tag:blogger.com,1999:blog-18748185273637760282024-03-05T18:28:39.095-08:00Sierra Leone's Invisible WarSusan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-1874818527363776028.post-64850220040966562922015-02-23T14:34:00.002-08:002015-03-03T09:02:41.943-08:00Magical Laser Thermometers<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQA0Cs07EfOxoEaPhazdKCOvRFnaTVXPh4_MFb3LK7tKBzXS8RehqbfOdrIyzE7i_pzjiNmJaMBEHDWRhfLvCVI0J-eDCMLJHK0ovJ-nq9QES12ebZBnWc_Km0vIDOHqaFxDReUb1CsVM/s1600/nina+thermometer.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQA0Cs07EfOxoEaPhazdKCOvRFnaTVXPh4_MFb3LK7tKBzXS8RehqbfOdrIyzE7i_pzjiNmJaMBEHDWRhfLvCVI0J-eDCMLJHK0ovJ-nq9QES12ebZBnWc_Km0vIDOHqaFxDReUb1CsVM/s1600/nina+thermometer.jpg" height="320" width="232" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nina outside
Crown Express -- a lunch spot</span></td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbC0PsOX20laAcdXmV6luyHjlRn11JmR7xILfa2dTzdiOeDwahQeWSlHqe72vBufYhsyOV-jL5OxU6Oq32VuLBEuXYq7f44CJh8rpErFWduoaKDcbdKR5loMnluiYRKiySObTssd1BWaI/s1600/Brussels+thermometer.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbC0PsOX20laAcdXmV6luyHjlRn11JmR7xILfa2dTzdiOeDwahQeWSlHqe72vBufYhsyOV-jL5OxU6Oq32VuLBEuXYq7f44CJh8rpErFWduoaKDcbdKR5loMnluiYRKiySObTssd1BWaI/s1600/Brussels+thermometer.jpg" height="198" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Susan checked on
landing in Brussels</span></td></tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-no-proof: yes;"></span><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"></span></div>
<div class="MsoNormal">
<span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-no-proof: yes;"></span><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"></span></div>
<h3>
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: major-latin;">Laser thermometers (actually </span><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><a href="http://www.harborfreight.com/non-contact-infrared-thermometer-with-laser-targeting-69465-8905.html"><span style="color: blue;">Non-Contact Infrared Thermometer With Laser Targeting</span></a>)
are ubiquitous in Sierra Leone at the moment.<span style="mso-spacerun: yes;">
</span>Because fever is one of the symptoms of Ebola, it is assumed that if you
don’t have a fever you are not sick and therefore not contagious.<span style="mso-spacerun: yes;"> </span>One’s temperature is taken before one enters
government ministries, businesses, and hotels.<span style="mso-spacerun: yes;">
</span>The person manning the thermometer points it at your head for a few
seconds, then turns it around the show you the display.<span style="mso-spacerun: yes;"> </span>The front-desk staff at our guesthouse were
very proud of their laser thermometer and, when they remembered, rushed to use
it on us when we returned from our interviews at the end of the day, crying out
“35.1!” or “36.2!”</span></span></span></span></h3>
<h3>
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> </span></span></span></span></h3>
<h3>
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">As we travelled around Freetown our vehicle was
sometimes stopped at checkpoints where we were all asked to come down, wash our
hands, and have our temperatures taken.<span style="mso-spacerun: yes;">
</span>(The Red Pump checkpoint I wrote about earlier is an example.)<span style="mso-spacerun: yes;"> </span>However, we found that </span><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-weight: bold; mso-hansi-theme-font: major-latin;">we
could often pass through checkpoints without having to come down to wash
our hands or have our temperatures taken if we claimed we had hand sanitizer in
the vehicle (which we generally did.)<span style="mso-spacerun: yes;"> </span>I
don’t really understand the logic there, but in practice is seemed a way not to
have to stop NGO vehicles.</span></span></span></span></h3>
<h3>
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> </span></span></span></span></h3>
<h3>
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">It might sound like a good strategy, but we found
many problems with the ubiquitous use of laser thermometers.<span style="mso-spacerun: yes;"> </span>First, people did not always know how to use
them.<span style="mso-spacerun: yes;"> </span>They would wave them around in the
general direction of the person instead of properly aiming them.<span style="mso-spacerun: yes;"> </span>Someone from the CDC said that the
thermometers need to be calibrated regularly, and they were generally not.<span style="mso-spacerun: yes;"> </span>Sometimes the thermometers were simply not
working.<span style="mso-spacerun: yes;"> </span>At one checkpoint I was told my
temperature was 32</span><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">°</span><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> Celsius (or 89.6</span><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">°</span><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> Fahrenheit).<span style="mso-spacerun: yes;">
</span>I’m not sure, but I think I would be pretty ill if that were the case,
but the man checking believed that I didn’t have a fever and that was enough to
pass.<span style="mso-spacerun: yes;"> </span></span></span></span></span></h3>
<h3>
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; font-weight: normal; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><span style="mso-spacerun: yes;"> </span></span></span></span></span></h3>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">So, <span style="color: blue;">if the
thermometers often didn’t work, why were they so omnipresent?</span><span style="mso-spacerun: yes;"> </span>I believe it is because they gave people a
sense of efficacy, at least <i style="mso-bidi-font-style: normal;">something</i>
they could control.<span style="mso-spacerun: yes;"> </span>Indeed, as we work
through our data and our findings, I think one of our main conclusions will be
that many of the actions taken (everyone washing hands, banning public
gatherings, closing shops at 6PM, etc.) were not in line with the actual risks
of transmission, and made people feel themselves to be under constant threat
with no real recourse.<span style="mso-spacerun: yes;"> </span>This is why the
theatre of the checkpoints was likely more important than any actual public
health benefit.<span style="mso-spacerun: yes;"> </span></span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Before this
outbreak I had never seen a laser thermometer in Sierra Leone.<span style="mso-spacerun: yes;"> </span>We heard that at first the thermometers were
feared, that people suspected they might be a kind of Ebola gun (after all,
they had never seen the machines before Ebola came around).<span style="mso-spacerun: yes;"> </span>Over time, they became accepted and even in
demand. During our interviews we asked some questions about Ebola testing, and
interestingly a few people seemed to believe that the thermometer itself was a
kind of Ebola test and not just a thermometer.<span style="mso-spacerun: yes;">
</span>One respondent told us that the “guns” had the power to look right
inside your body to see if the Ebola was in there.<span style="mso-spacerun: yes;"> </span></span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Calibri; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Near the end
of our stay, we were fortunate to shadow a tracing team and see them in action
as they monitored quarantined houses. We discovered that although there is a
spot on the tracing form for recording everyone’s temperature every day for 21
days, the contact tracers weren’t supplied with thermometers.<span style="mso-spacerun: yes;"> </span>Nina and I got checked going into any fancy
ex-pat place for the duration of our stay, but the actual contact tracers who
were following up with people who may have actually been exposed to Ebola did
not have thermometers. <span style="mso-spacerun: yes;"> </span>What a crazy
misallocation of resources!</span></span></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTxEoZu0CFz9BRlcZnOIxVXQANRFgSc7UJEa9xco7XrzqsQX50LqYPR3dRvxEfbcASGHGw3Px3DXMnlL5ZUwtO2bCtcPy1xx6h7alQF-9vTEiD-nqmkTzqiPRzchJ9n172wZBgTu6RxiY/s1600/B_Lv-kpVEAAbdbp.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTxEoZu0CFz9BRlcZnOIxVXQANRFgSc7UJEa9xco7XrzqsQX50LqYPR3dRvxEfbcASGHGw3Px3DXMnlL5ZUwtO2bCtcPy1xx6h7alQF-9vTEiD-nqmkTzqiPRzchJ9n172wZBgTu6RxiY/s1600/B_Lv-kpVEAAbdbp.jpg" height="213" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">returning to school</td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
</div>
Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-90548671702707862015-01-11T05:31:00.001-08:002015-01-11T05:33:56.416-08:00People are fighting in this war<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: blue;"><b>People in Sierra Leone are not only fighting this invisible, deadly virus, </b><span style="color: black;">they are fighting against huge amounts of poverty</span></span> (the country is among the bottom countries on the Human Development Index) and a grossly inadequate social welfare system. Sometimes they are fighting with no supplies, like the cases we heard of a maternity nurse who was performing deliveries without gloves and the driver who couldn't access chlorine to clean her ambulance of the remains of human suffering. It angers me to hear of these situations, which should not happen in an epidemic of this proportion, but it's hard to know who's to blame. To Susan and me it really seems like everyone, from the Ministry of Health to the CDC, to the international and local NGOs, are working hard and trying their best. The most heartening stories for me to witness were those about ordinary about Sierra Leoneans fighting for each other. As we prepare to fly home from this beautiful, heartbroken country, <span style="color: blue;"><b>these are the hopeful stories that I want to tell</b></span>. <br />
<br />
<b><span style="color: blue;">My favorite prevention story</span></b> was told to us by staff at <a href="https://www.facebook.com/pages/Centre-for-Coordination-of-Youth-Activities-CCYA/204117279742429">CCYA</a>, a local NGO that focuses on young people's development and leadership. Their staff were involved in a case where a family wanted to dignify their dead father with a burial in his hometown. To get through the checkpoints, the family sat the dead father in their car and dressed him like a passenger. They then headed to their father's hometown and asked their relatives their to receive them. The relatives initially said yes, they would receive them, as is customary. While the corpse was making its way to the hometown, community members intervened with the relatives, pleading with them not to accept the corpse and the people in the car who were exposed to Ebola (Ebola corpses are very contagious). Many community members, including CCYA's leaders, spent time convincing the father in the household not to accept the corpse. He eventually conceded and refused the visiting family. Several people in the car with the corpse later died. This story speaks to me about the power of community-based networks to intervene, persist and ultimately prevent transmission. <br />
<br />
We also witnessed first hand how Sierra Leoneans are working hard on <span style="color: blue;"><b>surveillance and quarantine</b></span>. We tagged along with a district surveillance officer, Musa (a medical student), and a contact tracing team in Freetown. Musa was assigned to the area where he lives so he knows the streets well. He had the lab reports from the command center and it was his job to go out and follow up on the positive cases. We visited two households that he had recently quarantined due to a woman who had recently tested positive and was now in a treatment unit. There was a rope around the two quarantined households and the people were out in their yards. Musa and his team spoke to them on the other side of the rope. The families were quite agitated and upset about their conditions. Food and supplies had not been delivered to them. There was also a man there who had traveled to the area from up-country and resented the fact that he had to be quarantined. Musa and his team spent at least half an hour convincing the people to stay under quarantine and asking them to be patient for the supplies (as I mentioned earlier, coordination of supply delivery is a problem). They also told the husband where his wife was taken for treatment. It was impressive to see Musa and his team -- how much they had learned about the dynamics of the epidemic, how committed they were to doing their jobs and connecting people to resources, and how they seemed to care about the people they visited. <br />
