Regan Rickert-Hartman

Regan Rickert-Hartman

Q: This is Sam Robson here with Regan Rickert-Hartman. Today is December 10th, 2015, and we're in the audio recording studio here at the CDC [Centers for Disease Control and Prevention] campus in Atlanta, the Roybal campus. I'm interviewing Regan as part of the Ebola Responders Oral History Project. We'll be discussing her life, her career, and especially her response to the 2014 epidemic. So Regan, to begin, for the record, could you please state your name and your current position with CDC?

RICKERT-HARTMAN: Regan Rickert-Hartman is my name. Currently I am working with the International Task Force, and I will be taking a position in Sierra Leone coming up in the next few months.

Q: Okay, thank you. When were you born?

RICKERT-HARTMAN: January 30th, 1975.

Q: Can you just start off by telling me a little bit about your youth?

RICKERT-HARTMAN: Sure. I was one of two girls in the family. Grew up in a small 00:01:00neighborhood, Reading, Pennsylvania, and was actually born in Manchester, Iowa, but I was very little when we moved back to Reading. I was a swimmer at a very early age, so I learned a lot about motivation and coordination and time restraints. I wasn't really a typical kid out playing all the time and I remember missing lots of fun football games because I was in the pool practicing. It was something I loved to do, and when I think back about my childhood it's what I remember the most, was being an athlete and a swimmer. Eventually that's what took me to college.

Q: Were there any coaches who you remember in particular or teammates?

RICKERT-HARTMAN: I remember my high school coaches because they would push me in 00:02:00all the right ways. Being an athlete young growing up in high school was hard because you missed out on a lot of things, and there were many times where I thought, maybe I don't want to do this. Maybe I would rather just be hanging out with my friends on the weekends rather than traveling all over the country to swimming meets. But, I think between my high school coaches and my mother, in particular, they made it very clear that going to college and getting a swimming scholarship and being able to continue with something that I did love and was really good at--some of the benefits that I would eventually gain from that.

Q: I want to pick up on what you said, your mother was in particular pushing you with the swimming. Can you talk about that a bit?

RICKERT-HARTMAN: So, growing up closer to my mom than I was with my dad. My dad 00:03:00was working all the time. Trying to think of being a child, it's hard to remember him a lot of the times because I was with her so often. She was really my backbone and my strength growing up. She was an athlete herself--she was a gymnast in school, and I think that might be where some of it came from. Her pushing and seeing some talent at a young age and other people telling her that there was talent there and her wanting to cultivate that because it was something she had done. She would travel with me to swimming meets all over the country at a very early age. I think I started when I was probably seven, competitively, and then through college. She was just always there, never missed a meet. Would travel to my college swim meets whenever I had them, and I lived 00:04:00[on the] western side of Pennsylvania, so maybe a four or five-hour drive for her and she would always be there.

Q: And you said that contrasted a bit with your dad.

RICKERT-HARTMAN: A little bit. He would try to make some of the bigger meets, but I think it was more difficult for him with working and his schedule, and I had an older sister. An older sibling who--she spent more time with my dad because she was not traveling to the swimming meets with us. So I think of my family dynamic growing up as I was closer to my mother and my older sister was closer to my father, just because the traveling that my mother and I had done.

Q: Can you tell me about your sister?

RICKERT-HARTMAN: She's two years older than I am. She has three children. She lives at the beach, something I've always been jealous of. I have said for many, many years that I would follow in her footsteps and eventually move to the coast 00:05:00myself. I think being a swimmer and a water person--so the trip to Sierra Leone will be fun, it's on the coast of Africa. I'm looking forward to that. But I see her occasionally, at holidays more than anything. We're not really close. I'm actually closer, I have a younger sibling as well who didn't come along until I was fourteen years old, so she's a sister, but somebody I also helped take care of at a young age so I think there is some motherly aspects of that with her and I. I even still to this day will mistake my daughter's name for her name. Sometimes I'll call her Amber, which is my sister's name. My daughter is Taeva. Especially when we go home for the holidays and I see Amber, then I'm calling them each other by each other's names. So her and I are very close. She's twenty-seven.

Q: Can you tell me about some of your academic interests in high school and then 00:06:00in college?

RICKERT-HARTMAN: In high school I was in accelerated math. I took accelerated math courses, so I had a knack at mathematics. I don't remember loving academics though. I think for me, I was so sports-minded that that's really where I focused and ultimately ended up getting a swimming scholarship to college. Sometimes I do laugh and joke and say if it wasn't for my swimming maybe I would have not gone to college because the academic part is not really what I was interested in; it was the athletics and the competitions. I did study psychology in college, which I ended up ultimately really loving, just the subject matter. Then, after my undergraduate degree and swimming was over--

Q: And where did you go?

RICKERT-HARTMAN: I went to Clarion University, which is western Pennsylvania. It's a state school in Pennsylvania. I took a couple years off after my undergraduate degree and remember thinking to myself, I want to do this, I want to go back and I do want to study and I do want to learn more about something academic. It just had never been my focus before. Being in the workforce and working with my psychology degree--I worked with foster kids--I thought, you know, I want to do something different and I want to learn something different. So that academic part came, but it just came much later for me. I ended up going back for my master's degree in public health, which was at Westchester University, outside of Philadelphia. I remember telling myself, I'm going to graduate with a 4.0 and I'm going to earn As in every single one of my classes because I know I can do it. I felt that way I think because it just was not a 00:08:00focus of mine before and I wanted to prove to myself that I was smart, and I did just that. I graduated with a 4.0 with my master's degree.

Q: Can you tell me why you went to public health school?

RICKERT-HARTMAN: I graduated with my psychology degree and immediately started working with foster children, and I also had a part-time job at an alcohol and drug abuse center. I remember thinking that I was too young to be working with people with mental health issues, that I had had my own or that I just was not at a place in my life where I could help somebody in that capacity. The children I worked a lot better with, and I felt like I could contribute, working with the foster children using some of my degree. But working in a recovery relapse unit at a drug and alcohol center and having people who were in their forties and 00:09:00fifties look at me as a twenty-four or twenty-five-year-old who was never in recovery, never had addiction problems, and wondering why I was telling them anything really. It made me realize that at least at that age, getting a master's degree in psychology maybe wasn't where I was. I just wasn't ready for that--I wasn't ready to counsel people. I didn't even know who I was myself. So I was looking for a change and I found the program at Westchester, which was a master's in public health program, but they had this integrated health track that I was interested in because you could have different focuses within your MPH. There was a lot of work being done on holistic healthcare, which I had been interested in, and so I decided I would try it.

Q: Tell me about entering school. What was that like?

RICKERT-HARTMAN: Going back was difficult, and I was not a traditional live-on-campus student. I had the job still with the foster children and I was living forty-five minutes to an hour away from campus, so I was commuting back and forth and I was taking evening classes. So it was very different than college life as an undergraduate. It felt more mature. It was just different. So it was working the days, driving, commuting the nights, coming back and then studying. Long days like my undergraduate degree, but just a very different feel to it. And then this drive for wanting to do really well and wanting to focus on my academics, which was--like I said before--not really my drive in the beginning when I was working on my undergraduate degree. But I enjoyed public health, I enjoyed learning about epidemiology and sitting in class and somebody 00:11:00saying, "Everybody knows who the Centers for Disease Control and Prevention is, right?" I thought, I think I've heard of them before. Really just this lack of information when I decided to go to school for this particular degree. But as I got into it and learned more about it, I realized that this, like psychology and mental health, is about helping people, and that's where I come from. I've always wanted to learn how I could help somebody in some way. With the psychology degree, knowing that I wasn't quite ready to help people with the mental health side of things, and then learning about public health and how I could maybe help people in that capacity, was enlightening for me. It took me about two years to earn that degree, and then I was in the public health world and I've been there ever since.

Q: What happened right after college then, or after grad school?

RICKERT-HARTMAN: I took a job with the Montgomery County Department of Health, which was a small county health department outside of Philadelphia. I was a--Disease Intervention Specialist was my title, and I investigated outbreaks, the outbreaks of foodborne illness, sexually transmitted infections. I remember, this was in the early 2000's, so SARS [Severe Acute Respiratory Syndrome] hit at that time, which was an exciting time to understand, wow, all the training I had done in the past two years in public health and what it really means on sort of a larger scale. That was my first experience investigating anything international because that was--the outbreak spread, and it spread because it 00:13:00was airborne and it spread because people travel. Just having that knowledge early on in my career that infectious diseases do not know borders. That's always been there, and it's certainly in Sierra Leone we saw that with Ebola.

