tag:blogger.com,1999:blog-34435357800250531592024-02-19T05:25:57.108-08:00Thoughts From The Hot ZoneTom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-3443535780025053159.post-39045157787465701072015-05-25T11:59:00.004-07:002015-05-25T11:59:50.790-07:00These are the days of miracles and wonde<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/AVvXsEgRhof7aMdr-VWqU0-pDvz9lI4vtqslH3xyFtzUtmW54gjQRO54hyphenhyphenrn_y_2cT5BPnyN2Zgx7croc5126dF0YYxnUuTMwgwaybG7kMAoRenRILImPPxHMldmG5c9gvogS_G3zgQIove7G-w/s1600/IMG_2330.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRhof7aMdr-VWqU0-pDvz9lI4vtqslH3xyFtzUtmW54gjQRO54hyphenhyphenrn_y_2cT5BPnyN2Zgx7croc5126dF0YYxnUuTMwgwaybG7kMAoRenRILImPPxHMldmG5c9gvogS_G3zgQIove7G-w/s320/IMG_2330.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bopolu</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">The kid with the glasses kills me</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Kids of Bopolu</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Off to Bopolu</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">M-17</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">The Ritz....</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOMEfSDPeJhR-dxrEKihiO-cJ55CTFimKiZ0eo6SG9gr_haFczCE3jINWj04Lopxp0GrnKgWykVvl6mlbwR8JAijwLyyM6v_RmvPQ-sjC5aUtaVZfdjywV01J-Y9E5CwEy7nYf6gTbeiQ/s1600/IMG_2308.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOMEfSDPeJhR-dxrEKihiO-cJ55CTFimKiZ0eo6SG9gr_haFczCE3jINWj04Lopxp0GrnKgWykVvl6mlbwR8JAijwLyyM6v_RmvPQ-sjC5aUtaVZfdjywV01J-Y9E5CwEy7nYf6gTbeiQ/s320/IMG_2308.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ensuite bathroom</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">The mess tent</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRczHtbCoNhEy0ShKCQoIITyCVgZ8kEV4gFaWWIzLtzY4uo4SNA7auzpSyPFue2aTUbtM_QXg52FqKh3FjkRR1XvI1mB2USrXXHG6sMwOrzUVMC3NC-K-WmC6nHV12qdmSZHwyRPA6j0k/s1600/IMG_2326.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRczHtbCoNhEy0ShKCQoIITyCVgZ8kEV4gFaWWIzLtzY4uo4SNA7auzpSyPFue2aTUbtM_QXg52FqKh3FjkRR1XvI1mB2USrXXHG6sMwOrzUVMC3NC-K-WmC6nHV12qdmSZHwyRPA6j0k/s320/IMG_2326.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Meal rations for the trip</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7Iz2hUgiwVneFf0kUgcgfkCl5VsvS-DsTvGviJRkhN2_UoNx7k3swIlZ2RUrFor4UATpkhIG7g1WPz7EXtseHmQnw_yJ9DiZIhFdE1ib7tiHIRAemEq18SngGpAJ4rQcO5mPoQSKI750/s1600/IMG_2311.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7Iz2hUgiwVneFf0kUgcgfkCl5VsvS-DsTvGviJRkhN2_UoNx7k3swIlZ2RUrFor4UATpkhIG7g1WPz7EXtseHmQnw_yJ9DiZIhFdE1ib7tiHIRAemEq18SngGpAJ4rQcO5mPoQSKI750/s320/IMG_2311.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My morning latte</td></tr>
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<div class="MsoNormal">
I’ve spent New Year’s Eve in fancier places and more elegant
surroundings but never before in a place more filled with wonder. I am in a
village called Bopolu. Say it out loud and smile. The ETU in Bopolu is slated
to be open for business starting January 4<sup>th</sup>. I am here to make sure
my clinical team is ready to take care of patients. That means we go through
patient care scenarios, know how to triage and test, confirm we have the
necessary supplies and drugs, know where everything is, know how to put on and
take off the personal protective gear known as PPE, know how to enter and exit
the red zone, know how to document. The list is endless. Just a quick aside on
documentation. No electronic medical records here. Paper charts return. And no
charts in the red zone. We keep a record on a white board and then through
fogged goggles read, shout actually, any data back to colleagues several yards
away back in the green zone. Old school rules. <o:p></o:p></div>
<div class="MsoNormal">
The classroom lectures are over thank God. Our training
teams are true stars. The instructors are all ETU veterans and a mix of locals
and expats. Power point is kept to a minimum. Classroom size is not. Yesterday
there were 144 students by my count. Some 30 or 40 true clinical staff, 30 or
40 local support staff and the rest I think were just there for the show. It
was ungodly hot and by midafternoon the funk quite simply burned your eyelashes
off. Today the students are run through all the PPE on and off rituals or more
correctly called donning and doffing.<span style="mso-spacerun: yes;"> </span>Sounds
like two of Santa’s reindeer actually. We keep them in the suits throughout the
patient care training – up to two hours at a time – and I promise you it is NOT
comfortable. Critical yes, comfortable no.<o:p></o:p></div>
<div class="MsoNormal">
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<div class="MsoNormal">
We had a new teammate join us yesterday. His name is Eric
Dieudonne. There’s a picture below. He’s from Chad and an expert in water and
sanitation and has already built and worked in a number of successful ETUs.
He’s just a young kid but a wealth of knowledge and experience. His formal
training is in civil engineering. He went to school in Tunisia, lives in Chad
but travels the world for causes like this. His flight itinerary here was the
stuff TSA nightmares are made of - Chad to Mali to Casablanca to Dakar to
Monrovia. Within a few hours of landing in Monrovia we had him in a helicopter
to Bopolu. Let’s talk about the helicopter. Pictures below. There is no more
essential piece of equipment given the terrain and timeline. We have two
repurposed Russian MI-17 aircraft from Afghanistan I think. They are ugly,
noisy and smelly but get people and stuff from point A to point B with a degree
of safety. The flight to Bopolu took only about 45 minutes but it was 45
minutes at high speed straight into the middle of nowhere. We passed over
countless miles of untouched jungle and yes I know it’s a cliché but the shades
of green seemed too numerous to name. The pictures just do not capture the
electric shimmer some of the green presents.<o:p></o:p></div>
<div class="MsoNormal">
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<div class="MsoNormal">
Once landed, offloaded and officially welcomed by all the
kids we settled into our new digs for the next couple of weeks. Comfortable
enough with a tent, floor cushion, pillow and blanket but someone forgot food.
Oops. Flights are dedicated to essential medications and materials so food will
wait. Dinner last night for a group of 30 or so was 4 tins of sardines, a few
pieces of flat bread, 2 cans of mackerel (no can opener) and a jar of jam.
