Carlos Kamara

Albert A. "Carlos" Kamara

Q: This is March 21st, 2017. This is Sam Robson, and I am happily joined today by Mr. Albert Andrew Kamara, commonly known as Carlos, in Port Loko, Sierra Leone, here at the DHMT [District Health Management Team]. This interview is part of our CDC [United States Centers for Disease Control and Prevention] Ebola Response Oral History Project. Thank you so much, Carlos, for being here with me.

KAMARA: Thank you too. Thank you for thanking me.

Q: Of course. [laughter] Would you mind just saying "my name is," and then pronouncing your name?

KAMARA: My name is Albert A. Kamara, Albert Andrew Kamara, commonly known as Carlos. It's a common name. It's a name I got during my footballing days. There was a renowned footballer from Brazil, and I was playing similarly to him, so my colleagues gave me that name, and to this day I bear this name.

Q: Thank you very much. Can you describe what your current position is?

KAMARA: Currently, I'm the district disease surveillance officer for the entire district.

Q: If you were to describe to someone in just a few sentences, two or three sentences, what your part in responding to Ebola was, what would you say?

KAMARA: My role during Ebola was purely surveillance. Surveillance, that is early detection of cases, [reporting of cases], doing line listings, and quarantine of cases. In a nutshell, surveillance was there to actually break the chain of transmission so that the disease does not spread to too many people all over the district.

Q: Thank you so much. We're going to back drastically up for just a second. Would you mind telling me when and where you were born?

KAMARA: I'm from Tonkolili District, the northern part of Sierra Leone, in a 00:02:00village called Yonibana. Both of my parents are dead, but they didn't die during the war, they died before the war. I came from a very poor family [background]. I owe my education to a [US] Peace Corps volunteer that is currently in the United States, Florida. He was responsible for my education, right through and through, and I owe it to him to this day. To this day, we are still talking. He has plans to visit us in Sierra Leone, particularly to go and see where we were in Yonibana.

Q: What was his name?

KAMARA: He is Colin Baenziger, Mr. Colin Baenziger from Florida.

Q: Baenziger. Okay.

KAMARA: We are still communicating. A group of them were coming and they were helping us with paying our school fees, providing food for us, doing everything that we need to keep us going. It was not only him--first, they were two when 00:03:00they came. Alan Cathcart, he's also American, and then Mr. Colin Baenziger. Then Mr. Paul [A.] Wilson is in Canada, he is a Canadian, from Canada. Mr. Paul Wilson has actually been to see me after the war because they thought I didn't survive the war, so he came back and we met and we had some discussion. He went to Yonibana, took pictures of our old house where we were living. Actually, I didn't grow up in--part of my schooling was in Yonibana, and the rest of it was in Freetown.

[break]

Q: You were saying that you did not spend all of your youth in Yotibana?

KAMARA: Y-O-N-I-B-A-N-A.

Q: Yonibana?

KAMARA: Yonibana. I didn't spend all my youth in Yonibana. I had to relocate to Freetown, where I spent the rest of my schooling days up to the time I went to Njala, Njala University, where I became a CHO, community health officer. But before I went to Njala University, I did nursing first. I did nursing, community nursing, state and rural community health nursing in Freetown, in Freetown. Soon after I completed that, I went to do the community health officer course because it was a higher course, higher than the nursing course. From there, I came back to--when I graduated, I started working in Kambia District. Kambia District is in the north of the country, it's bordering Guinea. My first PHU, peripheral 00:05:00health unit where I worked, was Kawulia in the Masungbala Chiefdom in Kambia District. From there I was transferred to another peripheral health unit in this same Kambia, Gbonkomaria [Community Health Center]. I spent a few years there and then finally I was transferred to Port Loko District in Lunsar, where I worked up to the time of the Rebel War.

I was forced to move from Lunsar to Freetown by the rebels because the rebels overran us and some of us had to walk with my kids in the bush, walk through the bushes of Lunsar, access Port Loko headquarters, which is the district headquarters. Walked there, picked up a cab, and then went through the ferry to Freetown. News was doing the rounds of our relatives who had been killed during 00:06:00the war, but that was not--we are very lucky we escaped them. We came to Freetown. We were there until in January, a week to Christmas, a week to Christmas, that was in 1999 when I ran away from--finally ran from the provinces to Freetown. We came back to Freetown, and tension was building up. Rumors were rife that they were going to attack the city. Indeed, the guys on my way past, when we were coming, some of them--some of the rebels knew me because I treated some of them because they were playing double roles. Some were soldiers--at one point they are soldiers, at one point they are rebels. When they get sick, they go to the center, I treat them. They told me, they said, "Hey Carlos, don't go 00:07:00to Freetown because we will surely attack Freetown. If you are choosing to go, go over to Lungi and stay there." They told me that, so I went back and I told my wife and relatives we should locate to Lungi. But they were very much--they had belief in the forces that came to actually--these Nigerian forces. The ECOWAS [Economic Community of West African States] forces. They very much trusted them because they helped the president, the former president, to come back and rule. When I told them, nobody was eager to actually leave, so we were here until we were overrun again. The guys came, and this time they were deadly, they were so deadly. They came, I was in one of the houses, in a family house, they came and settled down, set fire on the--settled down and then--

Q: They set fire?

