Those Who Stayed

This post is not only about the foreign aid workers, but also about entrepreneurs and other individuals who decided to stay in Ebola affected countries, and those who are still arriving to provide needed services. This post is also not about singing any of us here a praise, nor it is about complaints about the situation we find ourselves in. It is to describe the environment we are operating in and the kind of personal and professional concerns and decisions we are challenged with every day.

The psychological stress of living with an invisible killer may be the most obvious one. Every daily routine is aligned with infection prevention. We keep a distance from one another, our lives have become a touch-less operation. We are suspicious about exchanging documents, goods and other items. We bleach-wash our hands obsessively. The threat of Ebola seems far more real than skin cancer. One day we will have to consider it too. The skin on our hands shiny and smooth from excessive bleaching, often with incorrect bleach solutions. Not everyone knows the standard bleach solution for hand washing and others just like to exaggerate, operating on “the more the better” principle. And we are obliged to wash our hands everywhere we go. There is no entry without hand washing.

And we have to think about whether the staff working in our houses (no need to point out the luxury of it, we are aware of it and we immensely appreciate it) are healthy. Whether they have considered the instructions provided, whether they believe the existence of Ebola, whether or not they will show up to work with a fever. And there is little control over it. For the most part they have the same working hours as we do, so we rarely meet in person. Should they still cook our food, prepare the raw food, take our dog out?

We are also suspicious of our own pets, dogs in particular. Dogs can get Ebola too and can pass it on. Who is touching the dog when you are at work, what is he/she licking? Well, don’t lick me, it’s Ebola time! They don’t seem to respond to this Ebola command. Probably some have considered and reconsidered the affection they have for their loving pets. Everyone is a suspect. Everyone is a potential Ebola carrier, even your cute dog.

We look at our colleagues and friends for visual assessment of their well-being. Does he/ she look well? Could this one have Ebola? Who has this person touched? Who did I touch?! Everyone looks a bit strange, everyone is tired. And we are starting to know the people who are infected. It is spreading and it is coming ever closer. We are all in the same boat and we think we know how to keep safe. For now at least.

More complicated issues are those of health care. There are very few safe health care facilities available. Most got infected at one point or another. People are in general scared of health facilities and avoid them as much as possible, some paying for that with their lives. And if you do get Ebola, access to the ETU (Ebola Treatment Unit) is not guaranteed. You will get in if there is an empty bed. No preferences, no priorities. Well, why should there be any, we are all the same people.

Our commercial health insurances have washed their hands over us. They will certainly not Medevac (medical evacuation) us in case of Ebola. They claim to still be willing to come for non-Ebola cases, but it will require a negative Ebola test. As if we are talking about malaria tests here. There seems to currently be only one commercial establishment equipped to Medevac Ebola patients. They only sign contracts with governments. So of course, several months into the crisis there is still no concerted action on that. The EU support is fragmented. It’s individual members states’ choice to take care of their citizens. Some EU member states have signed the agreements. Others are still thinking about it and others will just not sign. And forget about the EU consular protection agreements and treaties- Ebola doesn’t seem to qualify.

Some of us have been told by our representations to leave or bear the consequences at our own risk. What a great idea, asking aid workers to leave the country. As if it isn’t everyone’s problem! We get politically correct statements such as “we have no logistical or financial means to provide required support”. That actually translates as “we aren’t picking up the bill for your Medevac”. It’s costly, indeed. I heard it’s about US$ 1,000,000 to Medevac an Ebola patient. No small money.

But this crisis is everyone’s concern and everyone has responsibility to respond to it, to end it. And it will require people on the ground. You haven’t solved the problem by throwing a couple of hundred thousand euros or dollars at the WHO! That does not absolve you from responsibility! Not to mention our African expat colleagues. Their embassies rarely even offer any statements. And when they do they are just as politically correct, but empty of any support. Soon we will all be signing waivers (those who haven’t signed them yet) that we are here at our own risk.

This isn’t all. Many among us are not allowed to go home, not for a break (we actually need it sometimes), not to visit families without 21 days quarantine. Many countries just don’t accept us to enter at all, with or without quarantine. The popular opinion in many countries that allow us to enter is negative too. They don’t want us to come. They don’t need us to be importing Ebola to their safe beautiful places.

When we are actually allowed to enter a country, many face problems with families and friends. Some of them don’t want to be in the same room with us, touch us or want us to stay under the same roof. Others are trying to be brave, but are probably horrified and must be reconsidering their attachment to us and wondering why they are exposing themselves like that. You’d be surprised how common this is. Fear prevails. And we are feared by our closest. There are of course those who are well informed and ask us questions and have no problems with us.

You should know that we are also scared. We don’t want to put you in any danger. We love you. And we do know how to keep you safe. We are aware of the risks and we are (for the most part) a responsible bunch. Ask us questions. It is allowed and it is completely understandable. You should know that we know what to do to keep you safe.

The commercial airlines aren’t helping us either (appreciation is extended here to Brussels Air and Air Maroc who are still operating regular flights to Liberia). With so many cancellations of operations they have created an ever worse connectivity environment that has already existed before. Some people have to travel absurd distances to come in and go out. It is delaying the response. FYI.

All of the above is unfortunately not part of the solution, but part of the problem. Not just for those of us here. We’ve made our decisions and we are staying. For now. But many have left due to the lack of protection and lack of support, and no one can blame anyone for leaving. It’s not a normal situation. In a lab setup the Ebola operations follow protocols of biosafety level 4 (the highest). What kind of a nut stays with no protection and support anyhow (it’s a rhetorical question, no need for anyone trying to define us).

But the problem is that due to many of the above considerations, people also cannot be deployed. And we need people in the field. At some point money, nice words and strategic plans aren’t useful, when they cannot be translated into real action on the ground. We need solutions. And everyone has to participate in finding them.

We need to be here. We need to stop Ebola before it gets worse. And if we are not here and we don’t stop it, it will come your way. So please, be on our side. We are not the enemy, we are the ones fighting it.