Dr. Seung Hee Lee

Dr. Seung Hee Lee

Q: This is Sam Robson here with Seung Hee Lee-Kwan on March 11th, 2016, here in the CDC [Centers for Disease Control and Prevention] Roybal Campus audio recording studio in Atlanta, Georgia. Today, which is our second attempt at an interview, I have to say. The first did not record adequately. I apologize for that.

LEE: It's fine.

Q: Today we'll be talking about Seung Hee's life and career and especially her work as part of the 2014 Ebola response that CDC did in West Africa.

Seung Hee, can you please tell me your full name, your current position with CDC and where and when you were born?

LEE: My name is Seung Hee Lee-Kwan. I'm currently an epidemiologist at the Obesity Prevention and Control Branch at the chronic disease center [National Center for Chronic Disease Prevention and Health Promotion]. I was born in Gunsan, South Korea, in 1983.

Q: Tell me a little bit about growing up.

LEE: Growing up, I am that typical tomboy child. My parents really never raised me like a girl, perhaps like gender neutral. I would go out, catch dragonflies and rip their wings off and pop the frog eggs, but also go foraging with my grandmother. I had the special gift of tasting things, so I would help my mom, who was a full-time professor, around the kitchen. She would call me and say, "Can you push the rice cooker?" Wash the rice, let it sit, and she'll remind me to press the button so the rice cooks and things like that. That's basically my childhood--helping my mom cook, run around. I think the fact that I grew up in 00:02:00Chungju, which is two hours south of Seoul, gave me a unique perspective of things because it's a small town, everyone knew each other. It was less developed than Seoul, if you will, so I was able to really get that country life experience. Then I had the opportunity to live in East Lansing, Michigan, when both of my parents were at Michigan State University as visiting scholars.

Q: How old were you when you went there?

LEE: I was in fifth grade. I was there for two years, and it was perhaps my first experience to blend in to a completely different culture. I didn't speak English at all. That was really eye-opening. Up until then I was that happy, 00:03:00pretty smart, leadership oriented kid, but if you don't speak the language, it's really hard to be yourself. I think I really learned how to be observant, learned how I can fit in in a new environment. Granted it was a university setting, so it was very diverse. I was able to be exposed to kids from Iran to Russia. That was a really good experience for me to understand diversity, and I picked up English pretty quickly. Again, my father--who is an English literature professor--knew how to nudge English maintenance in that he made me write journals every day, even after I came back to Korea. He would give me a book and 00:04:00a dictionary for a child who doesn't know English at all. Said, "If you finish this book, you can go out and play." Pretty harsh. I remember crying doing it, but his idea was all your answers are here. It's a code book, this book is written in code and you have to decipher the book. It's actually brilliant because then I was able to understand, oh, B comes after A, C comes after B, all those kind of things. I got pretty good at it quickly. After six months, I was able to hang out with friends like a normal kid. Well, I don't like the word "normal," but just like any other kid at school. That was a good experience.

The first year in America was amazing. It felt like I was given some sort of 00:05:00freedom. Compared to the Korean education system, the American education system was so different. We were able to gather--sitting around a teacher when she would read us books. Things like that just [don't] happen in Korea. It's very one way of learning as opposed to in America, you touch things and you have recess and you run around, and little things like fire drills. I think those kinds of things were very different, but I knew some of these things are really good. I think the first year I was able to observe good things about American life. But then second year when I went to middle school, I think I became a little bit more observant and identified perhaps flaws of American life, like discrimination or violence and drug problems and things like that. I was a 00:06:00little bit more--I don't want to say exposed to, but I read more about it, and I was quick to understand that it became, oh, those things do exist. This is not a utopic world that I had seen a year ago. So I was like, okay, now that I know pro's and con's I will reevaluate whether or not I want to come back, because we were headed back to Korea.

I went back to Korea. It was very difficult to adjust because--but I knew the Korean system. Basically, you take tests every month, your grades will be posted in front of the classroom, so basically you're always ranked. You're either number one or you're number fifty in class, and then that goes school-wide, citywide, province-wide, nationwide. You have a number attached to your academic 00:07:00achievement. But I knew that in elementary school--so I came back as a middle school student. I did fine. I didn't scrape by. I was maybe tenth in class. It was fine. Maybe because of that, I just stayed on living what was expected of me as a Korean child, as opposed to my brother, who struggled quite a bit because he was first introduced to the American education system, so adjusting to Korean life was very difficult. He ended up coming back to the United States for his high school, and I was really jealous about that, and that kind of goes back to gender expectations. My parents would never have sent me alone because I'm a girl and they were okay with sending him to live with a foster family. So I was a little bit jealous.

I made it to a pretty decent college in Korea and planned an "escape route," I 00:08:00call it. Like, what is a legitimate way for me to go back to the United States that is acceptable to my parents? It's going to grad [graduate] school. Where I lived in East Lansing, it wasn't the color of the skin that really dictated discrimination--I think it was more of the English proficiency. At least that's how I interpreted it as a child. So I was like, okay, I'm going to study English. Although I majored in food and nutrition because I loved cooking and I wanted to be a chef, I also minored in English. I watched a lot of television and I watch it with subtitles, I watch it again without subtitles. I watch it over and over again until I understand how the authors are writing. It's really 00:09:00interesting. You can learn about the writers quite a bit by watching series. So I tend to watch TV shows as opposed to movies.

Q: What did you watch?

LEE: Oh my God, I watched so--I watched ER starting from season one up to the final season--was twenty-something--like in three weeks, nonstop. I would just watch if I wasn't eating, over and over again. I was afraid that if I go to a school of public health of some sort and with my nutrition background, I might not be able to pick up on some of the medical terminology. That was one of the reasons why I decided to watch ER. And after that, you know, Sex and the City was really big so we all watched that. I don't think it's the best English in the world but that was fine.

Q: When you say "we all," who are you referring to?

LEE: Me and my girlfriends. It was a big thing. And I went to an all-women's college, so that was our repertoire. Prison Break. All kinds of TV shows, and picked up on English proficiency and studied for the GRE [Graduate Record Examination] while I was getting my master's. Then I got accepted to Johns Hopkins [University], and I say it really nonchalantly but I was very anxious that I might not get accepted to any of the universities I applied to for a PhD program. Like I said, to me it was like an escape plan, so what do I do if this plan fails? Whenever I say this, my brother gets really upset because he finds that I did pretty good in Korea, why did I want to leave so badly? I think it 00:11:00was because of gender discrimination that I experienced that my brother probably doesn't experience day to day, and just watching my mom juggle her professional life with her personal life. I just didn't want to live like her even though she's a highly successful exercise physiology professor. And my dad's also a professor. You would think my dad would be really supportive, and he was, but he's also a typical Korean man who expects his wife to make him dinner. So he would often call her lab and say, "Why are you not here making me dinner?" I remember, I think I was in college maybe sophomore year, I got really upset at 00:12:00him and said, "Do you want my husband to call me like that and come home and make him dinner? Because that's exactly what you're doing." And I think that was eye-opening for him because he never really portrayed his daughter like a layer on top of his wife, and I think that was an eye-opening experience for him. Since then he takes care of his dinner. [laughs] It's really interesting how people do function around certain social norms. When I was in Korea going to an all-women's college, I was expected to be very eligible because it's an all-women's college--very eligible, educated, you know, "Mrs. degree." You're getting a Mrs. degree. Everyone carries Louis Vuitton bags, high heels, all 00:13:00dolled up. But you're a college student. So I really had this idea of American kids going to college with pajamas on. That just looks so liberating on television, that's how I want my education to feel like. There was a lot of anticipation of experiencing that. I ended up in Baltimore with two suitcases.

[break]

Q: We were about to get into Johns Hopkins, but one question I did have. I think we're still rolling, right? Okay, good. One question I did have was, it sounds like between your bachelor's and your master's, you changed focus a little bit.

LEE: Oh, yes. I said it before, but I was always a very chubby kid. I liked food and nutrition, and all my guy friends always treated me like a dude. In Korea it's one size fits all, or small or medium, and I was just a little bit bigger than medium. So I had to wear boys' clothing, and that's not fun. Going to an all-women's college, I just kind of [pictured] how things are. Everything's picture perfect and I am this kid, a chubby kid. My boyfriend at the time, it was junior year, my boyfriend at the time was like, "Don't you think your hip is a little too big?" And there was this fire in my belly like oh my God, I'm going to lose weight and dump your ass. I started digging through research. Up until 00:15:00then, I'd tried just about anything from taking medication, doing one-food diet, and all sorts of things that didn't work. So I really dug into the literature, learned about the obvious calorie-in and calorie-out, but also like changing the dietary composition. I basically did an intervention on myself and lost about forty pounds in three months over summer vacation. I come back to school and everyone's like, oh my God, you don't look like you, did you get plastic surgery, liposuction? Like, I can actually see your nose now. [laughs] Koreans are very brutally honest, and I can tell you that. They'll tell you, oh, you look like you gained some weight. Things like that is a greeting. Actually, they say, you look good, you look like you're doing well. That means you gained weight. So I lost weight, I dumped my boyfriend, and based on that experience, 00:16:00that really helped me understand how difficult it is to go through that weight management experience. So for my master's, I did weight management counseling on top of my nutritional science degree to really help other female college students who suffer with weight management, eating disorders and what-have-you.

That really got me to thinking, one-on-one counseling is great, but I want to do something larger in scope that could really influence the population base. That's one of the reasons why I wanted to do public health. Because if I can change the environment, I don't have to tell my patients, you need to boil eggs for you. If it's available at the school cafeteria, it's so much easier for 00:17:00them. More access, availability, and also affordability. Those concepts really came to me, I just didn't know how to put it all together. Then I got into my dream school at Johns Hopkins and everyone told me in Korea that I should do nutritional epidemiology because "it's the new hot field, we don't really have a lot of experts in Korea, if you do that you'll sail through." So I did because I've always been doing what was expected of me to do. I was really good at that--meeting others' expectations.

Mind you, I'm all by myself in this new country again, and up until my master's, 00:18:00I didn't really study hard. I'd never really studied hard. It was more of intuition for me. Didn't put a lot of effort. But I still did really good, so it sounds really arrogant, but that's how I honestly felt up until I came to Johns Hopkins. It was a true struggle. I spent eighty percent of my energy studying epidemiology, and I still got Cs. That just was not acceptable for me. I thought if you put effort, you get the outcome. And for the first time that wasn't the case. Granted, my colleagues were epi [epidemiology] professors in their home countries, so they already are very well in tune with epi concepts. I still remember learning the term "confounder." In epi, the confounder is often talked about, and I needed to look up confounder, and the dictionary definition is, 00:19:00"it's something that confounds." [laughs] So I'm like, okay--or collide. "When things collide." I was like, I don't know what "collide" is. It brings that bad memory of my father giving me a dictionary and you have to decipher through this whole thing. So reading an epi paper, for all my friends it probably takes thirty minutes. It took me a good three hours to really digest, so you can imagine how much effort I put in yet I still get a C.

It just hurt my ego so much, and then I really asked myself, why am I doing this? I'm doing this because my parents told me I have to be a professor just like them. I was brainwashed growing up. As a very small child, you're going to be a professor, you're going to be a professor. Here I am asking myself, do I 00:20:00really want a PhD? Why do I have to do it when I'm so unhappy? I started seeing counselors, and I reached out to my friends, and I realized it's probably because I am not a natural epidemiologist--or maybe I'm not the natural numbers person, or I'm just not good at taking tests. And I switched my advisor from nutritional epidemiology to nutritional anthropology.