KAMARA: They set fire on the building. We had to jump through the window with my little kid. We jumped and went and hid ourselves in some banana trees. Then later they came out, it was horrendous. They nearly shot my wife, they caught my wife. She was captured by the rebels and the rebels told her plainly that they were going to chop off her arms. I was there, I just breathed, just breathe, just breathe, and my little kid was there begging and pleading on them, "Please don't cut my mother's arm, please don't cut my--" All of a sudden, a small boy about the age of twelve materialized from nowhere and said, "No, this woman resembles my mother, you are not going to chop her hands off. Go." He commanded my wife to go, to just go, and she ran. We used to have a common whistle, so she 00:09:00whistled me, and I noticed, I waved, and she just beckoned to me that we should move. So we moved, so we were there.

I had to come back, but before I came back, I had to join--because I needed to eke out my living somewhere. I had to join some NGOs [nongovernmental organizations]. I had to work for some NGOs. Save the Children UK [United Kingdom], I was there as program manager. I was charged with the responsibility of children left behind in the war. I was with that program until actually the program folded up.

I decided to come back to government, and I came back to Port Loko in 2006. I'm here to this day. When I came, I had the opportunity to go back to Ghana. I was [told] by the district medical officer to go and do epidemiology and health system management in Accra, Ghana. So I was there, I got a certificate from 00:10:00there, and soon, I came from there. That brought about the beginning of my surveillance, because we did some surveillance stuff while I was there. They thought, the district thought the most befitting person to head this unit is me. From that time to this day, I have been a surveillance officer, together with one of my assistants. That's how I came to surveillance.

Q: Were there certain diseases or outbreaks that you remember tracking especially?

KAMARA: Yeah. Before Ebola, we had--in 2012, we had an outbreak of cholera. That was my first experience with investigating and responding to outbreaks. That was 00:11:00the first outbreak we had, I had, and we survived it. We went through it.

In 2014 came Ebola. It started somewhere in the Southeast, in the East, that is Kailahun [District]. When it started, it started with people saying it's a political thing, it's a ploy by the northerners to keep people in the South so that they would have lesser numbers, those sort of things. It was there until we had a taste of it sometime in June, June around the 24th, 25th to the 29th. A 00:12:00certain driver is plying his trade between Mambolo [Chiefdom], which is in Kambia District, and is doing his trade in the East in Kailahun, the remotest part of Kailahun. He came to Mambolo, he's trading in fish. Gets loads and loads of fish because the ocean is in Mambolo. He gets traders to give him--to leave Mambolo to go and sell their wares in the East, in Kailahun. But that week when he left for Kailahun, he didn't have a very good market, so he decided to further his trip to Monrovia. He went to Monrovia for desire, for the dollar. He went and sold his wares, and [met] with these long-distance truck drivers. I 00:13:00think he had some affair whilst he was in Monrovia, in Liberia. He came back, went through Koindu--that's the border. Went through the border, came back, and he picked up a nurse from Koindu. Little did he know, little did the lady, the nurse, know that this guy is infected. The guy did complain, this truck driver did complain to him that he was not feeling well, so he said, "I have my peripheral health unit along the way. So we'll take you there to be treated." So he went there and got some medicines, and he left that very night. Not together with the lady, is one of these PHUs along in the East, the PHU's name is Daru. Daru Community Health Center, so he left there.

He came here, he also had a girlfriend in Masiaka. Masiaka is where there is the 00:14:00bifurcation where if you want to come to the South, and this road to the South and this road to the North. He came there, he called on this [nurse], this [nurse] girlfriend. The girlfriend came, and he told the girlfriend and she should help to treat him, said he was not feeling well, but nobody--they were all least expecting it was Ebola. Fortunately for the peripheral health unit in charge, he was not there. She had to manage this case. He slept there. Early in the morning, he left for Mambolo. He came to Mambolo, things turned out for the worst. He went to the hospital. The hospital staff [member] there identified, 00:15:00based upon his signs and symptoms that he had been taught, he noticed that this guy fit the definition of Ebola. He alerted his boss in Kambia, and provided the guy with some medicaments. But I think he didn't feel better, so he had to go underground. He went to a traditional healer. From there, it didn't get better. He hired a taxi and came to one of our hospitals in the district, that is Mabessaneh [Hospital], to be admitted. You know Mabessaneh? I think we were called.

