Kenema, Kenema District, Sierra Leone
Sunday, June 11, 2017—Dispatch 2
By Randy Thomas Jones
We are at the Internet café in Kenema, a town with a population large enough to sustain a full market(1). We could have used the visit for some purchasing, but the priority today is repairing some of our tech. The single independent server we have (Ivan usually brings about 5 of them to ensure redundancy) is inoperative, so he is currently engaged in the traditional activity of travellers since time immemorial—field hacking. It might be time soon for another order of cold water . . . one time is usually all it takes to clarify the issue for the ex pat of whether one is asking for cold water, or just water! And for another thing, the market is closed, the shipping containers that are one of the typical housing for small shops . . . all the small shanties that provide shade for the smaller suppliers are bare—it is Sunday.
On a successful note, Ivan has just procured a piece of wire. Literally one piece of wire, but with the kind of resources that are available in a smaller African town, it was probably a good bet to give up after one wild goose chase in Segbwema this morning. Let the field hacking commence! To return to the introduction to our adventure, or, to use the more generally accepted term, “mission.”
In Haiti in 2010, after the earthquake, Gayton faced a similar problem to the one John Snow faced in London in 1854—cases of Cholera were beginning to arrive at the MSF hospital in Port-Au-Prince, and everyone knew that a second, potentially even more devastating disaster was developing fast. Gayton knew of Snow’s solution, but the problem was trying to identify the neighborhoods people were from was an impossible task.
To describe why the task was difficult perhaps can go back to what many might know from some rudimentary exposure to anthropology—many cultures have names for themselves that simply mean “The People” in the local language. Left to their own devices, people will name things in a vernacular fashion. Haitians were no different than any other people—they didn’t mind at all having dozens of similarly named streets called “Avenue of the Church, “ or “Market Street.” Of course, they know where they are from, but when they are coming into a medical facility, they may be too ill at that point to communicate the extra important information that can disambiguate the Patient Origin, the technical term used in the medical world. And if a person is coming in sick with Cholera, you know that they have only arrived after infecting several other people, who will either be arriving soon, or not even able to make the journey to look for help.
Cholera is actually possible to treat; mostly the issue is rehydration, while a person’s own immunity has a chance to successfully fight the infection. It is not necessarily any kind of heroic rocket science, but it is a daunting task that quickly becomes unmanageable in an outbreak situation. The stress on resources will quickly break any attempt at a logistical solution that relies on the Kantian idea of giving the all and best to each new patient. The outbreak needs to be stopped at its source, or many will die.
Recognizing the gravity of the situation in Haiti, Gayton had an idea . . . identify danger areas of outbreak properly, using modern technology—could Google possibly help? After a series of phone calls, Google sent Ka-Ping Yee, who had actually been invited to join Google in the very early days as a founder. Within a week he was on the ground. The organization Missing Maps (also one of our project partners) had already made what is called a base map, using the knowledge of Haitian diaspora volunteers looking through satellite imagery to name streets. With the help of British Red Cross and MSF UK, Ping and his partner were able to quickly scrap together code that enabled a visual dashboard to be used by administrators. Now it was possible to open a map of the city that showed the cases of Cholera as red dots—a “Heat Map.” At a glance, just like John Snow’s map, you could see where the highest incidence rates were located, and resources could be concentrated on where they were most needed.
Jump to 2014, and now Gayton has been called to Sierra Leone in the height of the Ebola outbreak. Full quarantine protocols have been instituted for MSF staff . . . no one is even allowed to touch another human being during the time of their posting. It is clear that Ebola is another transmittable disease. At the height of the outbreak, 1.7 people were becoming infected out of every case. It was looking like a global apocalypse in a time frame of months. But again, the mathematics were germane—if the infection rate can be brought down to less than 1.0, the epidemic is stopped. Ebola also exists in the background environmental reservoir. It came originally into the human population through consumption of what is called “bush meat” in Africa—often unauthorized or even illegal hunting of wild animals for food sustenance. On its own, left in the forest, it is not much of a danger to humans, but once in the human world, it can become a specter of incredible danger.
At the height of the outbreak, the MSF Ebola treatment facility in Magburaka, Tonkolili District, in Sierra Leone had 110 patients, and effective contact tracing (That old question from John Snow: “Where are you from?”) could only be done for 20% of the patients. Why? Because many villages had identical, or very similar, names. Many people from different walks of life had to risk exposure to the disease to intervene against the developing catastrophe. Any contact with exposed people had to be ended, and here mapping had a sinister side—some villages with known outbreaks had to be forcibly isolated to delay the spread of the disease. The experience was heartbreaking, and MSF had a rotation of three shifts of personnel—one on the ground, while the second group was in recovery from the trauma, and the third group, which had sufficiently recovered, was on a vacation rest before heading back to the field. And the damnable thing was, that the outbreak could have been stopped cold (on this point, Gayton emphasizes by thunderclapping his hands together with a vigorous and defiant grief).
Had the availability of accurate maps and a gazetteer been available there is no doubt that the situation would have been ameliorated. As it was, 12,000 people died in West Africa, actually a testament to the sophistication of modern intervention strategies. It was a light toll, considering the nature of the jeopardy.
(1) The city of Kenema had a population of 200,354 in the 2015 Sierra Leone census. Wikipedia