<br />
<b><span style="color: blue;">The effects of this epidemic on children are the hardest for me to see</span></b>. We saw one very poor, quarantined household where a mother lost her infant to Ebola. There were about 12 children, most of them toddlers and babies who were all climbing on top of each other, and they had about 3 meters space to play. The mother's look of trauma was one that I will not forget. And all the shell-shocked parents and children can't leave, they have to just sit there for 21 days while they watch their children and hope they will survive. Musa couldn't do much for them except check to see if anyone was feeling unwell. I felt badly that more couldn't be done. It's hard in this outbreak - you can't even reach out and comfort someone, you can just hand them something across a rope. <br />
<br />
But there was another<span style="color: blue;"><b> story about children that was somewhat positive</b></span>. We went with Musa to a quarantined household where three children, ages 8, 4 and 2, were sitting inside with the corpse of their dead father. Their mother had already died of Ebola. The burial teams had not come to pick up the father's body for over 24 hours and there was a rumor that the burial teams were on strike because they had not been paid. Community members were gathered outside the house and were very concerned, none of them wanted to touch the children because they feared they were contagious, but they were worried that the children would starve. With Musa and the CDC's help, a burial team finally arrived. Musa then called the child protection hotline to take the children to an orphan interim care center, but the person who answered said their vehicle was not working. After many phone calls and a visit to UNICEF by Susan, a vehicle was dispatched to get the children.<br />
<br />
<br />
Susan and I are glad that we came here. I have to admit that it was a hard time to be away from the U.S., with our own country's problems to work on and wanting to be a part of that. It was also scary to come to a place where we knew that we would be at risk. But it wasn't as scary as we imagined. We enjoyed listening and hearing ordinary people's stories, and learning more about the challenges in stopping this epidemic. <span style="color: blue;"><b>Susan even offered some suggestions </b></span>which I am proud of her for and I hope will be heard. She suggested that the radio, which everyone listens to, offer some programming specifically for children who are not in school (this was also done during the war). We have heard that people are now working on this. She also suggested that the child protection teams be better integrated with the surveillance teams, which seems very important to caring for orphans and also for mitigating the spread of the disease through children. <br />
<br />
I am very impressed with Mama Salone's people. I will be thinking of them and hoping hard that they win this fight soon. I hope to come back some day and enjoy some good times together.<br />
<span class="st"><i>Ah tell god tanki</i>,</span><br />
~Nina <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHHq9OYvETF_Gnhk8n1cbLoIoc2g1wLWXxop7jGz2UCrOR0VOu0ys94xqw5-NVhn9go5_2-yPQkZcdM7YKJ2GFoGoF-TV2MQdr-6Jg25bC2wDuOFqZ56rP9w8nP-zKooQTz_JEVpmHq0ch/s1600/us+with+the+health+promoters.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHHq9OYvETF_Gnhk8n1cbLoIoc2g1wLWXxop7jGz2UCrOR0VOu0ys94xqw5-NVhn9go5_2-yPQkZcdM7YKJ2GFoGoF-TV2MQdr-6Jg25bC2wDuOFqZ56rP9w8nP-zKooQTz_JEVpmHq0ch/s1600/us+with+the+health+promoters.jpg" height="178" width="320" /></a></div>
</div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-50602497210308460582015-01-09T03:58:00.003-08:002015-01-09T03:58:28.555-08:00Commodification of Survivors
<style>
<!--
/* Font Definitions */
@font-face
{font-family:Arial;
panose-1:2 11 6 4 2 2 2 2 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:"Courier New";
panose-1:2 7 3 9 2 2 5 2 4 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536859905 -1073711037 9 0 511 0;}
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;
mso-font-charset:2;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1107305727 0 0 415 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0in;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
mso-themecolor:hyperlink;
text-decoration:underline;
text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-noshow:yes;
mso-style-priority:99;
color:purple;
mso-themecolor:followedhyperlink;
text-decoration:underline;
text-underline:single;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-type:export-only;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
mso-add-space:auto;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:1613439743;
mso-list-type:hybrid;
mso-list-template-ids:-1205465580 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
@list l0:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;}
@list l0:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
@list l0:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;}
@list l0:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
@list l0:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:"Courier New";
mso-bidi-font-family:"Times New Roman";}
@list l0:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Wingdings;}
ol
{margin-bottom:0in;}
ul
{margin-bottom:0in;}
-->
</style>
<br />
<div class="MsoNormalCxSpFirst">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial; font-size: 10.0pt;"><br /></span></b></div>
<span style="font-family: Arial; font-size: 10.0pt;"></span><span style="font-family: Arial; font-size: 10.0pt;">Ebola
survivors have been through hell.<span style="mso-spacerun: yes;"> </span>Just
imagine the pain, the fear, staying in an Ebola Treatment Centre with people
dying all around you every day.<span style="mso-spacerun: yes;"> </span>But they
are the lucky ones.<span style="mso-spacerun: yes;"> </span>And as the number of
cases grows, the number of survivors also grows.<span style="mso-spacerun: yes;"> </span></span>
<div class="MsoNormalCxSpMiddle">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: Arial; font-size: 10.0pt;">They
are in great demand.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpLast">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">To make the case that it is possible
to survive, they are used in radio, television, <a href="http://restlessdevelopment.org/news/2014/12/09/ebola-champions-survivors">posters</a>,
even <a href="http://www.newsweek.com/ebola-survivors-share-stories-health-tips-new-app-297151">smart
phone apps</a>.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">Because they have antibodies to the
disease, there are stories that their <a href="http://www.washingtonpost.com/news/morning-mix/wp/2014/09/17/the-black-market-for-ebola-survivors-blood/">blood
is traded on the black market</a> and more reputable stories about the <a href="http://www.theguardian.com/world/2014/dec/31/scottish-nurse-ebola-survivors-blood">use
of plasma therapy</a>.<span style="mso-spacerun: yes;"> </span>So their stories
and their bodies are valuable.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">They have been called on to <a href="http://www.msf.org/article/sierra-leone-aminata-sankoh-critical-condition-caretaker">work
where others dare not</a>, most frequently <a href="http://america.aljazeera.com/articles/2015/1/5/caring-for-ebolaorphansinsierraleone.html">with
children whose parents have died from EVD in OICCs</a>.<span style="mso-spacerun: yes;"> </span>(Let’s hope these are short term jobs as the
crisis ends.)</span></div>
<div class="MsoNormalCxSpFirst">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: Arial; font-size: 10.0pt;">Nina
and I have been interviewing people on the streets about what they know about
Ebola, what they do to protect themselves, whose messages do they trust, and so
on.<span style="mso-spacerun: yes;"> </span>But many of our interview subjects
have not come close enough to the system to have much to say about it.<span style="mso-spacerun: yes;"> </span>So earlier this week we were thinking that it
might be nice to talk to some survivors, to hear about their experiences in
treatment and to get their recommendations for how to improve the system.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: Arial; font-size: 10.0pt;">A
colleague here shared the contact information of a survivor, and head of a
survivors group organizing in Freetown.<span style="mso-spacerun: yes;">
</span>I called to see if we could set up a time to talk, and hear more about
the group they were organizing.<span style="mso-spacerun: yes;"> </span>He
wasn’t sure, and complained that he’d already been called on to talk on the
national television station.<span style="mso-spacerun: yes;"> </span>He said
he’d have to get something out of it.<span style="mso-spacerun: yes;"> </span>I
asked how much and he said $100.<span style="mso-spacerun: yes;"> </span>In all
my years of interviewing people in Sierra Leone, this is the first time I’ve
been asked to pay for an interview.<span style="mso-spacerun: yes;"> </span>I
certainly don’t blame the man for trying to get paid.<span style="mso-spacerun: yes;"> </span>When I told the story to one of my Sierra
Leonean friends who works in the NGO world, she said he’s probably being
contacted by NGOs who are scrambling to put together proposals to work with
survivors and get some of the Ebola money that is reaching the international
NGOs now and probably soon to trickle down to the local NGOs.<span style="mso-spacerun: yes;"> </span>To me, it was just a very clear symbol of the
commodification of survivors. </span></div>
<div class="MsoNormalCxSpMiddle">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: Arial; font-size: 10.0pt;">One
last story.<span style="mso-spacerun: yes;"> </span>A former colleague of mine
lost six members of his wife’s family to Ebola over a week and a half period in
October. The wife told us her awful story. One of her brothers was sick, but
survived.<span style="mso-spacerun: yes;"> </span>Over a beer, I asked my former
colleague how his brother-in-law is doing now, or whether they ever talk about
what happened in the Ebola Treatment Centre.<span style="mso-spacerun: yes;">
</span>He said he doesn’t want to talk about it, people dying all around
him.<span style="mso-spacerun: yes;"> </span>So now my colleague says when they
come together they “play and laugh” and try to help him forget.<span style="mso-spacerun: yes;"> </span>It’s not easy.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: Arial; font-size: 10.0pt;">Honestly,
this is why I believe in ethnography as a method. When I was in Sierra Leone during
the war and working with former child soldiers I had the chance to take the
time to build relationships with people over time.<span style="mso-spacerun: yes;"> </span>I <i style="mso-bidi-font-style: normal;">never</i>
asked anyone “what happened to you during the war?”<span style="mso-spacerun: yes;"> </span>We talked about football, or America, or whatever.<span style="mso-spacerun: yes;"> </span>If they felt like opening up, I was ready to
listen, but to ask someone directly to talk about their trauma always seemed
unethical or even inhuman to me.<span style="mso-spacerun: yes;"> </span></span></div>
Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-5243032878277592012015-01-07T16:50:00.000-08:002015-01-08T08:05:01.836-08:00Community Organized Checkpoints<div dir="ltr" style="text-align: left;" trbidi="on">
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"MS 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0in;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
</style>
<br />
<!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Version>14.00</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">A banner hangs above the entrance to a
Freetown community. There is a small covered area with a few benches, a
bucket with water and soap to wash your hands, and a young man with a laser
pointer thermometer. He asks me to wash my hands, and I do so (for
probably the fifth time today.) He says my temperature is 31 degrees (or
87.8 degrees Fahrenheit), clearly not correct, but part of the standard theater.