I'm merely giving you a gist of how we, Port Loko, got this index case. They came to Mabessaneh, but before we actually went to Mabessaneh, our colleague in Kambia--Kambia is a just about forty-two miles from Port Loko. The guy called 00:16:00us, said that a case by so-so-so, XYZ name, we have just been reliably informed that he has left Mambolo for the Mabessaneh hospital. Can we do a follow-up? Straight away, we went and did the follow-up, collected some blood samples--oh, it was hell. By that time, if you suspect somebody of having Ebola, it's like you are passing a death sentence on that individual. So the relatives were not happy with us, and in fact, there was a standoff between the relatives and us in terms of obtaining blood samples. But finally, we succeeded in obtaining blood samples, and the samples were sent all the way to Kenema. The samples came five days after and they turned out to be positive. That is how we got the first case.

The authorities in Kenema by that time demanded that this patient be sent to--because it was the only treatment center for the whole country for Ebola. Now, the tussle is, how will we disclose this, how are we going to disclose this to the very patient himself that he has Ebola? We went and we decided to go through the wife. Oh, it was worse. She said, "Who the hell are you? What do you think? Who are you to tell my husband that he's got Ebola? God forbid, no, we will not accept it. We will not accept. No, he's not going, he does not have Ebola." So there was a standoff. We went to security; we went to the services of 00:18:00the police in Lunsar. We had to seek the services of the police in Lunsar for us to get this man loaded in the ambulance to be taken to Kenema. They took him to Kenema, and it took almost about two weeks.

Then we started--all those guys that were in contact with this, they started having symptoms similar to what the index case was presenting. Oh, my friend. So we left. This girlfriend in Masiaka, we went straight to her. "Lady, we heard you had an affair with this index case that passed away that has been sent to that place." She said, "Me?" It was always self-denial. Nobody wants to be 00:19:00branded as having Ebola. We said, "Yes, please, if you could allow us to collect--" Because it was us who were collecting blood samples with hand gloves and things like that. We succeeded after some persuasion in collecting a blood sample. The news about a nurse in Masiaka suspected of having Ebola spread like wildfire in the township. The lady became ashamed. Said we were going to actually make her name scandalous in the community. I was blamed. People went personally and attacked me and told me, "My friend, my friend, you of all people are telling our nurse that she has--" I said, "It's not me. I am only here to 00:20:00collect a blood sample and that's it." I'm only there to collect blood samples. So we collected the blood samples, and later the samples turned out to be positive. Then it comes again to move her here. We had to involve the services of almost all the key stakeholders in the township for her to be taken. That is how we got our first cases in the district.

After those two cases, then we started having a succession of cases, [unclear] cases, until we had the driver's mate. The driver's mate was also in the district, in the village called Mange Bureh. But he could not make it, he died. He died, we went out, we collected blood samples, myself and my assistant went 00:21:00and collected blood samples. He presented all the signs and symptoms of Ebola by then. We collected those samples, we sent those samples. When the results came--the result came before the guy died, so the guy died [unclear] in Mange Bureh. I offended--when we went to disclose that we suspected the guy of having Ebola, that was hell for us. How are we going to bury this man? We went to Mange to bury that chap. From twelve o'clock, we didn't leave Mange Bureh till eleven thirty in the night, just trying to convince people to allow us to bury, and not 00:22:00them burying the dead as usual. We're there, so we convinced them that, okay, we wouldn't mind them joining us in doing the burial, but they should clad themselves in PPE [personal protective equipment]. They agreed, initially. After we dressed them up, we went with one of our guys, because in fact, there was very little known about Ebola. So instructions were given to me on the phone about disinfection of corpses. The instructions were [given to] me through the phone. I followed those instructions. We went, and the guy was starting to disinfect the corpse when all of a sudden, some irate guys came and said, "No, no, no, this is rubbish, this is rubbish. In fact, this guy didn't die of Ebola, he died of pneumonia. Who the hell are you? You want to bring bad luck to our village? Now people are dubbing our fish where we get our money--they are 00:23:00dubbing these fish as Ebola fish. They are no longer selling in the neighboring village. We will teach you guys a lesson. No, this guy will not be buried by you." They took the guy forcefully, in fact they tore the PPEs that we clad them in, they tore them and said, "This is not Ebola, this is rubbish, we are going to bury this--" You know what they did? They took that corpse, went to the center, left the corpse, abandoned the corpse there, and went away, and they came after us. When we saw that danger was lurking, we decided to go to the nearby police station. Thank God there was a police station. We went to the police station because the inspectors saw it all. We're there, we are in the police station. I called my boss in Port Loko here to explain the whole incident. He asked that we secure--we stay at the police station. So the police 00:24:00people provided us some escorts. This is how we left. That was the case.

