Closing remarks.

Hi everyone. Long time no see.

If I remember right, last time you heard from me was in mid-January. A solid three months ago. Around then, I was still trying to figure out what we were going to be doing, bleeding a bit of optimism and waxing philosophic about the meaning of life or something.  Sounds about right.

But around then or just after, the bottom really fell out in more ways than one. From then on, I tried to sit down and write more than a few times, but nothing would emerge. Well, nothing I was proud of. I didn’t understand what happened then, nor did I really for the entire rest of the trip – but I genuinely couldn’t bring myself to put e-words down on e-paper. Entering my third week back in the States, I’ve been processing continuously, and finally feeling a little clarity. So if you’re interested, I feel like I owe it to the people who faithfully followed – and myself really – to revisit a little bit. Anyway.

storm rolls in. someone better get the laundry.

storm rolls in. someone better get the laundry.

So, I mentioned earlier that the bottom fell out. I’m referring primarily to my ability to write, but also to the general state of things as they stood in Liberia. I’ll revisit briefly starting at the very beginning, to provide a little context. In November, before I left, there was a big push from the powers that be, to get to Liberia very quickly and get an ETU up-and-running. I didn’t know this at the time, but the number of Ebola cases had been trending downward since August, at least where I was going to be. Very simply, the U.S. government was really slow in getting the humanitarian ball rolling, and there were two big consequences. First, they threw a huge amount of money at the problem (in my opinion, to take the heat off for being way behind) with poorly-defined and incomplete regulations and oversight. Second, the overall attitude was super-rushed. One time last year, I had an appointment I was late for at the DMV. I was streaking out the door, but needed certain documents in a certain order I had not, of course, laid out in advance. So I just grabbed every white paper within arm’s reach, threw them crumpled and mangled in my bag, backed out of the driveway and proceeded to forget my photo-ID. For some reason, the DMV lady wouldn’t accept my six-year old cousin’s crayon portrait of Severus Snape in its stead, so the trip was a wash. Swap Liberia for the DMV and a mess of papers for six-billion dollars, and you get a little idea. It was just a bad tone for things.

I’m sure you can imagine how well things go when a government holding a six-billion dollar suitcase for combatting a deadly, pandemic virus is rushing anywhere. At my ground level vantage, this was demonstrated by the embarrassingly goofy design of the initial ETU (“OK, there’s no door here, so how do I walk into that room?” and “Do you think we should put the electrical box outside the hot zone so we don’t have to ask the Ebola victims to trip breakers for us between pukes?”) and just an overall pressure to hurry-up. Hurry to get training done (“maybe just skip a few unimportant aspects?”) hurry to finish construction and hurry to open our ETU up. We were actually told by one administrator “we need to look into what an emergency-opening of the ETU looks like” ostensibly because of organizational pressure. As someone putting on the suit with a millimeter of plastic between you and headline news, it doesn’t instill confidence in the preparation.

nathaniel and the water-fight gang.

nathaniel and his kid-gang.

Now before I go any further, I want to be really clear. It’s not my intention to put anyone – people or organizations – on blast. As you may guess, the government branch dealing with Ebola (USAID) and the NGO I went with (Heart to Heart) had some significant issues we were working through and around, but I don’t care to, nor enjoy, airing dirty laundry or pointing fingers. However, one of the primary reasons I quit writing, I’ve since realized, was that there were a lot of negative things occurring, but I felt guilty about writing anything other than positives. Well, I’m not gonna do that either because if I can’t write honestly, then I may as well not. Despite that, I do hope everything is said in good taste and for a purpose.

Perhaps the biggest contributor to my self-imposed censure was the rampant waste of resources and money I observed. Now, for a guy who feels a face-slap of guilt when glass goes in the trash or a half-eaten burger is bussed from a table, waste is a big deal. But this is a different level entirely. One time, in early in January I think, Dr. Taty and I were walking around Monrovia and he was explaining to me how it was his dream to someday bring his wife to stay with him in “de nicest hotel in the WHOLE Liberia, my man!”, the subtly named Royal Grand Hotel. Now to clarify, this is not Liberia-nice. This is anywhere-nice. They know they’re the nicest hotel in-country and they charge you like it – the cheapest room was I think $250-$270 per night. Expensive for the United States, but in a city where eighty Liberian dollars equal one U.S. dollar, astronomical. Apparently, President Clinton stayed here when he visited the country and breakfast is advertised as $19 like it’s a bargain. We decided to feign importance and strut to the front desk to tour a room. So we ambled across the gleaming marble with particularly straight backs and asked to see a room. “Well’, came the response, ‘we only have one room empty right now, but you can see that one.” Hm. Fifty-eight rooms of sky-high prices and they’re full? Off the elevator and onto the smoking deck we quickly saw why: occupying every table except maybe two, was the largest gathering of white people I’d seen since leaving the States. I recognized proper English and French being spoken, immediately followed by the large lanyards around most of their necks: CDC (Center for Disease Control), WHO (World Health Organization) and others. These were the foreign organizations camping out in Liberia to coordinate the management of Ebola, where they’d been stationed for a solid four to five months. Now, I’m not saying it’s evil to stay in a nice hotel, or even that these groups weren’t helping. They probably did a lot. But in a city with around 40% unemployment and where an average day-laborer earns five bucks for eight hours of manual labor, observing a booked-out hotel costing some government $15,000 a night made me sick to my stomach. Millions of dollars was being spent, but none of those dollars were getting directly to the people. Lots of that going on, from what I saw.

i had some balloons (see: the christmas tree) and it somehow came up that the kids had never had a water balloon fight. well then.

i had some balloons (see: the christmas tree) and it somehow came up that the kids had never had a water balloon fight. well then.

don't worry, it wasn't drinkable water.

don’t worry, it wasn’t drinkable water.

Adding to that was the management of our own ETU’s resources. Our specific locale was built to accommodate a massive influx of patients – a kind of worst-case scenario Doomsday-preparedness that seemed to be the hallmark of a lot of the Ebola plan. We were armed to the teeth with two whole warehouses worth of supplies, a full staffing matrix and enough saline in our medication stores to float a warship. Awaiting the apocalypse. When it became apparent that the torrential onslaught would in-fact be a meek trickle, a number of us were both disappointed and hopeful. It wasn’t what we planned on doing, sure, but in a destitute and impoverished area like Liberia, there were surely other ways to contribute, right? Community work, clinics, education, staffing. Being next the hospital aided that illusion, as we imagined ourselves donating boxes of medications and supplies to a large facility (second largest in-country) whose yearly operating budget was the equivalent of two months of our ETU’s. Nope, nope, nope. Red lights all around. “We’re not allowed to do anything outside the contract” was the stance. January was when we as a clinical staff officially inquired, “what else can we be doing besides Ebola work?” But when I left in mid-March, we had just begun to start teaching small, informal classes. That was it, even with less than fifteen patients total to that point.

So whose fault is that? The government? The NGO? Ours? I have opinions, but I’m not here to share those. To be sure, some of it was pure misfortune. It’s no one’s fault that the disease plummeted so quickly in Liberia, and it’s crazy to even talk about it as if more people living is a bad thing. But despite that, our operation was the Titanic: too big, too cumbersome with too much momentum to take necessary evasive maneuvers, regardless of who was manning the steering wheel. But enough negatives, you get it. And it wasn’t all bad.



So why didn’t I just write that at the time? Well, if I’m going to be really honest, I’ll say that I went into a little bit of a personal tailspin at that point. I had high hopes, and a lot of negative emotions and ideas developed that I’m, as of this writing, still processing through. I just felt useless, like I’d deceived everyone as well as myself. I didn’t write about it for a few reasons, which I can see now. First and foremost I think, pride. Everyone sent me off with such flowery language and heroic declarations, I guess I began to really want to live up to that ideal. Well, I didn’t. Now you know, ha. Feels good to say! Second, and I still worry about this a little bit, I don’t want to put people off of humanitarian work. It’s my great fear that people will hear about Ebola and the debacle that engaging it kinda was (and is) and decide that it’s not for them. I actually felt like that for a while during the trip and a little after. But someone I respect recently told me that I wasn’t giving people enough credit, and I see that now. As hilarious and fantastic of an author as I am, to think I could singlehandedly put someone off compassionate work is pretty arrogant. I’m still gonna go out and do things like this, and so should you. Lastly, my mom’s words rang in my head constantly, “It says this somewhere in the Bible, but if you can’t say something nice, don’t say anything at all!” Well, sorry mom. And also, that’s from Bambi, not the Bible.

i'll admit, I had no idea they looked like this.

i’ll admit, I had no idea they looked like this.

To put a ribbon on it, you may be surprised to hear this – I’m kinda surprised to say it –  but I’m glad I went. I remember I was really depressed one day and told a fellow nurse I felt like I was wasting my time. She, a veteran of more than a few humanitarian trips, said – which I’ll never forget – “It’s not fun, but you grow as much from negatives as from positives. You’re learning, you just don’t realize it yet.” I can say now, she’s right. The people were so kind and constantly refreshed my belief in the goodness of humanity, even as I was losing it for earlier stated reasons. Africa itself is a really weird and wonderful place. The pineapples are worth the plane ticket in themselves.