My new advisor was Joel Gittelsohn, and he had an ongoing project in low-income neighborhoods of Baltimore, trying to change the store environment to improve the food availability in these low-income neighborhoods. A lot of these small 00:21:00stores were owned by Korean immigrants, so it was a win-win situation. For him, he needed a Korean-speaking nutritionist who can convince these store owners why selling these healthy foods might be beneficial for not only the community but for their business. I was really good at talking to people, and I was like, sure, if you're going to pay money for me to just talk to these people, okay, great, yes. Then I realized how gratifying it was. Every interview that I do, every sit-down, building rapport made me feel really good about myself. And I was like, you know what? Screw it. I'm just going to do what I'm good at, and that's how my career transition happened. Ever since then, I was happy-go-lucky.

Like I said, Joel did a lot of work on small stores, like corner stores, and 00:22:00then we really wanted to tap into restaurant venues in these small stores. They're called carry-outs. I developed a proposal. Because I've been out in the neighborhoods all the time, I know people go there very, very frequently because not only they don't have cars but often these people work two, three jobs. They don't have time to cook, so they rely on these small, Mom-and-Pop restaurants, which are also owned by Korean Americans. These Korean immigrants basically make Southern food that's been handed down to them twenty, thirty years ago. So I developed a proposal on how to improve some of these offerings in these carry-outs. Went up to the committee, and all the committee members were very, very skeptical, saying, are you sure? What makes you think these restaurant owners will change recipes? They have it down, they have a system. You're being 00:23:00too ambitious. So I had my own soul-searching, like okay, these are the experts and they're saying it's not going to work. What do I do? How can I convince myself that it deserves moving forward? I decided that if I fail, that's still good research because then I can communicate with other researchers, don't try to do the same thing I did in low-income neighborhoods of Baltimore because it won't work. So I moved forward with it and it ended up becoming one of the most successful interventions that Gittelsohn's team has ever put out because I knew the limitations of his previous research. A lot of the impact that we measure was relying on recall. The interviewer will go in and ask the store owner, "Do 00:24:00you think the intervention improved your sales?" If the person said yes, then it's yes. But it's not quantifiable, and I knew that limitation very well. So early on in the research, I asked the restaurant owners, "Would you be interested in using these electronic cash registers so we can document what you sold and whatnot?" But they weren't used to that. In fact, they were really afraid of that because of all the IRS [Internal Revenue Service] audits and things like that. A lot of things that you didn't even anticipate is their day-to-day life.

What I really liked about Joel's approach was he really wanted to find answers within the people that we're serving. He said, ask them what's feasible. They might have answers for us instead of us going in and saying, use this. They all 00:25:00had these pads that they will jot down the orders, very specific orders. Some like it fried hard, some like it fried wet. I really didn't understand what that meant until I actually, visually saw. Less golden is wet fry, more brown would be hard fry. Everyone has their preferences. Some want extra mayo, some want chopped peppers on their sandwich and what-have-you. They all write it down, and that piece of paper goes to the cook, and the cook will make the food and then toss that piece of paper. So I said, is it okay--can you not throw away that piece of paper and perhaps put it in this box that I give you, and we can take that home? They were like, yeah, that's totally fine. That wasn't a burden for them. So every week we would go to these intervention restaurants, collect them, 00:26:00like all the receipts smell like fried chicken, and we had to type that into a [Microsoft] Excel sheet. Over the course of seven months, we collected about 186,000 pieces of paper that had to be entered. A lot of them were in codes, so we had to create a code book, and some were written in Korean, so I had to hire Korean undergraduates to type that in. And it's really repetitive work. No one likes to do it more than two hours, so I really had to understand how to motivate them, motivate such boring work. I told them whoever gets it done fastest, I'm going to make you a Korean family meal for four. That motivated them. That worked. And you have to change all the time. You can't give out the same incentives. I would sit down with them and do it to show that I do it, too. 00:27:00I also gave them reasons why this was so important, like this is the first study to quantify intervention of this sort. This is going to be big and this evidence will be used to convince other restaurant owners. It's quintessential to scale up. That motivates students.

With that data, we were able to document sales of healthy foods that we were promoting over the course of the intervention, and just after one month of highlighting healthy foods, they sold--increased by one hundred percent. What does that mean? Well, if they sold two grilled chicken sandwiches, then it became four. If compared to four hundred fried chicken they sell, it's small, but it's how you communicate with others that you're not going to lose money. 00:28:00That's the biggest fear that these restaurant owners have. The fact that not only you're doing good, so you feel good about yourself, but your business will be fine. Anecdotally, I heard from restaurant owners that they earned new clientele. I was like, oh, tell me more. Some of the unintended positive consequences were that the rumors got out, oh, these small corner stores are now selling salads, they're selling healthy foods. So nearby elementary school teachers who would almost always bring their own lunch started coming to these local carry-outs because they heard from the community that they have healthy food.

That also resolved some of the tension [between] Korean immigrants and predominately African American community members. Back in the nineties, the LA 00:29:00[Los Angeles] riot, Rodney King incident, and all of that created really negative relationships between Korean immigrants and African Americans. Community members will say, they--"they" as in Koreans--come in, make money and leave. They don't give back to the community. Those are the main sentiments that you would hear. Korean immigrant store owners will say they [African American customers] are very rude. They will come in, they look at you in the eye and they talk back. Which is really interesting because in Korea, looking in the eye is considered rude, especially if you're a younger person looking into an older person--it's very confrontational. So, some of those cultural barriers are happening when they're both trying to be respectful but they're actually being interpreted as disrespectful. Very interesting, and me being that bridge between 00:30:00these two populations, I was able to create a fact sheet for the store owners. You know, "In African American culture or American culture in general, looking in the eye means they want your trust; avoiding eye contact is in fact disrespectful." And Korea is like a no-touch culture. We barely shake hands. We always bow. But in America, there is a lot of contact. We hug to show respect or we shake hands and things like that. It's not for them to be disrespectful to you, it's just their way of showing friendship or closeness. So it was a really good experience for me to bridge the gap between the two cultures, learn about 00:31:00the burden they go through day to day. It was just really an eye-opening experience. A lot of my family and friends were very concerned that I'm in these very dangerous neighborhoods. Have you seen the show The Wire?

Q: Mm-hmm.

LEE: I'm in The Wire, right. There were gunshots at times and a lot of the gang members always hang out in these carry-outs to deal drugs or what-have-you. At first, the community thought [I was] probably like a niece of the store owners. And then because I kept coming back, early in the phase, they would say things like, you don't belong here, go back to where you're from. But because I show up all the time, they will say, oh, Miss Lee, God bless you, you always come back.

Q: Who was saying this to you?

LEE: Just, you know, some old lady sitting on the stoop or people who come to the restaurant like every day.

Q: Are they like African American, Korean?

LEE: Yeah, African Americans. We're talking about like twenty-thousand dollars annual income citywide at the time. Some of the communities I would go to reported neighborhood annual household income would be like nine thousand. I can't even wrap my head around that. All these houses are boarded up. And people get by. I don't want to put a number on it, but a majority of the people living in that neighborhood do their best to live day to day, and because of a small fraction of people who are involved in gang activities and what-not gives them a bad reputation. But I even put it in my dissertation acknowledgement section that this gang member, who is really, really nice, very polite--in fact, he's the one who, when he orders food at this carry-out, he will say, "Ma'am, may I 00:33:00have" blah-blah-blah. He was really worried that I go home late at night, so he would walk me to the car and say, "Miss Lee, this is a dangerous neighborhood, you really shouldn't be walking by yourself, alone." I'm thinking, you're probably causing the vast majority of the problem dealing drugs, but thank you. I didn't say that to him. But you see what I mean? Whatever situation that they got into dealing drugs, that doesn't mean they're bad people. They're good people at heart. I was really able to experience that with my entire body being out in the field all the time.

That kind of shaped my attitude towards public health, and I wanted to do more. I wanted to go bigger scale than the community, and CDC felt like it was a good 00:34:00opportunity for me to understand nationwide policies and how the states are doing at a larger scale. Coming from Korea, the federal system is really interesting because we don't have that, it's such a small country. It's a centralized government as opposed to here, states have their own autonomy and then the federal level. I really wanted to understand that, so I applied to the EIS [Epidemic Intelligence Service] program and also professorships because I also really enjoyed teaching. So I had two options on the table. Couldn't decide. Again, I was brainwashed to be a professor, right, and now I'm given a professorship. It felt like I need to take this. Brainwashing is a powerful thing. And then this EIS thing that I applied, not knowing much about it--I did 00:35:00it because other people said you can find jobs. Like, you can be positioned in states. My husband and I were doing long distance. He was going to start medical school at Tulane [University] in New Orleans, and I wanted to be with him, so if I do EIS and get positioned in Louisiana, that sounds great. That's why I applied with EIS in the first place. Ha ha. I got accepted, and I consulted with a former EIS of '63, I think, Dr. Bob [Robert S.] Lawrence, who was my mentor, who was a director of the Center for a Livable Future as well, who gave me Eating for the Future fellowships, and that scholarship was really meaningful to me because my grades were bad. When I was applying for that scholarship, I wasn't the top of the class. I told you I had several Cs. But he really saw my 00:36:00vision in the carry-out project. I would always go back to some difficult decision making, I would ask for his advice, and he basically said follow your heart, you know what you want to do. You'll probably still be a good professor candidate even after EIS.

So I did EIS, and it was probably the best decision I made ever in my life. EIS really changed my life completely. Really amazing colleagues, first of all. You learn from your friends, you learn from your colleagues. I have the utmost respect for them. I don't know why it's making me emotional because I can see 00:37:00their faces and--really good people. I had the privilege to work with really, really good people, and interesting. In public health emergencies, we're like first in line to go. Sometimes I don't go. I was stationed in the obesity branch. People aren't dying of obesity like right at this moment, but I still learned from friends going out in different outbreaks and some of the difficulties they experienced. I asked myself, how would I have done that? Or like, wow, that's really cool. All these very difficult Latin names of viruses that I can't pronounce, like that's so cool.

Q: Can you tell me a bit about coming down to Atlanta?

LEE: What do you mean?

Q: Oh, that's right, you went all over. Sorry. Did you have EIS training in Atlanta at first?

LEE: Yes, I did. We had a matching week in April. I came down and we got matched, we went back home and then came back at the end of June.

Q: Another thing I wanted to follow up, just thinking about the people. Who are some of your fellow EIS--I don't know what you call them--class members?

LEE: Classmates, yeah.

Q: Classmates who come to mind?

LEE: A really good friend of mine who actually did PhD at Johns Hopkins as well several years ahead of me, Becky [Rebecca D.] Merrill, she was also positioned in--we were in the same division. She was in the nutrition branch, international nutrition, and she was like my big sister. She would be my soundboard and very good listener. I have a really huge respect for her. She was actually first to deploy to Liberia and told me about her experience and that really got me excited to go. The reason why I couldn't go any sooner than September was because of my non-US citizenship status, and the whole medevac thing became a real concern. I didn't have the guts to go to affected countries without knowing that I could be medevacked back to the United States. That kind of held me back, 00:40:00but I worked at the EOC [Emergency Operations Center] doing my part. I wanted to do something infectious, international, and Ebola happened.