After that first incident, there were a lot in the number of cases. Then in July, we started having a succession of cases, during which time logistics were far and few between. We only had four vehicles to surveillance this entire district. Four vehicles to do surveillance in this district. We did not have--some of us were only given crash training. [At that] time there was no phlebotomist to be collecting blood samples, no goggles. You wear gloves, PPEs, you wear gowns, and that's it. No boots, no wellies, no nothing. We were risking 00:25:00our lives. The two of us, because it was only the two of us. The whole district, the people they look up to, it's us. We were going into the field on a daily basis, coming back, giving reports to the emergency operations center on a daily basis, giving the reports about that. That's our role. It came to a point that friends were very much afraid of us. They did not come closer to us for fear of contracting EVD [Ebola virus disease] from us, so we were sort of isolated. I stopped visiting my usual joints and decided to stay alone. Because during the first few months of Ebola, it was hellish. I mean, you tell anybody--it's better to say you are a thief than to be branded as having Ebola. It's like you are sure to die.

We went through all of this, and I think towards the end of the year, the 00:26:00British came in and helped us. Logistics were flowing like mana from Heaven. Doctors were set up, and we continued with that, with this up-and-down thing. One moment there's a lull in the number of cases materializing; the other moment has an increase. We came up with all sorts of strategies in order to bring the outbreak to a close, but we struggled a lot. From there, I think trainings were done in between, during the operations, and the number of surveillance officers was increased from the four of us to up to forty-two, with some help from 00:27:00outside. Forty-two surveillance officers were divided from among the eleven chiefdoms in the district. Surveillance officers came in, were increased. There was a burial team, there was a decon [decontamination] team, there was a quarantine team, there was a nutrition team that provided food, there was establishment of holding centers, CCCs, community care centers, [unclear], all over the district until we actually brought Ebola to some form of control.

At the start, that's why I always want to thank Regan [Rickert-Hartman]. Regan 00:28:00was very, very much instrumental in helping us and seeing that we were provided with logistics, even with the allowances, because we started with no allowances until the British came with all those structures [unclear]. She was going all out to provide us with--like this one, this printer was provided, this printer. Provided us with two laptops to be doing our reporting. It was good when I saw her back in the country, I was very happy for her coming because she played a good role in motivating staff and seeing that staff are motivated. She was giving us the moral sort of impetus for us to do more, go the extra mile. She 00:29:00was with us in the field even at the riskiest of all of those places. I can remember I took her to one village wherein we found about ten corpses and kids dying. My sad moment was when I met with an eight-year-old boy. He was bleeding from everywhere, and there was no food, he didn't have water. I had a liter of water. I mixed some ORS [oral rehydration solution], I gave it to that boy until the ambulance came and took him to Kenema. And I was told that he did survive. So I had wanted to see him. I went to the village at one time, but I couldn't find him there.

My sad moment was with the first case when I went to the village. There was this 00:30:00certain chap who had just taken the NPSE [National Primary School Examination]. The NPSE exam is the exam you took to graduate into secondary school. This guy just took that exam, and he became infected. I went and I pressed upon the pa [father], after the results came and turned out to be positive. "Please, don't take this child away, don't take the child to an herbalist to be treated." He would be treated. He refused, and the small boy died in the bush. That was my sad moment. Later on, I went there, this pa became a [health advocate] in the village. He was sensitizing people, he was pointing at houses that have cases because of the lesson he learned, and he cried when he saw me. He said, "If I 00:31:00had listened to you, my child would have survived." Those were the sad moments.

To this day, I am still with surveillance. Our structures have been formed, I have benefitted from some trainings, and now we have structures. For now, on a weekly basis because of the structures that have been formed, we have a surveillance meeting. The surveillance pillar is having surveillance meetings on a weekly basis to update key stakeholders on the situation of reportable diseases in the district. Diseases that have epidemic proportion in the district, and to look for more. On a weekly basis, we do have this surveillance 00:32:00meeting wherein we give presentations on those diseases we discover that are either a resurgence or an increase in number of cases that are presenting to the district. Because the surveillance structure here is--the strategy we are using currently is integrated disease surveillance and response, wherein on a weekly basis, you get reports from all over the peripheral--all the health facilities are reporting to you on twenty-eight priority diseases. These twenty-eight priority diseases are the diseases which we felt if they are monitored very closely, in the event of any outbreak or anything untoward, we will not be caught with our pants down like we were with Ebola. That's what we are using to 00:33:00this day.