</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">I ask if I can talk to them about the
checkpoint, and I am directed to a woman sitting on the nearest bench.
After the informed consent process, we begin. During the interview,
people are passing through the checkpoint, washing their hands and having their
temperatures taken.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: So, you said you all organized
this place?</span><br />
</div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: We have one brother who, you can
see his name up here (written on the banner), [name redacted]. So, he thought
it was a good idea to help the community. </span></div>
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>X-NONE</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="267">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman","serif";}
</style>
<![endif]--><br />
<div class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGnR_OpFcYwoymixz4yRc2NMZSn1MxSPfwoSgcrnW51VGEKl3TgR1n1F7ZFCiNtXIU1Q0v769uzRBFQxmbemq8NS2OZiBIZwAHH5axC4ZJEZDENxBjcVyvurE0e31wFeuRlWB2i2ipZ-0/s1600/2015-01-04+15.18.57.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGnR_OpFcYwoymixz4yRc2NMZSn1MxSPfwoSgcrnW51VGEKl3TgR1n1F7ZFCiNtXIU1Q0v769uzRBFQxmbemq8NS2OZiBIZwAHH5axC4ZJEZDENxBjcVyvurE0e31wFeuRlWB2i2ipZ-0/s1600/2015-01-04+15.18.57.jpg" height="240" width="320" /></a></div>
<br />
<!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Version>14.00</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: He lives here?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: He lives here. So, he said
let’s organize this Ebola center, where people can wash their hands, because we
don’t have anyone in this community who has been infected by Ebola. So
we’ll make the thing continue, and let it not infect anyone inside the
community. So we took the bold step to do this kind of thing. They
don’t pay us, but we just give our voluntary labor. So, we can be with
people, do things well, no problem. Around 10 to half past 10 at night
then we’re off. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: So, do you stop people? Say they
can’t come inside if you don’t know them? </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Yes, if there are people who
want to come in here, if you’re a stranger, if we don’t know you, we send you
away. We say not to come inside here to bring the sickness, because we
don’t know you. But if we know you, we don’t have any problem. We
accept you to come inside. But if we don’t know you, we will tell you to
turn around and go back. Until you have someone to come and say, “this is
my person.” So then we can give you space to come inside, but we’ll still
be watching. If anything happens concerning Ebola, we won’t go along with
it.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Have you all reported to any
authority in the city to say that you’re here? To say, “we’re blocking
here” or “we’re doing this”? Do you understand? Is there any
coordination with any other…. Police, or, I don’t know, Ebola response
effort? Or you just did it?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Yeah, we just did
it. Because we didn’t see anyone take the initiative to come do something
like this. We didn’t see the councilor, we didn’t see the Minister, we
didn’t see anybody. So this man here (gesturing towards the name on the
banner) he thought it was a good idea for him to do this thing. Because
we were looking for the councilor or the Minister to come to the community, but
we looked and didn’t see anyone, so we decided to do it for ourselves. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Well, that’s fine. Is
there ever any tension here at the checkpoint? Like, someone says they
don’t want to stop?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: (laughing) Yes, exactly what
you’re saying. Actually, we have one case right now. Look at the
car’s license plate number (points to writing on the brick wall behind
us). This is the number Ma’am. When we said to wash his hands, the driver
refused and said he wouldn’t get out of the car. We said, “why?” He
refused to explain, and caused a scene. He said, “When Ebola has come and
you’ve got money out of it, you want to eat the Ebola money. You think we
want to join you?” </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Did you ask him, “Which money
are we eating?” (laughing)</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: yeah, we asked him, “Which
money? Where’s the money that Ebola brought for us to eat? So if you know
that Ebola brought money for us, come join us!” That’s what we often tell
them. It’s not really easy for us here. Some people curse us, and
say, “leave me alone, I’m tired of washing my hands. All the time!
I’m tired of washing my hands! I’m cold.” You know? They have
some words they can bring, so we are just patient. After all, it’s
voluntary work, we don’t want a problem, so we say, “OK, continue. If you
were the only one to get sick, fine. But if you get sick, it will affect
everyone in your house. So we feel you should wash your hands.
Because if you have the sickness, and you make people inside your house get it,
then it’ll affect all of us.” So that’s why we say <i>pa-o-pa</i> (no matter
what), you should wash your hands. If you don’t wash your hands then turn
around and go back where you came from. If you’re coming inside this
community, you should wash your hands. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> Susan: So, you all don’t have
any more doubts that Ebola is real?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: (enthusiastically) No, Ebola is
real. Ebola is real because of the way they show us, it’s a sickness that
doesn’t have a cure. If it affects one person inside this house, then it
will affect everyone inside the house. So we know Ebola is real and it’s
here. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: And you’ve received all the
messages about how to prevent it?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Yes Ma’am. They say you
should wash your hands, don’t touch, avoid body contact – ABC. So we have
all those things. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Do you think everyone in your
community is following the rules?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Yeah, no problem. We’re
doing it. We’re not perfect, but we’re doing our best. Because some
people when you tell them to wash their hands they refuse, but later on when we
talk to him and encourage him, he turns around and does it. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Do you think everyone in Sierra
Leone has got the message?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Yeah, because the radio, the
television, you sleep and wake up and that’s all that’s on right now.
Ebola, Ebola. Ebola, Ebola. So that’s the song we have now:
Ebola, Ebola. Even a small child, if you ask him what’s here right now,
he’ll say “Ebola.” So they know it, they say, “Don’t touch me. Ebola.
Don’t shake my hand. Ebola.” So, we know, Ma’am.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: So why do you think people are
still getting Ebola, if everyone knows how to protect themselves?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Because people are stubborn (<i>tranga
yes</i>). Like how the Minister and the President say, it’s the educated
people who are the most stubborn. The ones who have learned the most book
are the most stubborn. The reason I say they’re stubborn, because if you
say, this thing here, don’t do it, they’ll say <i>pa-o-pa</i> (no matter what)
I want to do it. So the educated are stubborn. Because if you tell
them, this thing here, if you do it, it will affect you. He’ll say, well,
I want to take the risk. If this thing will be hard for me or won’t be
hard for me. So the educated are stubborn. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: So are they the ones who catch
it more often?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: The Ebola gets them, the
educated ones. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Interesting.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Another woman sitting nearby: This community
effort, we thank God for it. We really guard it, and that’s why we make
it strict here. We don’t have any problem. So, we thank God for
that. Let God continue to do it for us more and more. That’s why we
don’t joke with anybody who passes here. What we say they should do, they
do it. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: So is it mainly the women who organized
this thing?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: The men too. It was the
man who volunteered, [name redacted]. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Yeah, I see his name
there. So, he paid to make the sign, and ….</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: He did everything for us.
He made T-shirts for us. What we eat here, he provided it for us. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> Susan: So, what do you think
about the government’s response to the Ebola crisis?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Well, they’ve responded.
No problem, because he is trying. All the best, he is trying. He’s
going all out to see that this illness is finished. He’s going all out,
he’s praying to make the sickness finish. Because everything we wanted to
do inside 2014, we weren’t able to complete it. So he is praying, and we
really see that he’s stressing this illness. Because it’s not his own
will that this sickness should be here at this time. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: You mean, Pa Ernest? (the
president)</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Yeah, Pa Ernest
(laughing). </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: What about the international
community? (“the whites”)</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: They are also helping us.
They are also trying to make the illness be done. We’re happy for
them. We’re happy for the ones who’ve come to help us. We
appreciate them. They didn’t just leave us here, they came to help
us. So, we’re happy for them, the white people who’ve come, to come help
us and see that this sickness is done. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: So, if you see a person here
with some of the symptoms, maybe he has fever, maybe he’s begun to vomit, what
would you do?</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: Well, we would call 117, for
them to come collect him and take him away. But thank God, we haven’t
seen anybody like that. We haven’t seen anybody who is shivering, and
then vomiting, then you see some symptoms around. Thank God for
that. We haven’t observed it yet. Because if we observe it, we
won’t wait until it’s worse. As it begins, we’ll call 117. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: You wouldn’t be afraid the
person would say, “oh man, why are you reporting me?”</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: No, I wouldn’t be afraid.
Because I know it’s a family issue (it affects us all). If I say I’ll
wait to report until it’s worse, then I will be a victim. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Well, that’s all my
questions. I don’t know if you have any questions you want to ask me, or
anything else you’d like to say that I didn’t ask you about. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: No, I don’t have any questions.