Believe me, I saw some very interesting deconstructed cuisine. The Jenny Craig
plan has nothing on the Liberia weight loss plan – less in up top and more out
below. And speaking of below, the toilets are actually pretty good for field
toilets but they look a lot like the little shower tent. As such, a lot of the
locals mistake the shower tent for the toilet tent. Again, oops.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While we weren’t able to conjure up a miracle with the fish
and loaves of bread I do see evidence of amazing things everyday. Team members
continue to pour in from all around the globe. Heavier than air machines bring
them to sites carved out of virgin forest. Local villages step up with
everything they have and more. We’re only missing a soundtrack. For now, I
can’t get the old Paul Simon album Graceland out of my head. Looking up at the
stars last night I kept hearing the verse from one of the songs…the way we look
to a distant constellation that’s dying in the corner of the sky…these are the days
of miracles and wonder so don’t cry baby don’t cry don’t cry.<o:p></o:p></div>
<div class="MsoNormal">
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<!--EndFragment--><br />
<div class="MsoNormal">
POSTSCRIPT – I did not have internet access the last few
days – so much for miracles and wonder – but do now that I’m back in Monrovia
for a bit. I’ll send this off and post again in another few days before I head
to Zor Zor.</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/AVvXsEittpY1hxWwjhkeWYKh33XrmKpGwG4pReLODY-7r71KnBVz70gQgZQ7nq1JxOG44qVCo-OU_ioVFH0owQzHsZBvagZu8nSjHECz6HRBOtFbATypGzpDBA1xjpfs5x9Lo2rzO3GCeBXGskM/s1600/IMG_2307.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEittpY1hxWwjhkeWYKh33XrmKpGwG4pReLODY-7r71KnBVz70gQgZQ7nq1JxOG44qVCo-OU_ioVFH0owQzHsZBvagZu8nSjHECz6HRBOtFbATypGzpDBA1xjpfs5x9Lo2rzO3GCeBXGskM/s320/IMG_2307.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">These signs are everywhere in the country</td></tr>
</tbody></table>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-_zZGzyYSgv1nqvce_cCpLIuIRpOj2FftzkVyvzoJaF3RmAVcM-odsD2jlXrJaS68tkzoH_PS66iZTT_5dVg1HthTBgs_-69IQQruHHLQU9sgQ58ZL0_MQ__NbYisnkiaD5VGZ5UKzaE/s1600/IMG_2316.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-_zZGzyYSgv1nqvce_cCpLIuIRpOj2FftzkVyvzoJaF3RmAVcM-odsD2jlXrJaS68tkzoH_PS66iZTT_5dVg1HthTBgs_-69IQQruHHLQU9sgQ58ZL0_MQ__NbYisnkiaD5VGZ5UKzaE/s1600/IMG_2316.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"> </a><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/AVvXsEjG99cpH8U06luaw4nYg8hmmP4w6JsDZYobZR4-JT9F2OtQgMz0TnDDzqZ5HumJzHMupRdw7bzftTmprzwWjI7VT_DpCEBwWfyADXo0z40IYj19nYm5ebO8n0uB0BY_0hcfbhDHfMXf8s0/s1600/IMG_2343.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjG99cpH8U06luaw4nYg8hmmP4w6JsDZYobZR4-JT9F2OtQgMz0TnDDzqZ5HumJzHMupRdw7bzftTmprzwWjI7VT_DpCEBwWfyADXo0z40IYj19nYm5ebO8n0uB0BY_0hcfbhDHfMXf8s0/s320/IMG_2343.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Learning to put PPE gear on correctly</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/AVvXsEhy20Ch2H5VhOOAtyLNQoXd5-Ja_26W0CzGiDHY6eg98fw4MJXuqF0WZ1FIcajEg8xl62DY0aZTcOXqfEWbTLA6h26bQQK-FEC02_uKegllHxTcxkbRPO0CDxldU8AZmNx-0_C8SI41mxo/s1600/IMG_2358.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhy20Ch2H5VhOOAtyLNQoXd5-Ja_26W0CzGiDHY6eg98fw4MJXuqF0WZ1FIcajEg8xl62DY0aZTcOXqfEWbTLA6h26bQQK-FEC02_uKegllHxTcxkbRPO0CDxldU8AZmNx-0_C8SI41mxo/s320/IMG_2358.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">More PPE instruction</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-_zZGzyYSgv1nqvce_cCpLIuIRpOj2FftzkVyvzoJaF3RmAVcM-odsD2jlXrJaS68tkzoH_PS66iZTT_5dVg1HthTBgs_-69IQQruHHLQU9sgQ58ZL0_MQ__NbYisnkiaD5VGZ5UKzaE/s1600/IMG_2316.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-_zZGzyYSgv1nqvce_cCpLIuIRpOj2FftzkVyvzoJaF3RmAVcM-odsD2jlXrJaS68tkzoH_PS66iZTT_5dVg1HthTBgs_-69IQQruHHLQU9sgQ58ZL0_MQ__NbYisnkiaD5VGZ5UKzaE/s320/IMG_2316.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Eric from Chad</td></tr>
</tbody></table>
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZm94Up-ZjoDIfww5-52qf3VJVxaZju8YuLucPEchDORbUJS0y6L6bdoj2bTflFl6XDvkUWg36lj2Ooc5RVJ1xRkZC1pmcqLdkz8XcLOI84248ZD8c379i96q0MJ1jgVP6titymppYcqc/s1600/IMG_2306.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZm94Up-ZjoDIfww5-52qf3VJVxaZju8YuLucPEchDORbUJS0y6L6bdoj2bTflFl6XDvkUWg36lj2Ooc5RVJ1xRkZC1pmcqLdkz8XcLOI84248ZD8c379i96q0MJ1jgVP6titymppYcqc/s320/IMG_2306.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Classroom lectures</td></tr>
</tbody></table>
<br /><br /><o:p></o:p>Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com0tag:blogger.com,1999:blog-3443535780025053159.post-60921629395928238702015-05-25T11:49:00.003-07:002015-05-25T11:49:44.837-07:00On earth peace, goodwill towards men…<div class="MsoNormal">
Christmas Day in Liberia starts the same as Christmas Day in
Hawaii Nei – sunrise, peace and palm trees. It changes quickly though. A
pleasant sunrise turns to a blast furnace and the morning peace becomes chaos
as the workday begins. Organized chaos yes but chaos nonetheless. I spent all
morning at Spriggs airfield getting a contingent of our docs and nurses on to
helicopters bound for the ETUs in Bopolu and Gbediah Town. I love saying
Bopolu. I’m not sure whether I’m imitating Fats Domino or Ricky Ricardo when I
sing it. Aerial pictures of both sites are attached. The livin’ ain’t easy on
either site but will get better over time as the sites develop. Over the next
week I send teams out to even more remote sites that make these two look like
the Four Seasons.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s just after lunch and our next pow-wow isn’t until 3. Time
to get this out. I thought a Christmas playlist delivered in a low tech setting
in high tech fashion (via Bluetooth and JamBox) would be just the ticket.
Wrong. I start off with Nat King Cole. I can remember my dad playing it through
enormous speakers in the impossibly small living room where I grew up. Within
seconds the tears well up. I switch to Frank Sinatra (Jessie’s favorite
Christmas album) – mistake. A fast-forward to Windham Hill selections should
dry me up. Nope. How about Hapa? Arrgh. Only makes me miss Hawaii more. I give
up, switch it off, blow my nose and resume typing. Jeez. Keep it together. Stop
slobbering. Any minute I expect to have someone open the attic access on me and
I fall through the roof like Chevy Chase in Christmas Vacation. Where are the
Moose Cups when you need them? I am fahklmept. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Finally, a special Merry Christmas to Jessie, Haley and
Piper. You three are the greatest gifts I could have ever hoped for. To the
rest of you a very Merry Christmas as well. Treasure your time with each other
today. Treasure your family. Treasure your health. They are all gifts. And
speaking of gifts, I am gob-smacked at the level of generosity displayed here
by the responding community, the local Liberians and a very special group of
locals – the Ebola survivors. There is no harder working group here. They teach
us how to take better care of the current victims. They work in the hot zone
caring for the infants whose mothers are too ill to do so. They play with the
older children in the same situation. They take home the orphans who’ve lost
everyone and everything. They even give of their own blood. It’s called
convalescent serum and does appear to help improve survival when transfused
into infected patients. Now that’s a gift. They are defining examples of what
Christmas was, is and should always be about. And on earth peace, goodwill
towards men…<o:p></o:p></div>
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Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com0tag:blogger.com,1999:blog-3443535780025053159.post-19924909582204291102015-05-25T11:49:00.000-07:002015-05-25T11:49:04.005-07:00And so it begins…<div class="MsoNormal">
I’ve been here in Liberia for a few days now and would like
to share some thoughts and observations. First off, despite countless previous
deployments, trips, and missions I am shocked to realize just how much more I
miss my family and friends. My heart just aches at times. Could be that it’s
Christmas-time. Could be that I’m just getting older and it’s cumulative. Could
be that my girls are growing up so fast. Could be the fact that Ebola is scary.
Could be all four. I miss Jess and Haley and Piper and all of you dearly.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was asked to be the Chief Medical Officer for a US State
department funded assistance effort helping mitigate the Ebola crisis in West
Africa. More specifically, I am working on a day-to-day basis recruiting,
organizing, training, budgeting for and deploying hundreds of international and
local health professionals to staff the Ebola Treatment Units (ETUs) we are in
charge of.<span style="mso-spacerun: yes;"> </span>Other daily duties include
validating the clinical care protocols and perhaps my biggest job of all is keeping
the peace (at least our part of it) with the various partners we have ranging
from the US government and US military to the Liberian government, the multiple
NGOs and private sector concerns and even the occasional church group here to
save a few souls and hand out some medicines. I work on an hourly basis with
Brian who is our Liberian contract manager and Erik my assistant medical
director. Their talents and enthusiasm make up for my shortcomings. My clinical
work and wearing of the bubble suit is limited. The larger effort is a bit
colonial with the US taking the lead for Liberia, the UK for Sierra Leone and
France for Guinea. I help run the Liberian part. My colleagues at Aspen in
Australia are covering the Sierra Leone part under the auspices of the British
government. I am lost as to what the French are doing in Guinea.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If you haven’t asked by now I’m sure you will. What is a
plastic surgeon doing in this setting and what do I know about Ebola? The
answer to the first question is fairly straightforward. I’ve spent my whole
career developing a second skill set where I’ve gotten quite good at managing
medical groups in austere and complex settings. Liberia certainly fits the
bill. I’ve been a practicing surgeon for 27 years and needed a break quite
frankly.<span style="mso-spacerun: yes;"> </span>Also, the company I helped start,
Aspen Healthcare Services, is the US affiliate of Aspen Medical Global and once
we won this contract it became very apparent that it would require my full
attention. In a very short time frame I needed to up and go from my day job at
Kaiser and head to Liberia. Jess and the family were hugely supportive even
given the uncertainties of time away and risk. I cannot thank them enough for
their love and support.<span style="mso-spacerun: yes;"> </span>The answer to
the second question is easy. What do I know about Ebola? Nothing more than
anyone else prior to this outbreak. It is not something you learn about in
medical school. It wasn’t even discovered until the mid 1970s. Previous
outbreaks were isolated and quick to burn out. This one was so tragically
different as you all know. Still, the care is not that complex – even a surgeon
can get it quickly. It’s all about proper diagnosis, isolation protocols,
presumptive care (treat them like they all have malaria too which most do) and
supportive care (fluids, nutrition and the like). For now there is no vaccine
or direct treatment.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Our job is to provide the clinical staffing and support for
several sites around Liberia. We do this in conjunction with our business
partner PAE. PAE is a large very well established and preferred provider of
services to government missions. In this case they are the prime contractor and
provide all the logistical support. Together we are running four ETUs and
perhaps a fifth. They range from 25-50 beds and are truly scattered around the
country from the remote border regions of Sierra Leone, Guinea and Cote D’Ivoire
to the inland jungles and coastlines. We rarely drive anywhere and if you do
some of the places are a solid 24-hour drive away. Helicopters serve as the
primary means of personnel transport. My clinical teams are comprised of US,
Australian, New Zealand, European and African professionals. Just today I took
another 20 Kenyans under my wing. My site management teams have the same mix. Some
are brand new to this work. Others have the well earned t-shirt logo of been
there done that. I learn from both groups.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I live in a base camp in Monrovia the capital of Liberia.