Honestly, there are times when I feel down. I feel down because--I'm thankful to CDC because they have come up with this FETP [Field Epidemiology Training Program] training, because that is fine, they will build my capacity because my aim is to become an epidemiologist, and that's why I've gone to do my [unclear] course. I hope when I finish, God be my helper, I'll become an epidemiologist because during the outbreak, we didn't have epidemiologists. All epidemiologists who came were from East Africa or from other countries. We are thankful to CDC that they have brought--but from the start, some of us, we are very lucky we 00:34:00didn't die, because if we had died, we would have died for nothing. My kids would have [unclear] because I didn't have that much training actually to handle such a huge outbreak. So if you are here, that is the story. That is how we got Ebola, and that's how we fought with international assistance. If there had not been international assistance, I would not have coped. The Ebola escalated in the district for lack of logistical support. A district of eleven chiefdoms, we only have four vehicles with four personnel, it was rather impossible. The personnel who are even motivated. See, I have served in the Ministry for close to thirty years now. It's only in 2015 that I have been promoted to a senior 00:35:00community health officer. Can you imagine? Very, very [unclear]. And some of us are far advanced in age now, going on mid-fifties now. But my only solace is that I have been able, through this job, to educate my eldest daughter. She has graduated, she graduated a year ago from IPAM [Institute of Public Administration and Management] and she is currently working as an accountant at one of the banks in Freetown. And the second one has just acquired a general certificate of education. Here it is locally known as WASSCE [West African Senior School Certificate Examination]. She has just got it, so I'm thinking now, funds to educate her. But anyway, I believe, and I strongly believe, the 00:36:00Lord be my helper, I will see them through, yes. So that is it being a surveillance officer here in this country.

Q: Thank you so much for that description of what happened. Seriously, thank you for that. I have a couple questions, going back, if you wouldn't mind. You said that one thing that you worked on was quarantine. I understand that there were sometimes some debates about the form that the quarantine should take. For example, do you post police officers outside of homes or do you not? What kind of resources do you provide with the community and what do you not, that kind of thing. Do you remember any kind of conversations like that, and what your ideas were at the time?

KAMARA: Yes. There are always quarrels, even almost resulting in confrontations 00:37:00between the quarantine officers, the officers manning the quarantined homes, for reasons of not being provided with the kind of condiments that they're used to eating. I'm used to eating cassava leaf and palm oil. In the quarantined homes, they are provided with just the basics, and there are times these rations are not up to scratch, are not enough for them to go around, and at times there are some delays. With this kind of thing, somebody who is being used to having a big bowl of rice with cassava leaves, beans, and all the other condiments, pepper and salt, you name it. You quarantine that somebody and are not providing very 00:38:00close to what is [unclear], it's a recipe for chaos. There have been some chaotic moments, but thank God, these chaotic moments have been managed by local authorities because the services of local authorities are always called upon. Because these people, the quarantine, some of these homes are from their own locality, and it's been that they are moved to other localities that would have created a whole lot of hullabaloo. But thank God that some of the communities were quarantined in their own locality. So you always have in hand the services of local authorities, coming in to actually talk to them. And most times they listen, they listen to them. Yeah, so that has been the way when settling some 00:39:00of these upheavals and quarrels in quarantine. But it has not been easy, especially in the area of providing them with those things that they're used to eating. If I am used to eating rice and palm oil, you're give me oil, oil, oil, oil, all day long, I don't have the right things.

Q: What kinds of things were they giving that were so different than what people were used to?

KAMARA: Well, all sorts of things that they do provide them to cook. At times they only cook soup. They want leaves, they are used to eating leaves, so if you don't provide it--and when they provide it, they don't provide them with the Maggi sauce. Maggi sauce is a sweetener. We do not provide them with sweeteners to actually make their soup palatable and things like that. So we used to have quarrels, and it was often WFP [World Food Programme], the quarantine team needs 00:40:00to come back, sit and look, re-strategize so that people--quarantine is one of the worst things people like about Ebola, which continues dialogue and things like that. People often run from quarantined homes because they fear that they won't do--it's like jailing them, they are putting them into prison.

Q: Do you remember any specific instances of someone running from a quarantined home and what you had to do?

KAMARA: Yes, yes. Well, there was a certain case between the borders--the Kambia and Port Loko border, and certainly it was diagnosed as having suspected [Lassa fever]. The [unclear] from the other chiefdom, from Kaffu Bullom, where the 00:41:00airport is. This [unclear] came to collect a laptop from the quarantine. They went, and that chap was treated, was taken to be treated elsewhere, and that was how people got--I think up to eighty-five deaths were reported as a result of that one [unclear] escapee to Kaffu Bullom. Then others, they provided them with mattresses, they run with the mattresses to the bush, and the whole area has to be shut, from village to village, bush to bush. You have a contact tracing sort of team that actually goes after people who run away from quarantined homes for them to be traced. They report on the outcome on a daily basis during meetings. 00:42:00So, it's not easy. When people run away until you catch them or you know about their outcome, the team will not rest, the team will not rest, they will ask about that patient until actually they know his or her whereabouts. They will go from village to village, individual to individual, just trying to get information that will lead to the retrieval of--well, we succeeded, and some, to this day, we didn't succeed. We assume then that maybe they have died.