So here’s to learning, however the heck it happens.

And I suppose that’s all I have to say about that. Thanks for following along.

A ribbon for your trouble.

Day thirty-seven.

I can barely remember the misty, grey mornings that met us upon our arrival in Tappita, not that long ago. Anymore, it seems like the sun just wakes up and races to the very top of the sky, looking for the best position from which to pummel us. I suppose I could take it as poetic retribution for all these plastic water bottles I’ve thrown away (note: if you ever visit Africa, do not be the guy who, upon arriving in a third world country ravaged by a deadly epidemic, asks where the recycling is. You will be laughed at, I promise.), but mostly it just makes me grumpy. At the moment, our poor little canvas tent is having an especially hard time keeping us from roasting – little metal fans are our pathetic defense against the blinding, white sunlight and hot, red earth outside the flaps.

ETU headquarters, Kim, RN presiding

ETU headquarters, Kim, RN presiding

Speaking of hot, I asked Dr. Taty the other day if it ever gets cold enough to snow in Africa. First, he didn’t understand the concept and then confused it with “dew”. I’m thinking that might be because the word is so seldom used that people forget it exists, like chicanery (meaning trickery, but cooler) or Jake Lloyd (seriously, whatever happened to that guy). After laboriously communicating the meaning of the word snow (“like frozen rain, you know, cold. Brrr.”) he burst out laughing and couldn’t stop. I didn’t understand all of what his joyous response was, but understood parts of it – “Hahaha, ah my man! De BIG, BIG pile of sno and not seeing anyting! No walking anywhere, eva! Hahaha” – then proceeded to re-enact what looked like a man spinning a car wheel frantically, wide-eyed with squealing noises included, before crashing because of “de BIG ice evra where, all ova! HAHAHAHA! My man!”. I took that as a no. Which made me wonder: what do Africans with no experience of snow think we mean in holiday carols like White Christmas? Is Bing Crosby an infamous symbol of white supremacy in the third world? I’m too nervous to ask. So, if you’re keeping track, the rules for “looking intelligent during African discourse” now include: don’t ask about recycling, winter weather, or Christmas music with possible racist overtones.

my climbing buddy, Tracy

my climbing buddy, Tracy

the tappita hospital at dawn

the tappita hospital at dawn

Oh, right. Ebola. On that front, a little bumpy, but we’re rolling along fairly well. Today marks our fourth day officially open. We were informed last week as the finishing touches were being applied, that the Liberia Ministry of Health needed to visit to approve the structure. This was a little surprising and pushed us back about a week, but went fairly well from what I’m told. I wasn’t actually there – when important people arrive I’m usually asked to go run errands or find myself oddly locked in the bathroom for a few hours at a time. In addition, while we were waiting for the dignitaries I was called into a meeting with our charge nurse and pharmacist, who would be leaving shortly. Somehow, I exited the room bearing the title of Pharmacy Supervisor, which means I oversee pharmacy shifts and training, ensure medications are stocked appropriately and carry a lot of keys. I still don’t know what most of them open. At this point, I’m not sure if they selected me because I did well on my drug calculations or because it’s another room to lock me into (I was starting to wise up to the bathroom thing). We have air-conditioners to keep the medications cool however, so honestly either reason is fine by me.

my domain in the ETU pharmacy

my domain in the ETU pharmacy

the throne room

the throne room

So yeah, we’re pretty much done and stocked and staffed except for one small detail: we don’t have any patients. We’ve had a few sent over for evaluation by way of the hospital, but we’ve sent them right back because they don’t fit case criteria. The principle at work is: you don’t want to admit someone to an ETU unless you’re reasonably sure they have Ebola, because if you’re wrong, you could very well give them the disease you’re fighting. And we’re not equipped to be anything but an ETU. Which, you know, sounds good in principle, but if I’m really honest, is frustrating. Now to be fair, viruses are difficult to predict and you can never be sure what the next few weeks will hold, but to most observers it appears that the disease has slowed considerably here and migrated north to Sierra Leone. Last we heard, there were less than forty confirmed Ebola cases in-country.

It feels a little bit like training for an Olympic event only to discover its cancelled (I’ll have much more sympathy for the curling team when their bell tolls) or walking in after the punch line of a joke while everyone is still laughing. It’s frustrating to be late and feel like you’ve missed out on your goal, but as I’ve thought about it, I realized there’s also a little embarrassment mixed in. Which is a weird emotion to feel in this scenario, right? It doesn’t really make sense at first. But in trying to sort through it all, I’ve discovered that I feel embarrassed because of failed expectations – because of what I think my friends and family expected of me. Because of what I expected of myself. I’d planned to come here and suffer in the heat and battle the disease on the front lines and come home with something to show for it. Or something like that. After the outpouring of well-wishes and kind words lavished upon me, to come here and not risk a whole heck of a lot or see many patients feels almost like a deception. As if you were to go to a funeral and say nice things and make a slideshow Powerpoint and cry, then realize the guy was sitting in the back of the church the entire time, healthy as a horse.

the market, before I got told to put my camera away. it's totally packed

the market, before I got told to put my camera away. it’s totally packed

the hospital linens out to dry

the hospital linens out to dry

I’m sure that most of you will tell me there’s nothing to be ashamed of or disappointed in. I’ve been amazed so often by others’ graciousness that I really should just start expecting it. But regardless of how others feel – and I’m sure it’s all genuine – I think the hardest thing will be to allow myself the same grace. I can’t say that I came here expecting to be Hercules and cut through Ebola like the three-headed Hydra, but I did want to play a part in something important; to serve in something I could be proud of. You know, there’s something about growing up and acting “responsible” that makes life feel hollow sometimes. You find yourself getting disproportionately upset when HyVee is out of your favorite peanut butter, or disproportionately happy when gas prices are under two dollars. Then if you’re like me, you get to a place where you think, “What am I doing? This is all so insignificant! What have I done that’s really meaningful for anyone else?” Then in what feels like no time, you’ve quit your job, boarding a plane to Liberia with a backpack and your optimism, proud of yourself for finally doing something about it. But to what end? I finally busted out of the hamster wheel to find another hamster wheel with more sun, right outside. That’s where the disappointment sets in, if that makes sense.

As I read through what I’m writing, it all sounds a little selfish – as if the point of anything always has to begin and end with me – but it’s how I feel. I am learning a lot about myself here – as you’ve all been privy to – but I’m not sure how much good it’s been for anyone else. I’ve seen many a Pinterest post about the journey being more important than the destination, but it’s harder than it sounds to buy into it. No one really wants the stupid participation ribbon. So what is the effort really worth, regardless of the payout? As a great friend once told me, “Do the next best thing you know to do.” Maybe I’m just going to start with that and hope something valuable takes shape amidst the insecurity. I can think of worse ways to live.

“…So I decided I must stay.”

Day Twenty-seven.

T-minus five days until opening.

As I wrote about in my last post, building an ETU is a long, multi-faceted job. Our specific location in Tappita has been bogged down in red tape and a little too much oversight, but hope springs eternal: we officially received the keys on Friday! This means that although we’re not finished yet, we can finally start doing the modifications we need without layers and layers of approval process hovering overhead. Some of the big things still to be done include supply stock and organization, erecting another storage tent and drilling a well. The well has proved to be super-problematic; shockingly there are not many people hanging around Western Africa with a drill bit the size of my body. Also unfortunate for our plans, I had the foresight to include a no manual labor clause in my contract (called the “Perspiration Brings Resignation” addendum), so the well remains a fantasy. I simply did not bring enough Old Spice. Despite all these hurdles, our goal opening date is January fifth. It’s frustrating to delay this much – I think we all were hoping to open sooner – but the primary goal is to make sure this thing is safe and functional. You don’t get a do-over once Ebola is in the house.

the critters grow large out here

the critters grow large out here

While waiting on the opening, I’ve been spending most of my mornings with the Liberian clinical staff. Heart to Heart made it a priority to boost the local economy by hiring people from the surrounding villages and communities – which I really appreciate. However, we’re not at all familiar with the training and experience level of the locals, so our team was asked to develop some sort of training and orientation to the ETU. Our charge nurses – John and Kim – have a paltry fifty years of flight, critical care, emergency, managerial, education and first-responder experience combined. Obviously I –as I am sure the reader is as well – was very concerned that I was not leading the operation. But despite the glaring lack of oversight from an opinionated nurse with a decorated thirty month career, they’ve developed a really solid curriculum for the class. We’ve gone over pharmacology with a pharmacist on-loan from the States, proper decontamination from IMC (International Medical Corps: an NGO that has been working with Ebola since day one) and even a lesson on intravenous therapy from yours truly. They’re really smart and already knew everything I told them though, so I had to make up a lot of fake medical terms and say “that’s not how we do it in the States!” to save face.

