While I was in Brussels for my training with MSF, I learned several things about Ebola that made going a very serious decision.  So serious that on the last day of training, in the last hour, they asked all of us to seriously consider if we were ready and if we were not, to PLEASE not go.  They told all of us that it was not shameful to walk away at this point but to know your limits.  Here is what they shared just before asking us to consider our decision:

1. 311 health care workers have died in the outbreak and all worked in Ebola treatment units. (as of early November)
   
2. Everyone who has had a needle-stick has died.
   
3. Liberia has lost 30% of its doctors.
   
4. The disease goes against our natural instincts to care for each other...it destroys families.
   
5. The time of diagnosis is not playing a factor in mortality or survival.  The onset of illness and day of the beginning of therapy does not make a difference in survival.

These are grim facts to hear just hours from boarding a plane and heading into a country infected with a deadly disease that has no cure.  It's no wonder that I didn't sleep much the night before I left for Liberia!  But, my decision to go never wavered.  I think about 1 Timothy 1:12, which says, "I thank Christ Jesus our Lord, who has given me strength, that he considered me trustworthy, appointing me to his service."  It really is an honor to serve and go forth... I know that must sound corny to some people, but it's the truth.  I am honored to be able to go to the places I go and work... to be a light... to show love and compassion through medical work.  I really have the best job in the world!

My first day in Monrovia (after a late night arrival and the beginning of weeks of no touching, temperature being monitored and hands being washed in a 0.05% chlorine solution) started with the World Health Organization (WHO) cluster meeting.  This was a meeting where all aid agencies gathered together once a week to learn about the current situation, any changes and new information.  The who's who of everyone Ebola was there... and now so was I!  I learned that there was a new language being spoken... an acronym language that I didn't understand.  In fact, in the next few days, I wrote down almost 100 acronyms specific to Liberia and Ebola that were used like actual words in most conversations!  I had a lot to learn.  I had originally thought that language wouldn't be a problem because Liberians spoke English, but the reality was that Ebola had a language all its own and there were no classes to take to help me learn.  I just began writing acronyms down and looking them up every night until I had my list.  Within 72 hours I was nearly fluent with basic conversational Ebola, and after a week, I was giving advice to another new volunteer and passing along my word list.  How quickly time was flying.

My job in Liberia was to help the Liberian trainers that worked for Medical Teams International (MTI) teach infection prevention and control (IPC), triage set-up and waste management at almost 130 non-Ebola health facilities that MTI was assigned to by Ministries of Health and Social Welfare (MoHSW).  (See all of those acronyms in just one sentence!!)  Each day 4 teams of 3 trainers would be assigned a set of facilities within Montserrado County, load up SUVs with donated supplies and make site visits.  If it was the first time we were visiting a facility, we would tour their facility and do an initial assessment of IPC, waste management and their ability to have triage point in their facility to prevent Ebola from entering the clinic.  Then we would begin training from scratch.  Other days, we returned to previously visited facilities to mentor or re-train them.  This training could take 3-4 hours at a facility and some days we were at 4 facilities.  If a clinic was 2 hours away, it could be a long day!!  Some centers were rural with poor access to the main city of Monrovia, while others were right in the middle of major market areas and we actually had to ask vendors to move their stalls to drive down roads to get to the clinics that were down back alleys and pressed between larger buildings.  Some people were happy to see us and very receptive.  Some of the clinic staff could care less that we were there and were blatantly rude.  I never knew what to expect each day that I went out with the teams.

The one constant of my day was the dedication of the trainers that I worked with.  They were amazing people with a heart for making their country safe and ridding it of Ebola.  They shared their lives with me and laughed with me and answered my myriad of questions about culture, life and disease in their country.  It was hard to say good-bye.  I felt like I was abandoning them when they still needed so much support and encouragement.

Imagine spending 4 hours training at a clinic, encouraging the workers, giving them supplies so that they can do all of the things you've asked them to do so that they are safe and they send you off with smiles and assurances that they will do all you've asked.  Then you go back in just a week and they are doing nothing and pretend that they don't even know you.  It can be so discouraging.  It can feel like you've wasted your time and energy.  Yet these trainers keep going out, day after day, because they still find clinics that are making positive changes and keeping Ebola at bay.  We are finding clinics who have made BIG changes and now have more patients than ever because they are now considered safe clinics when before they were not.  Change is happening, but in a way that might seem too slow for many of us.  I learned a phrase that my Liberian friends taught me... "small, small."  Accept the changes you see.  They don't have to be big or grand... they can be small, small and that's still a change and that's still ok.  So, today, I pray for change to keep moving in a positive direction... little by little... small, small.

The biggest issue when I left was that people were starting to get too relaxed about Ebola.  The numbers of cases were down, so people believed it was gone.  Hand-washing stations were disappearing or people just stopped using them.  Chlorine wash buckets were empty and no one cared about refilling them.  Unfortunately, 3 health care workers died the last week I was there. We have to do better.  So the trainers still go out every day and make a difference one clinic at a time.