Q: Thank you. It sounded like you identified when the British came in, when the 00:43:00British military came in and provided more resources, as a major turning point.

KAMARA: That was a turning point.

Q: Was that the only turning point? Is that really the big one, you would say?

KAMARA: Well, at that time, we had little or no resources. We didn't know where to turn else, where we could turn for help at that particular moment. We did not have vehicles, staff were ill-equipped, our staff in the field were not trained, and actually handling some of these cases, and that had resulted in the death of most of our colleagues in the field because they didn't have the requisite training on how to actually handle some of these cases. Little to say about IPC [infection prevention and control], maintaining IPC measures in the area that they work. As a result of this, most of our guys died for the love of the work 00:44:00and caring for their relatives. One thing that I noticed why many people died is the empathy that they do have for relatives, yes. Here, when a relative is not well, you summon the entire family because if you don't come, it's like you don't sympathize with them, so they come. In the process, when you do come, they touch. Handshaking is a common thing here. If you don't shake hands it's like you are a white man. [laughter] It's only during this Ebola that people had thought not to do handshakes because they believe that you can get Ebola through contact. But before this time, it was very difficult to convince people not to do handshakes. People in the first place, the denial aspect of the whole issue, 00:45:00the denial aspect of the whole issue, that this is not Ebola, this is just a ploy for people to get money. In fact, we had to meet some representatives or some high authorities in this township. We were called to task, they said we are just giving figures, we are just providing figures in order for us to get money. Get money for what? We are not providing result work. Our responsibility was to collect samples and send them all the way to Kenema. How are you coming now accusing us of inflating figures? Well, we are blamed for that. We are blamed in this township. Highly-placed people blamed us for inflating figures for love of money. How can I do this? These are the sort of things we had to go through, but we love our country and we should work for our country.

Q: Did the accusation come from the capital? Come from Freetown? Or where did it come from?

KAMARA: Locally, locally.

Q: Oh, here locally it was.

KAMARA: Locally, locally, we were accused of inflating figures because on a daily basis we would report the EOC [emergency operations center] that so-and-so number of cases materialized for XY chiefdom. XYZ chiefdom reported thirteen cases, another chiefdom twelve, another--well, for goodness sakes, where are these guys getting these cases? Are they doing this--some very much thought that we are doing it to get more money from donors. But until we were hit hard, that was in August and September, that was the worst time. we had so many cases. That was the time people began to realize that, oh, it was not surveillance that was--they were giving us the true figures. It came to a point when it just 00:47:00started, people are accusing us that we are inflating figures because we want to have some money from donors. It is not so. I'm telling them the true situation on the ground.

So, there are so many ups and downs in the handling of Ebola, but it was good that foreign help came in, and especially the military because they were jettisoning some--because they were so--resistance was rife, it was very rife. I saw the intervention of the military as so important. If I tell you my team, the experiences that we had, some of our team were arrested and taken to the police station because we went, we received information from Freetown, from 1-1-7, of a 00:48:00case in a particular chiefdom, and in this chiefdom is the wife of a paramount chief. We went to investigate. The team that went to do the investigation were manhandled and taken to the police. It was not easy. It was not easy. The husband called me on the phone, and he called me all sorts of names. "Excuse me, who is that?" He rained invectives on me. "You are--" I don't want to use that because we are using the media, I don't want to use those invectives that he actually used on me. He did not only stop there, he came here, came to the compound to register his protest that he was not very [unclear], he was 00:49:00disrespected as an authority, he was not respected, and again, I became thankful we had the military in the compound; otherwise, it would have been hell for us.

Q: Did the military--

KAMARA: Yes, they came. They came with thugs, thugs. They came, and during the meeting, they stormed into the meeting, registered their protest that they were not happy. But because we had the military here, I mean the guys, immediately when they saw these guys, became calm. Otherwise, it would have been hell. It would have been hell for us. We went through that during Ebola. [laughter]

So the start was not easy, it was not easy, and that is why we welcomed the intervention of the foreign donors and the inclusion of the forces into the 00:50:00whole thing because earlier, which we would have otherwise not been able to go, we penetrated then through the use of the military.

Q: Can I ask you--you have talked a bit already about Regan and the work she did here. Would you mind just describing Regan? Like, who is Regan?