I just appreciate you, that you came and interviewed me. I’m happy about
that, because we were hoping we’d have someone come interview us and ask about
the community, how we were able to get this help in our community. I’m
really happy that you came to interview me. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Susan: Do you mind if I take your
picture? </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Woman: I don’t mind at all! </span></div>
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>X-NONE</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="267">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman","serif";}
</style>
<![endif]--><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><br />
<div class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in;">
<br /></div>
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWG4rumHxJdKQoPEOFqT981I6-UV1FKWkrPF5nlkcYwOUYqVV6NoVLSM4jePR_YnwKgxVy0GUl9yLVMwoS9BmbKz_Xk9x_kfB3lzRXm8MnULoXUEc8kM8chSwuen7eyu3otdW6cx-PmkA/s1600/2015-01-04+15.30.08.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWG4rumHxJdKQoPEOFqT981I6-UV1FKWkrPF5nlkcYwOUYqVV6NoVLSM4jePR_YnwKgxVy0GUl9yLVMwoS9BmbKz_Xk9x_kfB3lzRXm8MnULoXUEc8kM8chSwuen7eyu3otdW6cx-PmkA/s1600/2015-01-04+15.30.08.jpg" height="240" width="320" /></a></div>
<div class="MsoNormal">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">
</span></span></div>
Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com1tag:blogger.com,1999:blog-1874818527363776028.post-30009620107838860232015-01-06T14:53:00.000-08:002015-01-14T12:59:05.224-08:00The MSF Community-Based Model of Treatment<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div style="text-align: left;">
I have always admired the humanitarian organization Médecins Sans Frontières, or Doctors Without Borders (<cite class="_Rm"><a href="http://www.msf.org/">www.<b>msf</b>.org</a>)</cite>, without knowing the details about what they do on the ground. We had the privilege of touring an <span style="color: blue;"><b>MSF treatment center</b></span> being constructed at a school in Kissy, Freetown (there were no patients there yet). Since school is closed right now, they are using the school grounds for the center. Fernanda Falero with MSF Spain gave us the tour. Fernanda is a humanitarian anthropologist with a specialty in Ebola. MSF has been responding to VHF outbreaks since 1995, and Fernanda started in 2006. As an anthropologist she does her best to make the treatment processes transparent and participatory. Her initiatives, she hopes, help to clear up misconceptions about Ebola, make treatment more accessible and acceptable, and involve community members in prevention (see below).</div>
<br />
We have not visited other centers, so we are not sure if these efforts are unique to MSF. Sierra Leone has treatment centers around the country that are being run by different groups, including the Sierra Leonean government, Partners in Health, Save the Children, the British Military, and the Chinese, Canadians, Nigerians, and Italians. Each one of these groups comes with their own protocols, logistics, data and staff. There is even a debate among some of them about whether to provide IV therapy to Ebola patients (<a href="http://www.nytimes.com/2015/01/02/health/ebola-doctors-are-divided-on-iv-therapy-in-africa.html?_r=0">http://www.nytimes.com/2015/01/02/health/ebola-doctors-are-divided-on-iv-therapy-in-africa.html?_r=0</a>). From a patient and community perspective, interaction with the centers likely varies depending on which group built a center close to them. I bet that not all centers employ the kinds of community outreach that Fernanda and her team do. Also, it's no surprise, given all these NGOs, that people here perceive that internationals are profiting from this epidemic (more later). <br />
<br />
From what we learned today, MSF seems to have a thoughtful model that reaches beyond medical treatment and into the community. And the fact that MSF hired Fernanda, an anthropologist, to work with their team may be unique and useful. It would be great to someday see the MSF model formally evaluated. Here are a few of the ways in which Fernanda and her team intend to employ transparency and community participation in their work:<br />
<br />
1. The treatment center is <b><span style="color: blue;">open to the community</span></b> as much as it can be. On the perimeter, the center is surrounded with open chain-link fencing so that community members can see inside. This is in contrast to some centers that put up opaque walls on the perimeter. Community members are invited to visit the center. Family members are invited to visit patients, and if the patient is very sick, one person from the family can wear PPE and go inside to visit the patient. MSF is also producing a video that shows the entire process of detection to treatment to survival that they will show to the surrounding community. <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUAebDTZpVLKxF6g-S1G2XjiywQ0ehTZYjR5ahuSdX_Iw6YRw4f3URKWF11K21Ef9m1lYH2bOo0hhVTgaNGKEy0R1FomtQH-O6yeITUEZaf8xKUDeUBkbZmhV1TklVjlXc-KBXe-D4tNqB/s1600/IMG_5757.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUAebDTZpVLKxF6g-S1G2XjiywQ0ehTZYjR5ahuSdX_Iw6YRw4f3URKWF11K21Ef9m1lYH2bOo0hhVTgaNGKEy0R1FomtQH-O6yeITUEZaf8xKUDeUBkbZmhV1TklVjlXc-KBXe-D4tNqB/s1600/IMG_5757.JPG" height="240" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
2. <span style="color: blue;"><b>150 community members, both skilled and unskilled workers, are being paid to construct the center.</b></span> Fernanda believes that this increases buy-in of the community for the center. We met the Member of Parliament whose constituency is in this community. He said that as a politician people always ask him "What have you done for this community?" and now he can say he has done something, which makes him proud. He also said that this center brings resources to the school, which will be good for the school once it reopens.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1WkdCmEbVEBynCwj1LVrWcr1wBiNrTtedjQ8cfPzndJlAG1ya9HjczXKgB2exDcrhsGx5DWwGRQyDSlwN2Ii_ywFawsi3z456u-jbMNNA0KajCd0Tsy1Zia-kA4xSe9wslnScaO9HlDPU/s1600/IMG_5749.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1WkdCmEbVEBynCwj1LVrWcr1wBiNrTtedjQ8cfPzndJlAG1ya9HjczXKgB2exDcrhsGx5DWwGRQyDSlwN2Ii_ywFawsi3z456u-jbMNNA0KajCd0Tsy1Zia-kA4xSe9wslnScaO9HlDPU/s1600/IMG_5749.JPG" height="240" width="320" /></a></div>
<!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Version>14.00</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]--><br />
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>X-NONE</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="267">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman","serif";}
</style>
<![endif]-->
<br />
<div class="MsoNormal">
<div style="text-align: left;">
</div>
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Version>14.00</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]--></div>
<div class="separator" style="clear: both; text-align: center;">
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>X-NONE</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="267">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman","serif";}
</style>
<![endif]-->
</div>
<div style="margin: 0in 0in 0.0001pt; text-align: left;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">3. <b><span style="color: blue;">The family will be
allowed to visit their sick loved ones in the treatment unit</span></b>. Family
members can wear PPE and visit their sick loved ones. This is important because
people have not wanted to send their loved ones to treatment centers because of
fear that their loved ones will be mistreated or will never return. The
patients who are well enough to walk can meet their family members outside the
sick (red zone) tent. Patients and their family members are instructed to sit
two meters apart during the visit. Below is Fernanda with the poles indicating
the two meters distance. Family members can bring anything to a patient
(food, etc.), knowing that whatever goes into the treatment center will not
come out. MSF also provides confirmed patients with phones so that they can
communicate with their loved ones while they are in the treatment center.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjKhF3sv5bZTVd1LCRplk8dq3iMZ3U6FBs5PEDqMdrPUAH3fRUckMDqiTl_24Y_dD-Z3rcy_Rq0foHHHaW4i2jhaoCJGxywq38M3fPZ53YfmtxSpPZfKhznMTLs7zgy5AQyhB8ql_IbBuq/s1600/Fernanda+showing+where+the+family+members+can+stand.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjKhF3sv5bZTVd1LCRplk8dq3iMZ3U6FBs5PEDqMdrPUAH3fRUckMDqiTl_24Y_dD-Z3rcy_Rq0foHHHaW4i2jhaoCJGxywq38M3fPZ53YfmtxSpPZfKhznMTLs7zgy5AQyhB8ql_IbBuq/s1600/Fernanda+showing+where+the+family+members+can+stand.JPG" height="240" width="320" /></a></div>
<div style="margin: 0in 0in 0.0001pt; text-align: left;">
<br /></div>
<div style="margin: 0in 0in 0.0001pt; text-align: left;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Version>14.00</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]--></span></div>
<br />
<div style="margin: 0in 0in 0.0001pt; text-align: left;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>X-NONE</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="267">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:"Times New Roman","serif";}
</style>
<![endif]-->
</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">4. <b><span style="color: blue;">Once a patient
dies, MSF will consult the family on what to do with the dead body. It is