I’ve been here before and we have had a primary care clinic here for several
months, Aspen Medical Liberia, so I already had some friends and contacts here
but it is still so far away. The base camp is comfortable enough with air
conditioning and hot water most of the time. The food is OK. The coffee is
bloody horrible. Still, I can’t complain. Many of my teammates, especially at
some of our newer sites and extra remote sites are basically camping. I get to
fly in and fly out a few days later usually. Most of them are on site for 6-8
weeks at a time. I expect to be here until March with a break and then perhaps
another tour. When I’m finished with this effort I’ll return to Aspen full
time. I may do some clinical work just to keep the hands warm. I do miss my
patients and teammates in Honolulu.<span style="mso-spacerun: yes;"> </span>A
special shout out to Tracy and Brenda. I could use both of them here in a
heartbeat. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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We are on a crushing 16-hour a day schedule so that’s all
for this first missive. I have two teams heading out Christmas day but I
promise to get a short note out then and at least once a week after. Please
take care of each other and thank you from the bottom of my heart for all the
love and support you’ve shown my family in Hawaii, San Diego and Boston. And so
it begins. Aloha.<o:p></o:p></div>
Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com0tag:blogger.com,1999:blog-3443535780025053159.post-69403918404495184812015-05-25T11:31:00.003-07:002015-05-25T11:31:48.883-07:00My Stunning Mystery Companion<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">I know that you don't want me to be</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Out here forever on this road</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Or live among the boxes</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Where all our past lives have been stowed</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Maybe you're thinking of our place</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">With a garden by the sea</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Where we could slow down</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">And you could put a little more work in on me</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">What with all my expectations long abandoned</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">My solitary nature notwithstanding</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">You're the one who pulled me</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Out of that crash landing</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">My stunning mystery companion</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Three days and
a wake up is what we used to say in the Army. It means 3 sunrises, 3 sunsets
and a rooster crow and I’m home. Yes I know the last post was about exactly the
same thing but that was a too quick trip home for vacation. I’ve been back a
little over a month working on transferring some of the program assets to the
government of Liberia. I’m done. Time for a final post. This time it’s
homecoming. Home to Piper. Home to Haley. Home to Jessie – my stunning mystery
companion. To be honest, taking a break from surgery and jumping into this had
all the elements of a potential midlife crisis – uncertainty, unplanned, unexpected.
Instead, it was life affirming, wholly absorbing and crazy interesting. And
there was a safety net. Jess. I knew she was ever there – no crash landing.<o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">I’ve told you
about this place and this disease but not enough about the people I worked
with. There was a core group I spent most of my time with on this project and
another core group who staffed our clinic in Monrovia. To a person they
represent everything one could hope for in colleagues – a great sense of humor,
a tireless work ethic, ridiculous competency, selflessness and impenetrable
accents at times. More on the last one in a second. We were truly a polyglot
tribe. From our Liberian colleagues with their special brand of Libglish and
phrasing from the 18<sup>th</sup> century, to our Antipodean colleagues with
their awesome slang, to our South Africans with their very special brand of
English that I just could not understand at times, we cobbled together a common
tongue and understanding. <o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Let me tell you
a little bit about the ones I was with almost hourly. Forgive me if some of
these comments may have a bit of an inside joke flavor to them. I spent the
most time with Brian and Nick. I’ve mentioned Brian before. He served as the
program manager and hails from NZ. The success of the Aspen portion of the
program is due in large part to Brian. His steady hand, fairness and attention
to detail kept it all happening. His tales of Antarctica (Brian is a retired NZ
Air Force General and perhaps the world’s most experienced Antarctic helicopter
pilot) kept me riveted during countless dinner discussions. His theories of
everything from change to Brontosauri were entertaining as well. <o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Nick or Saint
Nick as we called him is from of all places Boston. Boston, England. He served
as our logistics manager and made sure the program lacked for nothing but on
the rare occasion when it did he could invent anything out of nothing. Of
course he was also great at finding things that “fell off the back of the
truck”. He will be transitioning to come work with Aspen on a different project
as we build a clinic in Freetown Sierra Leone. Unflappable is the best word I
can use to describe Nick.<o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Mike and
Muhammad were PAE counterparts for Brian and me. Muhammad while originally from
Pakistan has spent years working on USAID development projects across Africa.
Mike is from DC by way of LA (lower Alabama) and ran the whole show with aplomb
and a focused calm that taught me a lot. Together the two of them kept the
program running on all cylinders even when everyone else had run out of gas.<o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Russ our deputy
program manager is a former Australian military officer who now lives in
Tasmania. He will likely be the one to turn out the lights on Aspen’s part of
the program sometime in the early fall. Katie was our training lead and
singlehandedly was responsible for crafting our curricula out of the best WHO
and MSF had to offer and delivering it to nine remote sites in a very
compressed few weeks. Not a single ETU would have opened up had it not been for
her making sure everyone was trained and trained properly. She was also the one
to somehow find a blowup Santa and park him in the dining area when most of us
didn’t even realize it was Christmas day.<o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Finally let me
tell you a little bit about Kebeh our Liberian admin assistant. She worked
directly for Brian but made sure all of us thrived in our new environment.
Everyone got paid even though Liberian banks can be challenging to say the
least. Everyone got in and out of the country without hassles. Everyone had all
the licenses they needed. And, everyone who had a birthday while we were here
got a cake courtesy of Kebeh. <span style="mso-spacerun: yes;"> </span>There are
dozens of others I worked with some of whom I’ve mentioned in other posts.
These are the folks though that greeted me on day one and are still here as I
exit six months later.<o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">With a mixture
of fondness, nostalgia and good riddance I left the Congo Town compound
yesterday. While beachside and comfortable enough it just wasn’t home of
course. The waves were a constant source of torture to look at but I loved
hearing them. The concertina wire that surrounded us gave everything that
Martha Stewart minimum-security warm and fuzzy. The food was always plentiful
and safe and occasionally inspired-especially the curries-but I cannot wait for
a piece of monchong, fresh asparagus and a trip to yogurt mama.<o:p></o:p></span></div>
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<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">My colleagues
at the Aspen clinic deserve a shout out as well. Remember the clinic is a
totally separate effort from this Ebola program but it was a place we
congregated on an almost daily basis whether to get medications, bring
colleagues who were ill or injured, or just sit in air conditioning. Doctor
Leon took care of us all myself included. The clinic continues to grow and now
that Liberia is Ebola free people and businesses are coming back en masse.