Q: And you would've worked in the EOC in like mid-2014?

LEE: Yeah, July 2014. Early on, I was with the epi people. We had very little numbers to work with. We had to rely on WHO [World Health Organization] situation reports. I was able to see firsthand what kind of situation we were in, in July cross-sectionally at that time point. I met Barbara [Knust], who was a Viral Special Pathogens [Branch] person who had done many outbreaks related to Ebola during her EIS. We sat down and talked about her experience, what would be her biggest concern in outbreaks like this, and she brought up burial. In the 00:41:00previous outbreaks, burial was one of the main reasons why so many people would be infected. Huh, interesting. Because of my anthropological training at Hopkins, along with epi, I read some papers on how to go about incidences like that because burial is very emotional for many, and I also understood some of the local rituals. We look at it as a behavior that needs to be changed in a very public health cut-and-dry way. It's local, it's their livelihood. You really have to be subtle about changing their livelihood. Believe it or not, 00:42:00obesity prevention has a lot to do with behavior change. Telling people how to eat is a very emotional thing. You know, what's your favorite food?

Q: Probably chicken, but I'm a vegetarian now, so it's awkward. [laughs]

LEE: Okay. Let's say you really like fried chicken, you really like your grandma's fried chicken. And I tell you, you should stop eating fried chicken, you have to give up your fried chicken. Unless something dramatic happens to you, it will be very difficult and you'd be like, who are you to tell me to not eat fried chicken? Same for me. If someone tells me you should stop eating kimchi because it's really salty, I'd be like, dude, kimchi is who I am, so no. Right? Same goes for things like burial or how people eat food at home or things like that. It's just really difficult behavior to change. Becky, my EIS 00:43:00classmate, understood every single bit of that because she did her dissertation in Nepal. So she had years of field experience, what it's like to be in a different country, different environment, and she did micronutrient intervention. You can't tell people all of a sudden you need to eat more meat. Uh, I don't have money to buy meat. Then you have to find plant-based foods that have vitamin A, how to best eat vitamin A, you have to cook it instead of eating it raw. All those kinds of things she understood, and her sentiments really hit hard and really made me want to look into burial more because her experiences in Liberia were also echoing Barbara's sentiments around burial.

My opportunity came. In early September, Barbara emailed me, "If you want to do burial-related research, now is the time." So I created a small mini-proposal, a qualitative study that looks at barriers and facilitating factors around accepting new, medical burial. Why are people not doing it? "We have this perfect solution. If everyone follows this perfect solution, Ebola will stop." Why is it spreading like wildfire? I worked with Paul Richards from Netherlands, who was an anthropologist who worked in Sierra Leone for decades, and I wanted to hear his side of things, what it was like back in Sierra Leone. That's when I learned in depth about their civil war, how people don't trust young people 00:45:00because back then they used little boys as boy soldiers. There is a huge distrust in government. All those things that really impact nationwide efforts to end Ebola. It's like, okay, these are some of the things I should know before going in. The proposal was ready, we're ready to go, we communicated with the Sierra Leone team, the country lead, and at the time there was a burial lead. We shared a proposal, we thought they were okay, they wanted us to talk once I get in-country. I made it to country, met my team lead, and I was deployed as a health communication and promotion team [member], unlike all my other EIS officers who went in as epi's [epidemiologists].

Q: What time did you enter?

LEE: September 26th. I got in I think that evening or the next day. I met with the person who was in charge of burial-related work and I told her what I was envisioning to do, and the person said, "Do you really think that's going to end the epidemic?" Whoa, I put three weeks to a month of my energy into this, not expecting that kind of feedback. But then it made sense--what's going on here in Atlanta headquarters, what's going on in Sierra Leone country, there probably was some gap that the two sections couldn't fully understand. It totally made sense. There's bad internet, time difference, in-country field team in chaos all the time, we don't have enough people and people are dying. It's really 00:47:00emotional. We're busy running around. We don't want to sit in front of a telephone that is cutting on and off trying to report back what we just did. That's probably the last thing that in-field country team members, individuals would want to do. It's really burdensome.

Q: Burdensome to report back to headquarters in Atlanta or to continue with the study?

LEE: To report back. So I kind of understood what was going on. I'm an EIS officer, I've been in several fieldworks before. I'm just going to be a good, good field member. You tell me what to do, I'll do it. So my team lead and I decided to hold off on the project that I brought from Atlanta and decided to just work on the communication side of things. At the time it was "health 00:48:00communications team," it wasn't "health promotions team." A lot of it had to do with media response. We also provided our expertise in social mobilization, like messaging and things like that. As a communications team, we would sit in nationwide social mobilization pillar meetings that UNICEF hosted that involved local NGO [nongovernmental organization] leadership all coming in together. At that time, it was time to move to the next phase of communications. The first phase was the "Ebola is real" phase, and then we were now moving to actions against Ebola. Wash your hands, call for help, don't touch the dead body, that sort of messaging. Action items that could be penetrated into the districts. We 00:49:00were sitting at a high level.

I have a different interpretation now, but at the time as an EIS officer, I felt like I wasn't qualified to be sitting there discussing high-level things. I'm not the decision maker, and I wasn't really contributing to their discussion other than just absorbing what these NGO leaderships had to say, which is really, soak it all in. That made me feel frustrated. I like to do things on the ground, just running around. I'm totally comfortable with that. So I begged my team lead, you need to send me out, please send me out, I'm so much better out in the field, please. He totally understood where I was coming from, but he's also a good leader, so he needed to work with his leadership to find ways to 00:50:00send me legitimately out in the district that is still doing good work along with the response that the current Sierra Leone country team is doing. He came back to me I think the end of that first week, we got to know each other better. We were already working fourteen hours, exhausted. He's like, "I think I found a way to send you out."

Q: What was his name again?

LEE: His name is Nick [M.] Deluca and he's like, "I think I found a way to send you out." I said, "Yeah? What is it?" He said, "But you have to cover two districts, Bo and Kenema, and you have to focus on survivor support work that is part of the Focus [1000] KAP [knowledge, attitudes, and practices] study that's been going on. Kenema has a lot of survivors, so you can probably gather information around their experiences, lessons learned, and also support UNICEF, or the Ministry of Health [and Sanitation] as well as UNICEF's efforts on a 00:51:00survivor conference that's going to be held in Kenema for the first time. We need someone there to support that effort. And if you have spare time, you can also work on your burial." [laughs] He didn't say that like that, I interpreted it like that. He said it much more politically, I just don't remember. But he just basically said go out there, see if you find an opportunity to do something--it might be a portion of your research proposal. I also had to have a legitimate reason to do it. Just use your best judgment, go out there and see if you can find a way and you can try to convince me, basically, is what he said.

So off I go. I was assigned to a driver that would drive me back and forth, Bo and Kenema, and I brought this notebook here because it's like a good reminder 00:52:00of things I did while I was in Sierra Leone. It's a notebook of things, the meetings I sat in. I drew graphs and things like that. There's a calendar here. You can see "B" is Bo, "K" is Kenema, "F" is Freetown.

Q: Each day in the week is circled with a B or a K or an F.

LEE: Yeah, because I needed to let the logistician in Freetown know where I will be ahead of time so that he can ensure there's a room for me. I had to juggle that and every district, they have different meetings on different days and I 00:53:00want to really attend that meeting and there's curfew. You can't enter or leave a district after 7:30 pm. Things like that, and it takes time to drive there, etcetera. A lot of personal logistics to figure out. I basically lived off of two backpacks because I couldn't really settle into any of the hotels because I had to keep traveling.

I got really close to my driver, and I knew he would be--my life depended on him. While I wasn't in Bo or Kenema on the road, I was alone with him. I knew developing a good relationship would go a long way. So I asked a lot of things that I obtained from the research around like secret societies. I asked him, 00:54:00"Are you a member of a secret society?" And he started laughing, he's like, "It's a secret, I can't tell you." And I was like, "I know, that's why I'm asking you." And he basically said--there are several things that are already well-known in the world like Poro, which is a male secret society, and Bundu, which is a female secret society. If you're born male or female, you'll be part of it, period. That's the Sierra Leonean way. Initiation process involves circumcision for men, female genital mutilation for women. Because it involves blood, the president at the time [decreed] no secret society initiation nationwide, and that traditional healers should not practice what they practice. 00:55:00I said, "Okay, well tell me more about this traditional healing. Why do people say Ebola is witchcraft? What is witchcraft? How can someone witchcraft somebody else?" And he explained to me you have to hire the traditional healer to witchcraft someone else. It might involve money, might involve some rituals, and that usually it curses the person and makes that person really sick, oftentimes the entire family gets sick. Ebola is just like that. One family member becomes sick and then the entire family becomes sick. The way the disease progressed looked as if it was with traditional understanding of witchcraft. I said, "Okay. But then, sure, it came from Kailahun, but now it's all over the country. How do 00:56:00people explain that with witchcraft?" And I sent you the journal that I wrote that talks about witchcraft. There are witch planes. It's an airplane that you could send witchcraft messages across districts, and there are multiple, very spiritually powerful people all over the country. When they're sending witch planes, they might collide in the air, and then unintended consequences because that witchcraft has landed onto random villages--therefore still witchcraft. Not intended for that specific person but, you know, collision. And there are witch guns. It's a one-on-one contact, like it might be made of wood or something. You stick that to you, you have been witchcrafted. That's one-on-one, but a witch 00:57:00plane, it's big enough to infect the entire village. They wipe out an entire village. That's their interpretation. That's locals' beliefs. To fight that or to overcome that is going to be a very difficult, challenging thing to do if that's how people think about it.

When we create some of the training-of-trainer materials, I really wanted to learn from the locals, how can we convey the message that Ebola is a virus? A lot of people brought up measles. Many people in my country experienced measles, we all know it's a virus, there's vaccine. And then the frustration comes, why does Ebola--why do we not have vaccine? One of the most interesting things I 00:58:00heard amongst these high-level conversations when I was in Bo District and Kenema District was that if there's no vaccine, why should we go to the hospital? That's a big, a very important statement on my end. Like, wow, never thought about it like that. I always thought if you were sick you should go seek help, but a lot of people in the local believe that there's no treatment, there's no way to prevent it. If you get it, why should you--you're going to die. So we created a message around if you seek help early, your chance of survival becomes great. Fifty percent of the time, people survive. But if you don't seek help, a lot of people die. That was important lessons learned that I obtained while I was out in the field, which was really, really great.

Also, traditions around burial. I wanted to know the nitty-gritty. "I heard that you wash the body. How do you do it? Why? What is it about burial that so many people get it?" My driver was Muslim-born but he became Christian. His name is Abu. Like Abu Bakar, that's very Muslim, but he's Christian. How ironic is that? But that's how it is in Sierra Leone. You're born Christian, you become Muslim. You're born Muslim, you stay Muslim. All kinds, but they all live happily together. It's incredible how they do that. He explained to me about the Muslim burial, and then once I got to Bo and Kenema, which are heavily Muslim, they explained to me how the burial is done. So usually men wash men's bodies, women wash women's bodies. Someone close like your sister. If I die, my sister or aunt or female relative would wash the body starting from the right side and then the 01:00:00left side. You either have the best clothing you've ever owned and then wrapped with white shroud, and there's a whole list of processes: how that body gets transported to the gravesite, who goes into the grave to hold that body right-side-down facing where it's supposed to face. Then, there's a rectangular hole. They put trees vertically and leaves vertically and then put the soil in. I said, "Why do people do that?" They said, "Because, one, they don't want animals getting to the body, but also, how can the body breathe if the soil is right on top of the body?" "Like, breathe? Please explain further." Many people 01:01:00explained to me that the day of burial is the best day of your life because you then will enter the eternal, painless world where all your ancestors are waiting for you. If you're not cleaned, you won't be welcomed. Ancestors will not accept you, so then you end up floating in this gray area. That's why when the burial team takes the body from you, they will find the body, dig it up, wash it, because you want your loved one to be in a painless world. Wouldn't you want that for your loved ones?