critical for the family to believe that their loved one has received a
dignified burial</span></b>. Fernanda explained: "When the body is
prepared for burial, the family is allowed to come in and have a moment with
their loved one...the best way to do this is to sit down with the people and
talk. You explain the protocols and why the body cannot be manipulated because
of the transmission of infection. Then we ask them 'Do you have any
alternative [ritual other than touching the body] that your heart and your soul
will feel fine with?' Because it’s a special moment. I did burials in other
outbreaks and it worked fine. It’s just you need to take that time to
listen.... And then when it comes from them, then it’s fine because they accept
it." </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">It seems so logical when Fernanda says it,
and it seems like this process would help allay people's fears in Sierra Leone
that dead loved ones won't make it to the afterlife. We wish this consultation
with family members would be the usual procedure. We have heard stories of a
corpse either left on the ground for hours or days until the ambulance picks it
up or the family buries the corpse themselves, which puts them at
tremendous risk of infection. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5. <b><span style="color: blue;">MSF hired
health promoters from the community and is training them to talk to their community
members about prevention</span></b>. Below are some health promoters who were
just being trained. This woman is a teacher who has not been working
because school has been closed due to Ebola. She was not afraid, but rather
excited to have a job and talk to people about prevention. As Fernanda
said: "[The prevention work is] what needs to be done at the level of the
community. We have to close the tap. We don’t want more transmission, we don’t
want more cases. But.. we cannot reach that tap from here (the treatment
center). <b>We need to empower people to be part of the solution to their own
problems</b>." We have heard that health promoters have made a difference in
reversing the tide of this outbreak and hope to see them in action soon. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xBlbqzB82gxTMXgekDcGtmdcIF9choFqoIN-LqrIoGDHEqLhG4huttlD4ILHvgVk4qgM1jqpY_O3Ku-ovwUg0KDqIQ1EFGGcisNkrCeLqxy3nxd9K8tLAOtOZLPjJ5W34Hgf6sX9cs_e/s1600/Health+promoter.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xBlbqzB82gxTMXgekDcGtmdcIF9choFqoIN-LqrIoGDHEqLhG4huttlD4ILHvgVk4qgM1jqpY_O3Ku-ovwUg0KDqIQ1EFGGcisNkrCeLqxy3nxd9K8tLAOtOZLPjJ5W34Hgf6sX9cs_e/s1600/Health+promoter.JPG" height="320" width="240" /></a></div>
<br />
<div class="MsoNormal">
<span style="mso-spacerun: yes;"></span></div>
</div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com2tag:blogger.com,1999:blog-1874818527363776028.post-28502058963154823032015-01-05T07:49:00.000-08:002015-01-05T10:14:00.896-08:00Some Ebola posters<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioigMNJPyHc6q3A312iTo6f0XV4qJ6MBkN8iFwifxNoUfqga7da57KJo_VPcrMmndvkY2AejP1dfG_CLeId7xS5IaPRb6_IpPVJLXOnjKQY9DtMfLTWhhFloIDy31Mw11VWt4wdEvlCus/s1600/2015-01-05+10.11.31.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioigMNJPyHc6q3A312iTo6f0XV4qJ6MBkN8iFwifxNoUfqga7da57KJo_VPcrMmndvkY2AejP1dfG_CLeId7xS5IaPRb6_IpPVJLXOnjKQY9DtMfLTWhhFloIDy31Mw11VWt4wdEvlCus/s1600/2015-01-05+10.11.31.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This poster is the most graphic one I've seen. You can really see the diarrhea!</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg1z_O3w5fLVURNyBxQJjip6KpJKVoHj_xK83FAGM785VIkZbDbMkBivBzzXpG1UoPtUiferRmtvGlricCs8ZH2O9v-A8NNYab9ENEzDOeRB0h-yhmQ2OvHlLdcDTsIKbIKm8MZiPPOjg/s1600/2015-01-05+11.52.53.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg1z_O3w5fLVURNyBxQJjip6KpJKVoHj_xK83FAGM785VIkZbDbMkBivBzzXpG1UoPtUiferRmtvGlricCs8ZH2O9v-A8NNYab9ENEzDOeRB0h-yhmQ2OvHlLdcDTsIKbIKm8MZiPPOjg/s1600/2015-01-05+11.52.53.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This one is just about safe burial.</td></tr>
</tbody></table>
<br /></div>
Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-66993573868825992992015-01-04T16:20:00.005-08:002015-01-06T11:12:07.390-08:00Ebola is a Disease of Love<div dir="ltr" style="text-align: left;" trbidi="on">
A friend heard someone say that <span style="color: blue;"><b>Ebola is a disease of love</b></span>.
People know that they
are putting themselves at risk when they care for a sick child or loved
one. But who wouldn't do it? It is human nature to help someone who is
sick.<br />
<br />
I
think it must be especially difficult to know what to do when a <span style="color: blue;"><b>young child</b></span> is sick. Young children require care and may not be able to communicate when they feel ill. Sierra Leone has the highest child mortality rate in the world at 182 <span class="_Tgc">children who die by the age of five per thousand live births per year</span> (<a href="http://www.unicef.org/infobycountry/sierraleone_statistics.html">http://www.unicef.org/infobycountry/sierraleone_statistics.html</a>, 2012). Approximately 12% of deaths of children under 5 in
Sierra Leone are caused by diarrhea ( <cite class="_Rm"><a href="http://www.path.org/publications/.../VAD_rotavirus_sierra_leone_fs.pdf">www.path.org/publications/.../VAD_rotavirus_<b>sierra</b>_<b>leone</b>_fs.pdf</a>) </cite>and about 38% of the death<cite>s are due to </cite>malaria (<a href="http://www.aho.afro.who.int/profiles_information/index.php/Sierra_Leone:Analytical_summary_-_Malaria">http://www.aho.afro.who.int/profiles_information/index.php/Sierra_Leone:Analytical_summary_-_Malaria</a>). Even
if a child doesn't die from diarrhea or malaria, she or he is likely to have one of these diseases at some point. So a mother may think that a young child's
diarrhea is from ingesting unclean water or a child's fever is from malaria, not Ebola . She may not want to call 117 because
she fears that her child will be taken away from her, away to a holding
center to await a lab test, where her child might get Ebola from others, or be taken to a
treatment center and she might never see her child again. Right now
there are few health services for people experiencing problems other
than Ebola. So, the mother might wait, or consult a community nurse or a
traditional healer, in the hopes that her child is not infected with
Ebola.. the mother then may become ill herself. The people we met with today say they want to do more to prevent infections among nurses and traditional healers in communities.<br />
<br />
Another
point about love - many people in Sierra Leone feel that if they don't wash the corpses
of their loved
ones, their ancestors will not pass to the afterlife. This is a real
and powerful belief that is not so easily changed. The woman who lost 6
family members said that she was not allowed to wash her mother's corpse. She said that one of her friends had a
dream that her mother was unhappy because she was unclean. This dream
haunts the daughter and adds to her grief.<br />
<br />
<span style="color: blue;"><b>Washing dead bodies and attending funerals frustrates responders to this outbreak because it is where they suspect that a lot of transmission happens</b></span>. Corpses are very infectious so people are warned not to touch them or be near them. Many people have stopped attending funerals now or are watching them from a distance, which is great because touching or kissing the corpse is also a tradition. Among people we talked to who had Ebola deaths in their networks, all of them reported going to the funeral but watching from a safe distance. But not washing the body is like a Christian condemning someone to hell (see Les Roberts' blog: <a href="http://pfmhcolumbia.wordpress.com/2014/11/28/les-roberts-day-53-what-r0-is-not/">http://pfmhcolumbia.wordpress.com/2014/11/28/les-roberts-day-53-what-r0-is-not/</a>). People persist in this behavior, even though Imams and Pastors have warned them against it. <br />
<br />
Speaking of pastors, we saw a lot of people gathering together at church today. It was nice to see so many people out, like normal, in their fine Sunday dress.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnkiX0-1XolpVaLFldrTPuCpGPVW1G7imsgpTcOzMV_MXGDUOxivLTABhucYlQy_FgrimoQxopg8TF7JUOmTzpwVxmZCFSa-wRwfwyxj11aen4PPyf2VAdvzTRxCOP8-V8bVWLP28hDdJf/s1600/IMG_5724.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnkiX0-1XolpVaLFldrTPuCpGPVW1G7imsgpTcOzMV_MXGDUOxivLTABhucYlQy_FgrimoQxopg8TF7JUOmTzpwVxmZCFSa-wRwfwyxj11aen4PPyf2VAdvzTRxCOP8-V8bVWLP28hDdJf/s1600/IMG_5724.JPG" height="260" width="320" /></a></div>
<br />
<span style="color: blue;"><b>So how can we get people not to wash dead bodies? </b></span>This is not an easy
question to study.. we know that people are washing and burying corpses
in secret when they know they shouldn't. People may not own up to it or they may just tell us what we want to hear. I think
there must be some way to acknowledge that people need to be able to wash their loved ones' corpses, while reducing Ebola transmission.
As I mentioned in an earlier blog, one of the innovations is allowing
people of the Muslim faith to bury white clothes with their dead loved ones. But, still, maybe we need
more of this... to somehow acknowledge the need to ensure ancestors'
transition to the afterlife while reducing Ebola transmission. In HIV
there is what is called a harm reduction approach to transmission among
injecting drug users - we don't try to change their drug using behavior,
but we give them clean needles to inject so that they don't get HIV.