I probably should have been paying attention.

I probably should have been paying attention.

The Emergency Room

The Emergency Room

Maybe my favorite thing thus far happened yesterday: a walkthrough of the hospital and a meeting with the CMO (Chief Medical Officer), Dr. Ben Kolee (Kew-lee). He is one of the real heroes of this country. A tall and lanky Liberian, he has a trustworthy face and uses large sweeping hand gestures to emphasize almost everything he says. He thanked us for coming (“You are all MOST WELCOME always in Liberia!”) and elaborated slightly on his role at the hospital in a very methodical and matter-of-fact manner. It was after we began asking questions however, that his real story began to emerge. When asked if he does any care at the hospital in addition to administrative duties, he offers a short laugh and responds, “Well, we are in Africa!”, educating us that while Liberia is a country of four million, there are only around eighty physicians currently practicing. Because of this, Dr. Kolee (an Internal medicine physician by trade) does primary care, sees patients in clinic, performs general surgery, works in the Emergency room and moonlights as an OB/GYN.  All quite impressive; but it was something else he said that will stay with me.

Dr Kolee was discussing the flight of medical staff from Liberia in the early days of Ebola (such as the Chinese hospital workers) and why he did not follow:

“At the time I began hearing about Ebola in Liberia, I was also very scared with everyone else. No one knew how bad this could be. But I had heard already that many NGOs and physicians were planning to travel here to help. I thought: ‘If my house was on fire, it does not look too good for the owner to be running away as the firemen and helpers rush in to save it.’ This is my home, so I decided I must stay.” Who of us would make that sacrifice? Probably very few. Even if I never see a single Ebola case out here, meeting people like this would be worth it. There are noble people everywhere – many like this man who toil away in anonymity, a million miles from any news camera or copy of Time’s Person of the Year issue, for no other reason than an inner dedication to others.

Dr. Kolee

Dr. Kolee

Dr. Kolee shows us the surgical ward and radiology departments.

Dr. Kolee shows us the surgical ward and radiology departments.

In the movie Blood Diamond, Leonardo DiCaprio’s character – a South African diamond smuggler with perfectly tousled hair and an impressive body count – frequently says when something bad happens: “T.I.A., mahn. This Is Africa, eh?.” And while I’m sure the screenwriter has never been to Africa (I’d guess closer to Canada), it has rung somewhat true here thus far – like a tropical substitute for Murphy ’s Law. I’ll demonstrate this with an example from our ETU walkthrough this morning.

After multiple days in the classroom, it was time to take all the staff on a field trip of the ETU. The layout of Ebola treatment units vary somewhat; enough that it is helpful to see the structures in place, walk through the flow and today, to receive on-site training from our colleagues from IMC. Around seventy participants flooded into one of the white tents I’ve come to love so much, to listen to an initial lecture on how to dress in proper personal protective equipment. This about the third time we’d gotten the talk, but I attempted to look interested and keep quiet while all the demonstrations were done. The problem was, I’d accidently stood at the front of the crowd and so couldn’t browse my phone discreetly. You’d think after attending church for twenty-five plus years of my life, I’d have learned how to text in secret, but I guess the heat got to me. I wasn’t the only one. As I scanned the room to keep my mind busy, my eyes fell on a hygienist that seemed to be bobbing his head to some kind of music – the problem being of course that there wasn’t any music. In the second that followed, I noticed he was wearing a winter coat, pouring sweat and had flickering eyes.

He was definitely going down.

thought I'd stop for a quick scan

thought I’d stop for a quick scan

some of their wards are actually not bad. Dr Kolee explained that this was because they were constructed by the Chinese after Taiwan built a hospital over the hill (now defunct).  Notorious rivals, the Chinese decided to add a little extra flair, I guess?

some of their wards are actually not bad. Dr Kolee explained that this was because they were constructed by the Chinese after Taiwan built a hospital over the hill (now defunct). Notorious rivals, the Chinese decided to add a little extra flair, I guess?

Without thinking, I bounded a few steps across the room and grabbed the material at the front of his jacket, calling for a chair just as his legs went rubbery. It took everyone a quick second to realize I wasn’t attacking a friendly Liberian, before we got the poor guy a chair and sat him down. I was checking a radial pulse and trying to bring him around, when a voice behind me said, “Zach, step back! You don’t have any gloves or anything on.” I was about to flip around and say “Really? Gloves, right now?” in the condescending way only an ED nurse perfects, when I realized something everyone else already had. This is an ETU. In Liberia. In the midst of a horrifying viral outbreak.

Um, right. Gloves.

In retrospect, it’s fascinating to watch a room full of trained health care professionals respond to something like that. In the less than twenty seconds it took for me to step away and begin donning my own PPE, a few nurses had already put on most of theirs, and the physicians had started organizing a plan. I felt a small wave of fear wash over me – had I exposed myself to an Ebola patient? – but pushed it out of my mind almost immediately: Think of the criteria! Fainting by itself isn’t criterion for diagnosis! (Note: The five criteria for Ebola suspicion are: 1. Contact and fever, 2. Contact and three symptoms, 3. Fever and three symptoms, 4. Unexplained bleeding and 5. Unexplained death. For a more detailed explanation, click here.) As I was raising my own spirits and pulling on my last glove next to two other nurses and Dr. Ravi, I overheard his friend say: “Don’t worry about him, he has just been thinking a lot about his father. He is really sick at home.”

Oh boy. Happy thoughts.

it's weird to see a hospital that is relatively empty. this is when the power goes off for four hours a day, to rest the generators

it’s weird to see a hospital that is relatively empty. this is when the power goes off for four hours a day, to rest the generators

PACU, I think?

PACU, I think?

We quickly parted the large, gawking crowd and the four of us in protective equipment shuttled the poor, embarrassed hygienist into the unfinished ETU. During the interview, he expressed he was feeling better and had no symptoms, but was just worried about his father. At the same time, we were relayed a message from a different community member, who said the patient’s father had actually died earlier that day, but that there may be some family denial. Which was sad to me for two reasons: one, it’s his dad. Two, it meets criteria.

So as not to keep you in painful suspense, we ended up not keeping the patient. When we began to ask about his father’s symptoms, he talked to us about slurred speech, one-sided weakness, inability to swallow or eat, and gait problems – which sound exactly like stroke. He also looked markedly better after a banana and water, had no fever and denied other problems. After a lengthy, spirited discussion (with fifty onlookers), the physicians agreed that this patient did not meet case criteria and therefore did not need to be transferred to another ETU. Ya know, because we have no water or beds yet.

My faith in our physicians remains unshaken, but I was allowed to leave class a little early to take what may be the longest shower African has ever seen.

TIA, indeed.

So this is Christmas?

Day Twenty-one.

Three weeks, with no signs of slowing.

Our training complete, we arrived in Tappita on Monday evening, the permanent location of our ETU. Word was that it was getting close to being finished and we were needed to gear up for the opening. The trip was itself fantastic, primarily because we were able the bypass the normal method of transit – a ten-hour car ride fraught with a perpetual red dust-cloud, zero bathrooms and potholes that could be used to collect rainwater for a small village. Somehow we connected with a group offering free helicopter flights to Ebola workers, which took our journey airborne. Gliding over the green forests and brick-red, Liberian soil gives you a new perspective of this place. It really is beautiful here, above the smog of the city and oppressive smell of burning trash. Forehead smashed against the glass of the small cabin, I could see small, wooden huts, lunch stoves burning black smoke, vivid fabrics laid to dry in the sun like confetti, and brilliant headscarves chasing small dots of children around. These people were just living their lives, cooking their meals, building their furniture. Totally oblivious to the bearded nurse in the sky overhead.

i was so focused on taking pictures that they almost took off without me.

i was so focused on taking pictures that they almost took off without me

hovering over the town of tappita

hovering over the town of tappita

We landed in a small, grass field directly in the center of a dirt circle, and were quickly picked up and driven to our home for the next four months. The first thing that grabs your attention is the red dust. It reminded me of being a six-year old, of the sandbox of blush coating the bathroom sink after my grandmother finished aggressively blasting her cheeks with it. It blankets everything out here, so much that it almost feels like buildings and people are made of it. Roadside shops, trees, and the eyelashes of the many motorbike-riders are caked with it. The hospital itself is a sight to behold, out in the middle of nowhere. It rises slowly into view and is woefully out of place: a massive white building, sun glinting off its many windows, wrapped by an iron fence and gilded with what could almost be described as landscaping. Built and staffed by the Chinese six years ago as a gift for Liberia, it was totally abandoned by them shortly after Ebola struck the area. It has remained open with a skeleton staff composed of volunteers and nationals (the only hospital to never close during the outbreak), but even still is the second-best health-care facility in the entire country. It possesses a surgical center, pediatric ward, an emergency department and Liberia’s only CT scanner (currently broken, however).

a jewel in Africa

a jewel in Africa

Directly to the side of the hospital stands our ETU, still under construction. I’ve learned very quickly that the process by which one plans, receives funds, builds and maintains an ETU is a massive undertaking, as slow and annoying as a grandmother in the fastlane. Since the entire thing is funded by a grant from USAID, there can be no quick changes or modifications, regardless of how necessary they are. Take for example, something we discovered yesterday, during one of our tours. I realized our triage area needed another door, as currently the same door used for possibly infected patients would be used by staff. Not only that, but a fence was being built that would block it. And you know, I just don’t feel like getting Ebola. Upon bringing this up to the leadership, they confirmed that yes, this was something they were aware of, but couldn’t yet be fixed. Meanwhile the workers continued to drive the misplaced fenceposts deeper into the ground. I offered to simply go tell them to stop, but apparently it’s not that simple.