I'm speechless. Everything makes sense now. But then, what can I say for these people who have that kind of belief not to wash the body? That was my ultimate question. To find answers from the people, and I really wanted them to have an answer, [laughs] like is there any way we can bypass this whole washing part but still respect the body so that the body can enter the eternal world? Because that would be a win-win for all of us. Can we please find that? But like I told you, when I first got there, at the time, British support was coming in. We're very excited, the British military is coming. A few of the people were saying, just have the military do the burials because they follow orders, and so there 01:03:00is less chance of mistakes. Because we were having some trouble training the burial team so quickly, and sometimes there were mistakes wearing PPEs and what-have-you, let alone too stressful, so stressful for the burial team. No human should ever have to do that. You know, ripping the loved one's body away from them and then like stacked up high in the back of the truck because that's the only truck you have in the district. But you also are told to remove the body because that body is carrying so much virus it can infect people. That's hard for anyone to do, and we were training local community members to do it. Some will do it because it's a high-paying job. So, that idea of let the 01:04:00military do the burial. I understand that ending the outbreak, that's at the top of the--that's our main mission, but this country had gone through civil war and slavery from the British. They were slaves. They came here to have their lives, and how interesting the social dynamic is in Sierra Leone. People who speak Krio were the slaves, or not all of them but you know what I'm saying. The majority of the Krio speaking population were former slaves. They now have a higher social status because they can speak English and they've had opportunities for 01:05:00education and they've seen the advanced culture, what-have-you. Now they've become the top class in Sierra Leone. And then there's locals--Mende from the South, Temne from the North and that dynamic. And you want British military to take burial? It's like digging up old wounds. I didn't say--I mean, I was here and those people are like there. That didn't happen, thank God, but the fact that people can think like that made me very depressed. Often, we are so goal oriented that, you know, yeah.

Q: Do you know why it didn't happen? Do you know what caused it not to go that way?

LEE: Because it doesn't make sense.

Q: Do you think it was really because it doesn't make sense?

LEE: Yeah. I mean, no. Because British military weren't there to militarize the country. They were here to provide medical support, communications, and really build hospitals. More structural support as opposed to carrying guns around and telling people--they weren't there for that. We were idealizing. Oh, British military is coming, maybe they can do the burial. And like I said, I see the point of that. It's just the other side of me finds that sad because it's a 01:07:00little ignorant, and sometimes Americans are like that, unfortunately. I don't necessarily find myself cultured, but I am exposed to a different way of looking into how Americans do things. Some of the people I worked with in the field had never left the country before. It was their first international experience. I thought, that's bad news. Not everyone, but in my head that's bad news because Sierra Leone of all places is not the place you want to be exposed to international experience, because it's so devastating. Very little electricity and what-have-you. But we were staying at a five-star hotel, the Radisson [Blu 01:08:00Mammy Yoko Hotel] and A/C [air conditioning] and electricity, internet. You're in this unimaginably different silo. That's why I wanted to leave. Becky was also a good informant, that you want to be out in the districts. Don't be in the capital because what's out there is so different, and if you don't go out there and see what they're actually experiencing, what you're talking about in the capital, you'll never be able to resonate. I'm really grateful for that.

Where was I? I think I lost my train of thought.

Q: Well, now I have a bunch of questions that relate to this current train of thought. One of them is, were there public health arguments being made by you or others, based in public health, based in epidemiology, that it didn't make sense 01:09:00to have the military removing bodies very pragmatically? I can imagine the argument being made that gaining community trust is important for improving--you need buy-in from the community, and if you have the military going in and taking away bodies, you could have people hiding them.

LEE: We were that desperate. Everyone was so desperate. We didn't have enough cars. We really didn't have the luxury to be dignified. It was complete chaos, so I can't blame the person who said that and I can't blame how the response actually panned out because I think we did the best we could. Yeah, of course, it's great to obtain community trust, yes. But also what we're telling them, 01:10:00like wash your hands, don't touch the dead body, that's also true. That's the truth, but we just didn't have enough people to execute those missions, so we had to prioritize. And that, at the time, was a top-down approach. Sure, in an ideal world you have top-down, you have bottom-up, we meet in the middle, that's a beautiful public health--in the real world it's never that beautiful, it's always dirty, there's always something missing, there's always something we could've done better. But I happened to be a little bit more experienced in anthropological approaches and locals that I'm working with--when I say locals, they were Americans or British NGOs that they lived in Sierra Leone for a couple of years for a different mission. They were telling me, we were waiting for you, 01:11:00we heard that you're a CDC anthropologist. I'm like, okay, well, I'm an epidemiologist but I also do anthropology, not professionally but I know what that means. That's what they needed at the time, so I really decided to wear that hat and function as that role while I do the public health mission that I was told to do, which involved listening to people. That's all they wanted. They wanted their voice to be heard.

So I tried to do that outside of meetings. "Tell me, what do you think would really fix this problem?" That sort of thing. There was a call center, 1-1-7, you're supposed to call that number to report that you have a sick person in 01:12:00your house or there's a dead body in the house. Dead body was always a priority. What happens is you call for a sick person, no one shows up for days. By the time that person dies, then an ambulance would come. Unintentional. It's just how we allocated resources, risk mitigating. But then people like, you just call--no, actually some of the sentiments were like, people are making money when people die. The burial team is making money because there are dead people. So then the locals don't trust the burial team. They're making money every body you bury, so you want more people to die. You know what I mean? Very, very 01:13:00inhumane disease. Everything that humans do, like caring for the sick, being honest, everything that we are told to do as humans we were not supposed to do. We can't shake our hands, we have to always stay distant, very lonely, and everyone was on the edge like that. They've been doing the work for months in that kind of emotional state.

Dealing with distrust was I think the most difficult thing. I told you last time about the whole chlorine. When I was in Bo doing social mobilization, we went to different villages, and Bo was just getting new cases--neighboring Kenema. Kenema, height of the epidemic in July, they were getting controlled. It died 01:14:00down, but then Bo was starting to get new cases and they were getting really scared why we get pockets of cases, where did they come from? We would go out to the villages and ask the chief what happened and why does the chief think it happened. The entire village came close to our car, very upset, very hostile, telling us to leave the chlorine bottle next to the car if we were to walk into the village. We were really confused, and we don't want to go anywhere without chlorine because chlorine is my lifesaver. So we had a local who spoke Mende ask, "What's going on, why is chlorine bad?" And the chief started explaining, "We had a community clinic. A lot of the nurses died, and then a bunch of white-clothed people came in, started spraying inside the clinic. They closed 01:15:00the door, they locked the door, and the spray team said don't go inside." Without telling them when they could go back inside. So the chief thought, oh, it must be really toxic and that's why they told us not to go inside. So, one bad memory. And then when there were other sick people, he called an ambulance. The ambulance team takes the sick person, puts them in the ambulance, closes it and starts spraying outside the ambulance. They thought, oh, there's no ventilation inside and the fume is really toxic, so they're killing the person. Let alone all those sick people never came back, so what's the point of notifying that they have a sick person? We had to explain to them that it's our 01:16:00bad that we didn't tell you when you can go inside. Chlorine kills Ebola virus, but we just want to make sure that it kills Ebola virus completely before you go in and accidentally be exposed to the virus. That's probably why these people told you not to go inside. But we love chlorine--not chlorine itself, but the chlorine solution because I feel really safe, especially in a country where we don't have running water. We demonstrated in front of them, sprayed it on our hands, our boots, all over, and nothing happens, right? So the chief felt comfortable demonstrating the same thing in front of the village members. Village members looked like they were getting, okay, maybe it's okay, and they were starting to talk to us and listen to what we had to say and things like 01:17:00that. It was an eye-opening experience to understand what kind of communication barriers were occurring. Now we needed to move forward with that, chlorine is safe--like we have to incorporate that now. Those kinds of things, you would never know sitting in a room, unless the locals understand that nitty-gritty to tell us. So things like that were very nice to see.

Q: I have a good idea of some of the ideas that you're wrestling with and the messages that you're wanting to put out, but a little less of an idea of the things that you're actually doing to do so, like what your days consist of. Going out and meeting with leaders, or what are we talking here?

LEE: Yep. Every day starts at a small office at the DHMT [district health management team] with epi's and myself. I would usually work with the WHO 01:18:00representative who was covering Bo, who would go out to do social mobilization, what-have-you. Every week, there are two EOC [emergency operations center] meetings in Bo EOC. All the different pillars report back new cases, how the quarantine has been executed and things like that. After that I would meet with the social mobilization team in Bo that consists of local NGO leaderships like Catholic Relief Services and what-not, and we discussed ways to communicate from lessons learned. We craft a message that's going to go out on air, on radio. The radio folks were there, so it was real time. Like, oh, I heard about this chlorine, can you feature that in the radio show? Or the radio Q&A [question and answer], people will call and say, I heard that quarantined villages are not getting the rations, can you tell us more about that? The radio host doesn't know the answer. Then we will try to solve where that rumor might be coming 01:19:00from. Things like that.

Issues around burial were getting more interest because epi data from the Sierra Leone main office found that at the time, like eighty percent of the new cases were exposed to a dead body, like sixty percent went to a funeral, or something, a very high number, that we really needed to focus on burial. So it made sense for me to conduct focus groups and see how people felt in Bo. I trained Bo social mobilization team members on how to conduct focus groups. Me, as a technical assistant, created a draft of focus group discussion questionnaires, but I worked with them to revise some of the phrasing. One of the things that 01:20:00really struck me the most is one question was, what do you think about Ebola? Is like the first question. And all the locals are like, no, no, no, you can't do that. If you do that, you're going to hear the answers that you want to hear. You have to ask, how do people feel about Ebola? Then they'll tell you how they truly feel, what they're really thinking in their minds. It's that subtle difference of just different way of language spoken in that country. The findings were astonishing. We did sixty-three focus groups in twenty-one villages in three days--sixty-three focus groups in three days. And these people had to drive seven hours, stay in the village. They slept two nights there, did three focus groups a day, came back, and they all came back in three days 01:21:00without pay. They've been doing work without pay since May--not a single penny. I knew it was going to be difficult to convince them to do it, and at the very least the money was coming, but they've been hearing that for way too long, the money is coming. They weren't budging. Like yeah, right. So I had to do the whole emotional speech of, please, this will be really informative, I will do all the analysis. You go out there, gain trust from the community that you guys are actually listening to what they have to say, I will do all the heavy lifting. You know, like a please. I said, "For good faith, I will buy you lunch, I'll treat you to lunch." I paid like thirty dollars, twenty dollars to feed 01:22:00sixty people, and then there were leftovers to feed the entire compound. I still remember social mobilization members saying--and I was so embarrassed, like this is the only thing I can do for you to show my good faith that money is coming, you will be paid and I will do all the heavy lifting. It was like, "No one has ever given us anything since May, so it's the thought that counts, we trust you."