KAMARA: Regan is a down-to-earth person. She is down to earth. She is very sociable, she interacts with almost everybody. Our interaction at that point in time was very much [important] in making, giving us to go the extra mile. She was on our backs with some encouragement at a time when we were least provided for. She was even willing to provide from her own pocket, to give from her own pocket, to provide for us in terms of drinks, food, you name it. That helped us 00:51:00a lot, and in fact, when she was about to leave, we had to make a sendoff party to show our appreciation for her. We dressed--we provided her with some clothing, some salon clothing. Oh, she helped us. At that time, we were all staying in that room where I went in to introduce you to the DHSs, the district health sisters. [unclear] We had nothing to--and all a sudden they said, "You guys, I'm going to see to it that I provide you--you have some laptops, I'm going to do some advocacy." Advocacy was [unclear], she is so phenomenal, that lady. And she promised that she was coming back after the Ebola, and indeed she came. I wish you were here when she came back. The hugs she received from almost 00:52:00everybody. They were shouting, "Oooh, Regan! Regan!" [laughter] That woman, she can make the corpse walk. She knows how to go about it. I mean, she tells you something, even if you want to be afraid to do it, she gives you that sort of encouragement that will make you do it. Because at first, we thought she would not be willing to go with us into the field, [unclear] when other expatriates, where they have some moratorium in terms of movement into the field, in terms of diet. But she didn't mind.

Q: Thank you. Did you work with other CDCers to any extent?

KAMARA: Well, some of them were coming in and out, like [Regan]. Ruth also was another lady who worked with us. She too was very good. She was neck-and-neck with the surveillance team, everywhere we went. And a host of others. It came to a point when things went--like the August and September, when we were overwhelmed with cases, they had to set--they had to forcefully move them from our office, they provided them another office. Because they saw the risk of them being infected as a result of the interaction and the IPC measures, which we didn't have in place at that time.

Q: What other organizations were here in force?

KAMARA: This one, PIH.

Q: PIH, Partners in Health.

KAMARA: Partners in Health, they were here. Partners in Health were here, they also provided help with surveillance, provided their own vehicles, rented vehicles, and paying allowances to burial teams. CRS was also here, Catholic Relief Service. Then later, Oxfam. Oxfam was charged with the responsibility of [unclear], direction of holding centers, and making certain there is sanitary compliance in these holding centers and treatment centers. I think [International Federation of] Red Cross [and Red Crescent Societies] also came in. A host of other NGOs, CBOs, community-based organizations, were all on hand to actually help with the Ebola outbreak.

Q: Can you tell me a bit about working with--you know, you were supervising your surveillance team. Some of the people you supervised, some of the guys who went out into the field or women who went out into the field, I don't know, what they were like?

KAMARA: They are local guys we recruited from the community because at the end of the day, during Ebola, everything came to a standstill, and coming into surveillance was like [unclear] eking a living. Guys were very much willing to actually come to the field and help, and some of them are from communities, and they've been playing the role of community health workers. We thought it fit. These guys, we could use them because they've been helping with the health activities within their communities, so if we could make use of them, they know 00:56:00the terrain, they know their communities well, better than any other personnel. So if we use them, we will be able to go into the nitty-gritty of any community. That's why we used--so they were mainly local guys that were recruited from within.

Q: Sorry, I'm kind of going back and reviewing some of my notes. One thing I appreciate about what you've talked about is your vivid description of the resistance that you felt from community members, [laughter] to put it mildly. It was strong, it was--how did you deal with your own fear? Did you feel afraid when going into communities? You had people, as you said, coming here to 00:57:00confront you at your place of work.

KAMARA: That's why I said, had it not been for the intervention and the use of the military--the "Mark P" we call it, the police and the military [combined]--it would have been very difficult penetrating into some communities, especially in cases wherein people are dying. Breaking the chain of transmission would have been very difficult. It would have been really difficult because self-preservation is number one, yeah? I would not go into an area wherein I know my life would be in danger. But the fact that we have these military officers, that's why we're penetrating into the community. The mere appearance of the military personnel sent you nerve-racking, really. So, the coming of--was 00:58:00a blessing. Being included in fighting Ebola was welcoming. Because at the start, remember, the first--in the case that died at Mange. For that case to be buried, the police had to come in. Otherwise, we would not be able, because my boss told me to go there again, go and talk to them. They went and talked and they rained invectives on them. They abused them a lot. They were not listening. They said we brought bad luck to their village. Their wares are no longer selling because we said there are people with Ebola in their villages. So they are not ready to encourage anybody, they are not ready to listen to the 00:59:00authorities, in fact. The only person they would listen--the only time they became subdued was when a truckload of internal security officers arrived. That was the time those guys who were raining invectives on us calmed down. So you see, the military was a good thing, it was a good strategy, their involvement.

Q: Can I ask also, is there anybody else who you worked with really closely who we haven't talked about yet who you'd like to mention or describe a little bit?