We’ve decided to bring an airplane to Monrovia to fill a market gap in
aeromedical evacuation, cargo and passengers. My clinic and Aspen colleagues in
DC have worked so unbelievably hard to bring this to fruition. Airplane deals
are complicated enough but when you factor in three continents, multiple
stakeholders, three sets of lawyers and West Africa things get really sporty.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Verdana;">I had a great
time. I think I helped some. I learned tons. Jess and I celebrate our 20<sup>th</sup>
wedding anniversary late next month. She’s the only reason I was able to
experience any of this and any help I was able to offer the program is because
she made it so. The final stanza of Jackson Browne’s Stunning Mystery Companion
speaks of a partner sticking it out for 10 years and no more, but then taking
another 10 years just to be sure. Ten and ten is twenty. Can I get another
twenty more? I’ll see you Wednesday.<o:p></o:p></span></div>
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<span style="color: #262626; mso-bidi-font-family: Verdana;">Maybe you were joking when you said</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">You'd take me for ten years and no more</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">Maybe you've had the best of me</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">But you could take another ten years and be sure</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">What with all my expectations long abandoned</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">And a life that just gets more and more demanding</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #262626; mso-bidi-font-family: Verdana;">There's no doubt that you're the reason I'm still
standing</span><span style="mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.5in;">
<span style="color: #262626; mso-bidi-font-family: Verdana;"><span style="mso-spacerun: yes;"> </span>My
stunning mystery companion<o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;">Note: Words by Jackson
Browne<o:p></o:p></i></div>
Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com0tag:blogger.com,1999:blog-3443535780025053159.post-72195510783192303672015-03-22T17:07:00.002-07:002015-03-22T17:07:48.821-07:00Homeward Bound<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">Breakfast in cemetery<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">Boy tastin’ wild berry<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">Touch girl, apple blossom<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">Just a boy playin’ possum<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">We'll come back for Indian Summer<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">We'll come back for Indian Summer<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">We'll come back for Indian Summer<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">And go our separate ways<o:p></o:p></span></div>
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<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">What is that cheerful sound?<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
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<span style="color: #434343; mso-bidi-font-family: Times;">We'll wear a jolly crown<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="color: #434343; mso-bidi-font-family: Times;">Buckle up, we're homeward bound<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s been almost two weeks since the last Ebola patient was
discharged in Liberia. It’s been over a month since my mom left us. It’s been
more than three months since I saw Jess and the girls. The rainy season is
almost here. Time to go home. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Those of you who know me well know I’ve been a fan of REM
since the first four drum notes that start Radio Free Europe came over the
airways on WBCN in Boston. Amazingly, I had never heard the song Indian Summer
until just recently. To me the first stanza speaks to freedom, the seasons, birth,
rebirth, life, promise, growing up, new experiences and perhaps a bit more. The
last few months have certainly been full of all those thoughts…and more. I’ve
never met Michael Stipe the REM songwriter. From what I’ve read he would
probably think my interpretation crap.<span style="mso-spacerun: yes;">
</span>Oh well. Some final thoughts follow.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>The nasty filovirus that
is Ebola (filo means thread in Latin and the virus looks like a bent piece of
thread under the electron microscope) has killed more than 4,200 in Liberia. I
was here in September and October when there were literally bodies in the
streets, everyone wore a perpetual mask of fear and doom. No one knew what lay
ahead. I came back in December and saw a different country, a different people
and a different mask. People had hope. People felt it could be defeated. Three and
a half months later it looks like we’re there. Still, there’s bound to be a
case or two here and there. The reality is the disease may be endemic and
resident in the human population now meaning it is always around, in someone,
somewhere. Previously the disease was zoonotic meaning its host was something
in the animal kingdom. Most researchers now believe the host (the animal that
carries the virus but does not get sick from it) is the fruit bat. There are
many theories as to how the virus jumps from the fruit bat to people. In some
cases the virus may be in bat saliva on a piece of fruit that falls to the
jungle floor and is picked up by a human. People eat bats too. Maybe that’s another
way it is transmitted. No one really knows. And of course our nonhuman primate cousins
the chimps and the gorillas are, like us, very susceptible to the virus. As many
as a third of the world’s gorillas have been killed by Ebola. I<span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">n
West Africa, the recent Ebola outbreak probably began with a 2-year-old Guinean
boy who touched a droplet of bat feces in December 2013.</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The word Ebola continues to strike fear in people – and for
good reason. It still kills a significant percentage of people who get it. They
die in an often gruesome way and there is no proven cure or treatment. Instead,
we go back to basics. Even in the highest of the high-tech centers where
certain Ebola patients are treated we still do little more than support the
patients vital functions and treat the symptoms. <span style="mso-spacerun: yes;"> </span>The virus causes the body to mount an intense
inflammatory reaction that can wreak all sorts of havoc in the body (like
bleeding) before it begins to help and defeat the virus. It’s kind of a race.
The winner is too often the virus. Another race exists for drugs and vaccines.
Some of the drugs like ZMapp show great promise. Even better, certain vaccine
trials hint at a future where routine prevention may be possible. Time will
tell.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Despite all the critiques and finger pointing about the
early days of the response one thing is clear and indisputable. When the world
finally did get its ass in gear the global community rocked. Things got done.
ETUs were built in the middle of nowhere seemingly overnight. Staff poured in. Thousands
of people were trained to care for victims. Whole nations changed their
behaviors. Ebola etiquette became not only a catchphrase but also a way of life.
This is a war and like all wars it is being won with logistics. The amount of
stuff that rained down on West Africa in the last several months is simply
mindboggling. There is so much stuff the continent of Africa leans a bit to the
left now the west coast groaning under the weight of PPE, medicines and other
supplies. Fortunately the world also brought expertise and enthusiasm. Combine
stuff, expertise and enthusiasm and you have a recipe for success. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Friday cannot come quickly enough. The Brussels Airlines
flight leaves at 930 at night. It takes a little over an hour to get to the
airport from our compound. In order to get through the maze and madness that is
an African airport we get there a good two and a half hours to three hours
before. Wait in line to get the car into the airport. Have your temperature
taken. Drag your bags to the screening area. Fill out the form that asks if you’ve
washed a dead body, eaten monkey meat or had bloody diarrhea recently. Wash
hands in .05% chlorine. Hand in form. Fill it out another one since the
chlorine dripped and made parts illegible. Sweat buckets because it is hot as
hell and you’re dragging luggage and packed in with dozens of people. Have your
temperature taken again. Panic. Wash hands in chlorine again. Repeat. Now
you’re in the airport.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Between now and Friday I have to follow up with all my
medical officers and see how best to begin transitioning our people, services
and stuff. I suspect that may require a few trips this week out to the sites.
When I head back to Monrovia on Thursday from wherever I will be likely be bouncing
in anticipation. I miss everything about home – my friends, my waves and of
course my family. Jessie has once again proven herself our family’s anchor and the
best thing that’s ever happened to me. How did I get so lucky? Haley and Piper
make my heart sing every time I hear their voices on the phone. To imagine
hearing them in person is almost too much. Piper, God love her, demands that I
confirm my status prior to hugging me. I’ve promised her I will take a rapid Ebola
test before I leave. We’ve used them a bunch and now they’re WHO approved. That
said, I totally understand if any of my friends think it best to maintain a
certain distance. It’s such a weird disease and so misunderstood I would never
argue. Remember though – you are not infectious unless you are symptomatic.
Fever of course is the first sign. I’ll carry a thermometer. I wouldn’t know
what to do without one. Conservatively I have had my temperature taken over a
thousand times in the last few months. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Monrovia to Brussels. Brussels to Newark. Overnight Saturday
in Newark. Anyone know any good airport hotels? Sunday morning airport
Starbucks and direct to Honolulu. I hope to have my family in my sight and the
scent of plumeria in my nose by midafternoon Sunday. Buckle up. We’re homeward
bound.<o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Georgia;">Note: The lyrics to Indian Summer are by REM<o:p></o:p></span></i></div>
Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com1tag:blogger.com,1999:blog-3443535780025053159.post-33675049578273763812015-02-21T17:57:00.000-08:002015-02-21T17:57:34.775-08:00Words for MomGood morning everyone. I cannot make it today so I hope you don’t mind that I’ve asked Uncle Bob to read some words for me to mom. It is so totally unfair to do so but thanks for doing this for me. Funerals are hard enough for everyone and to have to step in and speak for someone else is especially difficult. Here we go.<br />
<br />
My dearest precious loving mother –<br />
<br />
This is both the hardest and the easiest thing I’ve ever written. It’s the hardest because it is a goodbye. A final goodbye. I said goodbye to you mom many times over the past 30 years since I left home. Hard as many of those goodbyes were I knew there was a hello coming soon. When I said goodbye to you in December when I left for Africa I knew then it was quite likely I would never see you again. You knew it too. It was hard. We both knew we weren’t going to get to say hello again in this life. Yes there is that great gettin’ up morning promised someday when we will see each other again but today is goodbye. Goodbyes are just plain hard<br />
<br />
This is also really easy to write though. When you have a great subject and some great stories the words flow. Mom, you can’t imagine the flood of memories and stories that have crossed my mind over these last few days. I hope it’s ok if I mention some of them to the folks here today. Each and every memory speaks to your kindness, your love for your family and friends, your selflessness, your faith, your optimism, your laughter, your gorgeous voice and your sense of wonder.<br />
<br />
Let’s start with the last one, your sense of wonder. Mom, did you ever think when you were growing up in Natick that you would ever marry a hillbilly, raise three boys, make countless treks across the country by car and air, spend 18 summers in the Ozarks, live in California, Hawaii, visit Europe. The list goes on. Your life was filled with adventure and wonder. I can’t believe you spent your honeymoon without running water. Even I didn’t do that to Jess. The adventure never stopped until this past Friday. The wonder I’m sure continues as you sit at the foot of the Father.<br />
<br />
Let me tell them about your kindness. I think the first Bible verse you taught me was Be Kind. You always, always were. There are a million times I remember you being kind but one stands out because it was so quiet, so simple but so kind. Remember when we worked at GBC – General Battery Company? I made 8 dollars an hour on Saturdays there. That was awesome money in the 70s. There was a kid there named Steve. I can’t remember his last name. He and his girlfriend had a baby girl and as you were fond of saying “didn’t have a pot to pee in”. On our way into work together one Saturday at 5 in the morning you had me get some bags and boxes into the trunk. They were filled with clothes, diapers, toys, and a baby seat. I asked who these were for and you said Steve and his family. I started to ask who gave them to you and before I could finish my jaw dropped. I realized you had bought all the stuff yourself and were just giving it out of the kindness of your heart. I saw it repeated by you throughout my life but that one memory really stands out. When we got there you called Steve to your car and had him bring his car over. He had no idea. When you had me open the trunk he just stared. He couldn’t speak. His jaw dropped. He too realized that you did something like this simply because you had a pure and perfect heart.<br />