Q: Can you describe some of the social mobilization members who stick out in your memory?

LEE: Yeah. Mohammad was a guy with a really thick accent I always had a difficult time understanding. He was from the Ministry of Health. Very strong-headed, but knew the way around the government, so it was really 01:23:00important for me to earn his trust. I can't remember--Yali I think was the social mobilization team leader. Very soft-spoken but gets things done. Understands the American way of things, you know, we have to show measurement and impact. He totally understood that. He comes to mind. There were some really young like twenty-some, early thirties men who did HIV [human immunodeficiency virus] work in the past or whatnot, and they were ready to hit the ground and they were just upset that they can't do the work. The entire social mobilization team had one motorcycle allocated to them when I got there. So you have to choose wisely, which village are you going to go to sensitize a community? 01:24:00Because a lot of the villages don't have radio, don't have cell phone signal. Radio communication reach is only to that of very populated villages. The real concern: to create like a complete seal, you have to reach these small pockets of communities, and the best way is actually to go there. That was a good opportunity for me to realize because I always thought efficiency. Cost effectiveness, you do very minimal but you reach a lot of people, that makes more sense, so I really didn't understand when I was sitting in the first week at the national level meeting, why do you want to go there? Why do you want to spend fuel to go there and maybe reach like fifty people in that village on that given day? That's not efficient. Think about posters, radio. When I got to a 01:25:00village, everything made sense. Like, no, because that's not possible.

Q: When you say it's not possible, what do you mean?

LEE: For them to receive radio, because there's no radio signal, [laughs] and there were a lot of text messaging thing happening, too. These people don't have cell signal. They have to drive like an hour to get cell signal. Everyone has a cell phone, but they don't get the signal. Things like that, experiencing real barriers firsthand, made me really reevaluate--okay, yeah, we really need to listen to what they have to say because they know their situation the best. We would drive four hours, educate for two hours, and come back for four hours. That's one day spent. And when we usually go out, we try to hit as many villages 01:26:00as possible. One village I went, they didn't get Ebola yet but their neighboring village did, so we wanted to make sure that they are well prepared if it were to come to their village. The village chief was a very powerful man. Within five minutes--there's some sort of communication structure that's embedded, incorporated. In five minutes, the entire village is surrounding us, ready to listen to what we have to say. I don't know how they do it, but they do it. And the chief was telling me a most interesting thing. Not me, but the other team, and they translated. That, "I heard from the neighboring chief that quarantine would happen if a family becomes ill. He also said the quarantine ration might not come in a timely manner, and that chiefs really have to step up so that the 01:27:00quarantined family can stay quarantined. I heard that from my neighboring chief." And I said, "Tell me more what the other chief told you." And he was basically saying, "I selected five reliable young men in the community to harvest for the quarantined family because that region, they're all farmers and it was during harvest season. They're not worried about the next twenty-one days, they're worried about the next seven months of food and money, the income." Because early on in the outbreak, one of the messages included do not eat bush meat. So all these bush animals are having a field day ruining these farms. Every individual I talked to said Ebola is only good for bush animals. [laughs] Bush animals are happy. They reproduce, they make a large family. So an 01:28:00unintended consequence of telling the message of "do not eat bush meat," they're not killing bush animals. Bush animals are ruining the farm. A quarantined family worried about their farm will not stay quarantined, will go attend to the farm. So the next neighbor chief told them, if you can ensure and comfort the quarantined family that there are other people attending the farm, make sure you give them ten percent of whatever the harvest comes out to be, we all win. And the other village chief said it's not to shame the family. The community really has to fight together. Neighbors will bring chicken in front of the border--like there's a radius you're not supposed to enter the quarantined home. They will 01:29:00leave fresh water or chicken or cassava leaves, things like that for the quarantined family because quarantined ration usually includes rice and beans and some lard and fuel. Some might think that's enough to survive, but that's not an exciting life when you were eating chicken and fish yesterday. All of a sudden, I eat rice and beans now? Come on. So that was a really good way to understand how organically some of these solutions were occurring. It wasn't always that positive when I go to the villages, but some of these good messages can be reincorporated into dissemination throughout the district or even to the national level, and that's what I did. I wrote up for my burial paper, these 01:30:00were the focus groups that we did and some of these findings were coming about, and organic solutions tend to be well accepted by the community. So things like that I did in Bo.

Kenema was a little bit different focus on survivors because--so every district I go to, they were hosting me and had more or less to do with social mobilization. Kenema uniquely had social mobilization and psychosocial as one. They were working together as one, so communication was also their responsibility but also supporting the survivors' needs was their responsibility. It all organically happened. They didn't really probably do that 01:31:00at first, but when these survivors are coming back to them and saying I can't go back to my home village because they boarded up my house, I can't get into my house. The leadership involved an HIV counselor in Kenema. For her, it made sense why they might be experiencing stigma, and how to empower them to go back to their livelihood. It was almost natural for them to counsel for the survivors and what-have-you. It was a really good model, and I wanted to learn how they did it so that other districts, once they started to have growing survivors, they would know what to do or at least they will have some sort of reference: oh, Kenema did it like this. Some of them were positive, some of them needed improvement. They have something to go back to.

I did a rapid assessment of survivor needs, so I did a lot of interviews with survivors. I also reviewed the packets that they received. It was the most comprehensive discharge packet. It included a mattress, some food, toothbrush, cell phone with some money on it, flip-flops, clothing, soaps, and female--like tampons and condoms and all those things that would be enough for like thirty days for a survivor. That looked really good at the time, but some people never received it, some people received it twice. That sort of thing led to the idea of a survivor registry to really keep track of them, to keep up with--if they have any medical concerns onward, how to react to it. That whole post-Ebola 01:33:00syndrome idea was alerted to Freetown when I first got there. That's one of the reasons I was sent to Kenema to do survivor things in the first place, because Kenema drafted a proposal that there are a bunch of survivors suffering from this post-Ebola syndrome, we need medical help. Understanding Sierra Leoneans' general tendency to seek medicine had to be taken into account. What that means is, I say I'm sick, I get Advil. The person sells Advil in an underground market or sells it back to the pharmacy or what-have-you because it's a resource-poor setting. If you can get that for free, you get it for free and you make profit somehow. There were some concerns around, are they really sick, are they really 01:34:00ill? I was there. I witnessed it myself. I had one survivor having a seizure in front of me. A lot of nurses were survivors, and they were explaining how they can no longer read charts because of partial loss of vision, or headaches, joint aches and things like that. I just documented all those, as a good epi would, take it at face value and ask them--because at the time we were really interested in utilizing survivors in Ebola care centers, treatment centers. Like I said, there were a bunch of laboratorians and nurses who were healthcare professionals. They understood the need. So I thought maybe we can get some buy-in from them. Some of them got really offended by the fact that I even suggested the idea, because they're like, we are still sick and why are you not 01:35:00looking out for our medical needs? You need to take care of us first. And they either couldn't go back to their jobs because they can no longer perform the jobs due to post-Ebola phenomena, or they lost it. They don't have a livelihood anymore, so oftentimes that would motivate them to say, yes, I can work, I will work, I will do anything because I need to be independent. That spirit is throughout the country, especially after wars. Everyone wants to be self-sufficient. They have their own farm, they grow their own food, they don't want to ask for help, they like that empowerment. So a lot of people I spoke to said yes, I want to work. And I said, why do you want to work when you're still 01:36:00sick? And they said, I want to be self-reliant. That would be the common theme that comes constantly.

One of the few emotional interviews I did with survivors--I shared that story in my TED [Technology, Entertainment, Design] Talk, but this really young lady, really thin, she lost so much of her body weight from Ebola, she was really thin, lost her husband and her child. She had this survivor certificate, and it's been folded and reopened and folded and reopened so many times that she was embarrassed to show me because it had holes and such. It's like, I really need to laminate this. The survivor support counselor said, "Yeah, that's like a passport here. Without that she can't go anywhere because she's still 01:37:00stigmatized." She's an Ebola survivor. Getting Ebola is one thing, but surviving it is a whole different level of witchcrafting.

Q: What do you mean by that, a whole different level of witchcrafting?

LEE: Other countries that experienced--like [the Democratic Republic of] Congo that had Ebola, they also used survivors as help, and the community members--it was a double stigma. You survived witchcraft? You must be a witch, you must be a powerful witch to survive witchcraft. And now you don't get Ebola again when you're treating them? That's the ultimate curse. [laughs] That's been documented previously. People were concerned about similar things, that the community will think that I'm somehow protected like, ooh, you have a curse, I shouldn't be near you. Things like that.

Anyway, this nurse survivor, I asked her, "Would you be willing to help?" She said, "Yes, I've been there, it's really a very bad condition. I really want to make clothing for them, I know how to sew. That will be good for me to have a job that will give me income." And then at the time in Kenema, we were struggling with survivor orphans, so we asked, "Would you be willing to take care of orphaned children?" Even though she said it's another good idea, I was concerned that I was insensitive because she lost her child. When I asked her, what do you do after Ebola, she said, "I just daydream about my husband and my 01:39:00kid." So I quickly realized, shoot, I was a little bit insensitive about that. For me, it was just a check box, but for her it could've been very emotionally difficult. I said, "You know what? You don't have to say yes, there are other things you can do. If you think you're going to miss your child doing that, you don't have to say yes, I'm sorry, I was insensitive." She was like, "No, I thought about it, I think it will be good for me because I'll be busy all day, then I'll be able to sleep at night, then I can see my family in my dreams again."

I say this story quite a bit because that story summarizes the emotion around it, but also that resiliency, but also grieving. A lot of these people didn't 01:40:00have the opportunity to grieve. All these survivors, they survived, but they lost a lot of their family. One person lost seventeen family members. Left alone. You don't even have the luxury to feel sad or feel bad about yourself because you're going to go hungry and you're being--all the burden that they have to go through. But like I said, Sierra Leoneans, they've gotten through civil war, they've really learned how to be self-reliant. When I ask, do you need mental health counseling or support, they'll say, that's a white people thing. That what your people worry about, we don't have time to do that. So very strong people, very admirable, and they learned how to create support within 01:41:00themselves. There's this survivor buddy system, like a senior survivor who survived a couple days before you [laughs] would be able to walk the new survivor through some of the nitty-gritty, like how to convince others that you are safe, or when you're lonely, you have someone to talk to. That buddy system really worked well in Kenema, and that sort of thing was talked about at the conference. The conference was to really bring survivors together so they get to know each other and brainstorm what were some of the difficulties so they can jot down and speak freely. The UNICEF folks were taking notes so that those kinds of things can be brought back to central level.

Q: When was this?

LEE: It was October 2014, and multiple conferences occurred in various districts over time. I was able to attend a few of them. It was good. Gathering information of what survivors went through. It was the first time ever to have so many Ebola survivors. That was very emotionally difficult for me, but like they said, I don't have the luxury to think about my own emotional problems, and I think a lot of those who deployed probably felt that way, like it's a luxury to miss my husband or it's a luxury to miss a hot shower because compared to the locals--my hotel, so shitty in my standards, but still way better than they could ever have. So yeah, it was hard to navigate when I came back from all of that.

Q: Can you talk for a minute about maintaining contact with home while you were in Sierra Leone, to what degree you were able to?