It was explained to me that because USAID is providing the funds, a planner in Washington D.C. had designed it, and had the plans approved by someone who wears expensive suits. The schematic was then gifted to the engineer under contract, which we are not allowed to see, nor modify in any way. To request something needing precise calculation and extreme oversight, like say, a hole in the wall you can walk through, we must communicate our request to the engineering staff. This will then be relayed to Washington D.C. who will place a satellite call to the Master Architect on his yacht in the Caymen Islands. After his masseuse is finished and his margarita is taken away, he will dictate to his assistant “maybe, but how wide do they want it?” This is to the best of my understanding, where we are on the great saga that is “The Door that Halted a Nation.” There’s probably enough source material here for a trilogy; someone call Peter Jackson.

working hard with nary a powertool

working hard with nary a powertool

Obviously, it’s a little frustrating to be held up in this way, but even without that the future is still somewhat unclear. Ebola incidences are down from their peak in late-July, and they seem to be moving over to Sierra Leone, so we’re also wondering how much work there will be for us. It’s bittersweet as a healthcare professional because of course, you would hope that a deadly virus ends its vicious devastation of the country. At the same time though, you want to be useful and productive in your time and do the job you came for. Many of us here quit our jobs to work here, so we’re hoping that someone out here can benefit from that. All in all though, we’re staying fairly optimistic, trying to keep busy with training Liberian workers and other things. That is, until I realize that it’s almost Christmas.

And it feels really odd spent anywhere but home.

What I really should be doing currently is what I’ve done almost every Christmas since just after the beginning of time: seated on my parent’s cold floor, walls layered with warm, red light from our overburdened Christmas tree, eggnog in-hand (dad offering nutmeg, Steph offering Bailey’s) crumpled piles of wrapping paper zipping by my ear and wondering what I’ll do with an electronic train set or Pokémon toys from my mom (“Hey, you used to love these! It’s a walk down memory lane!”).

Instead, I’m seated on a crusty, plastic chair on the patio of an old, washed-out Liberian hotel. A dim yellow bulb caked with a buzzing, dark insect crust illuminates my keyboard; a diesel generator roars in the background. The engineers under contract to construct our ETU – at the moment partially-obscured by a small mountain of empty Heineken bottles (all the rage here, for some strange reason) live here and allow me to hike over and leech some internet. Sweat beads on my forehead, but I accept the coffee they offer because it’s Folgers and reminds me of my dad. Trying to remember the Christmas music we’d have playing on cassette, all I can think of is the first verse of “O Little Town of Bethlehem” before the tipsy work crew start blasting Liberian hip-hop to stay awake. Why in the world did I come all the way out here?

Then all the things that seemed alright before, suddenly seem a little less alright. You remember that there’s no hot water in your bathroom, you haven’t gotten an email that’s not from Urban Outfitters in two weeks and you’re guarding Nescafe coffee crystal packets the same way you used to guard your credit card numbers. And then you just really miss home.

a fine mist of red dust at the marketplace

a fine mist of red dust at the marketplace

the Liberian preferred mode of transit

the Liberian preferred mode of transit

I was thinking about all this on the way to dinner tonight, trying to put on a good face for my crew. I’d heard that our Liberian cooks were going to put on a big festive, feast for us tonight and noticed that the goat who had been neighing (?) all week was suddenly gone from his little hill. I arrived to see plastic tables and chairs set up, Liberian beer bottles and off in the distance, a cluster of maybe fifteen Liberian women and girls hovering around three crackling fire pits. We were served snapper fish coated in peanut butter (?), roasted chicken and reintroduced to our missing goat friend. It was an emotional and delicious occasion, but not quite enough to get my spirits up to where they usually are.

Let’s not be sad, our friend the goat is in a better place. My stomach. -Dr. Ravi’s euology

As the night was winding down, I decided to go say thanks and “Merry Christmas” to the women who’d worked so hard for us. It was after all, Christmas night for them too and they’d spent it wrapped in dingy aprons working up a vicious sweat. As I made my way over to where they sat fanning themselves, I was thinking of their families, the people of this area, what Christmas-time is like for them. This morning, we saw the Liberian kids who live across from our compound racing out of their house with their gift: belts. It’s hard to put yourself in the place of someone whose life you’ve never lived, but from the little I’ve seen, it’s a pretty difficult existence. And just as I was trying to figure out how to split my inner grief down the middle and share some of it with these women, they broke into song:

Weeeee three kangs the orient ahhh! Berry geeefts we travel thaaa fahhh….!

With an unmistakable Liberian disregard for rhythm or pitch, they pressed on: substituting musicality for effort. And you know, that may be the worst Christmas song ever (tied with “Little Drummer Boy”), and I think some verses from The First Noel got mixed in there, but seeing these women parade around, dance and shout carols to no one in particular, really got to me.

late night culinary delight

late night culinary delight

mariah at work on a snapper

mariah at work on a snapper

Here are women who, in my limited perception of them, have no reason to be happy. They are all poor, feet perpetually dirty, and work on holidays to save enough for their children’s Christmas morning belts. I, at least, will leave that life eventually. This is their existence, probably forever. And yet, in the midst of all they have to battle with, find a reason to be happy, to celebrate, to sing. As I entered the circle of dark skin and colored headwraps, I couldn’t have thanked them if I wanted to, they would have never heard me. I joined them in song, as did the rest of my team – trying to sing harmony with no melody, shouting over the din, attempting to suggest anything but “We Three Kings”. As we danced and “sang” I wanted to retrieve my camera to capture the moment, but I just couldn’t will myself to leave twirling scene of joy and cooked fish. Just as I thought I was making headway towards “White Christmas”, Mariah, lead cook and the biggest, loudest music director of them all clapped her hands like a gunshot,  and the singing stopped. “Awright ladies! It’s time to clean it up!” And just like that, women scattered, laughing. They still had to walk home in the dark.

Later that night the staff had a white elephant gift exchange around our Charlie Brown tree. I carved a chubby, white elephant out of a block of soap I’d purchased at the market for some poor fellow nurse and received three tennis balls for my efforts. Someone broke out the M&Ms, which made things really rowdy. It was uproariously fun, but I kept thinking about those women and their songs. Man, that was just really fun. Then the thought hit me.

That wasn’t just fun. That was Christmas.

misty mornings are every morning here

misty mornings are every morning here

You can read the Christmas story a million times (as I have) and know it so well, that sometimes you lose the gravity. The skin and bones of it. It gets shuffled up with pumpkin-spice lattes and candlelight services and the realization that you’re going to have to find another home for another electric train set this year and the holiday monster just bites down so hard that December 26th is almost more of a holiday than the 25th. And I’m as guilty of that as anyone, even out here on this dusty continent with not a strand of tinsel for a million miles. I always seem to forget the simplicity that lies at the very center of this towering, holiday avalanche.

Jesus came here to be with us. He didn’t have to, we didn’t know we needed him to and we’d made our world into a pretty awful place to be, but he did it anyway. When he did that, he brought people hope: hope that this world that can be so horrible, won’t always be that way. Hope that our lives mean more than the sum of our parts. Hope that beyond the cold, unforgiving earth flows a current of love running underneath and breaking out in small pools of beautiful things. I think that’s what I saw dancing with those women: a reminder of that current, a reminder of the hope that was brought to us in Christmas. And while I don’t know fully what it all means for me, I learned a little bit more standing in that circle, listening to the shouts of happy women who shouldn’t be.

our tree, fashioned with ETU waste, balloons and love

our tree, fashioned with ETU scraps, balloons and love

For one thing, it means a wealthy, white, privileged man can dance awkwardly alongside the dusty feet of impoverished African women with nothing in common, except for gift that they share.

Merry Christmas everyone. May you discover anew the worth of what you’ve been given.

Honesty and Despair.

Day Fifteen.

Two nights ago, after my second day in the ETU, I was reading a book given to me by an esteemed colleague and loving cousin, Jordan. (He has a fun and very thoughtful blog here.) The topic is about as far away from Liberia as could possibly be imagined in that it deals with writing for comic books. But a particular passage stuck with me, which I think can be applied to many settings:

Write true. Write honest. That in itself is success. – Brian Michael Bendis

I’m about to test that theory here, so let me know if it’s valid or a load of crap.


every inch of you has to be cleaned, top of the head, bottom of the feet

Whenever I tell people my primary job is in Emergency Room nursing, I usually get the same response: “Oh, man that sounds really difficult.” My response is frequently that, yes, it’s challenging and soul-sucking at times, but in other ways rewarding. We have a great team, face challenges not many people get to and quite literally save lives that would be lost otherwise. In short, there’s a sadness and difficulty to what we do, but a beauty that makes it worthwhile.