Q: Any other outbreaks that stick out to you?

RICKERT-HARTMAN: West Nile virus became more prevalent during my time.

Q: So what did you do with that?

RICKERT-HARTMAN: That was, you know, taking case investigation report forms from people calling in who were sick or who were diagnosed with West Nile and watching as it moved across the country literally from hitting in the east coast and moving west and seeing how rapidly, once a virus enters another continent, 00:14:00how rapidly that could spread. So between the SARS and the West Nile and various foodborne outbreaks, it was a good start. It was a good start at learning and understanding how to investigate an outbreak and what it meant and using epidemiology tools and surveillance tools. I stayed at that particular health department locally for about a year. I got to know people at the Pennsylvania Department of Health from being at a local health department and was offered a position with the Pennsylvania Department of Health. So I moved up. I like to look back on my career starting very grassroots at a local health department and then moving up to the state level, which was the Pennsylvania Department of Health where I stayed for almost four years doing the same type of work, just overseeing some of the county health departments. So that I go from a very local 00:15:00person to still pretty local but not quite as local working with the state level, investigating outbreaks with CDC. So now I'm working on multi-state outbreaks; particularly, foodborne outbreaks. I also did some work focusing on HIV [human immunodeficiency virus] and AIDS [acquired immunodeficiency syndrome] for two years. And then similar story, from working with people at CDC now--since I'm at the state level--getting to know colleagues at CDC, working with them on multiple different multi-state outbreaks. Four years in, being asked the question whether I'd be interested to come and work for CDC, and the answer was yes. So, now I'm working at the national level working on outbreak investigations and very similar work, just different capacities. Being able to learn what it's like to be at the very local, grassroots level, and now being at 00:16:00the national level and helping to oversee all local and state health departments.

Q: So when you entered CDC, what were you doing?

RICKERT-HARTMAN: Let's see--I was working as an epidemiologist for the National Antimicrobial Resistance Monitoring System, which is referred to as NARMS. I was an epidemiologist and the program coordinator for that program and I stayed in that position for just over eight years. I just left that position about a month ago. It was interesting and fun and I think my experience at the local and state level really helped me to understand that the little piece that I was working on at the national level, or what I thought was the big piece--this is the program that I'm coordinating, so this is my whole life at CDC--but for people at the state and local level, this is a very small sliver of the whole slice of pie that they're constantly working on. They have so many hats and they are pulled 00:17:00in so many different directions. So just having that basic understanding of what it's like being at the most local level when you're trying to work at a national level I think has been extremely helpful to me. I liked working at each different level because of what it brought and the experience and the expertise. If I had to pick one, I would probably say I really enjoyed the grassroots work because you're in the community and you're local and you're working more with the people.

So, the move to Sierra Leone, again, is so unbelievably exciting because that's exactly what I'm going back to. I'm going back to that grassroots epidemiology work, but having to represent a government federal agency. Having to represent CDC. So I understand how to work in both capacities. I think that it makes me a strong candidate for really helping Sierra Leone out with their surveillance and 00:18:00epi [epidemiology] work that needs to be done there.

Q: So sticking on your time at NARMS for a second, was there kind of a, like a day-to-day you could describe, what you were doing on a typical day?

RICKERT-HARTMAN: It was always different, which is one of the things I liked. A lot of it was supporting local health or state health departments, helping them to identify isolates that they would submit to CDC NARMS for testing, and this is all again antimicrobial resistance testing. So susceptibility testing is what the program was doing, and it was related to enteric pathogens, so foodborne pathogens primarily. The NARMS program is an interagency collaboration among three federal partners. So CDC's role is just one part. You have USDA [United 00:19:00States Department of Agriculture], CDC, and FDA [Food and Drug Administration]. And the purpose of NARMS is to monitor antibiotic resistance, if you will, from the farm to the fork. So, for example, what farmers may feed to their animals on a farm when it comes to antibiotics, how that impacts human health. So we've done many studies and have written many papers on how that resistance can spread from the animal on the farm to the person eating the meat if the food is not cooked properly or at proper temperatures. Somebody ends up with an enteric infection; it could be resistant based off of the antibiotics given at the farm level. So the program looks at all different levels: from the farm, which was USDA, to the fork, which was FDA really because they would partner with state 00:20:00health departments to go out to grocery stores and actually pick up retail meat. So meats sold in the stores. Then they would test those meats and see what antibiotics were there. Then CDC was responsible for the human side, so if somebody gets sick with Salmonella for instance, a sample is submitted, we run susceptibility testing to see if there is resistance there and just trying to understand that whole cycle.

Q: Any particular experiences of yours while you were at NARMS that stick out?

RICKERT-HARTMAN: There's so many. It's been eight years. I think for me professionally and personally, one of the things I'm most proud of from coordinating the program is the work that we've done around surveillance. When I came, the system was a paper-based system, and this was just eight years ago. We 00:21:00weren't using electronic reporting. We would receive paper-based log sheets that would have handwriting on them from our state partners, and then we would have to transcribe that on our end. It was very tedious. A lot of validation needed to be done at the end of the year, a lot of manpower. So one of the things I led with this program was developing an electronic surveillance system, which we currently have. Local and state health departments who partner with us can now go online and simply and quickly enter in any information they want to about the isolate or the person that submitted the [sample] that's being sent for testing, and then the same thing happens at the laboratory. Once the testing is done, it's electronically uploaded into the system to meet up with the demographic information. So the time is much less.

We just received the [National Center for Emerging and Zoonotic Infectious 00:22:00Diseases] Director's Award for a project that I led that was just put out a couple months ago. It was one of those bittersweet endings to my career in NARMS where we took all of our data--NARMS has been in existence for almost twenty years. We took twenty years' worth of data at CDC and put it online for people to review. We didn't just do this at an aggregate data level, but we did this at the isolate level, so any researcher or anybody interested in going in and downloading fifty thousand records' worth of data or twenty years' worth of data could do that and look at it. So we were really proud about this. We also took all that data and made some data visualization tools online. So for somebody who wants to learn more about resistance and our program, they could see trend lines over time, they could see a map of the US, they could see how resistance has changed over time by clicking a display that would show them year-by-year on the 00:23:00map in different colors and how it's changed. It has been a very well-received tool. It's been viewed I think now in over forty countries worldwide. I'm very proud of that and it was a good way to end my NARMS career.

Q: Tell me about when the Ebola epidemic really got on your radar.

RICKERT-HARTMAN: Probably when we received an e-mail from our branch chief. I was working with NARMS, which fell under the Enteric Diseases Epidemiology Branch. Patty [Patricia M.] Griffin, who is currently the branch chief there, had sent an e-mail talking about the Ebola outbreak and the crisis in West 00:24:00Africa and that they were looking for volunteers and that she wanted to see if anybody within her branch would be interested in helping. Helping may have meant going or just supporting stateside in the EOC [Emergency Operations Center]. That e-mail, I remember reading it the night that it came out on my Blackberry and thinking, I want to go. I didn't hesitate. There was no hesitation, I was just like yeah, I want to do this. Then I thought oh, oh, my husband will never want me to go and do this. You know, just sort of going through this in my head. But the very next day, I went to--not my branch chief who sends it out, but our deputy branch chief, her name is Barbara [D.] Mahon, who I had worked with very closely because she was our acting team lead for some time in NARMS and I had built a good rapport with her. So I went to her office the very next morning and sat down, and I said, "I saw Patty's e-mail," who is our branch chief, "and I want to go." She sort of just stopped and looked at me, and she knows I have a 00:25:00very young daughter--I've talked to her a lot about my daughter and vice versa with her son--and she said, "Are you sure?" I said "Yes, I want to go," and we just had a very candid and frank conversation for maybe fifteen, twenty minutes, and I think she was just trying to make sure this is something I really wanted to do. After that conversation, that's what started everything.

Q: So what happened next?

