Nepal

     Today we began receiving reports about a devastating earthquake in Nepal.  It was very strong, 7.9 on the Richter scale and located in the vicinity of their capitol city.  I was immediately brought back a little over five years to when I went with Heart to Heart's initial medical team to Haitian earthquake.  The similarities are striking.  Both countries are poorly developed with an inadequate health care system.  In both countries the earthquake occurred by the capitol where the centralized apparatus of state resided.  Both earthquakes were massive.  I am scared.

     In Haiti, the initial, fragmentary reports hinted at something awful without giving concrete evidence of what really happened.  When Heart to Heart arrived in Haiti, we saw the full manifestation of the power of the earthquake.  We saw the widespread destruction and the massive loss of life.  We saw a society torn asunder.  We are seeing the same situation developing in Nepal.  I pray that I am wrong but I fear for the worst.  

     Pictures can show a terrible scene, but they don't come close to conveying the horror of the situation.  They don't convey the choking dust, the distraught faces or the smell of death.  They don't convey the cries of the children who are alone, the sobs of those who have lost their loved ones or the blank faces of those who have seen too much.  I can't go at this time since we are still in standby for Ebola and we close the ETU in two weeks.  However, Heart to Heart is assembling a team to go to Nepal.  Please support Heart to Heart as the team prepares to depart to help the Nepalese.  And keep the people of Nepal in prayer.

Closing the ETU

     At midnight, 15 April 2015, the Heart to Heart Ebola Treatment Unit in Tappita, Liberia was closed to new patients.  Over the last several months, the number of Ebola cases in Liberia has been falling.  As of today, Liberia is over 3 weeks free of Ebola.  There isn't a need for the many ETU's that are here although some will be maintained for cases that might enter the country from Guinea or Sierra Leone or that come from natural reservoirs.  Also, male Ebola survivors can harbor active virus in their semen for up to 6 months and maybe beyond.  The last Liberian case is thought to have come from unprotected sexual contact.  However, the large number of ETUs are unnecessary at this time and our ETU is included in that number.  We have been in standby status since the 15th and our last day in standby is 8 May.  

     After that, we will be decommissioning the ETU, decontaminating the area, disposing of equipment and supplies in accordance with USAID and Liberian Ministry of Health rules.  This will need to be completed by 31 May which is the end of our contract with USAID.  Wow, there is a lot of stuff here we need to distribute in three weeks.  Some of it is pretty straight forward, medical supplies are distributed according to need as agreed to by HHI and the county Health Officer.  Others are ones I wouldn't have suspected.  There is enough plywood and timber in the structure and shelving in our warehouse for two small houses.  People have approached us about selling the crushed rock with has significant value.  Even the PVC piping buried under the gravel has value here.  Then we have to factor in possible ongoing projects and we are left with a lot of moving parts.  There is so much to do that I am reminded of an old Henny Youngman line about people at a party 'they stay longer when they are leaving than they do when they are here'.  

     There are a lot of emotions about leaving.  A lot of them revolve around people.  Anticipation of seeing loved ones when we go home.  Sadness at leaving behind Liberian friends and watching expat friends depart.  I guess I will write more about those feelings later when I have processed everything.  I just know that we have been a small part in a noble effort to save lives for people in need.  And I thank God for the opportunity.

Road Warriors

I got in the vehicle with the new driver for the trip to the Sanniquellie County Health Partner's meeting.  The vehicle was an old one.  It registered 164,000 miles on the odometer, but looked like the speedometer cable had been disconnected a good portion of it's existence.  I thought it a little odd that the vehicle keep rolling a little down the hill whenever the driver concentrated on something else.  We picked up our Community Relations officer and two nurses who wanted to go to Ganta for the day and took off.  I tried to buckle up my seat belt but found that the belt had been cut off at the floor board.  The vehicle rattled and creaked and I noticed that the driver had to pump the brakes 2 or 3 times every time wanted to slow down.  That made me worry more and I realized the the vehicle was also too old to have airbags.  Well, I thought, this will be an adventure.  

     I kept flashing back to a talk I had heard a number of years ago that addressed motor vehicle accidents in sub-Saharan Africa.  If you analyzed MVAs like a disease, it would be the third greatest killer in Africa, behind malaria and diarrhea.  I also remembered an article that noted that the single greatest killer of missionaries in the developing world was the motor vehicle accident.  Well this will be interesting.

     There are a number of reasons why MVAs are such a problem over here.  One is the poor condition of the roads with the ruts, potholes, absence of shoulders and mud with occasional exposed areas of eroded pavement.  The stretch we were to cover was noted to be one of the worst in Liberia.  A second reason was the usual poor condition of the vehicles.  Our vehicle was no where near the worst on the road but it was much worse that we normally have.  A third reason were the crazy drivers.  Yep we got that one today in spades.  To be fair, drivers have a lot to put up with.  They have to negotiate the road, the people who use the roads to walk and other crazy drivers.  They have to comply with the informal 'rules' of the road.  Basically, they follow the old navy rule of right of way by gross tonnage.  If you are driving a car and you approach a motorcycle, the motorcycle has to get out of the way.  If you approach a truck, you have to get out of the way.  If you approach another car, you need to figure out who is chicken.  As a driver, you have to factor in non vehicular traffic on the road.  Adult pedestrians are pretty good about getting out of the way, older kids are too.  For that reason, the driver doesn't take any extra precautions knowing that the pedestrians will move.  They are a little more cautious around little kids, but not if there is someone older with them.  The driver will almost universally slow down for the sheep, pigs and goats that commonly occupy the road.  Chickens don't get as much respect.  I don't know what all this says about their priorities.  

     Back to our trip, our driver likes to drive very fast.  He will slow down for a few miles when you tell him to slow down, but then the speed creeps back up.  My arms ached from holding on to the interior handles and the poor folk in the back of the vehicle come out once we arrive in Ganta looking pretty green.  We spend the night in Ganta and took off the next day for the early morning meeting in Sanniquellie.  We survived that and then headed back to Tappita, again setting what for me is a speed record.  Two hours over a distance that usually takes three to 3 & 1/2 hours.     

     I did have the head of our transportation section get our vehicle into maintenance. I mentioned the driver to him as well, but nothing much will happen.  He isn't that much worse than the others.  Next time, though, I will make sure that I ride in a vehicle with seat belts.