Finishing up three ETU days, and I can’t really say the same for it. There’s just not much beauty to be found inside. This is not to say that the staff isn’t excellent, the patients aren’t gracious or that the facility isn’t well-run and efficient. All that is true. But in the time I’ve spent here, I think an ETU is perhaps one of the last places on earth I’d ever choose to be, but maybe not for the reasons you might think. Starting with the obvious, the environmental challenges are constantly on the assault: de-humanizing stormtrooper suits, inability to speak or see well through the stupid mask and goggles and blazing sun wringing every bit of moisture out of you like a soggy towel, but really, those parts aren’t as bad as I thought they’d be. The most devastating part is seeing what the virus has stolen away from these people.

hot training, observing triage

hot training, observing triage

We enter the first ward of the day. Everything but the cement floor is covered in white tarp – railing, stairs, walls, tables – so they can be sprayed down frequently with 0.05% chlorine solution: a stream of slimy-feeling, noxious fluid that lingers in the room long after it has evaporated. The long hallways loom ominously, partially because there is no décor, no color, nothing to distract your eye. Just an old clock and a pen hanging on the wall; items which will all be incinerated. In fact, everything will end up getting roasted: dirty bedsheets, pillows, toys the kids play with, the cell phone the patient unwittingly brought. It all gets cooked. It’s really weird to think about. It made me feel like I was living in a lifeless pop-up book; as fabricated and vacuous as if everything were made of paper, if that makes sense.

Getting my bearings, I look and see a row of green military-esque cots against the far wall and a single patient laying supine next to another cot, piled with blankets and rags. The young woman stares blankly at the ceiling. As the team makes its way towards the patient, I determine in my mind to be cheerful and encouraging, even though I feel as far away from it as I ever have. I drew six-pack abs on the PPE of the doctor next to me, just to remind me to relax. She doesn’t look very sick – actually not bad at all – and although she has a sad look about her, it brings me a modicum of optimism. Maybe she’s one of the half that get out of here.

“Zach, where are you going?” our instructor says. I turn to see our group huddled around the cot with the linens on it. Our actual first patient. The source of the barely audible whimpering I can just now begin to make out – the eight-month old, who we soon discover, lost both parents to Ebola and probably weighs less than the bowl of rice I had for lunch.

It’s a punch to the stomach in every way, without the fist. And you can just physically feel your heart scramble immediately, desperate for answers. To somehow make this fit it into your worldview and make it even a little ok. But it can’t. It just can’t ever be ok.

boots drying in the hot liberia sun

boots dry quickly in the hot liberia sun

Not sure how long I stood there and gawked at this little princess, probably only a few seconds. In retrospect however, I think I have a salty old hag in my heart that I met in the ER. Her name is Nurse Duty (probably RN, BSN, CEN), and she’s rude and morbidly obese. So fat in fact, that when she shows up – as she has many times before – there’s just no room for little Empathy or her sweet playmate Compassion to hang around, so they just get offended and skip away. She doesn’t usually see the patient as a whole – more like a collection of veins to poke and interventions to consider and data to gather. Like a breathing version of the case studies we did in nursing school. But say what you will about obscene, gruff old Nurse Duty. She gets her stuff done; she exists for a reason.

So I’m pretty sure she saw a patient, adjusted the height of her chair, cracked her knuckles and starting taking clinical notes. Pulse normal. Fine lanugo hair on the head, which should’ve been replaced by mature hair months ago – indicative of malnutrition. Approximately 6.5 kilograms. Poor neck strength. Decent veins for a scalp IV if needed, etcetera, etcetera. So let’s get it done, right?

Further down the line we encountered a family of patients: a mother, two girls and a boy that ranged between five and twelve. Of course, they can’t be next to, or touch each other. Being the sickest one of all and to protect her children, the mother had to be kept across the hall, where her kids could smile and wave at her. They’d had a close family member die of Ebola and so were all in the Suspect ward, awaiting their final blood test results. I’d go crazy if I was that mom, but I think she was too sick to notice.

“If there is meaning in life at all, then there must be meaning in suffering.”
Viktor E. Frankl (Auschwitz survivor)

So before I knew it, our two-hour time window was up and we were being hosed down with the potent, chlorine film. Post-class wrap up, a little more study, dinner, home. But perhaps the craziest thing? I didn’t think of that family or the little one even once, after I left. As if the memory was undressed along with the suit. It never reoccurred to me until a friend asked me how my day had been, later on that evening. I started in on the catalogue of the daily events and with no warning, the memory unleashed itself on me. All the injustice and anger and overwhelmingly despairing emotions that I should have felt at the time I saw that helpless baby, just washed over me in an instant. I felt like I’d tossed a boomerang and given up on it returning, until it hit the back of my head.

Side thought: that’s a scary realization. My brain quite literally realized that it couldn’t function with the feelings I was eliciting from it, so it just staged a coup and gave me a new set. I know professional detachment can be necessary, but it is a little frightening how it could happen so suddenly and without my consent. I think people who do difficult things or have painful experiences can put themselves through this, but for far longer than an eight-hour delay. Hiding things away for decades, only to erupt like an underwater torpedo someday all-at-once, unseen yet deadly. If I’m going to do and see more difficult things, I’m going to have to practice self-awareness just as intensely as clinical skills. Back to topic.

supply closet. most of the ETU is made up of these tents, but I can't take my camera in, so that's why you get boring pictures like this

supply ward. most of the ETU is made up of these tents, but I can’t take my camera in, so that’s why you get boring pictures like this

The place just steals so much dignity from these patients. They get no physical contact (which in my opinion is essential to being a great healthcare worker) except through 3-4 layers of plastic. Voices are muffled, everyone looks the same, every single thing they touch has to be drowned in germ-killer or tossed in the bin to get incinerated. I think it would be easy to see myself as the disease. It’s hard to express how difficult it is to watch, much less to experience firsthand. The world has some really evil things in it.

But as I lay in my bed last night and tried to find a place for this crazy stuff I’m taking in (self-awareness right?) I realized that as weird as this may sound, I want to see the evil things. I want to find out how dark it can really get. I think I mentioned this in a post before, but at the risk of being redundant: if the way I deal with these senseless tragedies is to put them out of my mind and act like they don’t exist, what good am I? I’m preserving my rosy worldview sure, but to what end? I’m no different than a child who hides by putting his hands in front of his face. How can anyone be proud of a life like that?

I want to be the kind of person who can see suffering and stare it right in the eyes, whether that’s a starving orphan child or a friend who tells me he lost his mother to cancer. And you can’t just decide to do that; you have to actually experience it. We can see that in others that have been there, right? I can. When I read about Hellen Keller (fantastic category of dark humor, nonwithstanding) who made something of her life although deaf and mute; Mother Teresa who spent her days comforting dying people; or Harriet Tubman (a saint here, since Liberia is founded by ex-U.S. slaves.) who risked her life to conduct the underground railroad, I just feel as though they discovered something a lot of people never do. They weren’t perfect, but learned how to go in really deep. To plunge into the swamp of human despair, come up for air, and return to show others the way out.

a lady getting interviewed for triage. notice the two meter distance required at all times, and the tube for sending things to her

a lady getting interviewed for triage. notice the two meter distance required at all times, and the tube for sending things to her

So in a really perverse kind of way, I suppose I asked for this. And I just found out that today, the first patient I saw – the one with the sad look; twenty-three years old – asked to adopt our little emaciated princess. She went to meet the mother and requested to keep the child, just before she died. Not a family member, neighbor or even a friend. Though sick herself, she just saw suffering and didn’t back away from it.

When I heard about that, I felt like a deep-sea diver approaching the surface, finally seeing the sunlight glittering through the waves.

An Earthworm in his Sauna.

Day Ten.

Graduation day finally came Friday, but not without a trial by fire. Well, as close to fire as you can get.

After four days of classes and lectures, our “final exam” so to speak, was a two-hour long scenario in which we had to apply the things we’d learned throughout the week to four separate patient cases, all taking place in the mock ETU. The actors/patients were all actual Ebola survivors, so they all did pretty well with the portrayal. Kinda like when Louis Stevens played himself in Transformers and the Indiana Jones movie. The simulation is partly to see how we react when some unique stuff is thrown at us (confused/combative patient, a healthy guy and dead body in the same room, etc.) but also to get us acclimated to wearing our PPE for around two hours at a time. The care aspect isn’t too tough by itself, but as they say, the devil is in the details.

dr. ravi beckons us towards the light

dr. ravi beckons us towards the light

they were good actors

they were good actors

One, you can’t touch your face. For any reason. Ever. Sweat in your eyes? Blink it off. Fly in your mask? Bat it down with your lashes or hope it suffocates. Anticipating these challenges, I shaved my beard off, which I frequently scratch and otherwise mess with. I have now officially given everything valuable I have to the people of Liberia.