<br />
Let me tell them about your love of family. Nothing came before family in your life. As a child you just assume you are the center of the universe but Billy and Stevie and I really were to you. Your husband too. You had an unbreakable bond of marriage, faithfulness to family and a strength that defined your love. You constantly kept us pointed in the right direction and served as a model for others. I can’t tell you mom how many people asked me over the years what you “did right”. I don’t know the answer and I don’t think you did either but it worked. Everyone recognized how special a mom you were. You touched so many with your love over the years -from little babies in cradle roll, to the neighborhood kids piled in the huge Imperial with you carting us all to Wingaersheek Beach, to college roommates who asked every other day when we were heading over to your house, to me. You always listened, never criticized and loved unconditionally.<br />
<br />
Your loved your friends too and they loved you with a purity and a power that is present today. It was just second nature to you. Everyone in your orbit loved you - your brother and sisters, your in-laws, neighbors, church family, dental patients, the pizza guy, the gas station guy, the bank lady. I often wondered why you were so friendly. Were you born that way? Did you decide to be that way? I’ve come to the realization it was your name. Myrtle. People named Myrtle have to be friendly. And people named Myrtle Crabtree have to rise above the moniker and be extra friendly and be the most normal, friendly genuinely loving person possible. You always were. I think you had practice with the name thing though. Your mom was Bessie Mae. Your mother-in-law was Gertrude. Goodness. When it came time to name our daughters, Jess and I never really considered Myrtle but maybe we should have. It defined you. Folks may forget Myrtle is mentioned throughout the Bible. It’s found in Isaiah, Nehemiah, and Zachariah. It always refers to the beautiful, fragrant evergreen that to this day adorns temples in times of celebration. It is fitting the plant was named after you.<br />
<br />
<br />
<br />
Your selflessness. It seems to be a special hallmark of the women of your generation. And it certainly was with you. You always sat down last. Whether it was scrambled eggs at O dark thirty on Sunday mornings so Dad could get to church to set up the speakers, or beans and franks on Saturday afternoons, or Thanksgiving dinners for my college classmates you always served yourself last. You also, quietly gave us more than we deserved and more than you could really afford. You let us talk you into the Victoriaville hockey sticks with the Bobby Orr signature when the Gary Doak Sherwood would have been fine. You made sure we had Levis when Toughskins were the smarter and more economical choice. You always sacrificed. You never thought of yourself first.<br />
<br />
Your faith and your optimism. Your faith was unshakable. I may have questioned parts of your beliefs but I never questioned your faith. The thriving church community that exists today in New England was built in large part on the bedrock your faith provided. All things were possible. Everything would work out fine. Your church burned down on your wedding day for goodness sake. How does one march on in that setting? You did. In the end, you knew your days on Earth were numbered but you never gave up. You accepted the fact that our bodies are not perfect that they wear out and that yours was quickly doing so but you met each day with promise and possibility. Just a few days before you left us mom you honestly told me when I called that you felt pretty good that morning. That today was a good day. Your optimism was your greatest gift to me. I like to think I share it in whole but I know only in part. Your optimism was boundless.<br />
<br />
Your laughter was infectious and continuous. Sometimes you laughed so hard you peed your pants. Many of us, especially your sister Irene, learned long ago not to get on the Tilt A Whirl with you. You found joy in all things. That was another lesson your sons learned, your friends respected and God will reward you for.<br />
<br />
Your gorgeous voice. Mom, you filled our house and our hearts with music. Dad had the big speakers but mom you had the voice. Yeah, I know dad has a distinctive voice but you had the signing voice - angelic, alto and oh so pretty. I close my eyes and hear you in the old Wellesley Park on a Sunday night when it was ok to rock a bit. I hear you in the St Joe Baptist church competing with Sarah Beth for the high notes, I hear you in our living room harmonizing with Dougie Mitcham on Unclouded Day and I hear you singing lullabies to your grandchildren. When I hear these songs I think of so many things. I think of Bert Mitchell’s perfectly scribed lyrics on the ancient overhead projector, I think of Tommy Mitcham and Wilma Shedd raising the rafters with their piano and organ and I see your hand tapping out the beat on the top of the pew. How I wish I could hold that hand again. Those songs often sang of a sweet forever… of a land beyond the river…of a place we only reached by faith’s decree…of a time when the King commands the spirit to be free. You’re free mom.<br />
<br />
Mom, promise me you’re singing to folks in Heaven. They deserve it.<br />
<br />
Mom, let me say a few words to the folks here. To all of you I am so sorry I could not be there in person. As many of you know I am in Liberia running a piece of our US government’s effort to help defeat Ebola. We are close. Your support made the difference. The war is not won but victory is in sight. Unfortunately one can only fly out of here once or twice a week. I just couldn’t make it. More importantly, Massachusetts would not let me participate in “public gatherings”. I guess funerals fall in that category. And can you imagine being there and NOT being able to hug each other? But worse, it is the cold and flu season and someone will have a fever and sniffles sometime in the next few days and I just couldn’t make them think they might have Ebola however unlikely. Mom and I talked about this possibility and I remember her words clearly. You take care of those folks. I’ll be with Jesus, everyone else is fine and I expect you to finish your job. It doesn’t make it any easier but I hope you all understand.<br />
<br />
Finally mom, I need to say a few words to dad. Dad, I cannot imagine the sorrow and heartache you feel right now. Mom was a wonderful mate. But I know your faith is strong too. I know you know you will see her again. And if I know my mom she’ll have a table set for you when you next meet. Only this time, what a special table it will be. Mom will have a place for you at the Master’s Table. Can I hear a good old-fashioned Grampie Sellars Hallelujah! And when you sit next to her dad please hold her hand under the table and give her a kiss for me. To all of you, please remember that first Bible verse mom taught me. Be kind. Take care of one another.<br />
<br />
If God truly did make us in his image then God is not the blue-eyed bearded guy shown in the painting that hung in the staircase of the old Wellesley Park. No, God looks like you mom. <br />
<br />
Jessie and I miss you so much mom. Piper and Haley miss their Nanny. Jess is here with you today. I am in Africa and Haley and Pipes are back home in Hawaii. But all of us want to say aloha and a hui hou. Until we meet again.<br />
<br />
Goodbye my dearest precious loving mother. Enjoy your eternal reward. No one deserves it more.<br />
<br />
Your loving son, Tommy<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com5tag:blogger.com,1999:blog-3443535780025053159.post-19828316732528978442015-02-13T08:35:00.001-08:002015-02-13T08:36:38.911-08:00Burn Your TV in the Yard<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">Burn your TV in your yard<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">And gather 'round it with your friends<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">And warm your hands upon the fire<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">And start again<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">Take the story you've been sold<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">The lies that justify the pain<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="mso-bidi-font-family: Verdana;">The guilt that weighs upon your soul</span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="text-indent: 0.5in;">And
throw 'em all away</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: Georgia;">People keep
asking why I am still here. Ebola is gone. Come home. The TV news said there
haven’t been any Ebola cases for weeks. The disease is defeated. The enemy
vanquished. Happy Christmas, War is Over was I think how John Lennon put it.
Victory. None of this is true. Burn your TV.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: Georgia;">There was a
positive case just yesterday here in Monrovia. He died. During the last few
days of his life he was not recognized as an Ebola patient and came in contact
with hundreds of people in the community to include many healthcare workers.
The good news is no one has since popped up as positive from this event – yet –
and the system the government and partners have put in place to find people
that may have been exposed is working well. The process is called contact
tracing and it is perhaps the single most essential part of defeating this
disease. What it means is you have to find every single person that may have
been exposed to the infected person and at a minimum follow them on a daily
basis for the proverbial 21 days. In some cases, depending on the potential
severity of the exposure you may physically quarantine them. The teams here are
now quite skilled at contact tracing. And it works. When you so closely monitor
potential patients and isolate them the minute they start to appear ill it
markedly decreases the chance they will continue to pass along the infection.
All the virus wants to do is propagate, build a chain link by link. Contact
tracing stops the next link from even being built. Think of how many people you
come into contact with every day in your routine. Hundreds? Thousands?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: Georgia;">Let’s explore the
word quarantine for a minute. We all know what it means. We hear it used on the
TV news, read about it in the papers but where does it come from? </span><span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">The word
"quarantine" originates from the Venetian dialect form of the Italian
<i>quaranta giorni</i>, meaning 'forty days'. This is due to the 40-day
isolation of ships and people before entering the city of Dubrovnik in Croatia.
This was a measure of disease prevention related to Black Death. Between 1348
and 1359, the Black Death wiped out an estimated 30% of Europe's population,
and a significant percentage of Asia's population. Just to refresh your memory,
the Black Plague was caused by bacteria that used fleas and rats as part of its
transmission cycle. Not nearly as exotic as Ebola which is a filovirus and
probably carried by bats but just as deadly back then. I have to remind you of
another part of the Black Plague’s history that you may not know. We are all
familiar with the children’s rhyme ring around the rosie, pocket full of posies,
ashes ashes we all fall down but we may not be aware that is all about the
Plague. The ring referred to a classic skin sign of infection, the pocket full
of posies was carried to mitigate the stench of death and the ashes and falling
down referred to the deaths. I am not sure if Ebola will birth its own nursery
rhymes. We’ll see.<o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">The
original quarantine document from 1377 is kept in the Archives of Dubrovnik and
states that before entering the city newcomers had to spend 30 days -a <i>trentine</i>
- in a restricted place waiting to see whether the symptoms of Black Death would
develop. Later, isolation was prolonged to 40 days and called quarantine.</span><span style="mso-bidi-font-family: "Times New Roman";"> Venice </span><span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">took the lead in measures
to check the spread of plague and appointed three guardians of public health in
the first years of the Black Death (1348). They enforced quarantine on ships at
harbor and even built quarantine facilities on small islands. Venice – such a
great city. <o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">So
what happens when somebody gets Ebola? I’ll save the clinical talk for a different
time but let me walk you through how a patient is cared for. There are of
course many schools of thought - doctors are even worse than lawyers when it
comes to arguing - but there are established protocols that most agree on. A
patient showing symptoms gets to care sites in many different ways. If a person
is laying on the floor of their house or hut showing symptoms people know now
to contact the authorities. A specially trained and outfitted team and
ambulance goes and gets the patient. They know to bring them to an Ebola
Treatment Unit – an ETU. Patients may also show up on foot, via motorcycle or
even via wheelbarrow. <o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">Once
at the ETU the patient begins to follow a very prescribed path that seeks to
isolate and protect the patient and protect the staff. The first part is
triage. There, across at least a meter or two of barrier separation, a quick
history is taken. The patients are guided on taking their own temperature with
an accurate digital thermometer. A judgment call is made right there whether or
not the patient fits the criteria. If so, a team in PPE (the spacesuits) comes
and escorts the patient into an area where they are cleaned and their
belongings gathered. They are now brought to a ward called the suspect ward.