Would it be acceptable for one person to wash a dead body while wearing
PPE (personal protective equipment)? What about assigning an elder or an
immune Ebola survivor to clean the body? I'm not sure.<br />
<br />
<span style="color: blue;"><b>How do we prevent the spread of a disease of love?</b></span> We definitely need to start by respecting people's feelings about their loved ones and
their beliefs. This is happening in many ways - we saw good evidence
of this at MSF today (more on that later). Today Susan said that instead
of messages that say "Don't do this!", how about we say "This is the problem. What
can we do together?". There are lots of things people are doing
together in this fight.. we need to keep going.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJNsIfUhPVLWaRq0chWCsId4i46V7Zz8VuAZ3nVmzPWUGcYsZzmQrSvq9N-0gJ0xyNNRZ6eiJv9Hza3DW_yea5sL2VeojwnPpXFaaosrzoXdWQhD89Q279LXsP36E5mHB2FNT_wQm8vSgH/s1600/Kick+Ebola+out.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJNsIfUhPVLWaRq0chWCsId4i46V7Zz8VuAZ3nVmzPWUGcYsZzmQrSvq9N-0gJ0xyNNRZ6eiJv9Hza3DW_yea5sL2VeojwnPpXFaaosrzoXdWQhD89Q279LXsP36E5mHB2FNT_wQm8vSgH/s1600/Kick+Ebola+out.JPG" height="320" width="240" /></a></div>
</div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-5732739428643541242015-01-04T16:01:00.003-08:002015-01-06T07:16:14.443-08:00Tracking Suspected Ebola Cases<div dir="ltr" style="text-align: left;" trbidi="on">
One of the problems in this epidemic so far has been the lack of good surveillance data that can identify Ebola cases and potential transmission events. Epidemiologists might say that if we had good data, it would be easier to dispense teams of prevention workers to hot spots and stop Ebola transmission. To understand the challenges of collecting good surveillance data in this environment, you have to understand how cases are tracked through the system. This process has become clearer (but probably imperfectly clear) to me while we have been here in Freetown. The procedures that are being used here are the same ones used everywhere when outbreaks occur, and these procedures can work really well, as we saw they did in Nigeria. However, the lack of coordination, a strong government and health system has created obstacles to the procedures working as they should. <br />
<br />
If someone suspects a case of Ebola in their community or is a suspected case themselves, they are advised to call the <span style="color: blue;"><b>national hotline</b></span> (117) in Freetown. I've read that only about
three percent of these calls trigger a household visit for a suspected case of Ebola. Once a household visit is triggered, <span style="color: blue;"><b>a
surveillance team</b></span> goes to the house in an ambulance wearing full PPE (personal protective equipment), which I imagine is a bit scary. At the house, the surveillance team then evaluates whether the person meets the case definition for
Ebola (<a href="http://www.cdc.gov/vhf/ebola/hcp/case-definition.html">http://www.cdc.gov/vhf/ebola/hcp/case-definition.html</a>):<br />
<ol style="text-align: left;">
<li>Fever or symptoms,
including severe headache, fatigue, muscle pain, vomiting, diarrhea,
abdominal pain, or unexplained hemorrhage; and </li>
<li><b></b>An
epidemiologic risk factor within the 21 days before the onset of
symptoms, including but not limited to exposure to: contact with body fluids of someone
with Ebola, a dead body from Ebola, or a person who had symptomatic
Ebola. </li>
</ol>
If the person meets the case definition, the surveillance team washes the area with chlorine and then takes the person to a <span style="color: blue;"><b><span style="background-color: white;">holding center </span></b></span>where they await the results of
a laboratory test for Ebola and malaria. Today we heard from MSF that
<b><span style="color: blue;">48 hours</span></b> is the fastest they can get an Ebola test result back from their laboratory (and this is probably the fastest in the country). So for two days the person who possibly has Ebola is sitting in the holding center waiting
for the lab result with all other cases that could possibly be Ebola. If there are good and rapid lab services, people who only have malaria
get identified and out quickly, reducing the chances they get Ebola. However, if the lab services are not good, or if the person's malaria test was negative, the person waits longer, increasing possible exposure to Ebola at the holding
center. If the Ebola test comes back negative, the person
is sent back home. However, it is possible that the person had Ebola all along
but needed a couple more days before the test turned positive
(remember there is a lag time between getting the virus and having a positive Ebola test because you have to be symptomatic). It is also possible that the person contracted
Ebola while at the holding center. So, really, they will need to test again. Then anyone who returns home from a holding center is supposed to be monitored daily and
quarantined for 21 days. <br />
<br />
Once a person has been confirmed
positive with an Ebola laboratory test, that person provides a <span style="color: blue;"><b>list of all people they have had physical contact with in the past 3 weeks</b></span><span style="background-color: white;">
(physical contact includes </span>sharing the same room/bed, caring for a
patient, touching body fluids, or closely participating in a burial <a href="http://www.ebolaalert.org/SOPct.pdf" target="_blank"><cite>www.<b>ebola</b>alert.org/SOPct.pdf</cite></a>).
There is a team of contact tracers (in Sierra Leone many are volunteer medical students)
who elicit and then trace the infected person's contacts. All of these contacts are then
monitored daily for 21 days for fever and symptoms. In addition, the
contacts are quarantined for 21 days and given food, buckets, gloves and
bleach. There have been some concerns mentioned to us that quarantined households have not been given enough supplies or food. During the daily visits, the quarantined contacts are asked if there are others in
their households have become sick. If anyone falls ill while under quarantine, they are
taken to a holding center for the Ebola test.<br />
<br />
<div>
</div>
A person with a positive
Ebola test goes from a holding center to a <span style="color: blue;"><b>treatment unit</b></span>, if there are beds available. In the beginning of this epidemic, even people who had a
positive Ebola test could not get a treatment bed because there were so few in the country. People would stay at home and infect their household members. Fewer people were reporting suspected
cases to the hotline because they knew there would be no treatment
beds for them. Now there are a lot more treatment centers in Sierra Leone, which
leads to improved surveillance and contact tracing. But no one knows
the effect that those early days had on the response. Some people fear
that people don't trust the hotline anymore. The other problem is that treatment centers
are still not everywhere in the country. A sick person might have to
travel many hours to then wait for a laboratory test or a treatment bed.<br />
<br />
<span style="color: blue;"><b>Who is providing all of these services?</b></span> The government of Sierra Leone is taking all
the help it can get. This means that in the contact tracers might be
hired by the WHO, but the holding center is run by MSF or another organization. The burial
teams are being largely run by the Red Cross. There is no one entity coordinating all these agencies, and therefore there is no one entity tracking identified or suspected cases. Which brings me back to my point about surveillance.. without coordination it's nearly impossible to track people through the system, creating a huge barrier to precise data collection and monitoring.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKDpijui8rEgpPa1_C7gV-NFmRyHDHbEhhxGTQX4NSsYOxFZRJgFmZz0T7wdFmYWbfxnYjbDgQA_MrdnbghY7pH22NZX8kUwyLNqV9gu2DBg_yT1gwwfygIApwuq70uvJw5gYnrHLBD0Hc/s1600/IMG_5697.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKDpijui8rEgpPa1_C7gV-NFmRyHDHbEhhxGTQX4NSsYOxFZRJgFmZz0T7wdFmYWbfxnYjbDgQA_MrdnbghY7pH22NZX8kUwyLNqV9gu2DBg_yT1gwwfygIApwuq70uvJw5gYnrHLBD0Hc/s1600/IMG_5697.JPG" height="240" width="320" /></a></div>
</div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-79849447812531519042015-01-04T06:39:00.002-08:002015-01-04T07:19:26.720-08:00Working at the Car Wash<div dir="ltr" style="text-align: left;" trbidi="on">
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1791491579 18 0 131231 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1107305727 0 0 415 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0in;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
</style>
<br />
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">There have been some unanticipated challenges to the
fieldwork as planned.<span style="mso-spacerun: yes;"> </span>(Aren’t there
always?). <span style="mso-spacerun: yes;"> </span>Our plan was to meet with
people working in the response for various agencies, but also to do a number of
open-ended interviews with regular people about whether they’d received the
Ebola messages, whose messages they trust, and what behaviors they’d changed. <span style="mso-spacerun: yes;"> </span>As a fluent Krio speaker, in the past I have
found it pretty easy to strike up conversations with people on the street.<span style="mso-spacerun: yes;"> </span>We start with an explanation of why I speak
Krio so well, I then ask whether they have time for me to ask them a few quick
questions, and 95% of the time people are more than happy to talk to me quite
openly and enthusiastically.