KAMARA: Well, Sister Mariama [Momoh] was the coordinator for surveillance during Ebola. I think Regan booked an appointment with her. She would also have to talk to you.

Q: Can you tell me about Sister Mariama?

KAMARA: Sister Mariama, she was the DHS, district health sister one. The district health sister one is second to--in the absence of the district medical officer, she takes responsibility. She was like second-in-command in terms of leading the DHMT, District Health Management Team. She's a lovely person. She is also nice to work with. In matters of things that needed to be done, she always stood her ground. She becomes annoyed when she puts in--thinks that--she wants things this way, and for no reason you say, no, it's not possible, and she quite 01:01:00believes in what she thinks that if we do this thing, it will yield us positive results. And for whatever reason, they decide to go the other way around, she's never happy with that. She's always pissed off when you try to play down on whatever serious suggestions, especially with the powers that be. She never approved that. She was very passionate at the time for bringing the outbreak to a logical conclusion. We had hiccups here and there with authorities, not getting actually what we want, getting what we want for us as a team, for work 01:02:00as a team. At times, I'm the calm type, I'm the calm type, I usually calm her down.

Q: Do you remember one of those instances where she was really angry and you could calm her down?

KAMARA: Well, there was a time they wanted us, as surveillance officers, to be seated in the EOC. My responsibility is surveillance. Sitting in the [EOC] is like I'm negating my duties, my roles and responsibilities. I am here as a surveillance officer, my duty is to detect cases for early response so that action would be taken, and you are saying I should be seated here receiving reports from the team. She was not very happy with it, and the team thought 01:03:00otherwise. She was pissed off, I was also pissed off, but we managed to settle that up. They saw reason with us because as surveillance officers, our main role is to go and get cases and ensure that the team actually visits those areas that they were mandated to visit. But without somebody to supervise and see that they actually go there, it's like we are wasting time here. Those were some of the things that she really doesn't like. If she demands that surveillance be provided XYZ and it's not forthcoming, she would also not be happy; I too would not be happy. But she has more clout than I do as a second-in-command. Advocacy 01:04:00power is such that because of our position, I mean, people who don't want to listen to us will listen to her.

Q: Is there anything else that you would like to share about Ebola or about anything else really before we conclude the interview?

KAMARA: The worst thing we are praying for is having another go with Ebola. We are praying not to have Ebola again in this country because it is nerve-racking, it is time consuming. You hardly have time with your relatives. People are always on your back, they are always on your neck. You do what is humanly 01:05:00possible; as long as people start dying, they will not appreciate you. We were not appreciated during Ebola. We were not appreciated. They didn't recognize our worth. Well, the Ministry tried anyway. I nearly had a stroke [laughter] as a result of pressure. No, it's no joke, Sam. I nearly had a stroke. For reasons that I don't get enough sleep, wake up very early, sleep very late--come into the house very late, don't eat much. You are always worried because everyone's 01:06:00on your back. "Oh, surveillance has not done much. There are so many cases in those areas and those guys are--Carlos, what is happening? What is up? What is up?" You do a thing, at least, the only way out is not about money but it's about, "My friend, you have done so much, thank you." But when that is not forthcoming, it's really demotivating. To this day, like all other expatriates, when they come during the Ebola and ever, they leave. You work around the clock. I work around the clock. The only time I stay at home is when I'm not feeling 01:07:00well. That's the only time. But during Ebola, you don't go on leave.

Q: I think that's a very important aspect of the response that we need to keep in mind, just the physical and mental toll that it took to be a responder.

KAMARA: Yeah. But thanks be to God, I'm still alive. Thankful to God that I'm alive.

Q: I do as well. [laughs]

KAMARA: Currently, like I said, we are monitoring these twenty-eight priority diseases, top of the list is the AFP [acute flaccid paralysis]. We're about to be certificated for polio. I think we are having the very last rounds of polio 01:08:00campaigns, and it goes along with surveillance. It goes along with surveillance. Currently in the district, we are coping with measles, suspected measles for which there are confirmed cases of rubella, rubella. In the entire country, there is no rubella vaccine; the MMR [measles, mumps, and rubella] vaccines are not available. We are having a huge number of cases of rubella, rubella cases. That's what we are coping with for now.

Q: Still today. Well thank you so much Carlos for your time, for the energy that you've put into this, for everything. I very much appreciate you, so thank you.

KAMARA: Thank you. I hope one day, I assure you, I will become an epidemiologist through the help of CDC, because that's my childhood ambition since I graduated from the medical school, that has been my mission to become an epidemiologist and I do hope and pray that, Sam, I will achieve that goal. Thank you very much for coming.

Q: Of course.

KAMARA: Thank you.

Q: Thank you.

END