RICKERT-HARTMAN: She, I believe, relayed that to Patty Griffin, our branch chief, and I in turn went home and sat down with my husband and talked to him about it. From what I can remember, I think probably within a week it was, yes, I'm definitely going. Several conversations back and forth between the 00:26:00leadership of my branch and my family and just trying to figure out, is this really going to happen? I want to go. I'm terrified, but I want to go. And just that drive of knowing that the last fifteen years, maybe not that many, maybe twelve years of my career has set me up to do this kind of work. I'm ready for it. I've done surveillance and epidemiology now at the grassroots. I have worked my way up to the national level. I can help. I'm terrified, but I think I can help. I probably deployed within a month of that. It took some time to get the deployment together and ready. The first time I deployed was September, the fall of 2014.

Q: Tell me about arriving in Sierra Leone.

RICKERT-HARTMAN: Well, I'll back up and tell you about the plane ride there because it was significant for me. There was nobody on the plane. We went from Atlanta through Brussels, a couple hours sitting in the Brussels airport. That plane was relatively full. But from Brussels to Freetown, which is the capital in Sierra Leone, there was hardly anybody on that plane and it was a huge plane. I remember thinking, what am I doing? Nobody else is going in. That's what it felt like, I'm going in. I remember I had a whole row of five seats to myself to just lay down and sleep on that second flight because it was straight from Brussels to Freetown, which is the capital of Sierra Leone, and there was just nobody going to Sierra Leone. It was very scary. But arriving, getting off the 00:28:00plane, it's just a whole different world there. You get off the plane, the airport there is you get off the plane and you're outside. You actually unload the plane and you're just outside. There's no big terminal. There was screening set up, hand washing, temperature checking at the airport, and then coming out and retrieving luggage and meeting our expediter. I didn't really know what to think. I just kind of was rolling with it. There were a lot of things going on and sort of hectic when you first arrive, and then the boat ride came. So you take a bus from the airport down to the water, which is a five, ten-minute bus ride, it's not far. You have your luggage, you have just your carry-ons with 00:29:00you. You don't see the rest of your luggage until you actually arrive to the hotel, which is very strange too, it just sort of disappears for a while. You get on a little motorboat with your carry-on, and maybe twenty other people can fit on the boat. And the waves--it's rocky and I get motion sickness, but I knew about this so I had taken a Dramamine right when I got off the plane. Then, you take this twenty, thirty-minute boat ride across the ocean to get to the capital. It was quite an experience, but I remember thinking how good the boat ride felt because we had just traveled for sixteen hours on the plane, plus several hours just sitting in the Brussels airport. So it was a whole day of nonstop travel, and to be able to sit on the boat and feel the breeze, it was refreshing. But it was dark. It was nighttime. You see nothing. You're just on a 00:30:00boat hoping the boat's not going to break down or sink when you're on it. You approach Freetown, the capital, and all you see is this mountain of lights. It's beautiful. So it was a very serene moment sort of before hitting the ground, which was nice.

Q: Now at this point were you alone or were you with other CDC personnel?

RICKERT-HARTMAN: I think I was alone my first deployment. I don't remember other CDC personnel. But when I arrived to the hotel, other CDC personnel were there because we had set up an office at the Radisson Blu [Mammy Yoko Hotel] in Freetown. There were other people there certainly that were going to work on the Ebola crisis as well, probably NGOs [nongovernmental organizations] and other 00:31:00organizations, but I do not recall other CDC people on the plane or boat ride over. I think I was one of the first people to go. I think it was the second wave of deployers. The first wave of deployers had gone out in August, and at that time there were far fewer people than what CDC was able to push out towards the middle and the end of the outbreak. In the beginning I think it was about just trying to find people who were willing to go and just to start getting our footprints on the ground.

Q: Who were some of the people who you met who you would start to work with quite a bit?

RICKERT-HARTMAN: I remember the epidemiology team lead, who was Daphne [B.] Moffett at the time. She's a CDC country director in one of the African countries. She's no longer there. She's moved to Kazakhstan, is my 00:32:00understanding, over this past year to take a position there, and she may not have actually been the CDC country director. I think she was just working in surveillance and epi at one of the CDC offices. Nonetheless, she was the epidemiology team lead for the response for CDC. I remember her because she could brighten up a day and she was just so great to work with and I was so thankful that we had a strong leader, especially the first time going. I think that they had already decided that I would be deployed out to one of the districts before I got there because of my background. So I stayed at the Radisson Blu for one night in Freetown where there was a small office of CDC people set up, and then the next day I was in a car with a driver by myself, and 00:33:00I drove about two and a half hours out into what felt like jungle sometimes to one of the districts. There [are] fourteen districts in Sierra Leone and I was placed in the Port Loko district. I was the only CDC person there for my first deployment of five weeks.

Q: So what happens when you get there?

RICKERT-HARTMAN: I meet the local staff. So my role was to help support what was referred to as the DHMT, which was the District Health Management Team. That's the local staff who--they have an office building out in Port Loko District and they would respond to outbreaks in the past. Prior to Ebola they had a district 00:34:00medical officer who would lead the DHMT. They had district surveillance officers. They had monitoring and evaluation officers. So they had a whole team of people who were there prior to Ebola, but their roles changed once Ebola had hit. So getting to know all of those people and their roles now that were dealing with the Ebola outbreak and working with them. WHO [World Health Organization] was also present. There [were] two gentlemen from WHO there who were helping to coordinate the effort on the ground in the district. And some partners. Not too many yet, it was still relatively early on. I mean even though this had been going on for several months, by the time people were getting on the ground and starting to work on the response, this is still pretty early on even though it was September. There were some spattering of partners here and there, and just introducing myself as the CDC person that's there to help 00:35:00support them in any way that I could really. The goal was--I'm actually not even sure what the goal was in the beginning. The mission of what I was there to do was really whatever we could, and it changed. It changed daily. So just trying to figure out where I could best support the people on the ground, and that was probably the first five, six days there.

I met with a gentlemen by the name of Jeffrey [D.] Ratto, who is a CDC employee who was part of that first deployment group that I told you about. They went out first, so I was taking his spot. I was able to overlap with him and learn what he had been working on, how I could help continue what he was working on, pick 00:36:00up other things that needed to be done, and I had I think two to three days with him of overlap before he had to leave. That was crunch time. Try to get as much information from him as I could. What did he learn? What needs to be done? What has been helpful? What hasn't been helpful? What's the next five weeks going to look like for me?

Q: What did he tell you?

RICKERT-HARTMAN: He told me a lot about the infrastructure of the DHMT. Who different people were, what their responsibilities were. We talked a little bit about some of the data issues. We were dealing with the VHF [viral hemorrhagic fever] system, which had been deployed to collect data for this Ebola outbreak. That's one of the things, one of the responsibilities of CDC was to continue to 00:37:00monitor that surveillance system and make sure the data going in was quality data. Helping to summarize the data so that we could be monitoring the epi curve and the number of cases and deaths and lab results and just making sure that that was all being done and being done well. So a lot of overview of that with him. We talked a little bit about a campaign that was coming up I think in maybe a week or two after I arrived and what that campaign meant. This was a Ministry [of Health] -led campaign, it was called the House to House campaign. Transmitting files, saving files, so that once he was gone I could at least go back and have something to reference.

Q: So what happens then?

RICKERT-HARTMAN: So then he leaves and now I'm the only CDC person there. Really just the focus for me in the beginning--once I felt a little more comfortable with the people and learning who they were and building some rapport with them and finding where I fit into the whole picture--the focus for me in the beginning was the House to House campaign because I knew it was coming and I was trying to learn more about what it was and what it meant and what the purpose was. This was something that the Ministry wanted to do, the Ministry of Health, and this is coming from the President of Sierra Leone. They wanted to make sure that the community understood what was going on because there was a definite resistance from the community to believe Ebola. What Ebola was, that it was 00:39:00killing people. There was a lot of distrust in the beginning, and so this campaign was meant to do several things. Find Ebola cases in houses, because the goal was to reach every single house in Sierra Leone, which if you know the terrain of Sierra Leone seems quite impossible because to get to some of these places it's several hours by car on rough roads, and then you take a boat and then you go across a little river, and then you get back in the--you know, you can't get back in the car, so then you have to trek for a couple miles. It's very spread out in the provinces. They wanted to reach every household to not only look for cases, but to educate people. They took them soap, they showed them how to wash their hands properly, and it was really just about building trust and at the same time trying to identify if there were cases in villages that we didn't know about. With that, the peripheral health units--or what they 00:40:00call PHUs--some of them were to be set up as holding centers in case we found suspect cases of Ebola. I remember going out and visiting some of them the day before this House to House campaign was supposed to start and none of them were set up. Not a single one. Each one was supposed to have several beds, medical supplies, PPE--personal protective equipment. I mean, there was a whole list. And they received the supplies for the most part, and they were just shoved in a room. So they weren't prepared, they weren't ready. I remember a certain woman, her name was Sister Mariama [Momoh], who was like the head nurse in charge of that district Port Loko. So her and I traveled to as many PHUs as we could that day before the House to House and just helped them get set up. Explained to them 00:41:00what they could be potentially looking at for the weekend if they got a suspect Ebola case, and what that meant for their health and wellbeing, and that they needed to have these beds a certain amount of distance away from each other, and that they needed to have the food supplies and the PPE and the medicines all out of the boxes and ready to go. Traveling from PHU to PHU, just trying to set up as many as we could because we knew that this campaign was going to start the next day. It was a big part of my deployment the first time.