LEE: I tried really hard. We would often not get a signal. I'll write like an email or two, and the time difference, so a short phone call like every other day. My husband is in the army and he's currently in medical school, but he will be serving as an army doctor, so he knew what it meant that I quote-unquote "deployed," and he was supportive. He understood that I might not be able to be 01:44:00in contact. Maybe I Skyped with him once when I was in Freetown. He was the only person I would call. I don't have time. I worked fourteen, sixteen hours a day. I can't believe I did that. It's the adrenaline, I tell you, with no breaks in between. My first R&R [rest and relaxation] was thirty days--on day thirty of my deployment. I was worn out and just so much emotional stimulants surrounding me. I hear about this, I hear about that. You really don't think about how you are currently feeling. It just--whew! But I also miss that. I'm an adrenaline junky, that gets me going. I always tell my friends, I think it's time I go back to 01:45:00Africa again. I really need to go back to Africa again. I need to feel alive again. Because there, I truly learned to appreciate little things. I told you last time, my hair was never dry because it's so humid and hot. [laughs] So humid and hot. Dry hair, I'm so grateful. And food. I was so hungry all the time. No one had lunch while we were there because we were working. It didn't make sense for us to leave the compound. We were told not to eat local food because if we had diarrhea from food poisoning, that would look bad. You'll have to self-quarantine yourself. So no one actually had lunch. We survived on 01:46:00granola--I can't look at Clif bars anymore. It grosses me out now. I've had my life quota of Clif bars. And breakfast. Yeah, Freetown it's nice, it's a hotel buffet, but in Bo every morning, egg and toast, egg and toast, egg and toast. The Bo hotel owner really liked me because I cooked for the entire hotel staff and my CDC colleagues one day. Like come on, we need to eat something different. I made Korean fried chicken, some bean salad. It was cooked--like warm salad, Korean scallion pancakes--out of good faith. So he loved me, so I always got special treatment. I was able to order Turkish coffee. He was Lebanese, so he 01:47:00had a lot of--all his dinner foods were Lebanese-based, like Mediterranean, and every morning I got Turkish coffee when other people got just hot water and they had to make their own coffee. So everyone knew, Seung Hee's got what's up--if you line up to her, you might get Turkish coffee in the morning. [laughs] That's one thing that comes to mind.

Kenema was in really, really rough shape. There were only like two small fire pits where they cooked food. Two menus only. Chicken and chips, rice and beans. But I cooked them--I tried to make coq-au-vin. We found wine somewhere. We couldn't get the cork to open, so I had to make Coca-Cola chicken, which is delicious, and some sauteed vegetables, and they love me. If you cook for them, they love you. It's very simple. [laughs]

I didn't get to talk about how I was invited to secret society, oops!

Q: Please do.

[break]

Q: We are back, and I think where we left off, Seung Hee was about to tell us a bit about getting invited to join a secret society.

LEE: [laughs] That's right. I was obsessed about secret society because I've read that sharing the secret is the greatest sin one can commit. So clearly, we don't know much about what goes behind the secret society. Earlier I told you that there are male and female secret societies, but of course, one can be part of many secret societies. There are leadership-level types of secret societies, what-have-you. It's like a sorority, fraternity and things like that. Because I'm a woman, I only gathered information about female-related secret societies. 01:49:00I asked them, can you walk me through how this were to occur? A lot of the women I worked with were highly educated women, so I would ask, would you want your daughter to go through it? Because based on what I've read, FGM [female genital mutilation] was a terrible thing, we want to eliminate it, blah, blah, blah. That's where we stand. But I really wanted to understand from these educated women what their thoughts were. And one woman that I became really good friends with, we still talk, she said, "I will have my daughter go through it, too." It was really shocking. She was educated in Saudi Arabia. I was like, "Why?" And she said, "You people"--as in Western culture--"look at it as a health issue, and I totally understand that, but there are other things that's more important for women's entire life, and we teach girls exactly that." After the cutting, as 01:50:00the girls heal, the secret society leadership women will feed them delicious food, teach them how to cook, teach them how to sing and dance, teach how to be a good member of the society, teach them how to serve their husbands, be a good person, blah, blah, blah. Those kind of things cannot be taught otherwise, was basically what she was saying. She wants her daughter to have that sort of knowledge of looking at life and all the good tips. That's the only way it's transcended down to generations. That's why she said yes. That was really powerful to me because I understand that. Coming from Korean culture, we don't have FGM necessarily but there is a very strong social norm of respect, respect 01:51:00of the elders. There's a huge Confucius tradition that's still embedded into everyday life. I understand where she was coming from. Now, that was Freetown, and I go to Bo and I start asking the same questions about tell me more about secret society, and some people will ignore the fact that I even asked that question. But after I developed some rapport--and being naïve always helps, "So what is the secret society thing, like what is that? I don't know anything, please tell me." It always works wonders. For the most part, people will take me to like the corner of the room and whisper the answers to some of my questions.

Kenema, which is closer to Kailahun and closer to the Guinea and Liberia border, there were different ethnic groups walking around the street that I noticed. I told you I'm pretty observant when it comes to things like this. There were a 01:52:00group of population that had like a crescent, like almost like a parenthesis-shaped tattoo or scar next to their eyes--two of them. I was like, what's that? It's like a special--it's that type of people. I don't remember the name, but it's that group of people, they do that practice. When they're young they do it and they put a special herb mixture into that little incision and it gives them different powers or different abilities that will help the baby to survive longer. So if a snake were to bite you, the snake will be afraid of you, or if someone were to poison you, your hand will shake so you will know that someone is trying to poison you. That sort of thing. There were different tattoo 01:53:00type of things that indicated certain ethnic populations, and I said, "How are they different than Mende?" Because I was more or less surrounded by Mende people, and they're like, "They're more savage-like." "What do you mean?" And they will explain to me, "Those northerners, they use body parts for rituals," like dead people's organs. One of the readings that I did, did say they will weigh part of the organ--I think it was pancreas or liver or whatnot, put it on some sort of liquid. If it sinks, you were a witch--or vice versa. If it sinks, you're okay but if it floats, you're a witch, or something like that. Then you use some part of these organs and blood and whatnot to do this special ritual 01:54:00that worked, either like I said earlier, bewitch somebody or un-witch somebody, heal somebody, or just a ritual in itself because that's the ritual.

That fascinated me because from one of the focus group notes I read was the burial team takes the body, dismembers the body. That's why all the family members cannot see the burial. They take the body away, they dismember the body parts, and do the ritual to strengthen the current government. That was one rumor. Another rumor is they use the body part--they sell it. I don't know who buys it, but they sell it to make money. They use the blood for something, and 01:55:00it's only benefiting the Westerners who came in and things like that. So everything kind of made a full circle. Because such traditions do exist, it made sense for people to think that burial teams will dismember the body. One of the reasons why they thought that was because they weren't letting us see it, and that's the really interesting part. When the secret society leader dies--and when I say secret society, we're no longer talking about men, women's secret society--more exclusive, more small, tightly-knitted secret society leader, like say the village chief will be part of a secret society, okay, the chief society. Let's say the chief dies. A secret society member will say the chief has become very ill. They will not say the person has died. The chief has become very ill, we need to perform rituals or ceremonies. The person is already dead. No one 01:56:00gets to see it, even the family. They do all sorts of rituals that involve a lot of not just washing, but now we're talking about more serious things, which I'll get back to. Then the secret society members will bury the body, and then tell the family, this is where your father or mother was buried, if you are in that special leadership secret society. What goes inside, I was told--one extreme end of things was when a chief dies, there will be a successor. If the successor is young, there will always be a group of people against that successor, like question them, "You are not the right heir." That sort of thing. So what they do to empower the person, they cut the head of the dead chief, place it on top of 01:57:00the new chief, which symbolizes a bloodline--all the knowledge will transcend into the new chief, all the experience, all the spiritual power, all of that will be now given to the new chief. In fact, some said that the new chief will carry the head on top of the stick for days just to show that this new chief is powerful. I really don't know whether or not it's true. I don't even know how to interpret this, but that's what I was told, and that really helped me understand--the other incident where family members cannot see their loved one's burial process is because there is some dismembering involved. So it made sense for me that when the burial team takes the body and the family is not invited to 01:58:00that burial scene, they can think whatever they want to think. So we asked them, okay, it's because we want to be safe, and sometimes there's a centralized cemetery where we have to bury. It might be hours away from where the family is from. What can we do then? Because yeah, one thing is for you to travel, but it's expensive to drive three hours down and three hours back, and these people are poor. What would help you? A trusted person observing the burial, and tell us how it happened. That's usually religious leaders. We thought, that's an easy solution, we just needed somebody high up that the community trusts to actually observe a burial and then talk about it on radio or talk about it when they're giving a speech on Sunday church. Things like that can be very powerful. They 01:59:00didn't want to hear it from government. They didn't trust them.

Then also, the whole dignified component was very important--I told you last time. At first, the body bags were black, and in Muslim culture a white shroud is essential in burial. And of course, Christian, coffin is very important. When I got to Sierra Leone in September, they were preparing for standard operating protocol, SOP, for burial to release on October 1st, one of which included dignified components like family members can provide coffins, family members can provide clothing or other things that were to be buried together. Because before 02:00:00I got there the burial person who was responsible for burial-related work had obtained a lot of, and observed a lot of the important things that community members constantly talked about, which it's sad that they can't do the traditional burial, and ways to fix some of that. However, that SOP to penetrate into the district level takes time, and oftentimes it didn't go as it should have because the burial team wasn't trained to explain to the family that they can give clothing or important personal items, blah, blah, blah. It was so fast and they forgot. Everyone is scared, you know?

Q: I have a question. When I hear about the practice of dismemberment to take on 02:01:00some of the essence of the previous leader of the secret society, the first thing that jumps into my mind is, wow, having a dismembered head on you is a good way to get Ebola. [laughs] So I'm wondering, was it necessary to reach out or even possible to reach out to secret societies about burial practices that they did?

LEE: Yes. There was extensive outreach for these leadership. We really educated them about the virus so that they understand. Oftentimes, these leaders have some medical training for initiation and things like that. Often the nurses in the community, which then, you're right, they might have potential to spread the virus even more extensively because they're the ones taking care of the sick. And--oh God, I lost my train of thought.

Q: That's okay. Sometimes it was the nurses who were the ones getting sick.

LEE: Yeah. I actually have a drawing of Paul Richard's article that talks about Moyamba. Moyamba is another big trading district where all the people--like Bo, Kenema, grow rice, they bring it here, Moyamba, they're known for delicious pineapple, and then Bombali--all bring their stuff. There's a big market called Moyamba Junction, and at the time there was an outbreak associated with this pharmacist. There's a new MMWR [Morbidity and Mortality Weekly Report] article that just came out about this one Ebola spread related to one funeral that describes that pharmacist. No one wants to read that goddamn article, which is a 02:03:00wonderful article that talks about very, very important anthropological understanding of things like that. No one has time to read twenty pages. So I drew it out in this diagram and explained to them how this happened, and that in order to do that, you have to go back to that patient who came to see the pharmacist. Where did this patient come from? This patient comes from a small village called Kowama, and this patient attended the funeral of--an important female secret society leader's funeral. That funeral involved, gosh, seventeen people. People came from all over the country because this secret society leader is a very prominent, powerful person. All come, all go back, all spread back into their things, because like I said, it involves very intimate rituals that 02:04:00involve washing the body.

