A Soccer Goal without a Net

I have watched more soccer on television here in the past month and a half than I have ever watched.  It is the African Nations Cup tournament, a time when all the countries in Africa who have qualified over the past two years square off in a format identical to the world cup.  They are each assigned to a group and the top two teams in each group advance to play teams from one of the other three groups.  Starting with sixteen teams in four groups, they are reduced to 8, 4, and then 2 remaining teams.  African players who play for lucrative European teams come home to join their national team for the honor to play for their country.   For their fellow countrymen and women.  For bragging rights.  Much like any sport, the affinity you have for your team is steeped in the story of your team, and when it is a national team in Africa,  the stories have chapters.  Colonization chapters.  Dictator chapters.  Corruption chapters.  Genocide chapters.  Starvation chapters.  Disease chapters.  Independence chapters.  Freedom chapters.  Redevelopment chapters.  Prosperity chapters.  Redemption chapters.  And always hope chapters.  

Guinea qualified for the African Nations Cup despite not being able to benefit from any home field advantage.  Because of the Ebola outbreak that started in Guinea in December, 2013, all its games had to be played in other countries.  They overcame great odds to qualify for the Cup and advanced to the 2nd stage before being knocked out.  Morocco was supposed to host the 2015 Cup but withdrew because of the Ebola outbreak.  Public gatherings to watch soccer are still banned here in Sierra Leone, so we didn't get to watch the matches together but everyone rooted for them and followed along on the radio or on the lobby television.  All of the teams have distinct, overt personalities shaped by the current state of affairs in their country.  Some teams are content with a take-no-chance conservative ball control management devoid of any flare for the dramatic or aggression.  They are stable, status quo.  Others are hungry, young, and aggressive, attacking with long runs that draw on power and individual skill, with a touch of undiscipline.  They want change and don't want to be restrained.  The teams that can find just the right combination of speed, power, and finesse and arrangement in proper spacing are the ones that advance.  Soccer is all about triangles.  And so much more. The "beautiful" sport indeed.

I am nearing the end of my time here.  The stories keep coming in, carried by ambulances from familiar and unfamiliar villages.  The longer you stay here, the more it becomes clear that Ebola is only one of many epidemics continuing to rage.  

Ali, a new driver for International Medical Corps, was interviewed here three weeks ago.  His wife was pregnant and due any day as he left his village to travel to Lunsar to interview for the coveted, yet temporary position.  He wore a full pin-striped suit and carried a brief case he told me as he rode in a "bush taxi" all morning to get here.  He interviewed well and was offered the position.  He was all smiles and couldn't wait to tell his wife.  A few minutes later he received a call from his village that his wife gave birth to a healthy baby girl but that his wife died in the process.  He continues to smile and call us "sir" and "mam" when he drives us to and from the Ebola tents.  Beyond Ebola, Sierra Leone has one of the highest maternal mortality rates in the world.  

Mohammed, a 34 year old construction worker who helped in the construction of our Ebola Treatment Center, was diagnosed with pulmonary tuberculosis back in August and was started on medications at a TB clinic called Lakka just north of Freetown.  He took the medications for about one month and then, according to him, the clinic shut down because of Ebola.  He was offered the job to work for the contractor who won the bid for our treatment center construction and left his hometown to come to Lunsar to work.  Without medications.  He was brought into our center 3 days ago because of shortness of breath and fever.  He was felt to be a suspected case of Ebola but it was clear when we saw and talked with him that he had progressive lung disease from TB.  He had a small head that sunk down between his shoulders and a flat, sculpted face that reclined slightly to expose a large patch of  forehead.  His arm musculature was defined in that way manual labor develops muscles-- without gross exaggeration of biceps or triceps.  His fit chest expanded and contracted in short, shallow breaths.  Sweat beaded at his adam's apple and streamed down the muscular mid-line canal that ended in his navel.  He was confused and restless due to the fact that his oxygen level was 75%, normal being over 95%.  He died six hours later.  Beyond Ebola, tuberculosis rates in Sierra Leone are the highest in the world.

We received 10 new patients over the past two days from several separate outbreaks from different villages.  I was giving a talk about fluid resuscitation for all the nurses and doctors yesterday in our canteen when we heard three ambulances were arriving simultaneously.  Ishmail and his 1 month old daughter Isatu, were admitted to our probable ward.  The wife, and mother, died from expected Ebola earlier in the day at their home in the village.  Ishmail refused to believe the news and lay in his bed with his head covered by the blanket as his IV fluid bag hung like a jelly fish from a make shift IV pole.  I came to see him last night and, through the Temne translator, tried to give him sympathy and encouragement at the same time.   His eyes were red and his two day stubble implied it had been a rough couple of days.  Isatu was on a padded table as three nurses in PPE hovered over her like space monks tapping her tiny hands, looking for veins.  Her skin was paper bag dry and stayed tented up when you pinched it.  The little soft spot on her head, the anterior fontanelle, was sunken in- all implying severe dehydration. The baby sucked on one of the Ebola survivor's fingers who would be assigned to her for the night as they tied off her arm with a tourniquet and tried repeatedly to find a vein to put an IV in.  A tube to be put in a tube.  The baby cried but wasn't able to produce tears.  Finally they found a vein on her forearm the half the size of  a coffee stirrer and were able to put an IV in it.  We gave her fluids and some formula as she hadn't breastfed in 5 days.  The father, Ishmail,, was too weak to get up to hold her.

Mariama, a one year old baby girl, lost her mother and father to Ebola and was in our suspect tent just last week.  She was discharged as Ebola negative but because of her family exposure, and now lack of family, was placed in a temporary orphanage where she could be watched for signs and symptoms of Ebola.  She was brought back in yesterday after developing a fever and is now positive for Ebola.  Armed with a stuffed animal my son gave me before I left, I went in to see her in our confirmed ward.  She was sleeping, her soft nose flaring and her tiny lung pumps working hard to breathe out carbon dioxide to balance out the acid level rising in her blood.  She had lost weight and was vomiting earlier.  I put the stuffed animal under her blanket and put my hand on her head and kept it there while I looked at her.  Yes, she could be  the first child under five that makes it out of here alive.   Yes, we got her in early didn't we? Just after the fever started, right?? You can do this Mariama. You can do this.  You can.  You.

The night noise outside our giant white tents is a relentless cricket screech and fat buzz of giant flying insects as I try to catch a few hours of sleep before morning rounds.  I only have four more days here in Sierra Leone.  I put my headphones in to take control over the noise.  I put on an album by Elephant Revival and close my eyes.  I am wide awake.