Second, I discovered that I sweat at a rate that is far above the norm. Now, being soaked from head to toe isn’t so bad by itself, because you can pretend that you just got out of the ocean or something. The problem arises when I can feel my toes actively pruning, like falling asleep with feet in the kiddie pool. Or worse, when I lift my arms above my chest, the unknown sweat reservoir that is currently pooling atop my tucked-in gloves rushes down the back of my arm like a foul Splash Mountain. There’s just no way to make that normal.

getting close to two hours in the gear, no part of me was dry. in the back is dr. phil, the german army doctor. can't make it up

getting close to two hours in the gear, no part of me was dry. in the back is dr. phil, the german army doctor. can’t make it up

In class on Thursday, we met a survivor, who ended up playing a role in the mock ETU and educating us on how it feels to contract it. She, her husband and young child all came down with Ebola at the same time, but both of them died while she was too sick to visit. Her community rejected her out of fear and anger, and so she finds herself alone in new city, figuring out what her future looks like. I thought of her as I pitied myself in my size-medium sauna and realized that if she can persevere, than I have laughably little in the way of excuses.

So next up is “hot training” where I’ll head Tuesday to work with actual Ebola patients, and get my (double-gloved) hands dirty for the first time. So we just wait until then. I’m not so great at waiting, so my mind sprouts forth observations about being here. Possible the most random: Liberia makes me feel somewhat like an earthworm. Plucked from its familiar entanglement of roots and earth, contorting blindly in a desperate attempt to find something familiar or safe, I relate to him. You realize after living overseas a few times, that your heart wriggles around like that whether or not you want it to.

my group randomly wore these colors. miracles do happen

my group randomly wore these colors. miracles do happen

In Kansas City, I had a thousand things in-process and a thousand things more to take their place if God-forbid, I actually completed anything. When you make the move to a place like Liberia, you prepare to give up the obvious: egg-nog shakes, Google Fiber, regularly-scheduled barber visits. But what you don’t realize is that all the tiniest things – notes you intended to write, thirty-second YouTube clips, poaching eggs in the morning; i.e. the muted buzz of your life motor droning on – these things sustained you a lot more than you knew. And you take one plane ride and all of a sudden, like a downed power-line, all the lights in the tiny windows of your life go dark.

Granted, I am doing something; something that I know surely makes a difference. But the issue is that it’s the only thing I’m doing and I’m not at all used to that. As the anxiety bubbles up more and more violently from an unknown fountainhead, I’m coming to grips with the fact that I live my life on monkey bars. Swinging from one to the next, I’m content when I’m in-motion and constantly anticipating what’s next. I’ve realized this from time-to-time in the act of swinging itself – when a meeting is cancelled or I accidentally wake up early enough to think – but always somehow convince myself that my relentless activity is noble. I plunge back into the beckoning tidal wave of my commitments, a motivated man seeking to ‘suck the marrow out of life!’ as Thoreau disturbingly chose to put it. But conversely and very strangely, Liberia has been for me somewhat of a momentum-killer. All I’m able to do is focus on these patients and my role in their lives. And my heart is absolutely throwing a kindergarten-sized tantrum in here.

this scenario involved a patient sprinting out of his room. ER instincts cannot be tamed however, and the blurry man is in a headlock. no lawsuits here!

this scenario involved a disoriented patient sprinting out of his room. ER instincts cannot be tamed it seems, and the blurry combatant was grappled instantly. Liberia: All of the excitement! None of the lawsuits!

But as time goes on and the dust begins to clear a little bit, I realize that it’s not noble at all – this desire for activity; this oppressive treadmill of accomplishment. It’s really just fear. Fear of not doing enough, having enough or being enough. And like the child, as my momentum stops with no new bar to swing to, I begin to think on how sweaty my hands have gotten and how distant the ground is and how I really haven’t come very far at all.

But it shouldn’t be like that at all! How awful it is to measure your self-worth on what you can get accomplished. I don’t want to live like that. I don’t think God intended me to live like that. What would my life look like if it could just be enough? If my work here in Liberia, whether I directly contribute to saving lives or just come out with a new appreciation for every-meal rice, could just be what it is and nothing else. I think that would be nice. I wonder then if my love and concern for my patients here would be more focused and substantial, not fractured in a million directions like light through a prism. I think there’s more than this panicked life so many of us live. Than the constant activity we both create and despise concurrently. But man, it is really difficult to find out about yourself. Hopefully, it doesn’t just end there.

“Sometimes I can feel my bones straining under the weight of all the lives I’m not living.” – Jonathan Foer

So maybe I’ll hop down off the old playground equipment for a minute (or four months), just to see what it feels like. I’ll let you know what’s down here.

Note: I updated the Page now titled, ‘the cause and the cure‘ for those of you who’d like to know a little more detail about Ebola and how we treat it. You can access it by clicking the menu icon in the top left corner. Also, you may notice I’ve started a gallery in the same area. I have more pictures than I can use in the posts, so please click through if it makes you happy.

Boot Camp.

Day Five.

Man, day five and I already feel like I’ve been here forever. I’ve learned a lot about this place over a short amount of time. A few examples. First, the no-touching policy thing we all heard about here? Absolutely true. They’re doing it to prevent Ebola transmission, which makes sense. But if you know me at all, you know it’d probably be easier for me to make-out with everyone I met on the street, than to not touch anyone for any reason – but that’s how it works here. The first few days I was ‘left hanging’ for a combined total of about 40 minutes – hand fully outstretched or fist extended like I’m posing for a boxing promo shot  – and that number doesn’t include multiple dodged hugs. Believe me, I’ve been through the fire and there’s no good way to play it off. You just come to the realization in the fourth second or so, and then try to focus on the next one while breaking eye contact ASAP. In Liberia, you can “touch elbows” as an alternative, but I’m still getting used to it.

i think they're dressed like that for the foreigners


Next thing. So, you’re sitting in a nice restaurant in the U.S., say, Applebee’s. You notice that a guy has an interestingly patterned sweater, and you’re trying to decide if it’s grey or green just to while the time away. All of a sudden, he looks up – and makes eye contact. He’s looking directly into your eyeballs! What do you do? Well if you’re me, you rip your eyes away as quickly as humanly possible and scan the room in a tizzy, trying to look interested in something, but really only interested in him and his gaze and hoping – just really, really praying he didn’t think you were staring at him. After a few seconds of trying to snap your own neck but secretly looking back to see if he’s still looking at you in your peripheral, you think “what the heck am I even doing?! He’s in Applebee’s, he’s not important! I don’t care about this guy! But you do. We all do. Liberia is the opposite of that. They don’t have Applebee’s here and consequently, have never learned the ‘no eye contact’ thing. Liberians will make eye contact with you and stare – hard. They will scan every feature – up and down – drinking you in until they’ve had their fill, until you feel like you can’t wear white on your wedding day anymore. When they’ve picked out another target, they will move on and leave you a crumbled heap of nerves. It’s not racist or dominating or sexual at all: they literally all do it, men and women alike to both foreigners and their own people. It’s just an African thing, I think.

After I thought about it and realized how silly it all was, I decided to hold the gaze of the next person who did it to me. A visual game of chicken, if you will. I sized up the least-threatening person I could find: a fifty-something year old grandpa with a pink shirt on and a pile of cassava on his head. He couldn’t beat Ghandi in an arm-wrestling competition. I turned to him and squinted.

Then it all went black. I don’t even remember what happened but I’m telling you, it physically hurt me. Never again.

class is never not about handwashing

class is never not about handwashing

Ok, so back to business.

Today was our second day of what they call “cold” training. Basically, this means that we’re in a classroom setting learning about the basics of Ebola transmission, treatment and logistics, without being around any active cases. We have five days of this training – put on by the U.S. Military – and then three or so days of “hot training”. This is when we enter an Ebola unit and work in our assigned role with real patients, but under supervision of an experienced team. A few observations from class:

I’m really proud of Liberia. I think my perception of this place – I’m ashamed to admit it – was that Liberia was a relatively ignorant place in need of foreign knowledge and education. I would come with my team of Americans, Europeans and Asians and provide the first-world aid they are in such desperate need of. I’m realizing too often in my brain, poverty and lack of resources get churned into the mixing bowl along with laziness and ignorance and I bake myself a cake of misconceptions. Let me clarify: these people are poor and do need help, but are far from lazy and ignorant. Sure, there are some older and rural Liberians who think Ebola is a myth, but there are many more than that who turn out to these classes every day, study hard and practice at home, so they can protect their countries and families. Of our class of sixty-ish, nine of us are on the Heart to Heart squad, three are German military and maybe eight to ten others are from other various places. The rest are all nationals: Liberian nurses, doctors, firefighters, health care technicians and some with no skills at all, other than the willingness to learn and help. How many of us would turn out to work in close proximity to a deadly disease that was threatening our home? We have a lot to learn from and admire about these people.

just such great people

just such great people

even I don't read it that thoroughly

even I don’t read it that thoroughly

dat education

they work harder than i do. I guarantee it

Great teams mean everything to a goal. In class today, we did a number of pretty challenging Ebola scenarios including: what do you do with a pregnant Ebola patient? A patient with stroke-like symptoms, suspicious for Malaria yet without an Ebola rule-out? What about when a patient comes in to the ETU and you think they’re making up their symptoms, or families are difficult? For scenarios like these (the last one especially!) I really want to make sure everyone in the KU ED knows how much I appreciate them. I was flying through these cases and feeling really confident and competent; but I haven’t been out of school long enough to forget that genetic intelligence has nothing to do with it, haha. In the last three-and-a-half years, the KU ED made me into the nurse I am, and so directly affected the care I’m going to be giving. For that and many other things, I’m grateful.