Let me tell you about washing the body. Some people cook with the water that the body has been washed in. Some widows are supposed to sleep with the dead husband for proper sending. What was the other one? I remember. At the day of burial, water is in this bucket, and everyone who comes to mourn would put a rock in that water. Then children will go to the burial site, and the dead body that's been wrapped in the shroud and other cloth when the body has been put down to the ground--again, this is Muslim. The youngest child is supposed to wear the 02:05:00cloth that's been covering the body and cry far afar. It comes up constantly in these sixty-four transcripts. [laughs]

Q: We have these transcripts of focus group sessions--

LEE: And this is not even transcripts, it's just notes.

Q: Oh, notes. A big pile of them sitting on the table here.

LEE: Yes. I was reading this and analyzing it in between Bo and Kenema because I couldn't waste time. It comes up constantly, how the youngest child is supposed to wear that cloth. There is another transmission opportunity. There's so many ways, things--when I tell this story to other CDC staff, they're like, oh, that's disgusting. That's their first reaction. If you say that, they're not going to tell you more. Now you have classified that what they're doing is 02:06:00disgusting. No one wants to talk about it.

It's almost like--I don't eat dog, but they always go, "Korean people eat dog, you're disgusting savages." Well, I know why Koreans had to eat dogs. It's an old agricultural tradition where you can't kill cows because they're doing all the farming work for you. You can't kill the chicken because it's laying eggs for you. The only protein source you have is a dog that lays puppies every year. It's sick. I, myself, have a dog, too. But that's the history behind it. There's a Korean idiom saying that when your son-in-law comes, that's when you sacrifice the chicken. You have to have a very important guest coming. That's the day you eat chicken. So I kind of came in understanding that some of the things I will 02:07:00be hearing will be very disturbing, but because of my personal experience how some people talk negatively about my own culture, I was prepared to listen and absorb. I also gained a lot of trust, I believe, because I shared some of the Korean practices, or something similar to witchcraft I suppose. Unlike Sierra Leoneans, where like eighty-nine percent of the people believe in witchcraft, in Korea nowadays it would be maybe 0.001%. But there were still rituals that had happened a long past time that still do it. When people go to multiple hospitals and they still don't have an answer, they're going to seek a traditional healer who often has like a God or some other spirit has entered into you, and it's usually a woman who would dress white and will dance and pray to the soul that 02:08:00is in that current sick person. Basically, the idea is that it's not the person, it's the other spirit that wants to communicate with the world. That's why this person became sick, is the idea. The person dressed in white will dance for like three days nonstop and pass out, and then the sick person gets better. That's the whole bottom of this Korean ritual. I explained it to them. You know, we often kill chicken and put chicken blood on that sick person and things like that, and they're like, oh, you do that too? Well, let me tell you about how we do it. That's how I got them to talk about some of the very intimate things. I swore that I will not share, but I'm doing it right now, but hopefully for the better.

I constantly say that I think I had different experiences than a lot of other epi's who were deployed. They were in the compound all the time, most of the time, unless there was a special case, and then they will go and observe and take notes, but their job was to really follow case numbers and focus on the surveillance because that's what CDC is known for, that's what we're good at, that's our bread and butter. For me to have experienced this whole health promotion, communication aspect of things--and after some of my efforts, the higher levels decided maybe it needs to have two different approaches. Like, there is a com [communications] person, but then there's health promotion efforts, because really a good way to show success is measuring behavior change. It's a proxy. Sure, numbers speak for themselves if Ebola dies down, but we've 02:10:00been putting a lot of effort into these messages and action messages. Are they really taking it in? What are people thinking? CDC collaborated heavily with Focus 1000 on doing KAP studies, constantly moving forward, and that's where my burial focus group falls under, the KAP study, same for the survivors. We learned how important it would be, and then I think the focus shifted to doing rapid behavioral assessment type things. I would like to think that I had the unpolished version of that, like really finding my way around things.

Q: Another question, and this has come up quite a bit, indirectly sometimes, but I wanted to bring it up specifically. The last time, you mentioned when you were in Baltimore doing a study on the Korean-owned shops in the African American 02:11:00community--the importance of your having grown up in Korea speaking the language, that kind of positionality, to the study. And I'm wondering if you can talk a bit about your positionality while you were in Sierra Leone and perhaps bring up a couple of examples in which it really came to the fore in your mind.

LEE: I was asked if I was Chinese a lot because Sierra Leoneans had not so good experiences with Chinese. They are the ones who made the highway from [Freetown] all the way to Kenema, but mainly for mining purposes. Sierra Leone is a very resource-rich country--diamonds and very important minerals and what-have-you. 02:12:00Chinese made the highway so they could transport the outcome of the mining quickly. A lot of locals didn't like how that had done, I guess, so they asked me if I was Chinese with stern faces. I said, "I'm Korean." [laughs] So I was lucky in that. I also knew that learning local language is an easy way for them to lower their guard down, so "wahala" is this word meaning problem. So I would say "Ebola wahala" to just random people, and they would just laugh out loud. Like this Asian kid, Ebola wahala. And they also said, "Yes, Ebola wahala." I also would joke, too, because joking is nice. I heard BMW means Big Man Wahala 02:13:00because in Sierra Leone all the BMWs are old apparently, so it's like a big man will drive BMW but it causes a lot of problems. So big man wahala, and the hotel staff would like laugh out loud. I think those kinds of things really helped me situate better in Sierra Leone because when I was in Korea or when I was in Baltimore, trying to fit in really helped, also without judgment. Like I said, in Baltimore, I would always smile at them. A lot of times they're not used to outsiders smiling at them. They're used to people avoiding them. I would get hit on all the time when I'm in Baltimore, like "Hey baby girl, let me be your baby daddy, can I get your phone number?" I was like, "Thank you but I'm currently 02:14:00taken, maybe next time, have a good day." The fact that I didn't ignore him and responded back was refreshing to them. It's a mutual--it goes both ways. So whenever they shout at me I'll be like, ha-ha-ha, smile as opposed to being afraid, was I think refreshing to most. A lot of my research assistants, I would tell them, too, they're humans, no one wants to be ignored. If they ask you a question, you smile--if you're smiling they can't spit at you. It's really hard for them to not like you if you're smiling. Try that and always go in pairs because these are dangerous neighborhoods, I get that.

I don't know if I should say this, but I was alone with my driver between Freetown to Bo and Bo to Kenema when I'm on the road. Well, there, I have colleagues, but when I'm driving I'm by myself, so there were times where I felt unsafe. There are checkpoints with armed guards, but that kind of speaks to how resource poor we were. We just didn't have the luxury--when I say we, like the CDC agency as a whole didn't have enough people, and we can't just send anyone out to the field either because you don't want to send someone who came abroad for the first time out in the district. It's not just danger for themselves, but danger for others. It kind of shows the magnitude of the response. It would 02:16:00otherwise never happen, but it kind of speaks to that.

Q: At one point we were going to get into coming home, and I want to get back to that, adjusting to coming back to Atlanta.

LEE: I remember right before coming back, I had to download to the newbies, and at the time there was a leadership-level person who was traveling three countries, Guinea, Liberia, here, with regards to child support. Because these displaced children, where are they going to go? She wanted to hear my experience in Kenema, and the orphanages and things like that. She asked, "How are our EIS officers doing?" I ended up crying because no one asked while I was in country. 02:17:00We ask, "are you okay," but no one asked in that manner. She was very motherly, and like, "Are EIS officers doing okay?" All the things kind of hit me emotionally and I ended up crying, and I told her some of the hardships I experienced and some scary moments and things like that. I think that helped me realize I'm going back home and I have to deal with this. It was right after Kaci [Hickox] had returned home. I worked with her in Bo quite a bit, so hearing her go through that made me really upset, almost as if she did something wrong. It's so unfair. We had done more than we were asked to do, but now we're going to be treated like that--was really unsettling, because at least in Sierra Leone 02:18:00I'm a hero. Why would I want to go back and be told a selfish vector?

Adding to the fire, if you will, I was only going back at that time, I couldn't extend more because I had a commitment at the American Public Health Association conference in New Orleans where my husband is. I'm going to go give a presentation, only to find out I was no longer able to go because Louisiana said anyone who had returned within twenty-one days from affected countries, basically you're not welcome. If you come, you'll be staying in a hotel and you 02:19:00cannot leave, was basically the message. So APHA [American Public Health Association] said don't come. I felt so betrayed. It's the biggest public health association in the country if not world, and it's the biggest public health response in the past few decades, and you're going to treat people who were actually there like this? So unfair. I even said, I want to do it via Skype, I want to do it via web-based. They said, "Due to cost, we cannot accommodate," blah blah blah. So me being me, I wrote Bob Lawrence, this is happening. He's high up there in the public health world. He told Michael [J.] Klag, who is the dean of Johns Hopkins [Bloomberg] School of Public Health, who is part 02:20:00of--member of the public health education board of some sort. He was really upset it happened. They started talking to APHA leadership. I also brought that up to the risk mitigation team here in Atlanta, and that caused a lot of turmoil. I cause a lot of turmoil wherever I go. I cause a lot of turmoil. Judy [Judith A.] Monroe, who was the center director of either OADC [Office of the Associate Director for Communication] or OPHPR [Office of Public Health Preparedness and Response] at the time, heard about my experience. She was like, we're going to fix this. She started talking to APHA leadership. That's why I got involved in the TED Talk here, so that we can record my APHA presentation 02:21:00and send it to them so that they can put it up on the website or what-have-you. She wanted to really work on making me feel good, like not abandoned by my own community. So I had that going on for me when I came back.

One of the biggest things that I really didn't realize was a big deal while I was in-country was an incident that happened between the Bo and Kenema drive. Two armed men came out from the bush and stopped the car when I was reading--that's why I brought this. When I was reading these focus group notes, two armed men stopped us in the middle of the road and demanded that I transport their sick sister. Because checkpoints, they measure your temperature, so if 02:22:00you're sick it's really difficult to cross the border, and because Bo has MSF [Medecins Sans Frontieres], a lot of people want to get into Bo in the hopes that they can get some MSF treatment. Our vehicle had a CDC logo on it, so they knew we often bypass these checkpoints because I cross--imagine, Bo and Kenema all the time? They're like, oh, you're here again. They just let me go, and I would get them water sometimes, we build relationships. I don't know how they knew that, but they wanted me to transport their sick sister. So I said no, and then we left. That's how I remembered it until I came back home because it was a small incident, nothing happened. I move on, there are more important things to 02:23:00do on my to-do list, which is to analyze the data, report back to Freetown, but the cell phone is not working, internet is not working, A/C is not working, all these other, bigger problems. That didn't seem like an important thing to me. I went to Freetown a couple days later and told the leadership that had happened. Like, "Good, because if you had done that we'd have to quarantine you." Like, ha ha ha, we laugh about it, talk about it, time goes on. Then when I returned, I had to talk to a bunch of people like post-assessment--do you feel okay, blah, blah, blah. I had to do that for three different reasons. EIS wanted to know it, I don't even remember anymore. At one point the question was, did you ever feel unsafe while you were in-country? So I said that incident. Whoever was interviewing me was like, "Can you tell me more? You said they were armed, can 02:24:00you describe them?" And now the memory that I subconsciously kind of put aside, I'm digging back and, yeah, they had a gun. I vividly remember that they were a little bit--I knew they were not checkpoint guards because checkpoint guards wear certain things and they always have this gun on their shoulder, like they fling it on and they never--it looks like a real gun, or serious, but I do remember one guy had his hand on the trigger as he was tapping--it was like a long gun, I don't know what it's called. He was tapping it on my side, but I didn't roll down my window. I never do that. My driver did, and they started speaking in local language that I didn't really understand, so he would have to translate to me, and my driver said, "They want us to transport a sick sister." 02:25:00And I remember looking back, seeing the sick sister on the ground, on the shoulder part of the road, and I didn't think twice. I just told what I was taught in my protocol which is, "It is CDC policy to only have CDC personnel in the vehicle, we don't have other people in our car. I'm sorry, the best thing I can do is once I get a cell phone signal, I will call an ambulance for you, that's the best I can do." My driver translated that and said a lot more, and there were some arguments a little bit, and I looked concerned--my driver, very calm, amazing, good driver, finished the deal and he rolled up his window and we left. She said, "Okay," and she documented that. And now that scene is playing over and over again every time I go to sleep. It's replaying in all different 02:26:00kinds of scenarios where, oh shit, I could've been shot, I could've been dragged out from the car, we could've been carjacked, we could've been forced to transport that sick sister. If my driver was aggressive and fled the scene, all kinds of terrible things could've happened. I'm reliving that like every night. And because I said that, now more people want to talk to me about that incident, and I think at one point I got really upset like, don't you already have notes or something? Because it's really traumatizing. That could have gone really bad.