</span></span><br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">What we didn’t anticipate was that the city would be on lock
down for so much of our time here.<span style="mso-spacerun: yes;"> </span>Most
days, all shops lock at 6.<span style="mso-spacerun: yes;"> </span>Yesterday, Saturday,
all shops locked at noon.<span style="mso-spacerun: yes;"> </span>(Thank
goodness a friend invited us over to her house for lunch when we realized there
were no restaurants open.)<span style="mso-spacerun: yes;"> </span>This has
meant that my usual hunting grounds for interview subjects have been sparsely
populated.<span style="mso-spacerun: yes;"> </span>Even the usually raucous Kroo
Town Road market was deserted when we went by yesterday.<span style="mso-spacerun: yes;"> </span>Our driver David agreed with me that he
couldn’t remember ever seeing it like that.<span style="mso-spacerun: yes;">
</span>But then we hit on an idea:<span style="mso-spacerun: yes;"> </span>what
about the youths who wash cars, they are <i style="mso-bidi-font-style: normal;">always</i> there.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">I came down from the vehicle and started chatting with the
young men.<span style="mso-spacerun: yes;"> </span>They were surprised I could
talk Krio, and when I asked if I could ask them a few questions about Ebola,
they took me to their Chairman.<span style="mso-spacerun: yes;"> </span>(In
Sierra Leone, groups of young men who are struggling to make a living are often
self-organized into groups:<span style="mso-spacerun: yes;"> </span>okada
drivers union, cassette sellers union, etc.).<span style="mso-spacerun: yes;">
</span>They took me to sit in the nicest chair, and Nina followed along.<span style="mso-spacerun: yes;"> </span>I said she was my friend from America and
that she didn’t speak Krio.<span style="mso-spacerun: yes;"> </span>They said,
“You are welcome mommy.”<span style="mso-spacerun: yes;"> </span>I cleaned my
hands with hand sanitizer, then handed the bottle to the chairman, saying he
should keep it.<span style="mso-spacerun: yes;"> </span>He handed it around to
the about ten young men gathered there.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">The first thing they talked about was their
“sufferness.”<span style="mso-spacerun: yes;"> </span>Things are much harder for
them under Ebola.<span style="mso-spacerun: yes;"> </span>The chairman said, “in
fact, we shouldn’t even be out here now, but we just have to ‘dreg’ (struggle
to survive.)”<span style="mso-spacerun: yes;"> </span>They said that the police
have always harassed them, but that it’s even worse now.<span style="mso-spacerun: yes;"> </span>One young man said he was released from the
police station only yesterday, and that he was charged with public gathering
but really it was a shakedown.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">The good news is that they were all aware of the Ebola
messages:<span style="mso-spacerun: yes;"> </span>avoid body contact, wash your
hands with soap, don’t touch dead bodies, don’t attend funerals.<span style="mso-spacerun: yes;"> </span>(That said, we were all sitting pretty close
together.)<span style="mso-spacerun: yes;"> </span>One joked that as car
washers, since they spend all day with their hands in soapy water, they have
the cleanest hands in Freetown. I asked whether they believed Ebola was real,
and they enthusiastically said yes; that, in fact, in October one of the car
washers just down the road had died from Ebola along with his wife, and that
they had left behind two small children who had survived Ebola.<span style="mso-spacerun: yes;"> </span>The chairman said he had attended the
funeral—from a distance, as required—and that seeing all the fresh graves at
the cemetery had really convinced him that this thing is real.<span style="mso-spacerun: yes;"> </span>I asked whether they would welcome the two
children to come and visit them, and there was some disagreement.<span style="mso-spacerun: yes;"> </span>Some said, “of course I would be afraid to be
near them.”<span style="mso-spacerun: yes;"> </span>Others said, “but the
government has said that once someone is cured we shouldn’t fear them. We
should embrace them.”<span style="mso-spacerun: yes;"> </span>Then I asked, “So
you believe what the government says?”<span style="mso-spacerun: yes;">
</span>And they said, “Oh yes, in fact, the President visited us here!<span style="mso-spacerun: yes;"> </span>He came to us and told us that Ebola is real
and that we should protect ourselves!” (Our driver later confirmed that, indeed,
it was reported in the news that the president had driven there with his own
car and talked with the youth personally.)<span style="mso-spacerun: yes;">
</span>I asked if they were happy with the government’s response so far, and
they said there had been delays early on because things were politicized, but
that they really believed the president himself was doing a good job. It was
only that he had greedy people around him who were making things
difficult.<span style="mso-spacerun: yes;"> </span>One said, “If the president
tells us, we must believe.<span style="mso-spacerun: yes;"> </span>After God is
the president.”<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">We then asked, well, if everyone has got the prevention
message, how are people still getting Ebola?<span style="mso-spacerun: yes;">
</span>They said, “well, we here in Freetown are educated, but the people in
the rest of the country still believe in traditional culture.<span style="mso-spacerun: yes;"> </span>They are stubborn and it’s very hard to get
them to change.” <span style="mso-spacerun: yes;"> </span>We asked, “If one of
you had a fever or other symptoms, what would you do?”<span style="mso-spacerun: yes;"> </span>They all said, “We would call 117 and go for
testing because we are here so close together, if one of us were sick it would
put us all in danger.”<span style="mso-spacerun: yes;"> </span>I pushed a
little, saying, “really?<span style="mso-spacerun: yes;"> </span>You’d turn your
colleague in?” And they admitted, “well, we’d call in secret so they wouldn’t
know it was us who called.” </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">I said, “Well, we don’t want to get in trouble for gathering
in a group.<span style="mso-spacerun: yes;"> </span>Any other comments or
questions?”<span style="mso-spacerun: yes;"> </span>Then they said, “thank you
mommy, we really appreciate you taking the time to come and talk to us.”<span style="mso-spacerun: yes;"> </span>As we were walking back to the car, one of
them asked me for Nina, and I had to disappoint him and say that Nina is
already married.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">My sense is that, at least in Freetown, there is no longer
denial that Ebola is real.<span style="mso-spacerun: yes;"> </span>The basic
prevention messages are getting out there.<span style="mso-spacerun: yes;">
</span>However, some of the measures taken to control people’s movement are
having a real economic impact on the poorest members of society.<span style="mso-spacerun: yes;"> </span></span></span></div>
</div>
Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com2tag:blogger.com,1999:blog-1874818527363776028.post-16288076506812676482015-01-03T15:00:00.000-08:002015-01-04T06:44:27.763-08:00Echoes of War<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1791491579 18 0 131231 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1107305727 0 0 415 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0in;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.25in 1.0in 1.25in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
</style>
<br />
<div class="MsoNormal">
<style>
<!--
/* Font Definitions */
@font-face
{font-family:"MS 明朝";
mso-font-charset:78;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1791491579 18 0 131231 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1107305727 0 0 415 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:-536870145 1073743103 0 0 415 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0in;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"MS 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.25in 1.0in 1.25in;
mso-header-margin:.5in;
mso-footer-margin:.5in;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
</style>
</div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Nina’s making me look bad by posting so regularly, so I
guess I’ll dive in.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">I’m finding it hard to know what to say about our
time here.<span style="mso-spacerun: yes;"> </span>I’ve been coming to Sierra
Leone intermittently since 1987 when I first arrived as a Peace Corps
Volunteer.<span style="mso-spacerun: yes;"> </span>Since then, I’ve seen the
country during the tail end of the war and during the decade long
reconstruction afterwards.<span style="mso-spacerun: yes;"> </span>As we move
around Freetown, I keep experiencing moments of déjà vu.<span style="mso-spacerun: yes;"> </span>Shops are locked and streets are empty after
6PM due to government decree, and it reminds me of times during the war when
the streets were empty because of fear.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">We stopped by NERC (National Ebola Response Centre)
Headquarters today to attempt to pick up our passes to travel through the
quarantined districts next week.<span style="mso-spacerun: yes;"> </span>It’s
housed in the complex that used to be the Special Court for Sierra Leone.<span style="mso-spacerun: yes;"> </span>An echo of the post-war period was the fleet
of NGO vehicles outside the compound.<span style="mso-spacerun: yes;">
</span>The driver commented that they are all circling around, looking for
contracts.<span style="mso-spacerun: yes;"> </span>That felt a lot like the
post-war NGO-ization as well.<span style="mso-spacerun: yes;"> </span>As happy
as people are that international experts are here battling the virus, we also
heard some stories of grumbling that expatriates were enjoying themselves on
the local beaches.<span style="mso-spacerun: yes;"> </span>I remember exactly
the same story with the UN peacekeepers fifteen years ago.<span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">I am not the only one making these comparisons.<span style="mso-spacerun: yes;"> </span>Several of the people we have interviewed so
far have said things like, “this is just like the war” or even “this is worse
than the war.”<span style="mso-spacerun: yes;"> </span>One woman said, “during
the war, if you needed to, you could run to your neighbors house and beg for a
few cups of rice.<span style="mso-spacerun: yes;"> </span>But now we all sit at
home, afraid to even go to our neighbors.”<span style="mso-spacerun: yes;">
</span>This war is about an invisible enemy, and perhaps the hardest part for
Sierra Leoneans is that they have to fight it isolation from each other.<span style="mso-spacerun: yes;"> </span>On the other hand, a professor friend told us
today, “the war was worse than this.<span style="mso-spacerun: yes;">
</span>Maybe people don’t remember, or they were in Freetown throughout so didn’t
experience the worst of the war.”<span style="mso-spacerun: yes;"> </span>People
are also invoking the resilience they learned during the war, saying things
like, “we survived the war, and we will survive Ebola, by God’s grace.”</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">I'm so glad Nina is here with me. Not just because she is better about remembering the Clorox wipes than I am. I think it would be easy for me to be distracted by my decades' long ethnographic project, and want to spend all my time thinking about what aspects of Sierra Leone's culture are changing or not as a result of this crisis. Nina keeps me on track, always bringing it back to the question: how can this knowledge help. </span></span></div>
Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-88278426724931097142015-01-03T11:39:00.001-08:002015-01-04T07:21:30.853-08:00On Transmission and Testing<div dir="ltr" style="text-align: left;" trbidi="on">
<b>To be in Freetown, you wouldn't necessarily know that this is a country with an Ebola epidemic</b>. I have been here for 3 days and have yet to see a person dying or vomiting in the street. Our driver, who lives here, has never seen these things either. Some of Susan's Sierra Leonean friends don't know anyone who has died from Ebola. People still gather, albeit with caution. Yesterday there was a birthday party at the guest house where we're staying. <br />
<br />