Here they have a blood test drawn and samples are sent. The patient receives
what is called presumptive care at this point. Presumptive just means you
assume that everyone may also have malaria and infectious diarrhea – both very
common – and while you are waiting for the test to come back you may as well
treat these. Supportive care like nutrition and fluids are also given and of
course symptomatic care is given for fevers, pain and nausea for example. <o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">It
may take a day or two for a test to come back. If it is positive the person is
moved to a completely new ward called the confirmed ward. Additional testing
takes place. More aggressive treatment continues. The same categories of care –
presumptive, supportive and symptomatic remain. Remember – there is no cure or
vaccine for Ebola – yet. There are very strict guidelines on how patients and
staff move and travel through the facility. One rule is there is no
backtracking. A patient will never go back to the suspect area once confirmed.
Remember some there in the suspect area may not have the disease. Likewise, a
staff member always travels from suspect to less infectious to most infectious
and does not backtrack either in order to minimize the chance of infecting
other patients. The whole patient and staff flow is exquisitely choreographed.
Those who went before us taught us. <o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">Once
in the confirmed ward there are two possible patient outcomes. The patient
either survives and recovers or succumbs to the disease. If they recover there
is a protocol for confirming a disease free state and the patient is released.
They exit through a special area called Freedom’s Gate by some. They are given
the appropriate support to include the basics like bedding, clothing and food
since most everything was destroyed on arrival. No one is just sent out the
door. The communities have a well-established network of support facilities and
services. Still, a stigma surrounds Ebola survivors and many find it rough
going. It is not unlike that experienced by HIV patients back in the day.
Goodness, I just thought about my early days taking care of HIV/AIDS patients
back at San Francisco General in the early 80’s. It wasn’t even called AIDS. We
called it Gay Lymph Node Disease or Gay Related Immune Deficiency (GRID). We
were all so naïve but terrified. Again, the similarities are striking. <o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">Many
patients die. Fatality rates range from 20-95% for Ebola. With good care in an
ETU setting the more favorable numbers play out. When a patient does die they
are treated with the utmost respect but again with very established protocols
for the handling of remains. A recently deceased body is highly highly
infectious. The ETUs all have proper morgues and a way to handle the remains. A
very special NGO called Global Communities has taken the lead throughout this
crisis for handling and burying remains. The ETUs transfer the deceased – again
protocols – to the Global Communities personnel who transport the patient for
burial. Every effort is made to include families in the process with appropriate
attention to infection control.<o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">I
neglected to mention what happens to those in the suspect ward who prove
negative. Those who recover are similarly discharged with the appropriate
support. Those who remain ill are usually transferred to a more traditional
health care facility or clinic. For caregivers as mentioned there is a
similarly stringent workflow that starts with putting on the PPE – donning –
through to how to safely perform even the most routine tasks like an IV and
then when your shift is complete how to safely remove your PPE – doffing. I’ll
save the mechanics of all that for a different time as well.<o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">A
couple of good video links give you an even better picture of what goes on
inside an ETU. The first link is of the MSF unit at ELWA3 in Monrovia. The
second is from another Liberian ETU.<o:p></o:p></span></div>
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<a href="https://www.youtube.com/watch?v=6Ib6WbIKyRE"><span style="mso-bidi-font-family: Helvetica;">https://www.youtube.com/watch?v=6Ib6WbIKyRE</span></a><span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;"><o:p></o:p></span></div>
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<a href="http://abcnews.go.com/International/video/life-inside-liberian-ebola-treatment-unit-25873937"><span style="mso-bidi-font-family: Helvetica;">http://abcnews.go.com/International/video/life-inside-liberian-ebola-treatment-unit-25873937</span></a><span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;"><o:p></o:p></span></div>
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<span style="color: #1c1c1c; mso-bidi-font-family: Helvetica;">I’ve
included some stock pictures of ETUs. You’ll note an abundance of concertina
wire and snow fence. No locals call it snow fence but those of us lucky enough
to have seen snow or even ski (how I miss it this season) do. The snow fence
and concertina wire are to help indeed demand one follows the traffic patterns.
No getting in (or out) unless appropriate. No backtracking. No left when you
should go right. Some ETUs are refurbished buildings or clinics that already
existed in the middle of a town. Some are just tents, although really good
tents, and plywood buildings in the middle of the jungle. They all operate in a
very similar fashion. They have all been critical to the success to date. Even
those that have not seen a patient act as fire stations ready to jump on any
ember. There’s still both smoke and fire. The house isn’t burning down anymore
but there is still work to do. Lots of it. Don’t believe everything you see or
read on the news. In fact, burn your TV in the yard. I haven’t seen TV in
months. I don’t really miss it. Ah, that’s a lie. I miss the John Oliver show
like crazy. How am I ever going to catch up?<o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Georgia;">Note: The lyrics to Throw it all Away are
by Toad the Wet Sprocket<o:p></o:p></span></i></div>
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<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/AVvXsEgKcs31ot5qojkQGfmtgz9ROfHgQcDhpCmet4o4AC8Lbk3Jnsvrc6FpxZw5XFtgIdQG3gCWXgSfGXqmGW_1Jny_619t6XUy3bKevfWj9si1t5_6Icb5OtjiqUcFXfnA-qDoLtxvKvDzcJY/s1600/snow+fence.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKcs31ot5qojkQGfmtgz9ROfHgQcDhpCmet4o4AC8Lbk3Jnsvrc6FpxZw5XFtgIdQG3gCWXgSfGXqmGW_1Jny_619t6XUy3bKevfWj9si1t5_6Icb5OtjiqUcFXfnA-qDoLtxvKvDzcJY/s1600/snow+fence.jpg" height="426" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Snow Fence</td></tr>
</tbody></table>
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<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/AVvXsEg-zkTCK01KPPbHOa-C_M4nghOncTGqIZpHj8RTCqIU_YNoQbHWBg7EhseXfYGIjgSVURMlQ1uchrfsiOmlr4Vn76lyDGD2tvwiS883C26KKRlagREjSCJerQyYUS2isp5gUUJQGieJ63U/s1600/island+clinic+etu.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-zkTCK01KPPbHOa-C_M4nghOncTGqIZpHj8RTCqIU_YNoQbHWBg7EhseXfYGIjgSVURMlQ1uchrfsiOmlr4Vn76lyDGD2tvwiS883C26KKRlagREjSCJerQyYUS2isp5gUUJQGieJ63U/s1600/island+clinic+etu.jpg" height="426" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Island Clinic ETU</td></tr>
</tbody></table>
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Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com2tag:blogger.com,1999:blog-3443535780025053159.post-65434205452303681582015-01-26T11:38:00.001-08:002015-01-26T11:38:38.925-08:00Heaven, what the Hell is Heaven?<div class="MsoNormal">
<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/AVvXsEg47klVMNkwkOYzbIFyek93yxowcSflyf-4EQupcfHzJYUTCY__l50htfY7yBY-YSNTGAuQMat2HAy8QQxXBOoOog3z7fqlOFA29BiPFo5ONznQdgXz4tQDQTLuN0SK4EFqdZdTVnuTnX0/s1600/IMG_2277.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg47klVMNkwkOYzbIFyek93yxowcSflyf-4EQupcfHzJYUTCY__l50htfY7yBY-YSNTGAuQMat2HAy8QQxXBOoOog3z7fqlOFA29BiPFo5ONznQdgXz4tQDQTLuN0SK4EFqdZdTVnuTnX0/s1600/IMG_2277.JPG" height="300" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A view of Monrovia from the air - my home away from home</td></tr>
</tbody></table>
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<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Beyond the rules of religion<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">The cloth of conviction<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Above all the competition<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Where fact and fiction meet<o:p></o:p></span></div>
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<br /></div>
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<span style="mso-bidi-font-family: Verdana;">There's no color lines castes or classes<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">There's no fooling the masses<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Verdana;">Whatever faith you practice<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Verdana;">Whatever you believe<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Oh, Heaven, Heaven<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">What the Hell is Heaven?<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Throw away your misconceptions<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Verdana;">There's no walls around Heaven<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Verdana;">There's no codes you gotta know to get in<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">No minutemen no border patrol<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">You must lose your earthly possessions<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">Leave behind your weapons<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">You can't buy your salvation<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<span style="mso-bidi-font-family: Verdana;">And there is no pot of gold…<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-family: "Gill Sans";">There are
no guns on the street in Monrovia. This is simply mind blowing given the fact
this country was torn apart by multiple civil wars over the last two decades.