My husband and I do long distance, and I think it was like day ten since I got back. I had to go through all of that on top of the whole APHA drama with this kind of newly surfacing. It was hard and I was really not myself, according to my husband, and he said, "I think you need to talk to somebody." At the time, he was doing psych rotation, too, so he was like psychoanalyzing my behavior, my attitude and what-have-you. I remember yelling at him, "Don't psychoanalyze me, I just want you to be my husband. Don't treat me like I'm some crazy person. Why can't you just be my husband?" And then I hung up and then I didn't pick up the 02:28:00phone. Oh, actually I told him, "I was gun pointed to my head." But the situation there was so dire, that didn't even come across to me--that wasn't something important that I acknowledged and then reported back. That was that whole scenario, and then here I am trying to complain that my coffee machine is not good enough. There's a lot that I'm handling. And he's like, "You have to adjust to blah blah blah." That's why I blew up. But the most important thing is my husband is like, "You were what?!" I was like, "I told you many times I was gun pointed to my head." And he's like, "You never told me that." I never told him that. Like, "Oh, I thought I did." He's like, "No, you did not tell me 02:29:00that." And there are times I probably wanted to tell him but maybe the phone didn't work. Then I hung up, so he was really worried that I was going to do something very dramatic, so he ended up driving up from New Orleans and he's like, "I'm so sorry, you really need to talk to somebody." [laughs] The risk mitigation team I think felt the same way. They kept wanting to talk to me and try to convince me that I needed to talk to somebody. I'm like, "Okay, okay, I'll talk to somebody." And because it's a combination of all the things I experienced there, I'm living it. Plus the guilt of my day-to-day being so contrastingly slow that the worst thing that happened to me was that this coffee machine broke. Like, why am I here? Why am I not back there? The counselor I 02:30:00ended up talking to was basically saying, you can still help here, you have to readjust here so that you can serve better here, and you don't have to be there. Things like that. Just that one session really helped me recalibrate, and then it was the holidays and being around family really helped me to appreciate my day-to-day as well, while continuing to--yeah, she's right, I need to put my experience on a piece of paper so that more people can read. So that's what I did. Wrote papers, gave presentations and shared my experiences. When I did 02:31:00bring up some of those security-related concerns, I said, always send in pairs. It's rule of thumb. Make sure the drivers are educated in how to deal with situations like that. I'm really lucky that my driver was a good person, and he was just an amazing person. He would always say, there's no such thing as bad roads, there are only bad drivers. I mean, I trusted my life with him on the roads. So I was lucky. It could've gone really bad. Make sure some of the security things--drivers are aware, and even those who are deployed, make sure that they know that things like this can happen, how to react. I'm sure other 02:32:00people had similar, very life-threatening situations, but that's my story.

Q: So what are you doing these days?

LEE: What do I do these days? I work on children's meals in restaurants to make them better and write papers about things like that, menu labeling. Those are my go-to, my bread and butter. On the side I have a cooking class at the Atlanta Wine School, so I'm teaching cooking paired with wine, that's coming up soon so I'm excited about that. Working on cookbooks, trying to spare my energy into other things that I've always been passionate about.

Q: Looking back over your experience in Ebola or anything previous to that, is there anything else that you want to make sure that we have on the record for this oral history?

LEE: I feel like I missed something. I probably did.

Q: Inevitably, yeah. [laughs]

LEE: I guess I really wanted to emphasize that the people I worked with on the ground were extraordinary. It's hard to describe.

Q: Can you name some specific individuals?

LEE: Yeah. Mutale [Mumba] was a WHO colleague from Uganda. He wasn't a local per se, but he was a very strong figure for me to really navigate and do the right thing in Bo. It's unfair to name them because there were so many. They took me in under their wings, gave me the name.

Q: I don't think that's something we've talked about in this one yet.

LEE: Yeah. I was given a local name in Kenema, Jatu--Mende word. J-A-T-U, which was told to me that it meant "competent person."

Q: Who gave this to you?

LEE: This local lady. I don't know who she was really. I always saw her, but I never really worked with her, at the Kenema general hospital compound. She said, "I'm going to give you a name, let me think about it." The next day she gave me the name and everyone around her agreed that I'm deserving of that name. So wherever I go since then on, I would introduce myself as such, "I am Jatu," and everyone loved that, really, really loved that. To the point one of the village 02:35:00chiefs wanted to take me as his fourth wife. [laughs] A marriage proposal. I had to politely decline. You know, "I'm very flattered, but I'm married back home." He's like, "Then I'll give you a goat, how about that?" That was his negotiation tactic. That was good.

The people that I worked with, they all lost somebody that they know. I really don't know what that means fully, but the fact that they had the energy and all of that--I can't describe it in English anymore but all of that is just so powerful. Like they were able to compartmentalize the sadness and grief and really move forward. That was really admirable. I'm not sure if I could do that. 02:36:00And that they've been doing it for so long. They didn't even have the chance to burn out. I complained that, oh, on my day thirty I had my first R&R. Good lord, they didn't have it for several months. That, I'm very, very grateful for. Also, the CDC colleagues I worked with. We became sisters. We still have dinners together because we don't have to explain all this because they also experienced it. We just have to say, man, did you hear about the news in Sierra Leone? There's a new case. Whenever that happens, yeah, we don't have to say much and we can kind of comfort each other. I'm very grateful for new friends I was able to make in that experience.

Q: Anything else?

LEE: What do you want to know?

Q: We will always have an opportunity to come back and record more in the future. I'm continuing the project through fall of 2018, so how you look back on things a year from now might be different in some ways.

LEE: Yeah. I was supposed to go back to Sierra Leone in June 2015. I was on cue, I was in the process of getting a visa again, but then the very last minute I was rerouted to go to Korea for MERS [Middle East respiratory syndrome], which also makes sense why I should be going to MERS outbreak and not Ebola, but yeah. It's really nice to hear all my friends who I worked with ended up going back in 02:38:00different points in time and can tell me how things are going, and that's what we want. We want them to not need us anymore. Personally, I want to go, but that's me being very selfish now. They are fine. So thank you for the opportunity. It was just great to kind of go back. I definitely feel like I missed something. If I do, I will let you know.

Q: Please do because we can set this up pretty easily and we got Tom, our brilliant audio engineer here can make sure that stuff works. It's been a privilege to sit here and hear your story.

LEE: Thank you.

Q: Thank you.

[break]

LEE: One of the things I worked on, because I worked with survivors, we had all the CDC staff donate their unwanted clothing, shoes and things like that here. Because survivors cannot often be discharged because they don't have clothing because they were stripped off when they got into the Ebola treatment centers. 02:39:00So my team lead will leave his clothing behind, my friends will donate their clothing and things like that, and I was going to do the same. On our drive back, Abu--so Abu took this position to go to Bo and Kenema and not see his family for weeks at a time because it's a higher paying job. He has an eleven year-old girl, and that's one of the reasons why, even though he had a college degree during the civil war, he couldn't move forward with his studies because he ended up marrying and then he had a child and then they divorced and he has his daughter. I asked him a lot about his daughter, and that's one thing that makes him really happy. Even though I didn't want to go back to Freetown because 02:40:00it didn't make sense to spend four hours on the road, I really wanted him to go see his family because I know whenever he's waiting for me, he's talking to her or talking to his daughter's mother about who can see who, what, when, all those kinds of things. So whenever we go back--Freetown at the time, food prices were going up dramatically and this is the sad reality of quarantining and having checkpoints and things like that, especially when all the agricultural side of things are done far out country, and so all the people who used to sell the rice, now they're eating it for themselves. Freetown on the other hand is not getting enough rice or not getting enough grains, or if it is, it's really expensive. There's not a lot of movement of trade going on. In fact, no one wanted to be in that kind of heavily populated place. So like Moyamba earlier, 02:41:00where all the trade is supposed to happen, the first week of October when I was driving that way to Bo, it was like a ghost town. I remember my driver saying, "This is so weird to not see a single person in this area because it's supposed to be really busy." Every now and then, kids with a pineapple on their head will try to sell it to my vehicle. So we go work in Kenema, Bo, and when we're going back to Freetown, he wanted to buy stuff for his family. I think the very first time he was shy and concerned to ask, but after we developed rapport, he's like, "Can I buy fuel, like coal here?" I said yeah, because it's ten thousand leones which is two bucks, a big bag here, but it's now forty [thousand] leones in Freetown. It's four times more expensive. So I was like, "Hey, load it up, load 02:42:00it up as much as you can." And some of the vegetable prices and things like that, he would buy stuff. So I said, "Let's drop those off at your house before you drop me off at the hotel." I said, "I also want to meet your daughter." Like I said, he was always very clean. You wouldn't think that he would live in a place like that. Someone with a college degree, someone with a decent job apparently in Sierra Leone, in this cement-based structure. He has his mother, his brother, about like twelve people living in a very small cement structure that's not even--I wouldn't call it a house. Extremely poor, but apparently he's better off. I cannot even imagine the real poor, the level of real poor in 02:43:00Sierra Leone.

I opened up my suitcase and I gave her one of my dresses that I brought, like a work dress to go into the meetings and stuff. I donated everything, but I kept that so I can give it to her. The smile on her face was priceless, and I said, "When you grow up, you can wear it." She was very happy. I asked her, "Is everything okay? What's the most difficult thing now with Ebola?" And she's like, "I just want to go back to school." She really wanted to go back to school, eager to learn. They had to rely on radio programs for kids because 02:44:00they've been out of school for so long. I told you, oftentimes radio is not--it's a luxury, and to charge or to put that radio on the plug is a big thing. Everything is run by battery, everything is run by generator. The roads don't have traffic lights. Why would you want to waste fuel on traffic lights? I remember that vividly, that she wants to go back to school, and that it's more of--this disease, because it's been prolonged for so long, imagine the education system, how to rebuild that. A lot of times, these schools will be used as Ebola treatment centers or places to quarantine. It's really depressing because it should be sacred. Education, once that collapses, then it's down the drain.

I wanted to make sure that gets into the recording, the very personal level, but also I think it has that structural-level experience that I had from an outside perspective.

Q: I think it adds a lot. Thank you.

END