Also, we’re going to stick patients for IVs and blood draws through a minimum of two heavy gloves and foggy masks, wrapped in plastic tarps in the blazing Liberia humidity. So my IV Therapy people get an electronic elbow touch from me too.

gotta get the face seal right

nice guy, tough critic

we're supposed to write our role on our fronts and backs. i wrote "doctor" on the front and "thinks she's a doctor" on the back. shhh

we’re supposed to write our role on our fronts and backs. i wrote “doctor” on the front and “thinks she’s a doctor” on the back. shhh

taking our lashes like true soldiers

taking our lashes like true soldiers

Lastly I want to say, I read all of your kind words about how brave and selfless I’m being out here in Africa. And while I really, honestly appreciate everything that’s said – seriously, keep saying it – I want to also make sure you don’t forget that we are the same. What I mean is, I think we can get so enthusiastic about someone’s story, that we put them on a pedestal. I know I’ve done this with a few of my personal heroes: Paul Farmer and Henri Nouwen. The danger in this is, we very quickly begin believing that they are somehow different, more equipped or just plain better, than we are. And the truth is, you all can do what I’m doing. I’m not any kinder, friendlier, more intelligent, or adventurous than any one of you. I suppose my point is this:

If you’re happy doing what you’re doing, by all means, stay there. If everyone was in Liberia, my Wi-Fi would be too slow. But if there’s something in you that feels like you should do something different; if, when you hear about Liberia and its people, the excitement swirls in your stomach like it did mine; if you just don’t even know what you want, but an adventure calls out to you, my advice is this: the movies lie. Gandalf will not come to your house asking about the Ring. Mr. Darcy will not be kneeling in a marriage proposal when you open your door. Hedwig will not come flying in your window. A great purpose or fulfilling adventure will not come to you. You have go to it. It’s out there, but you have to go to it. Sometimes it’s a single decision, and sometimes it’s a whole lifetime worth – leading you there.

But the thing you gotta remember is, you don’t have to be Henri or Paul or Frodo or Elizabeth or Harry. And you sure as heck don’t have to be me.


Day Three.

When I first arrived in Liberia, I was thrilled to see our team’s diversity. After a number of conversations with everyone, I realized that we’re all from such different places serving for such varying reasons. I thought it’d be interesting for everyone to meet the people I’m working with and hear their motivations. This morning, I talked with Dr. Bambuta Bole Taty of Congo. Everyone calls him Taty (tah-TEE) because as he explained, last names come first there. He’s been practicing for three years, is a newlywed and has worked in Liberia once before, as a surgeon. He’s a quiet man, but breaks into a broad, almost mischievous smile while discussing his wife. When English or third-world healthcare comes up, he leaps into conversation unfettered by his imperfect English. I admire him.

Note: Although his English is a little stilted, I think it would do a disservice to him to completely edit our talk. How he speaks is part of who he is, so I hope that is communicated well. Thanks for reading.

Me: So, what is it that motivated you to come to Liberia?

Taty: The first thing I can say: when I went in India I was asking about my post-graduate program, so they told me that I have to go first and practice for two years. Then I can go back and study. So that’s what I decided to practice; where they can speak English.

What kind of work?

Well now, I already change things! I wanted to do the pediatric surgery, but now I already change! I’m going to do the MPH (note: master’s in public health). You know most of times, most of our opportunity in the NGO (note: non-government organizations, synonymous with non-profit organizations) ask you if you have an MPH degree, and I say ‘no’. That’s why I want to get it. So I can work in an NGO.

What did your family and friends think when you told them about coming to Liberia?

Yeah, the first thing they say, “You know you heard about Liberia, what is happening there? Why did you choose to go back there?” So they cry and are very afraid. Especially my wife. Two days before to leave I think, she was crying. She was crying so I was there advising to her. I was saying “I will be there and be safe! Nothing will happen to me!” to convince her to agree for me to come in Liberia. So it was not easy, but at least she agreed!

What are three things that you brought to Liberia, that you can’t do without?

The first thing, it was my books. My study books from the tropical medicines and gynecology. For gynecology, I have books from U.S. States. The second things was my phone – my iPod – because inside I have my wife’s pictures! Haha! The last thing I like… I need to think about it.

What accomplishment are you most proud of ?

The first thing I did was when I gave the surgery experience. For me it was a big thing, yeah.

What kind?

Oh, hysterectomy. C-section. The first surgery I did was the hernia repair. The second was the appendectomy then I did the C-section. Then I did the hysterectomy so that was the big thing.  I work in a Liberia clinic in the past, then I receive from them a call yesterday. She was too glad I was coming back to the clinic. She say, “we are happy you are here!”. They think I am coming to the clinic!

democratic republic of congo

democratic republic of congo

You did your surgeries in Liberia? So you were the boss doctor?

Yes, in the clinic I’m the boss! The second thing achievement was getting married. It was good thing for me.  My wife’s name is Monica.

Tell me about a time that you were really scared.

Let me think about it. No, no the first surgery I did I was very scared. I could not sleep. I was asking how the patient was coming, all that. The second – I’m gonna explain you something – when I was asking my wife’s hand to get married, I was very, very scared because I was thinking she not love me! Haha!

That’s right! You were just married.

Let me tell you about a story. The first time I meet her was in the church. I was sitting somewhere, so the place I was sitting – when you take a look at the door – everyone was coming in. At that time, the Spirit told me to take a look to the door, the time she was coming in. So the first time, I saw her. Later on, I was a medical doctor and all the church know me, haha! She fell sick and they ask her to see me. When she came I said “Oh, thank you God!” because I was willing to, speak to that girl, but could not get the occasion. So this is the best moment for me! So she came and was suffering from Malaria. After that, I asked her if she was already engaged. She say “no”, at that time she was planning to go to South Africa for school – the college program. I say “No! I want you to be my wife if you can agree – if you are ready – so we can get married.” She told me that at that time, she was not ready because she was already plan to go to South Africa to college. But she told me she was feeling nothing for me! So she will be thinking about it later. I say “no problem”.

How long is later?

It was about 2010.

4 years ago?!

Yes, 4 years! Let me explain you. At that time it was 2010 – the first time I asked her. So she said she would think about it later. After three months, she travel to South Africa. When she was in South Africa, I could no get in touch with her because there was no contact.

How long was that?

Six months later on, I went to see her family for just a common visit. We are the same church. I went to visit her family and so during the visit the big sister asked me if I have Monica news. I say ‘no’ because I have no contact. She say, “I will give you her number!” Haha! So I was happy to receive Monica’s number. I started calling her every day, every day to start to remind her about my concern. So she took almost one year.

After you asked?

Yes. After one year, she agrees. She agree for me to become her best friend! And if I could wait for her, I say, “Yes, I’m going to wait for you!”

Dr. Taty and John preparing lunch for the crew.

Dr. Taty and John preparing lunch for the crew.

Then you waited for three years?

When I was plan to go to Liberia (the first visit), we going to see how we’re going to go. I said, “no problem”. So from that time, she became my best friend! In April, my family asks my wife to receive the first visit because you know in Africa, we have different steps for marriage. You have to go first to visit the family and they will give you the cost.

Is that called a dowry?

The cost of the dowry, yes. When you receive the cost, you will go to get the pay.


Money and some other materialistics. Like you know, one bag of sugar, one bag of salt. I give one shirt to the father: tie, shoes, the belt! For the mother I give one clothing. Shoes for the mother, shawl. And a big TV!

A big TV?! Ha!

It was thirty-two inch!

(laughter break)

And you hadn’t seen her in one year?

Not one year! A long time. So we came back so everything was already set. I was happy. And then we program our wedding, which happened August first. Why August first? Because it is a off-day in our country. That’s why we choose that.

So, how do you think you will be different after coming back from this trip?

Wait! I wanted to add something to the things I brought!

You had a third one?

The last thing I can’t forget is my bible. Always, I bring it, Always there. Ok, ready!

Alright, so how do you think you’ll change?

