We also need to increase our stockage levels of food, fuel and potable water to be able to withstand stretches of time when the roads are impassible.  Just a few more things to do that should pay dividends when the rains do come.

     Sometimes, though, the rain seems farther away.   Usually the sky is either hazy or overcast.  It looks just grey or dark and almost muddy.  Last night though, the sky was unusually clear.  The stars were just popping out from a deep navy blue sky.  They seemed both infinitely far away and close enough to touch.  They looked a little unfamiliar from my vantage point near the equator, usually recognizable but with a twist.  I just stood there a while and watched them.  The stars were gone this morning when I went out to jog but the sky was still clear.  It will probably mean that we will have a scorcher today, but maybe worth it with the beautiful sky last night.  I will continue to enjoy those nights until the rains do come.

R&R

     I need to apologize for the lapse in posting.  I have been pretty busy since getting back from R&R but that was expected.  I guess, though, that I should explain R&R.  When you work 7 days a week in this environment, it is important to take occasional breaks to be able to maintain focus and emotional energy.  Sometimes the stress is from the work, sometimes it is from the waiting.  But it is there.  Burn out is a significant risk here and it can be hard to replace trained people.  For that reason, USAID built into the contract respite breaks every 6-8 weeks.  It improves the sustainability of the effort and helps keep good people.  

     R&R gives people something to look forward to.  People plan what they are going to do and where they will go for their next break.  Sometimes people want to go someplace warm (we are pretty acclimatized to the heat and Europe can be cold this time of year).  Sometimes they want to get away from the heat and Europe at this time of the year is a draw.  Europe does have the advantage that they don't care if you have been in an Ebola zone as long as you are not sick and don't have a fever.  Some people just stay in Monrovia at a hotel where they can just relax and get away from the ETU.   Wherever you choose to go, it can give you a chance to control your own schedule.

     R&R also gives you an appreciation of the passage of time in an environment where each day can look like the next.  In a place where the day of the week, indeed the month, doesn't effect your activities, you can loose a sense of the passage of time.  You may not appreciate how long you have been the or it may feel like the end of your tenure is forever in the future.  The R&R gives you a marker for past and future.  

     All that said, Brussels was great!  Jo flew out to join me and we had a wonderful time in a city with a lot to recommend it.  I don't know what I will do for my next R&R, but I will start planning for it in the not too distant future.

Brussels?

It has been a couple of days since I have blogged.  The reason is that I am on a respite break from the ETU.  These are scheduled every 6 weeks or so and are standard among organizations the run ETUs.  Most of us take the break in Europe.  Two reasons, one is that you only have a limited amount of time and two, the European Union doesn't care about a person's Ebola exposure as long as they have had no known exposure and aren't having symptoms.  Some people, though, have gone to Tunisia which is desperate enough for tourist dollars that they don't mind potential Ebola exposure.  A few have stayed in Liberia where you can stay at a local resort and not lose the travel time at either end of the trip.  The important thing is that no matter where you go, you get away from the ETU and relax.

    I chose to go to Brussels.  One of the main reasons was that neither Jo nor I had had been to Brussels before.  A second was that all of our flights (all of two per week out of Monrovia) are routed through Brussels.  One of the nice things was that Jo was able to join me in Brussels.  It has been six weeks since we had seen each other and it was good to talk to her and to relax.  I must admit that I didn't travel over to Liberia with any thought of cold weather and I brought no cold weather clothes.  I have also lost a bit of weight while in Liberia and that didn't make the cold weather any easier to handle.  Jo was my angel and brought me my coat, hat, gloves and some long underwear so things have been manageable.  Since arriving, we have have relaxed and have done the usual tourist things and it has been a wonderful time.  I can't say that Brussels has totally taken me away from Liberia, I do have email.  But it has been quite relaxing.

     I will fly back to Liberia (and Jo to the U.S.) on Friday.  It will have been a good break, but there is more to do back in Liberia.  Much of it involving what needs to be done in running an ETU and mundane.  But we have to be prepared because the number of cases of Ebola have increased in Liberia for the second week in a row. 

Human behavior

     At the weekly Partners meeting in Monrovia this week, the CDC reported that Ebola cases had started increasing again in Liberia.  They also started increasing again in Sierra Leone and Guinea for the first time in a month and a half.   The reason is not yet known (or at least not reported to us) for the resurgence.  It could be a little statistical 'noise' which is the scattering nature of data as it occurs in the world.  It could be due to the Ebola deniers.  However, there are no more deniers now than there were 3 weeks ago.  This leaves us with the most likely answer, human behavior.  

     People here want to live what for them are normal lives.  They really don't want to worry about Ebola.  They have had enough of that.  They want to be able to hug friends, take care of sick family and go to parties to dance.  All of that was suspended when Ebola struck and it was a hard lesson.  If there was Ebola in your neighborhood and you ignored the rules, you stood a fair chance of contracting Ebola and dieing.  Losing friends and family changed a lot of behavior.  But it didn't change the desire for a normal life.  

     As the epidemic waned, people started relaxing.  They congregated with friends for New Years Parties and they could again be seen hugging and shaking hands.  Schools were scheduled to be reopened.  In that setting, Ebola can spread, if it is present and unfortunately it is present.  Hopefully, spike in cases is a little bit of statistical noise or just a minor letdown in protective behavior that can be rapidly corrected.  It is hard to say right now because the spike in cases is so new.  I guess we will just wait another week or two to see what happens.

Rick

PS.  The baby whose mother had died has herself died.  No one knows why and we will never know why.  That is how it is in the developing world.  There aren't enough resources here to keep people alive, much less to find out why people die.  We will just gather all the baby things that we had purchased for her and save them for the next opportunity.