Nevertheless, there are <b>messages</b> about preventing Ebola everywhere. The messages include: wash your hands, don't touch others, and don't attend funerals. Here are some of the many signs I've seen: <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYMYS85gqqoOYDH5-UvO2Y4niQe0pD7EISUT6OoAYZ9vlKQbwKUE1fFyXOEetEhRzZpQoJzhifSioj_qFZ7A1Moz5FMqhNWDxued6dFcrrlWtQol1ST589i1qytMIlg26LP8B-kHwmm5n2/s1600/IMG_5670.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYMYS85gqqoOYDH5-UvO2Y4niQe0pD7EISUT6OoAYZ9vlKQbwKUE1fFyXOEetEhRzZpQoJzhifSioj_qFZ7A1Moz5FMqhNWDxued6dFcrrlWtQol1ST589i1qytMIlg26LP8B-kHwmm5n2/s1600/IMG_5670.JPG" height="240" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdyApyprcUPetKwEtzB9SqSOvK4qZhg9ou6tR8J1Lg1skKrgyYqSQcyK-GFBoEbDhXYx2IjI1ldelKDPEzE4vLA-52-0ZgWZJ-t65692guIhCjqrPKVJ04rE1cz1wDHcp3NICDrk1YY3go/s1600/IMG_5707.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdyApyprcUPetKwEtzB9SqSOvK4qZhg9ou6tR8J1Lg1skKrgyYqSQcyK-GFBoEbDhXYx2IjI1ldelKDPEzE4vLA-52-0ZgWZJ-t65692guIhCjqrPKVJ04rE1cz1wDHcp3NICDrk1YY3go/s1600/IMG_5707.JPG" height="240" width="320" /></a></div>
<br />
We have interviewed a few people so far and everyone says that they understand that Ebola is real (in the beginning of the epidemic some people did not believe it was real or thought it was a conspiracy). People say that what convinced them that Ebola is real is knowing people who died. They also say they are convinced that engaging in prevention behaviors is a good thing: they wash their hands, they don't gather, and avoid touching people. <br />
<br />
<b>But.. if everyone is adhering to these prevention messages, then why are people still getting Ebola</b>? Some people say that only rural people or health workers are getting it. Another person said that mostly poor people get it. These perceptions may be partially true. In Freetown, most of the people who have died of Ebola lived in a slum or a ward where people from the rural areas often stop on their way into Freetown. However, we don't <i>really</i> know the demographics of people who died of Ebola because we lack good data (see previous blog post). <br />
<br />
<b>We asked a few people whose family members died how their family members got Ebola</b>. One person said that his mother contracted it while caring for her sick child and they both died. Another woman said that a traveler with Ebola came from a rural area to her parents' neighborhood. The traveler was taken into a house in the neighborhood and subsequently died of Ebola. Several people in that neighborhood also died, including 6 members of the woman's family. She doesn't know how her family members first contracted Ebola, other than that they may have been exposed to the traveler. However, she does know that at first her mother was inaccurately diagnosed with HIV which may have caused her to delay seeking care. She also knows that her brother slept in the bedroom of someone who had died of Ebola (even though people told him not to) and that's probably how he contracted Ebola and died. <br />
<br />
<b>One problem with tracing Ebola transmission</b> <b>is the time lag between infection and diagnosis</b>. Currently, Ebola can only be tested once there is enough detectable virus in the blood, which usually accompanies a fever. It may take up to three days after symptoms start for someone to test positive for Ebola (<a href="http://www.cdc.gov/vhf/ebola/diagnosis/index.html">http://www.cdc.gov/vhf/ebola/diagnosis/index.html)</a>. And people might attribute their fever not to Ebola but to malaria which is pretty common in Sierra Leone.<br />
<br />
I'm not sure how people are being informed of the time lag for diagnosing Ebola. We heard from the woman who lost 6 members of her family that after her mother died, her brother went to get tested for Ebola. Apparently his symptoms were not severe enough and he was sent home without being tested (he probably did not meet the case definition). <b>The family saw this as a slight and lost trust in the medical providers</b>. Her brother later developed Ebola and died.<br />
<br />
Tomorrow we meet with the CDC social mobilization team so I'm hoping we'll get some answers to these questions. Maybe we can also craft some research that will help them. Meanwhile, here is a picture of me at a Sierra Leonean buffet (the food was good!).<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmrrq4GxLVnwSavaKAIlb60m2U2M8YHw2-cN6huFxHNuF5baDKsXbtDgWLh6uWTNAC11Yis_03U7AGvMlKtFsBqr1U0xwKkrVLkCndBV_EeDO0KeMmeIL4JPsPWmdsPkgSulxFCyV-iGM6/s1600/IMG_5682.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmrrq4GxLVnwSavaKAIlb60m2U2M8YHw2-cN6huFxHNuF5baDKsXbtDgWLh6uWTNAC11Yis_03U7AGvMlKtFsBqr1U0xwKkrVLkCndBV_EeDO0KeMmeIL4JPsPWmdsPkgSulxFCyV-iGM6/s1600/IMG_5682.JPG" height="320" width="240" /></a></div>
<br /></div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-37043402135161785282015-01-01T15:21:00.004-08:002015-01-04T07:25:11.765-08:00Challenges and innovations<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><b>Today we heard about some of the many challenges in this epidemic. These have not necessarily been reported by the popular media so I will share them here:</b></span><br />
<br />
<ul style="text-align: left;">
<li><b><span style="color: blue;">Surveillance</span> </b>(tracking the number of Ebola cases in the country) <span style="color: blue;"><b>is difficult and imprecise</b></span>. Health workers who come into contact with a suspected case of Ebola are supposed to fill out forms that give very basic information about the person, including name, date of birth, etc. They are also supposed to fill out whether the person traveled or had a contact with someone with Ebola, but this information is rarely filled out. All the data are written by hand and then later entered into a computer. Right now the data entry to the computer is about two weeks behind the written forms. Also each person is given a unique identifier (a sticker with a number on it) that is supposed to identify their blood for the health care worker and the laboratory. There have been some problems with people putting the stickers incorrectly on the forms. All this makes it difficult to know who is getting Ebola and who is at risk for getting it.</li>
<li>People want to know what are the <b><span style="color: blue;">risk factor</span></b>s for Ebola - who is getting it and how. But if the system can't collect the basic data described above, right now it seems impossible to collect more complicated data about how Ebola spread from person to person. </li>
<li><b><span style="color: blue;">There is limited coordination among agencies</span></b> with similar missions. For example, WHO and CDC both have epidemiologists in the field who are supposed to be working with the contact tracers, workers who go to people's homes to find people with Ebola and ask them who they've been in contact with. There is speculation that some households may be counted twice. Another example is that different agencies provide different goods. For example, each house that is quarantined with a case is supposed to get a bucket with oral rehydration solution, food, gloves and bleach so that others in the household can protect themselves. We heard that there are different agencies providing each of these goods, and as a consequence these goods are not being delivered regularly. </li>
<li>Ebola can be treated with <b><span style="color: blue;">good hydration</span></b>. However, when people with Ebola ride in ambulances to the treatment centers (which can sometimes be 5 hours away on a bumpy road), they are not given water to drink. </li>
<li><b><span style="color: blue;">People can't find their loved ones</span></b>. A person with Ebola can be taken to any one of the 10 treatment centers in the country and their families don't know where they go. Also a lot of people have the same names, making tracing loved ones even more challenging.</li>
</ul>
<b><span style="font-family: Arial,Helvetica,sans-serif;">We also heard about some interesting innovations: </span></b><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: blue;"></span></span><br />
<div>
<ul style="text-align: left;">
<li><b><span style="color: blue;">Dignified burials</span> </b>are very important to the people of Sierra Leone, but are difficult to achieve given that corpses are so infectious. People are currently forbidden from attending funerals or burials. Corpses are treated swiftly by the burial teams. We heard from one woman today that when her mother died of Ebola, her mother's corpse was thrown on the ground in front of her community and sprayed with chlorine. This episode was naturally very upsetting to her daughter. </li>
<li>Nevertheless, we heard of two <b><span style="color: blue;">improved practices </span></b>today when it comes to burials. One is that burial teams are allowing bereaved loved ones to provide white clothing that is buried on top of the corpse (it is a Muslim tradition to clothe people in white before burial, but because of Ebola the corpse cannot be wrapped in the cloth). Family members are also allowed to see the burials from a safe distance. Some say that developing strategies to bring about dignified AND safe burials will be key to controlling this epidemic. </li>
</ul>
</div>
</div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-33132700796875750352015-01-01T14:23:00.000-08:002015-01-01T14:56:42.827-08:00Life goes on as normal, but there are signs everywhere that it is not<div dir="ltr" style="text-align: left;" trbidi="on">
We arrived on New Year's Eve, and I was curious if Freetown would be quiet, given the President's orders not to gather in groups and the cancellation of Christmas. Nevertheless, there was what sounded like a raucous
party in the streets outside our hotel windows. I
was happy to hear this joy, despite what has been a season of sadness for the people here.<br />
<br />
Today in Freetown we saw many
signs of normality - people go to the market, children hold hands when
walking down the street, parents soothe their children, and lovers have intimate conversations. Still there are signs everywhere that things are different. There is very little traffic. Markets close promptly at 6 pm. There are hand washing stations and young men who point thermometers at your forehead at random checkpoints and building entrances. Everywhere there are signs like this one about not touching people:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1uis68dmHij3eNSGJwoNAqsSi7wmCN9Z1dRdzZTk8o35tuL-z4KFyBAf4Z8MykBHO7BadnjZSe4nz-wYE0MDuZXqFc8aDx72JFwaTfMaYmKm4791tFXcP3K6AjEfixLx6aqE-zvdu9ezp/s1600/IMG_5647.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1uis68dmHij3eNSGJwoNAqsSi7wmCN9Z1dRdzZTk8o35tuL-z4KFyBAf4Z8MykBHO7BadnjZSe4nz-wYE0MDuZXqFc8aDx72JFwaTfMaYmKm4791tFXcP3K6AjEfixLx6aqE-zvdu9ezp/s1600/IMG_5647.JPG" height="240" width="320" /></a></div>
<br />
<br />
The other non-normal thing is that there are many expatriates here from all over the world. It is impressive to see so many mobilized to respond. We met people on our flight coming from Europe, Australia, Japan and Sri
Lanka. There were some muscular European-looking men who looked like they were ready to
stomp all over this virus. I talked to two women coming for the
first time to Sierra Leone, one to work as an epidemiologist for one
month and one to work for six months at a treatment center doing
administrative work. Agencies are now moving towards having staff doing
longer tours, so that there is some consistency with the response. I am glad for this - I have repeatedly heard that people here on shorter tours (4-6 weeks) feel frustrated by their short time in country.<br />
<br />
I am happy to be in the company of Susan. She has done work here for over 20 years, is fluent in Krio, and has a large professional network here. Her experience will definitely help us to maximize our time here over the next 10 days.<br />
<br />
<br /></div>
Nina Yamanishttp://www.blogger.com/profile/01346120953093138595noreply@blogger.com0tag:blogger.com,1999:blog-1874818527363776028.post-41553884368378378782015-01-01T13:36:00.001-08:002015-01-01T13:47:25.739-08:00Why we call this blog "Sierra Leone's Invisible War"Sierra Leone's Invisible War refers to the battle against the Ebola
virus. People here say that life under the threat of Ebola is similar
to life during the civil war, but with a difference. The enemy is
unseen but just as deadly. <br />
<br />
We are two professors at
American University's School of International Service, in Sierra Leone
for a short time, conducting research on various socio-cultural aspects
of Ebola and the war against it. We intend this blog to reflect on some
issues that we are observing that may not be captured in the popular
media. Susan Sheplerhttp://www.blogger.com/profile/15708287648004348338noreply@blogger.com0