Unfortunately, what we found, if you go back and just look at the epi curve for Port Loko itself--we were just looking at the district-level data out at the district and then we would send all that data up to the national level--so the folks in Freetown, Daphne's team in Freetown--and they would compile it and look at the overall national epi curve. What you saw in Port Loko, and I'm sure nationally, is that there was a huge spike after the House to House campaign 00:42:00because it did just that: it found Ebola cases, and they weren't ready for what they found. The cases in Port Loko doubled in a week, and there were no Ebola treatment units, no facilities, nothing set up for care. There were some holding centers like I had just talked about, but they had two ambulances for six hundred fifty thousand people. And Port Loko was one of the biggest districts geographically, just how spread out it was.

So what do you do? The nearest ETU I believe at that time was in Bo, which was like a four-hour drive, and you have two ambulances. So that was the reality for the next three weeks of my time in Sierra Leone, was continuing to identify cases more and more and more and more and having to leave them in the community because there was either no ambulance to take them anywhere, or there was 00:43:00nowhere to take them because the Bo facility was full, or we just couldn't get them to the Bo facility, or a holding center was full. It was jarring, some of the things I saw from the first deployment, because of that. I can remember sitting in meetings day after day after day saying, "We cannot leave these people in the community. We cannot leave these people in the community. Transmission is going to continue. It's ongoing." And that's exactly what happened for months--what felt like months I should say. I was there for three weeks, but I think that that continued until some infrastructure was put in place, and I believe a pivotal time for that was right as I was leaving. The British military was coming in and helping to set up the infrastructure and put things in place and helping to set up an Ebola treatment facility in Port Loko.

When I was there we had identified an old training site. It was a Red Cross 00:44:00training facility site where they used to train local staff, just different skills. It was these abandoned buildings, but they were concrete. I remember going to see the grounds and thinking, we could turn this into something. Sure enough, when I came back the second time, that was set up as an Ebola treatment center for Port Loko. So it was just those little things that--I didn't even know that that would turn into anything, but just saying to somebody, maybe you could use these structures, you could turn these structures into something; never knowing if it happened until I came again and sure enough there it was. Some of the little things that you didn't realize were so impactful.

I remember also one of the things about going back the second time, I became so close with the local staff, the local staff that were working at that DHMT. I 00:45:00went and there was a man by the name of Carlos [Albert A. Kamara] who I became really close with. Both him and Sister Mariama cried when they saw me the second time because they didn't believe I actually came back. It was sad leaving the first time, but to see people cry when you return because they realize you do still care and you do want to continue to help and having Carlos come over to me and say, "We told them everything you said. Everything you said the first time you were here, about how we needed to decentralize and how we needed more ambulances and how this needs to be set up, we told them and they did it." I didn't know, I had no idea that the things that I was saying to them at that time about what I saw and what I thought had to happen in order to make this better would be implemented after I left. That to me was just huge. It felt so 00:46:00good to know that the skills that I brought to the table were utilized and that when the military came there [were] more resources and more people to put infrastructure in place, that they actually listened to the advice of people who were there before them.

Q: Can you describe Carlos for me?

RICKERT-HARTMAN: Carlos, and his real name is not even Carlos. I don't know what his real name is, but I would call him Carlos and I don't know why. I think that happened before I got there, maybe with Jeff Ratto. But he's probably--if I had to guess--maybe late 40s, 50-year old male with a huge heart. He cared so much about the people and wanted to help however he could, but I just don't think he 00:47:00knew what he was supposed to do and a lot of us didn't. It was really just trying to figure out little by little, okay, today, what is the most impactful thing I can do today at this moment? And just trying to instill some of that in him. Like you can't fix this whole thing by tomorrow, but we need to take baby steps. He loved to learn. I remember sitting down with him and just showing some of the data tools, showing him how to just pull up a simple epi curve out of the data they were collecting.

I remember him telling me stories about a man who he met when he was a teenager who came with the Peace Corps. I can't remember the man's name. I have it written down somewhere, but he currently lives in Florida. And he wishes so badly he could reconnect with him because he's never forgotten him and how much he did for Carlos. He would tell me stories like that. He was one of the people who would have a frank and open conversation with me about the civil war. Even 00:48:00in the midst of an Ebola outbreak and all the sort of chaotic and long work hours, I would still take the time to just sit and talk to people. Sometimes I would invite them over to the hotel and we would sit over dinner. I did that with both him and Sister Mariama one night, and they came over to the MJ Hotel where I was staying, and I bought them dinner and we just sat and talked for probably two hours. He told me about the civil war; that's what we talked about. To just hear the stories from him first-hand and how it impacted him. Stories like running for his life with his family, carrying his daughter on his back, trying to escape to Guinea, and just what it was like there for ten years. I remember thinking, my God, these people have been through so much already and now they're dealing with this. So making those emotional connections with people 00:49:00on the ground were probably the most powerful, significant thing to keep you going.

Q: And Sister Mariama, can you describe her a little bit?

RICKERT-HARTMAN: Very driven, very outspoken, strong, didn't want you to see her cry, and that must be a cultural thing. She lost a close friend of hers to Ebola when I was there. It was another nurse, she was a nurse. It was one of her colleagues and friends. I remember sitting across the table from her and she picked up the phone, she put her head down, put her hands over her forehead and put the phone back down and I just saw tears dripping on the table. She didn't 00:50:00want to look up because she was crying. She was embarrassed. It was so hard because I loved her so much that I wanted to give her a hug and I couldn't. I couldn't give her a hug because there was a no-touch policy there. You needed to keep your distance because you just didn't know. In order to stay safe, you needed to keep your distance. There was no hand shaking, no hugging, no touching. So to see this woman in such pain, crying, and to not be able to hug her was really hard. That goes for a lot of people that I saw who had lost family members and loved ones. Not even being able to touch their arm in a soothing way, rub their arm or anything. Just having to stand a foot or two--even though it should have been more like five, but the office was way more crowded than it should have been really.

She was well respected because she wasn't afraid to say what she thought. She's 00:51:00a very powerful woman. I'll never forget her. I remember going out to those PHUs before that House to House with her, and she would walk in and she would say this, this, this, this, and this needs to get done, and people would start moving. They listened to her, they respected her.

Q: So when you went back for your second deployment, what month was that?

RICKERT-HARTMAN: That was in late February. I was there the first time in September, October timeframe, and then I came home for about three months, three to four months.

Q: What was that like?

RICKERT-HARTMAN: It was so hard. The first time of course was the hardest, but the first deployment was the toughest. The coming back, I remember feeling like 00:52:00I was on a cloud, sort of like walking around space for a little while. I think I arrived back on a Tuesday I think it was, so I took Wednesday, Thursday, Friday off and didn't go in to work. I waited until that following Monday. I remember I went for a haircut, and I was in my car leaving the haircut appointment. I got in my car, I started my car, and I remember thinking, where am I? Where am I? Like I didn't know where I was. I was just completely disassociated or disconnected. I called my friend that lives in Atlanta and I said, "Do you want to meet for lunch?" I just needed to get my bearings. I met her for lunch and that was extremely helpful to be able to just sit and talk to her. I semi-joked about it on the phone with her, I said, "Do you want to meet for lunch? Because I'm lost and I really don't know where I am right now." She knew I had just gotten back.