Instead, the weapons of choice are words. Angry words, loving words and words
of salvation and redemption. The capital city Monrovia – named after President
Monroe - has more churches than any place on the planet. Period. Everything is
somehow inspired by, labeled with or branded through Biblical verse. More
specifically Biblical verse straight out of the King James Version. Blessed
anointed hairdresser. Shadrack Meshak and Abendigo grocers . Blessed Overcomer
Auto Parts. Lo and verily office supplies. The list is endless. My favorite
branding thoughts though are those found on the back of the ubiquitous yellow
taxis. These Datsun like fossils are held together with duct tape, bailing wire
and sometimes hundreds of those plastic zip ties police use for handcuffs. They
carry up to 8 or 9 people crammed in for short or long distances. One hails
these vehicles from the roadside with a wave at waist level that is a
combination of a shaka, a quiet down hand signal and a throwing the dice
motion. There are of course a million variations but elements of all of the
above are in every one. The backs of these vehicles are painted with mostly
Bible verses. Corinthians and Proverbs are especially popular. Some are more
nebulous like "do not me" and “Boy Armah”.<span style="mso-spacerun: yes;"> </span>Others are straight to the point "Shut
Up!” <span style="mso-spacerun: yes;"> </span>The most clever one by far though
said "talk about me". I couldn't get it until I asked our driver and
he smiled and just said, "see". There we were, we were talking about
him. As we pulled up next to him as the traffic slowed I swear he looked over
at us and smiled and knew his sign had worked. Even the trucks have their
version of the Liberian bumper sticker. See the picture below. I think it says
God is #1, Real Madrid Two is #2 and goes through to Ronaldo who is #7.</span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9ZQcQPhph3qCWORFY-poBVFaDpqenHNzH-XWENJ03A4QdyFTrVnHmhWwFD9HOdcgquB8m3So0BAPiiBecA1F_6-dl1DNqEB0Dcy3RYb5TkDql3hZyZUcXMx0MbYpG2c_L-c6Fq0MxXfE/s1600/IMG_2423.JPG" imageanchor="1" style="clear: right; display: inline !important; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9ZQcQPhph3qCWORFY-poBVFaDpqenHNzH-XWENJ03A4QdyFTrVnHmhWwFD9HOdcgquB8m3So0BAPiiBecA1F_6-dl1DNqEB0Dcy3RYb5TkDql3hZyZUcXMx0MbYpG2c_L-c6Fq0MxXfE/s1600/IMG_2423.JPG" height="480" width="640" /></a></div>
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Amidst all the
traffic noise one can always pick out the sound of very inspired preaching any
day of the week and anytime of day.<span style="mso-spacerun: yes;"> </span>I
grew up going to church twice on Sunday and even some Wednesday nights. Many
Liberians go everyday and all day Sunday. When we first got here my colleague
Brian a silver haired and distinguished Kiwi thought it might be proper to go
and visit one of the African Methodist churches and show respect and learn some
more about the community. They sat him up front in the middle and six or seven
hours later he returned exhausted, well fed and hoarse from singing. What I
wouldn't give to have a tape of Brian's New Zealand accent joining with the
local choir at full volume. Church is serious business here. Every faith is
represented although the majority are some type of Evangelical Protestant. Just
along the 3-mile strip from the main base to the heliport that I drive nearly
every day I counted some 63 churches. Wild. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: "Gill Sans";">Speaking of
wild, the pastor of one of these churches is rather infamous in the recent
history of Liberia. During the Liberian civil wars he was known to all as
General Butt Naked. I am not making this up. And yes, for those of you familiar
with the play Book of Mormon this is the man who was the inspiration for the
character General Butt Naked. Well, those of you familiar with the play will
recall that’s not exactly the character’s name but given the fact my kids read
this we’ll leave it at that. He is now an Evangelical minister known as Joshua
Blahyi but in his former life was a feared warlord and admitted cannibal and
war crime perpetrator extraodinaire. Raised as a Sarpo tribal priest he
converted to Christianity</span><span style="mso-bidi-font-family: Georgia;"> when,
he says, Jesus appeared to him during a human sacrifice and asked him to repent
his sins. Today Joshua Blahyi devotes himself to running a ministry, making
amends, and rehabilitating former child soldiers. In his former life he ran the
Butt Naked Brigade, a militia aligned with Samuel Doe who ruled the country for
a time during the wars. There were countless militias in those days, led by men
who adopted noms de guerre such as General Bin Laden, General Mosquito, Colonel
Fire in the House, Major Blood and Lt. Double Trouble. Butt Naked’s soldiers
were particularly ruthless—killers and rapists who fought naked except for guns
and shoes. Their nakedness was meant to instill fear and, they also thought, to
protect them. By their own admission, before battle they often sacrificed young
children, ate their hearts, and drank their blood. “The hearts were
roasted,” Blahyi told a reporter, as if that were a mitigating detail. You
can find pictures of the same on the web but they are just far too graphic and
disturbing to post. In 2008, in front of Liberia’s Truth and Reconciliation
Commission, he claimed that he and his followers had killed more than 20,000
people.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Georgia;">Of all the
African conflicts in late 20th century, the Liberian civil wars stand as among
the most macabre, gruesome, and sensational. After his capture President Doe
was videotaped being tortured. His ears were cut off and he was told to eat
them. He finally bled to death on the floor as his captors sat around drinking
Budweiser. Child soldiers, some as young as nine, ruled the streets. Taylor
called his recruits the “Small Boys Units.” They were fueled by cocaine,
alcohol, and marijuana, and would at times fight dressed as women or wearing
wedding dresses, wigs, shower caps, and Halloween masks. Some fought naked,
cutting off limbs and beheading people as they went. Cannibalism was not
unusual. Some 300,000 people died in these wars, about 1 Liberian in 10. As
horrific and recent as these memories are the Liberian people have moved on.
Grace, forgiveness and redemption are not just words. They are truths they live
out everyday. The fact that Pastor Blahyi lives among them is but a single
example. There are thousands. Optimism is another overpowering fact of life
here. Despite the grinding poverty, the challenges of daily life and the
scourge of Ebola they never give up. I thought I was an optimist until I came
here. Now I sometimes feel like Eeyore.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Georgia;">Today the former
General Butt Naked lives in a rundown suburb of Monrovia called Chocolate City,
as in the P-Funk album. George Clinton, like President Monroe, is on the
Liberian map. Amazing Grace indeed. Heaven, what the Hell is Heaven.<o:p></o:p></span><br />
<span style="mso-bidi-font-family: Georgia;"><br /></span>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: 12.8000001907349px; text-align: start;">General "Butt Naked" Blahyi today</span></td></tr>
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<br /></div>
<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Georgia;">Note: The lyrics to Heaven are by Brett
Dennen </span></i><br />
<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Georgia;">and Natalie Merchant. Much of the information on General Butt Naked
comes from a Vanity Fair article by Tom Freston</span></i><br />
<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Georgia;"><br /></span></i>
<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/AVvXsEhIQMDPjGz1QeXbPMulAtYRpZpNlZvPkOKCT-1P3T-nwEvSf8zGRkO20l-gbq-EvTcrQrNwn_UUrDQMf9m5BtR5hlTvCrk6twqTvaLlfcxNKzPcoyFZhQaJTYjZ3ewXsMNR7qa1pWWjCyU/s1600/IMG_2599.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIQMDPjGz1QeXbPMulAtYRpZpNlZvPkOKCT-1P3T-nwEvSf8zGRkO20l-gbq-EvTcrQrNwn_UUrDQMf9m5BtR5hlTvCrk6twqTvaLlfcxNKzPcoyFZhQaJTYjZ3ewXsMNR7qa1pWWjCyU/s1600/IMG_2599.JPG" height="480" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A little slice of my Heaven...</td></tr>
</tbody></table>
<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Georgia;"><br /></span></i></div>
<!-- Blogger automated replacement: "https://images-blogger-opensocial.googleusercontent.com/gadgets/proxy?url=http%3A%2F%2F4.bp.blogspot.com%2F-1OaXN4J6pxE%2FVMaRE2tBtsI%2FAAAAAAAAAIE%2FR2iWDCLcleM%2Fs1600%2FIMG_2423.JPG&container=blogger&gadget=a&rewriteMime=image%2F*" with "https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9ZQcQPhph3qCWORFY-poBVFaDpqenHNzH-XWENJ03A4QdyFTrVnHmhWwFD9HOdcgquB8m3So0BAPiiBecA1F_6-dl1DNqEB0Dcy3RYb5TkDql3hZyZUcXMx0MbYpG2c_L-c6Fq0MxXfE/s1600/IMG_2423.JPG" -->Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com1tag:blogger.com,1999:blog-3443535780025053159.post-7392976823063817202015-01-11T20:56:00.001-08:002015-01-17T22:38:36.573-08:00I Hate Snakes<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">I hate
snakes. I really really really hate snakes. They are everywhere here. The
mambas even come in three varieties – black, green and Jameson’s. Liberia has
one of the highest concentrations of snakes in Africa. Of the 10 deadliest
species in Africa 7 are found right here in Liberia in higher numbers than
anywhere else. Wonderful.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">Let me tell
you more about the black mamba specifically. It is far and away the most feared
snake here for reasons that will become very apparent as you read along. The
black mamba (picture below) is not really black. It’s more of a dark gray. The
name comes from the intense purple black color of the inside of the mouth. They
are the fastest land snakes in the world. They can reach speeds of 10-12 miles
per hour in short bursts. You cannot outrun them. The average human can maybe
sprint faster but good luck getting up to speed faster than a pissed off black
mamba can. Being pissed off is a big part of the problem actually. Black mambas
are very aggressive snakes and very territorial. They can grow up to 15 feet
long and tend to race along with the front third of the body off the
ground.<span style="mso-spacerun: yes;"> </span>When striking they throw their
head upwards from the ground to about two-fifths their total length. Do the
math. Two fifths of 15 feet is 6 feet. Easily head high for most people and a
number of black mamba bites are indeed inflicted about the head and neck.