First of all, for me, I’m here to add one experience. Especially, how to help the Ebola patient. I think for me, I just asking God to give us one or two patients, so I can know really they can be take care of. So after this trip, I’m thinking that once I’m back there, I can taught to those that was thinking, “Am I going to be affect by Ebola?” So I will be maybe the one who can be informing people that Ebola is not what we are thinking.

Is there a lot of fear about Ebola in Congo?

Yes, so for me it’s to add something. Especially how to take care of patients, I think.

Do you know what a zombie apocalypse is?

Zambia? Yes.

No, not the country. Zom-bie. Have you ever heard of that?

No, not that?

It’s popular in the United States. It means when you have someone die and come back to life. They try to eat people and all of a sudden you have to fight them.

No, I understand! The movie, I know. The movie the zombies which can take blood from somebody.

And if they bite you, you become one. Is that popular in Congo?

Yes. Most of the youth, they like it. For me, I can’t believe it. Just fantasy, to make people amused.

I won’t ask what you’d do during a zombie apocalypse then. What kind of music do you listen to?

I like the gospel music. Like Don Moen? He say, “God will make a way” – the best song – where it seem to be not way. Myself I like that, for me. That is the passage of our soul with our belief. That anytime, God is helping us and when we are catching hard times. He will make a way, like for the Israelites in the desert with the river and the Egyptians behind.

this is how Dr. Taty looks when he’s on the phone with his wife.

If you could tell something to people who don’t understand Liberia or Ebola, what would you say?

Ok. First of all, those who don’t like to help, we must tell them about especially the protection. The more you are protected, the more safe. If you are one-hundred percent protected, there is one-hundred percent no chance to get Ebola. For those who are scared to come to the place where Ebola is experience, I can tell them that they are just wrong themselves. Ebola is a world problem. If we do not take care of Ebola in the origin, it could come to our country. So for me, I feel I am protecting my country, first. Second, I protect the world.



Day One.

I slept surprisingly well last night – probably because I forgot what I was doing today. A text at 6:30am – “Oh my gosh, our flight leaves in 6 hours!!” – awakened both my body and heart to the realization that spring of 2015 would be the next time I’d sleep in my own bed – or continent. After breakfast, three of my favorite people dropped me off at the airport and I waved goodbye to my city. Quick observation: MCI is one of the nation’s best airports. Sure, we don’t have world-class eateries or shoe-shining machines, but I breezed through check-in and security so fast, I almost went back through with a gel-like substance just to pass the time. Plus, no matter your departure or arrival city, there’s always Skymall waiting at the finish line with open arms and a voice-activated litter box.

if your goals are to remain well-hydrated and urinate every four minutes, I strongly recommend Camelbak as an in-flight companion

if your goals are to remain well-hydrated and urinate every four minutes, I strongly recommend Camelbak as an in-flight companion

Accompanying me from Kansas City are Brian and Tracy. Tracy is a rehab nurse from the area (whom you may recognize if you read our Pulitzer prize-winning article. I was trying to look cool. Did I look cool?) and Brian is our logistics guy from Heart to Heart. One of his primary functions is to coordinate all of our personal protective equipment (PPE) for the clinic, so in retrospect I probably should have bought him a coffee. Travelling to Brussels by way of Washington D.C. with a final destination of Monrovia is the plan for the next 48 or so hours. From Monrovia, we’ll drive between 4-6 hours with a final destination of Tapitta, Liberia. From what I’ve learned, it appears that multiple nonprofits are collaborating and setting up camp in different regions of Liberia. HHI will be based primarily in Tapitta – both in constructing a new clinic and assisting current city efforts. I’ve really been impressed with the coordination that seems to go on between all these organizations to minimize the people that slip through the cracks.

i forgot to be a british pop sensation

i forgot to be a british pop sensation

At lunch I was happy to learn some further details about the mission. The Ebola Treatment Unit (ETU) is under construction and scheduled to be completed in about a week. It’ll primarily consist of gravel and cement foundation, with wood-framed individual tent structures housing patients. Sadly, no update on whether we’ll have the internets, or any type of address to send care packages to. However, I’m sure if you just write “Zach/Liberia” on the package, it’ll make its way to me eventually.

As I sit here and type – 30,000 miles above the black Atlantic and unable to do anything except ponder how Kevin Hart has monopolized the in-flight movie industry – I’m doing a lot of “realizing” for lack of a better word. Realizing that I’m past the point of no return. Realizing that although my seat neighbor ordered chicken and I ordered ravioli, upon further inspection they appear to be fashioned from the same substance. But perhaps most of all, I’m realizing that it’s not really just me going on this journey.

the team lounging in Brussels at 3am

the team lounging in Brussels at 3am (everyone dresses so nicely here)

Ever since I first decided to take the plunge with Heart to Heart, the amount of support I’ve gotten has been nothing short of remarkable. I definitely expected it from my family and close friends, but it’s gone far beyond that. I’ve received innumerable texts, Facebook messages, notes, phone calls and emails from co-workers, friends of friends, parents of friends of friends; people that really have no reason to be supportive or interested, yet are. And in receiving this avalanche of love, I have to say that my heart is at rest.

I think the thing I feared more than anything else wasn’t catching a deadly virus, being trapped in Africa, or even death. My biggest fear is pulling the curtain back on what life is about, and finding something void and hopeless. That suffering is permanent, that it’s just about dodging sad things and that most people just don’t care about anything but themselves. I haven’t seen Ebola firsthand yet and I’m still a little scared of what I’ll find. But all of you who have reached out to me and expressed concern and support – for people you’ll never know and a country you’ll probably never visit – you’ve made me a little less afraid.

just the essentials

just the essentials

Know that I thrive on the community of people I love. Whether we worked in the ED, grew up in the same home or are just the most casual of acquaintances, I’m a product of your investment in me. And as I’ve learned so much through all of you – how to be kind to a co-worker, how to fight for a marriage, how to pursue a dream – I hope that somehow you can also learn a little from a male nurse who ran off to Africa.


When I tell people I’m headed to Liberia for work with Ebola patients, more often than not the first thing they blurt out is, “why”?  And that is a really great question. One I’m still figuring out the answer to.

I remember the moment when I first realized the world was a very large place; when the doors to the tiny room of my mid-western mindset ripped off their hinges, so to speak. Come back with me for a moment, to a simpler time. 2005. Freshman year.  The Fray was a new and cool band and Mr. Lucas had just disappointed us all for the third and final time. Introduction to Intercultural Studies class. Rocking back in my chair, probably thinking about what color of Etnies to buy next, my professor looked out over his thick-rimmed glasses and set wheels in motion that haven’t stopped since:

“If you are sitting in this class right now receiving a college education, you are part of less-than one percent of the world’s most privileged population .”

Surely that couldn’t be right. Less than one percent? I went back to my dormitory and fired up my computer and researched it for myself. Sure enough, he was right. 1%! I thought about it a lot that night, and while it’s crazy enough to realize how gifted I am, another even more insidiously disturbing thought crept in. Not only am I part of the less-than 1% of the world, everyone I know is too. Nearly all of my friends, family members and even the co-workers from my first high-school job as a dinnerware sanitation specialist (dishwasher) were either attending college or heading there soon. We were quite literally all part of the one percent. I immediately got this mental image in my head (caution: nerd alert):

if you don’t know what this is, just pretend like you do.

I exist there. On the very, very pinnacle of the central column. My friends, family, the businesses I drink coffee at, the car I’m driving, the hotels, vacations, Christmases, movie theaters, restaurants, everything I’ve ever experienced – they all do too. My entire life had taken place in the thin atmosphere above the clouds of extreme prestige. I had absolutely no idea what the world was like. If you’ve never thought about that, let it sink in for a moment. The artificial sphere we live in and all the layers inside – upper-income, middle class, blue-collar, rich, poor, homeless – nearly all take place in another much greater sphere in which we are at the top. Like a tiny planet in a gargantuan solar system. It really rocked 18-year old Zach (actually, it was Zac back then) and it still does.

Perhaps even more significant is the spiritual journey I’m on. Being raised in a house that faith was important, I’ve always been curious what the limits are. It’s easy to be a Christian when I get a great rate on my mortgage or when I’m the last one picked for free Chik-Fil-A, but what does it look like when it’s more difficult? Can we go deeper? Many Christians are quick to quote heroes of the faith, or Instagram a well-filtered inspirational verse pic (for the record, I’m against neither and have done both), but how many will actually step push the limits? Matthew 14 tells a story about a guy who jumped out of boat to see if Jesus could save him. Some people might say it was reckless, but it’s always made sense to me a weird way. I could see myself trying that. My friend Bottles introduced me to a quote I’ve pondered frequently:

A ship is safe in harbor, but that’s not what ships are for. -John Shedd

I don’t reach the end of life on a gleaming, unused galleon, or be laid to rest in a spotless skyscraper I’ve never stepped foot out of. Doesn’t that sound awful? It does to me.

So what’s pushing me to Liberia? Not sure entirely, but I guess the question for me now is, what’s keeping me away?

No more posts.