Then with the family, it was hard because you come back and you're doing this twenty-one-day monitoring and I knew I kept myself safe, but there is always that little bit in the back of my mind thinking, oh gosh, what if I didn't keep myself safe or what if I was exposed and I have a five-year-old daughter and my husband. The monitoring was very serious for me. Our next-door neighbor who we were friends with had a newborn baby, he was born when I was gone, and I remember her coming over and sort of just handing me the baby. I didn't hold the baby. I said, "You know what, I just--" but I didn't want to freak them out or make them concerned, but it was just something I felt like I wasn't ready to do. So I waited out that twenty-one days and sure enough of course I was fine. But there was that little bit of fear during that time. My daughter, of course, that 00:54:00was an amazing reunion. I had never been away from her that long, ever. So, five weeks without my five-year-old was tough.

I remember I had extended my first deployment by about a week because they couldn't get my replacement there in time, and I didn't want to leave without being able to brief the next person because I knew how important that was for Jeff and I to meet. I didn't want to miss that opportunity and I didn't want to feel like all the hard work that I had put in place was lost because I wasn't able to tell the next person where things were, so I extended by a week. I remember the phone call home because they had asked me to extend a little bit 00:55:00longer. My replacement was there and we had some overlap and I was considering it and my husband said to me, "I wouldn't normally tell you this over the phone, but I think you need to know," because he knew I was trying to decide whether I wanted to extend again. "I think you should know Taeva," our daughter, "looked at me the other day and said, 'Does mommy still love us?'" That was really hard. So, I came home.

Q: What was it like when you reunited with your daughter?

RICKERT-HARTMAN: Amazing. I remember rushing because I wanted to pick her up from school so bad. I wanted to surprise her. I was trying to get out of the airport, going through all these different screenings, and I remember thinking, okay, just give me the darn phone--the twenty-one day monitoring--I got it, let 00:56:00me go. Because they weren't there to pick me up and that was hard. I really would have wished my husband and daughter could have been there to pick me up, but they couldn't because the timing with my husband's work and her school and other things. I remember just rushing, thinking, okay, well I'm going to go get her at school. I got home and I was locked out of my house. [laughs] I quickly just got out of the cab, dropped my stuff off at the front steps, and we live maybe a ten-minute walk from her school. So I dropped everything off, I said ok, I'm just going to walk to her school, I'll go get her. By that time my husband had gone to pick her up, and I passed them. So I'm walking to her school and he passes me in the car, him and her, and I see them. I see him look over and he sees me, which I was glad about because that would have been really sad if they just kept on driving, but he stopped the car and he let her out. She was maybe two good blocks away from me and she just sprinted the whole way with her arms open, yelling, "Mommy!" So that was very sweet, I cried.

I remember I actually told Sister Mariama that story in Sierra Leone about what my daughter had said, and as much as I did not want to leave them, they understood that I wasn't leaving them for any other reason than my family and they were fine with that. They had a little meeting in the office the day I was leaving and they surrounded me and they gave me gifts and they put a circle around me. I was sort of in the middle of the circle and they prayed. We all bowed our heads and they all prayed for a safe journey home and reuniting with my family and I just kept thinking, gosh, they're praying for me and all I'm doing is praying for them.

I left and I didn't know if I'd be back. I didn't know if I'd have another 00:58:00opportunity, and I got the other opportunity and I mean I jumped on it; I wanted to go back. I had had enough time to sort of heal from that first time. The first time was emotionally and mentally challenging because of the things I saw. I think the thing that sticks with me the most out of all my deployments and all of my time over there was watching a four-year-old boy die in front of me on the ground with just a little windbreaker on. No pants, no bottoms. I'll never forget his face. I will never forget his face. I honestly think it is purposefully engrained in my brain for lots of reasons, more on the positive side.

I remember being in a village and I had gone out and we were responding to some 00:59:00alerts that there might be some people sick in this village and we showed up. We didn't have an ambulance. It was just myself and Sister Mariama again, and our driver, in an SUV. We show up in this village and I thought, okay, there's probably a couple sick people. Looking around, there were sick people everywhere. It was obvious this village was infected with Ebola. As we're there, we spent probably at least an hour if not two hours there, trying to gather information on what had happened. Somebody finally admitted that there had been a community burial, an unsafe community burial there a week or two prior to that. That was one of the big things throughout this Ebola crisis, was trying to educate people about how unsafe washing the body was prior to burial. That's 01:00:00what had happened in this village and there was just people sick everywhere.

I remember thinking, I'm the only CDC person out here. I don't even have cell reception right now. I'm in the middle of a village, in the middle of nowhere, and everybody's looking at me, asking me what we're supposed to do, and I have no idea. And thinking, my gosh, how is this possible? Why am I making these moral and ethical decisions on if I can get an ambulance here, if, who's going to get in that ambulance and where are they going to go?

So just by walking around trying to assess how many people were actually sick, I was asking--I think there was a miscommunication because I was asking for people to come outside so I could see them, just to see if I could visually see symptoms or get a better understanding of how many people we were talking about. 01:01:00And this elderly woman in one of the homes walked into her home, and I mean she was weak and elderly and I believe she had Ebola as well. As best she could, carried, but it was more like dragging this little child out of the home and laid him on the ground in front of me. His eyes were closed and he had just like a light windbreaker-type jacket on that was zipped maybe halfway and nothing else. Of course, I figured, you know what, he's sick, he's dying, they probably took his bottoms off because he was just going to the bathroom nonstop. It was probably easier for them. And I'm looking at him and all I can think about is my daughter because they're like the same age. I'm thinking, my God, if this was one of our children in the States--this doesn't happen, this just does not 01:02:00happen. I looked at Sister Mariama and I said, "We're gonna get an ambulance, and we're gonna get an ambulance right now, and I'm not leaving this village until the ambulance gets here." Several phone calls, several phone calls waiting, waiting, waiting, waiting, and I'm just monitoring this child. I thought he was dead. I thought he was dead when she drug him out. I was communicating--she was speaking a dialect, she was not speaking English. So one of the paramount chiefs--is who the local leader of a certain chiefdom in Sierra Leone--one of those people were there and they were speaking the language. He was communicating to me with the elderly woman and she said, "No, he's not dead. He's been very, very sick," is what she was saying, but he wasn't moving.

I had some water in our SUV that we were driving. So I got some water and I handed it to her and I said, "Can you please see if you can get him to drink some water?" She picked him up by the back and put the bottle to his mouth and he opened his eyes and that was the first time literally that I realized he was alive. I did not think he was alive. He drank water and I thought, oh my gosh, that's really significant for him to open his eyes and drink some water. Maybe we can save this child, not to mention the rest of the village. I was definitely--I think, because of my motherly instincts and it's a child--I was just so focused on him that as I was focusing on him, Sister Mariama was able to get an ambulance to that village because it wasn't far away. It was actually like right up the street at one of the PHUs because there was a bunch of sick people who had traveled from this village over to that health unit. Somebody 01:04:00else had already alerted that they needed an ambulance there, so there was one close by. It arrives, and as I'm sort of trying to assess what's going on with this four-year-old child, I look back. I knew the ambulance had showed up, but I wasn't really paying attention to it yet because I just wanted to get this child to the ambulance, and I was trying to figure out how we were going to accomplish that without me or other healthcare staff touching him. I finally look back, and the back of the ambulance is open and there are probably at least ten people shoved in the back of the ambulance. People that they had picked up at this peripheral health unit, other people who were in the village that were sick that just started piling in when the ambulance doors opened, and now there's no room for this little boy.

Again, I can't believe I'm here. I can't believe this is happening. There are 01:05:00sick people, likely with Ebola, shoved in the back of that ambulance, and I'm not even sure where we are taking them yet. So we made room for this child, and the grandmother gets in with him, into the back of the ambulance. Some of the local village people were helping them both, which of course was not safe, but I'm not too sure they were not already sick as well. The next thing is I find out that his mother contracted Ebola the week prior and she was at the Bo treatment facility. She was there and she was alive. I found this out because we were calling to see if there was any beds open anywhere for any of these people, and when we said the name and the village and all the information--it was, I think it was Doctors Without Borders who was running the Bo facility. I could be 01:06:00wrong, but I think that's who it was. I remember them saying, we think his mom is here. So now I'm happy, I'm excited, I'm like okay, well maybe, we can't, gosh, well now what? We've got like ten, twelve people shoved in the back of this ambulance and they're not going to take all of them and it's four hours away and how is this going to work?