What!! They are also great tree climbers and often hang from branches further
contributing to the number of bites on the head.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">The bite of
the black mamba is deadly. The venom is neurotoxic and cardiotoxic. If not
treated the symptoms include tightening of the chest muscles, shortness of
breath, coughing, blurred vision, mental confusion, and an overall feeling of
great discomfort. Sounds so much like falling in love. Except rather than
getting married, having kids, raising a family and living out your golden years
these feelings are followed by death in about 4 hours. Prior to antivenin a
bite was always fatal. And I know exactly the question many of you are now
asking. Do we have access to antivenin? Yes. We do. Oh yeah, as deadly as their
bite is you’d think they would be satisfied just biting you once but no. The
black mamba tends to inflict multiple bites in rapid succession. Let’s review.
The black mamba is huge, very aggressive, can outrun you, bites multiple times
about the head and shoulders and its bite is uniformly fatal if untreated. We
killed five over the past two weeks at one of the remote sites. Next time I’m
out there I am going to pee in a jar at night rather than venture out of the
tent. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">There are
other crazy bad snakes here too as mentioned. There is the lovely Gaboon Viper
famous for its two-inch long fangs, the black spitting cobra capable of
accurately shooting neurotoxic venom into victims eyes up to twenty feet away
and the black (what is it with black snakes?) tree cobra which is even more
ill-tempered than the black mamba by some reports. Liberians hate snakes even
more than I do. For a snake bites dog story – don’t fret, it ends well – take a
look at this story. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">http://turningleftatyesterday.wordpress.com/2013/02/03/cant-do-nothin/<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">There are
lots of other things that bite here. Seems at times most every critter has a
fang, a spike, a stinger or a spray. Darwin rules. There are countless species
of spiders, bees and even a beautifully colored ladybug like thing – it looks
like a ladybug – that sprays a burning chemical on your skin if you disturb it.
I have a spot on my right elbow that still itches after two weeks. I mistakenly
tried to flick it off and you can hear an audible hiss as it sprays whatever it
sprays. It burns like acid and then itches for hours. I can’t find what the bug
is. The kids put them on each other and disturb them to make them spray. Fun.
Of all the biting creatures though, the deadliest by far is the smallest – the
mosquito. Malaria is everywhere. We’ve had a number of cases amongst the team
already. Thank goodness for Coartem. Most everyone is on anti-malarials but it
still happens. Some of you may remember the US Marine deployment to Liberia
back in 2003 during the civil war. A quarter of the troops were hospitalized
with malaria. I now take malarone for my prophylaxis. Taking a daily pill is
hard though. I have to admit, I just realized while writing this that I forgot
today’s dose. See. I switched from doxycycline a few weeks ago. It was tearing
up my stomach. I had used doxy for years without a problem but not this time.
Must be getting old or something.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">It wouldn’t
be fair to speak of only the biting things here. Liberia is blessed with all
the beauty the West African rain forest has to offer. There are chimpanzees,
pygmy hippos, a bazillion beautiful birds and some 800 species of butterflies.
There are even orchids but Hawaii still wins that contest. Speaking of Hawaii,
love to all my friends and family there. I miss you all dearly of course. So
many of you have made a special effort to support Jess and the girls. They’re
strong and well practiced at dealing with my absence but your caring still
helps so much. Mahalo. And did you know Hawaii has NO snakes.<o:p></o:p></span></div>
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<!--EndFragment--><br />
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Gill Sans";">Ebola still
continues to dominate every aspect of life in Liberia. Mine certainly.<span style="mso-spacerun: yes;"> </span>There was a bump in cases over the holiday
period. The epidemic remains but the numbers do look a bit better. I’m at meetings all morning tomorrow and should hear the
latest. Sierra Leone is a different case unfortunately and my colleagues
there are in the thick of it. I’ll write about them sometime soon. I head back
to the bush later this week but will plan to put out another update before I
go. I’m planning on writing about life in Monrovia.
The café society – kidding – and what daily life is like here. I will do the
same for life in an ETU soon as well. We are opening more in the next 10
days or so. Time flies when you’re busy. Not fast enough though. Aloha. Did I
mention I hate snakes?<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/AVvXsEi-FTiOLzOM4pcXPntHat5l36D0EGynPQhR40KoXQwZIJ1EmCaTF9K2SRAcD2Lh3XbnFMzz6TQ9pJwhW6qMm836WTcDf5h1WAiyuli_RW-X7QAvlRE4hQHQAYjfftayJIswUpa3uGTk1iE/s1600/black+mamba.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-FTiOLzOM4pcXPntHat5l36D0EGynPQhR40KoXQwZIJ1EmCaTF9K2SRAcD2Lh3XbnFMzz6TQ9pJwhW6qMm836WTcDf5h1WAiyuli_RW-X7QAvlRE4hQHQAYjfftayJIswUpa3uGTk1iE/s1600/black+mamba.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Black Mamba</td></tr>
</tbody></table>
</span><br />
<br />
<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/AVvXsEibI695uIow6X_GUoy83LeKIJRZ6DTMWL7gJD5k2m0I7I8IiNjpwAyvWQuVqtycAQyC7Rz9Cx9n0wZkFNFVaVmocipKdYS-jMIXfV4d6TlmIGZveDFcUgGjaRCCKVriLKXDlz5gP5C-4Gw/s1600/black+mamba+mouth.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibI695uIow6X_GUoy83LeKIJRZ6DTMWL7gJD5k2m0I7I8IiNjpwAyvWQuVqtycAQyC7Rz9Cx9n0wZkFNFVaVmocipKdYS-jMIXfV4d6TlmIGZveDFcUgGjaRCCKVriLKXDlz5gP5C-4Gw/s1600/black+mamba+mouth.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Where he gets his name...</td></tr>
</tbody></table>
<br />
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<span style="mso-bidi-font-family: "Gill Sans";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD4Q3q-nMsP8q9oxiYIi5AcVmBY-I0civv7822nAYdi2dAwi1f0uuG7OF-1VlM_-oVme8J02KNf5n6-X139HB-UCMRu3O9A13-WXjz_BwuRgBGLAMeWGjkEv4STOed2teZ7VFbxhnr3nw/s1600/pygmyhippo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD4Q3q-nMsP8q9oxiYIi5AcVmBY-I0civv7822nAYdi2dAwi1f0uuG7OF-1VlM_-oVme8J02KNf5n6-X139HB-UCMRu3O9A13-WXjz_BwuRgBGLAMeWGjkEv4STOed2teZ7VFbxhnr3nw/s1600/pygmyhippo.jpg" /></a></span></div>
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<span style="mso-bidi-font-family: "Gill Sans";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisIl4dsYppuQ98qicy__JlPp1kIzuuqyt38JIn2lCFnqORyjq6Dk2axNCS_CAtBo5XL_z4e7jgqaQC6mhiO2B9vcgdw0cH0JRKV_tqeZdbORXE78ejpziWNqZyUy_KgRV-EX4Oui3mm94/s1600/chimps.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisIl4dsYppuQ98qicy__JlPp1kIzuuqyt38JIn2lCFnqORyjq6Dk2axNCS_CAtBo5XL_z4e7jgqaQC6mhiO2B9vcgdw0cH0JRKV_tqeZdbORXE78ejpziWNqZyUy_KgRV-EX4Oui3mm94/s1600/chimps.jpg" height="384" width="640" /></a><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: 1em; margin-right: 1em; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0UzClLJ4exr_A-GZ8E6eJG2nwXZpa5oDw08KsNxH2EpfrYgC-r0t15VUdsaECaRP_zqgp_chZjfHnwHJ51gU7uGGEJneeT71u4EWN2fdqP_OnFPZGp6YU72Sr_WutFaTkpYR__UA_5-w/s1600/black+mamba+in+toilet.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0UzClLJ4exr_A-GZ8E6eJG2nwXZpa5oDw08KsNxH2EpfrYgC-r0t15VUdsaECaRP_zqgp_chZjfHnwHJ51gU7uGGEJneeT71u4EWN2fdqP_OnFPZGp6YU72Sr_WutFaTkpYR__UA_5-w/s1600/black+mamba+in+toilet.jpg" height="479" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Saved the best for last!</td></tr>
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Tom Crabtreehttp://www.blogger.com/profile/09624529184018771366noreply@blogger.com5