What ended up happening was the ambulance went to a holding facility, dropped everybody off at the holding facility including the four-year-old, and we were still trying to confirm whether or not we could take him to the Bo facility to be with his mom. Medical staff at that facility had just contracted Ebola and made it shut their doors. They said, no more people coming in. So they were not taking new admissions, and that happened like the day before. So now we're begging. We think his mom is there, can he share beds with her? Just trying to 01:07:00figure out how to get this little boy there. That doesn't happen until the "okay, yeah, you can do that" comes several hours later, and by then it was night and everybody was at that holding facility and I thought, okay. But we finally got the okay. First thing in the morning we're going back there with the ambulance, get him, transfer him to that Bo facility, and by the time I got back he was dead.

It was too late. It was too late. I just remember thinking, how amazing would that have been for that mother to see him again? But that's what it was: making decisions that had to be made and feeling like they were so ethical and wondering why I was making these decisions, but nobody else was going to make them. And then ultimately, knowing that them being at a holding facility was no 01:08:00better than them being in the village other than they weren't going to transmit Ebola to anybody else. They weren't getting any care. They were getting no care because the nurses were afraid to go in and take care of them. So they basically were put into a holding facility. Maybe they got water, I'm not sure. There's no IVs [intravenous therapy] started, there was probably no oral rehydration started. They were just left there. And the little boy died overnight before we could get back with the ambulance. If somebody were to ask me what was the most impactful, significant sort of story of the four-plus months I spent there over the last year, that would be it. When he sat up and opened his eyes, that's the picture I have. I think that's the picture that makes me want to go back because it's just not fair. I mean, people shouldn't have to live like that or die like that.

The second deployment was far more happy than the first one. I had arrived, I asked to go back to Port Loko, that's where I want to go. I want to go back to Port Loko. I went back to Port Loko another five-plus weeks and was met like I said by Sister Mariama and Carlos in tears, and it was an amazing reunion, I was so happy to be back. Everybody was excited to see me, which made me feel really good. The British military was there and they were running operations and they had a whole operation center, emergency operations center at every district level. It was, I mean, very, very different. We had a team of CDC people there, 01:10:00so there was probably seven of us working on various different things between epi and data and communications and health promotion. There were partners everywhere, WHO, military. I mean, it was running and it was functioning. When I got back there was probably about twenty new cases a week. When I had left--the first deployment was a hundred new cases a week, and this is just in Port Loko. This is just in that district. Now we're down to about twenty a week, which was still challenging, still a lot of cases, hard to do contact tracing and cluster trees on twenty-plus a week, but we tried our hardest to identify all contacts, make sure they were being followed, quarantines were in place, making sure people were getting food.

The second time was really about making sure every single sick person got care because now there was facilities for it. I remember walking behind the DHMT buildings and seeing a whole lot of ambulances just for Port Loko and I couldn't 01:11:00believe it. This is three months, maybe going on four months later, and we had gone from two ambulances to fifteen-plus and staff to drive them all. It was amazing, and I remember saying to--there was a couple people in charge of the British group, Commander John [Raine] is who I remember the most. Looking at Commander John and saying, "You know, when I watch the way you run this operation and the meetings they sit in and how concise and straightforward and time-saving and to-the-point that they are, I realize I would definitely want to work with the military again because this is great!" Things were getting done. People were being held accountable. There were resources, there were ambulances, 01:12:00there were facilities. It was really about, okay, now that everything is in place and had been in place really I think for a couple of months, how are we going to get to zero? Now that's the focus. It's not oh my gosh, where are we going to take this person for care, it's how are we going to get to zero?

By the time I left Port Loko the second time, we were down to just a handful of cases a week--two, three, four--from twenty. So just drill and drill and drill and drill and finding those contacts, keeping those contacts away from other people and making sure people got the care right away. Everything had to be done right and we were doing it right and we were bringing those cases down. I felt really good the second time I left. I was like, this is going to be over soon, it's going to be over soon, and that was March of this year. I remember also 01:13:00being very sad though when I left because I thought, I'm never going to see this country again, I'm done. My work is done here. I'm going to leave, they're going to get to zero and it's going to be over. I felt very positive the second time I left. I came back and went back to my normal job, went back to NARMS. It was really hard to go back to NARMS after experiencing all of that and having to shift focus and go back to working on antibiotic resistance and sit behind a computer again and not have that feel of being on a team on the ground and locally with people--sort of that grassroots feel. I really, really missed it.

Summertime came and I was working on this project that I was telling you about, the sort of final project for me with NARMS with the data and the visualization 01:14:00tool that's online now. It's called NARMS Now. So I was working on that, so I was excited, I was wrapping that up and deployed that. That went live, had a lot of really good media and press about it, was feeling really good about my current job again. I was excited about it. And I got an e-mail asking me to go back to Sierra Leone again. I thought, they're never going to let me go back. My branch chief I think had TDY [temporary duty] fatigue by that point, because she was so open and willing to send her people in the beginning and we sent a lot of people from our branch and our division. At some point, you need to cut back on that, and rightfully so I think she was cutting back. I had already had two opportunities to go, which was great, and I was extremely thankful for it. But I had gotten this e-mail and I was like, oh goodness, I would really like to go back again, but you know there is like one case here or there, what would I 01:15:00really do? Do they really need me? I really want to go back, but just trying to think through it, and do I really want to ask? I don't want to shake the waters. I was allowed to go twice and I was really thankful for that already.

Soon after I got the e-mail requesting that I go back, Dr. Frieden sent an e-mail. I can't remember exactly what it said, but I do remember the tone of it was essentially, if you have somebody who wants to go, you need to let them go. I thought, oh, well, I'm that person, I want to go. I'm still kind of afraid to ask to go again, I don't want to upset anybody. I know it's hard on my team when I leave, it puts more pressure on other people and they have to pick up my duties, but I sat and here comes Jeff Ratto back in the picture again. He's still working on the response. He had been working on the response the entire 01:16:00year, and he was working on it stateside in the EOC, and he was one of the people who had reached out to me about going back the third time. I was trying to get more information on what would I do because Port Loko was having no cases and what does epidemiology and surveillance look like in a district where there's no cases? I want to go back, but let's make sure that I'm going back for the right thing and I want to make sure I'm really busy. If I'm leaving my family, it needs to be worth it, especially for the third time. I had already been gone almost three months.

I sat down with Jeff Ratto and we started talking about something called IDSR, and it's the Integrated Disease Surveillance and [Response] system. IDSR has been in place since the late nineties. This is a framework for surveillance that was developed by WHO and CDC in collaboration and had been deployed in several 01:17:00other African countries, and they wanted to set this up in Sierra Leone. So we started talking a little bit about it, and this is my love and my passion, surveillance and epi, and sort of talk about what that's going to look like for Sierra Leone post-Ebola was really exciting for me. The idea of, maybe you can go back on TDY to start talking with some people about IDSR in Sierra Leone. I had heard that Sara Hersey, who is the Sierra Leone CDC country director, was looking for people to come and help set up IDSR, because it had been talked about, but they didn't have the capacity on the ground to start moving forward with it.

I learned some more. I met with a woman by the name of Dr. Helen Perry here at CDC who is the IDSR guru. She has been working on IDSR since its inception. I learned as much as I could about the framework and asked in-country whether or not a TDY for somebody just strictly for IDSR would work, if that's needed. 01:18:00Rather than focusing on the response, I would focus on surveillance going forward. She agreed. I said this is an amazing opportunity, I would love this. This to me, what a great way to end--or what I thought I would end--this experience from the first deployment to the last one where now I'm looking past Ebola. I'm helping them get set up for their future. I went and I was extremely excited about it.

I was not in Port Loko the third time. I was in the capital in Freetown working very closely with the CDC staff there and with WHO and with the Ministry of Health and helping to start talking about how this framework would be set up. What this system is going to look like. What conditions and diseases and events will be included and what are we surveilling for and all those conversations. Getting the ball rolling. Some materials were already developed by the time I 01:19:00got there, so reviewing those. Getting some trainings going. That was the third deployment.

I loved it. I loved it so much, because this is what I--it's taking the federal, national perspective that I've had for the past eight years for surveillance, plus the love of the grassroots work of working locally at a local and state health department, and it's combining them. So it's setting up surveillance on a national level with the ministry, but having to work with the local people to do it. So it's like a combination of everything I love about what I do. I remember thinking, this is great. I just really, really enjoyed myself and loved meeting the new people I was working with. I got to have some reunions with the people in Port Loko, which was nice too.

Partway through the third deployment, I had a former colleague of mine show up 01:20:00on TDY. His name is Dr. Ezra [J.] Barzilay, who I worked for. He's who hired me at CDC for NARMS. He was my team lead when I first started. And here he is in Sierra Leone. "Ezra, how are you doing?" And we start talking. I start telling him about the work that I'm doing. He said, "Oh, that's perfect for you. It really fits your skill set, I bet you're excited." I said "Yes, I'm really excited." He started saying things like "They could probably use somebody like you here full time." I was like, "Well I'm going home in about two weeks." It just never--the idea of moving there and working on this long term and helping set up surveillance long term in Sierra Leone never entered my mind. It hadn't until that point. I don't think he knew Sara Hersey really well on a 01:21:00professional or a personal level, who is the CDC country director in office in Sierra Leone, but he went to her the next day. He said, "You need to hire this girl. I hired her when she came to CDC," and he just started telling her about all the work that I had done for NARMS. Then he called me. I had no idea he was having this conversation. He calls me and says, "I hope you're not mad at me." I said, "What did you do?" I know him personally too, so we joke around a lot. He said, "Well, I told Sara that she needed to hire you." I said, "You did what?" He said, "I told Sara that she needed to hire you." It went from there.

I was relayed a message from him, she said, "Well, if she's really interested have her come and talk to me." At that point I said, "Thank you very much Ezra, I really appreciate you saying these nice things about me and I need to think about this. I haven't even thought about this and I certainly haven't discussed it with my husband." As soon as I got back to the hotel that day I called my 01:22:00husband because it didn't take long for me to realize I would love this opportunity. I just didn't know what it meant for my family and I couldn't quite wrap my head around it. I didn't know enough about living internationally, at a CDC international post, because I had never done it. What would it be like for my six-year-old? She's six now and she's in school. So, I needed to talk to my husband--that's where I was at. I remember being on the phone with him every day for probably four days, every day, talking through it, talking through it, talking through it.

My first thought was, maybe I don't move to Sierra Leone or we don't move to Sierra Leone. Maybe I just take a job with the CDC Sierra Leone office and do like 50%, because I had heard other people were doing that. So I would be there 01:23:0050%, here 50%, and I'll travel back and forth. I'll support from Atlanta and in-country. I presented that idea to my husband and he said, "No, that's horrible." I said, "You know what, you're right, that is horrible. What was I thinking? I was just gone four months and now I'm going to talk about being gone six months out of the year. I can't, you're right, bad idea." It was him who said to me first, "I would rather move there." I remember thinking, oh my goodness, is that an option? Like in my own head, before I actually said it. And we just kept talking. Within four days we had decided we were going to do it. Put the pros and cons out. Because I knew that if this was something I really wanted to do, I wanted to talk to Sara in person while I was there and I wanted to show my interest. I wanted to have that candid conversation with her and I wanted to find out more about what it would mean to bring my family there and I wanted to answer lots of questions that I had.

I didn't feel like I had a lot of time to sort of pitter-patter around it. Do I 01:24:00want to do this or do I not want to do this? It seemed like we were all onboard pretty quickly. I feel like it was something that fell in my lap. I set up a meeting with Sara that next week. The night before I went into the meeting, after I thought we were--my husband and I were--all set, this is what we're going to do, I called him one more time. We were Skyping so I could see his face. I said, "You need to tell me if you don't really want to do this. This is the opportunity. I can forget this whole thing was even brought up. I can act like it never happened. I can come home. I am happy in Atlanta. Our lives are great. We both have great jobs. She's in a great school. We love our house. We love our neighborhood, everything is great, I don't have to rock the water or rock the boat. I can forget about the whole thing." I wanted to make sure for him. I knew for me I was going to be okay, but I wanted to make sure he was at the same place. And he said, "Let's do it," and that was it.

The next day I met with Sara. I sat down with her, and she at that point was still thinking that I was interested in doing the 50/50 thing because I think that's what her and Ezra were talking about. She started talking about this traveling back and forth, and I said, "No," I said "If I'm going to do this I want to move to Sierra Leone with my family." And she just stopped, dead in her tracks. She said, "You would do that?" I said, "Yes I would." So now it turned into, what positions do you have in your country office that you need to fill and do my skills and background fit one of those positions. She happened to have a lead for surveillance and epidemiology. I said, "Well, that's what I do."

Before I left the country the third time, I knew I needed to apply and I needed to make the certification and I needed to compete for this job and go through the USAJOBS and go through the process. But I knew the position was there and I 01:26:00knew she was interested and so I applied. That was just last month, it was November. Now it's paperwork and getting everything ready, getting both Jake and Taeva on my travel orders, and I'm being told that that could take four to six months. So realistically speaking, it's December now, we will probably move to Sierra Leone together as a family in April. But I'll go back next month in January on another TDY just to fill that gap until everything is ready to go.

Q: Can you tell me what your husband Jake plans to do?

RICKERT-HARTMAN: I think he's planning to tie a rope around himself and my daughter, or our daughter. He's not very concerned about finding a job right 01:27:00away. He is the epitome of a father [looking over] his daughter and talks about her safety all the time and that that's his number one priority and that she's not going to be left out of his sight. I'm okay with that. Have been there for many months. Maybe it's an overreaction, but I absolutely understand where he's coming from. We will arrive at a really great time for the family because Taeva will just be ending kindergarten and so she'll have three months before she has to start school there. The plan right now is that they will go to the beach and they will learn about the community and get their bearings and learn about Sierra Leone together while I work, and in the evenings I will join them, and on the weekends, and then our hope is that once she starts school he can start 01:28:00looking for work. One idea for us--there's two that we've talked about. One would be maybe getting a job with the US Embassy there. I know that there's usually opportunities like that for eligible family members coming to post with CDC employees. Also, he's talked about potentially working for an NGO. There's so many of them on the ground right now. He has a degree in psychology and criminal justice and he loves kids. I think there is a lot of opportunities for him to get involved in the community in Sierra Leone and love it as much as I do. That's the hope.

Q: I think you told me before that it was possibly an opportunity for him to get back to something that he knows he's really interested in.

RICKERT-HARTMAN: Right. He graduated with his psychology and criminal justice degree and got involved with investigative work for GEICO [Government Employees Insurance Company], so he was working for an insurance company. If you were to 01:29:00ask him what his goal or dream job would be it would probably be working for the CIA [Central Intelligence Agency] or FBI [Federal Bureau of Investigation] in some capacity doing investigative type of work, surveillance work. Thinking about the doors that it could open potentially working at the US Embassy in some security capacity, I mean, that's a great opportunity for him. When I had said that, that's what I was referring to. I had talked to the--they call him the RSO, the Regional Security Officer. I think it was the assistant, he was the assistant at the time, the last time I was there, and was talking about my husband with him and I remember him saying, "Oh, we can find him something along those lines." That there is certainly a need for that skill set and somebody who is interested in that sort of work. But we're going to wait until we get in country and get comfortable before we even explore it.

Q: Can you tell me about telling your daughter that you are going to move?

RICKERT-HARTMAN: I think he did that. I can't remember having that initial conversation. I believe that happened when I was there the third time after Jake and I decided, we had made the decision that this is what we wanted to do. I believe he mentioned it to her and she was all for it. I imagine in a six-year-old mind she knows that Mommy's been to Africa a lot this past year. She wants to go. She wants to see what this is all about. Years ago, Jake and I had talked about an opportunity for him to maybe join the Coast Guard. He thought maybe that was the direction he was going to go in after he finished school. I remember even then, when she was very little, we said we have the right child to move around because she's flexible. She just loves people and 01:31:00she's outgoing and she's friendly. We didn't do it then, but that same--those same characteristics of her still hold true today. She's that child that you talk to her, she says--I didn't say "adventure" to her. I don't know if somebody else has, but what she says right now is, "I'm ready for this adventure," like she's ready to go on an adventure. That's how she sees it and that to me is perfect. That's the way I want her to see it. An adventure where she's just going to learn a lot and see things that she would never have the opportunity to see otherwise. So she's excited.

Q: There is a question that I want to ask about--I think--a theme that comes up through your entire narrative, and that is your desire to help other people. Where does that come from?

RICKERT-HARTMAN: I don't know. I think I'm a humanitarian at heart. I don't have 01:32:00any answer for where I think it comes from other than--

Q: It started very early.

RICKERT-HARTMAN: I think so, yeah. Especially with my little sister and that motherly sort of instinct of wanting to be there for her because when she was born and she was very, very young, both of my parents were working. I remember having to take care of her, and that's helping. Right? But whether or not it was that, I'm not sure. I love meeting other people of other cultures and understanding the world in a much bigger, broader way. I can't say it was the 01:33:00Sierra Leone experience because yeah, it was there before that. I went to school for psychology because I wanted to help people. It was more on the mental health side of things. My mother was very nurturing. I don't know if that's part of it. But having that, at least knowing that that's--my sister is the same way. My little sister, she says the exact same thing. She's in mortuary school because our father passed away two years ago and she says that she went back to mortuary school because she wants to help other people grieve because she knows how hard it is. Maybe it's genetics. [laughs]

Q: Well great. Are there any other parts of your story that you want to talk about? Any other little memories that you have that you'd like to share for the record?

RICKERT-HARTMAN: I think for me and my experience through this whole thing is just how remarkable--when I go back and look at what it's turned into for me. The idea that on my first deployment, how emotionally and mentally draining and challenging it was and the things that I had to endure and what I had to see. Watching people die in front of you and not being able to do anything about it, to going back and seeing the progress and feeling uplifted by the progress, to the third time of, wow, we're going to get through this and we're going to move 01:35:00forward, to oh my goodness, I'm moving my whole family there because we're going to make this happen and we're going to look at Sierra Leone post-Ebola now. Each individual experience and looking at it together as whole--it's so empowering for me. I'm so thankful, I'm so thankful to have the opportunities that I've had and for it to have turned out the way it's turned out.

I turned forty this year and although, like you said, I feel like I've always known that I wanted to help people in some capacity and I've always known that I wanted to do more international work, I just wasn't sure how to quite get there or what my focus would be on. And being able to incorporate those two things now 01:36:00and have my family come with me for the ride--right? Because that's another big part of it. I feel like every time I've gone on these deployments or these international trips, even before Sierra Leone--it was Haiti in 2010 for the cholera outbreak--but I've grown as a person so much through all of them and I want my family to grow with me. I feel like it's all wrapped up in this amazing little package and that the universe has just given me a present. It's amazing, I'm excited. You asking me to do this interview is another part of it. You're feeling like you're making history.

Q: Well we are, right now. I am so grateful that you're here today to talk about 01:37:00your experiences and people years from now are very grateful to hear it as well. Thank you so much.

RICKERT-HARTMAN: Thank you for having me.

[interruption]

RICKERT-HARTMAN: I should have told the story about the necklace I had. I bought this necklace in New Mexico, and this was a long time ago. It was probably at least ten, fifteen years ago. Probably closer to fifteen. It is this turquoise necklace, multi-colored and it's long, and I remember getting it from one of the local women at her house. It wasn't even going to a store and buying a necklace that you knew one of the Native Americans had made. I was at this woman's house and she brought this bag of necklaces out. I remember buying it really cheaply and thinking wow, that's a great deal for all of that turquoise. I wore it all the time. I took it over there with me, the second deployment, and I had it on the one day and Sister Mariama made a comment. "That necklace is really nice." I 01:38:00was like, "Oh, thank you so much," and I walked away after we were done talking. I went, I sat and I was like, are you kidding me Regan, go give her that necklace. So I get back up and I walk over and I said, "Do you like this necklace?" She was like, "Oh, it's beautiful." I said, "Would you like to have it?" She just looked at me like, oh goodness, is she really going to give me her necklace? She just sort of nodded like she was almost afraid to say yes, but I could tell she wanted it. So I took it off and put it around her neck and she got teary-eyed.

I thought wow, how amazing. This goes from a Native American in the middle of New Mexico to a Sierra Leonean in Sierra Leone. Who knows where it will go next. I was only sad for like a second. [laughter]

Q: That's great. I love that.

RICKERT-HARTMAN: They were so giving the whole time I was there, giving gifts all the time.

Q: Really? Like what kind of stuff?

RICKERT-HARTMAN: Jewelry, handbags, lots of beads. When I left, Sister Mariama got me a big bedsheet that had hearts and stuff on it. She made a joke in a room full of people, like this is for you and your husband when you go home, like this heart bedsheet. And jewelry they had made and bought. That was one of the things that was sort of remarkable to me too, was just how friendly and giving they were. I never felt unsafe. I know there were stories of people being chased with machetes out of villages. I never experienced that. I always felt safe. I remember one morning--I would be there every single day at 7:45 to the DHMT, like everyday. I would get up at the same time every day, just like on this schedule. One morning, maybe three weeks in on my first deployment, I remember 01:40:00feeling so exhausted--I think it was after that House to House campaign--and I hit my alarm snooze maybe twice. I got there at 8:15, half an hour later than I normally do, but still pretty darn early. And I couldn't find some of the people I normally work with. I'm like, "Where's [Dr. Alie] Wurie and Carlos?" "Oh, they went looking for you because you weren't here at 7:45. They went to the hotel." I remember exactly at that moment I thought, I am so safe. These people are looking out for me. They are amazing. Sierra Leone people are absolutely amazing and they are strong and they are hard working. To see the same exact surveillance officers doing exactly what they were doing that second deployment as what they were doing the first deployment four months before when I was there, every single day, 7:30 until 7:30, nonstop. No days off, same group of people. I thought, I just took like three to four months off and here you are still doing it.

Q: Humbling.

RICKERT-HARTMAN: Very. And I thought I was tired. [laughter]

[interruption]

Q: One thing I am interested in is like Global Health Security Agenda and how Ebola fits into that. These CDC country offices especially, as part of [a] larger effort now to build capacity nationwide. So, if you would be interested in ever talking to me again after you come back from Sierra Leone, I think it would be really cool for the record to talk about that. If we're really documenting like the early days of this focus on building global capacity, that could be really helpful.

RICKERT-HARTMAN: I mean that is absolutely the way forward for all of us. I've read the Global Health Security Agenda, and I feel like there are people here 01:42:00that know way more about it than I do, but I know that what I do needs to fit into that. It's trying to get--and I've talked to people, Ray [Raymond L.] Ransom is an amazing resource here for this exact thing. I've talked with them as much as I could, and I will continue to talk with them about making sure that everything we implement on the ground fits under that umbrella because there are certain things that we need to do with that congressional mandate and the money that we've received, and surveillance is absolutely part of global health security in these countries. So it's making sure that the work that we develop in-country is in line with that bigger, overarching agenda.

Q: With a lot of these programs like development programs, the idea is that you're there, you're building country capacity until Sierra Leoneans are doing 01:43:00the same thing and then you move on. Is that kind of the idea with the country offices or is this really kind of a perpetual, we're-going-to-stay thing?

RICKERT-HARTMAN: From my understanding, I mean certainly CDC country offices--we don't really work ourselves out of a job I don't feel like. I feel like there is always a bit of a footprint on the ground, but with minimal staff. So what happens is--the idea is that you open up a CDC country office and you have a technical expert in X, Y and Z area. So you have a lab person, you have an epi person, you have the country director, you have the deputy, you have an FELTP, Field Epidemiology and Laboratory Training Program advisor, maybe a public health advisor. So you have the skeleton, if you will, of CDC direct-hire staff, but then you fill in the office with all these locally employed staff and you 01:44:00train them. The best-case scenario is that you open the office, you have your skeleton crew of CDC experts who train an office full of locally-employed staff who then can run the office. That's what we're doing in Sierra Leone. We've already hired several locally-employed staff. The surveillance epi lead position oversees four of them. I think in an office of maybe twenty people, six or seven of those might be CDC direct hires and the rest would be locally-employed staff. I imagine that ratio will change over time.

Q: Cool. Let's get out of here. [laughter]

END