Dr. Sophia Nur

Dr. Sophia A. Nur

Q: This is Sam Robson. Today is April 27th, 2016, and I'm here with Sophia Nur doing our second interview for our CDC [United States Centers for Disease Control and Prevention] Ebola [Response] Oral History Project. Sophia, thank you so much for sitting here with me again and going through your experience.

NUR: Thank you for being patient with me having to reschedule so much.

Q: Of course, it's worth it. It's a pleasure. When we last left off, I think I had just asked you about some examples of the Big Idea of the Week stories you had done and we were coming to the end of your first deployment. I'm wondering if we can pick up with that, with the end of your first deployment, the transition back home.

NUR: My deployment, I was able to extend by a week, only because--as I mentioned before--I was there over the holidays, so over Christmas and New Year's. There were not a lot of deployers in-country at that time, and so it was taking a bit 00:01:00of time for them to bring folks over. We wanted to make sure that people had ample time to get acclimated and transition into the work. People were coming in and out, but slowly things started to settle down a little bit and I was able to meet with the folks that would be taking over some of the activities, and so I extended for a week to make sure things move on as planned. They were starting an active case search program in the Western District where the capital is. There were a lot of activities around that time, so we just wanted to ensure there was a smooth transition for people coming from headquarters to Sierra Leone.

I stayed for an extra week, and then they give you like three administrative leave days post-deployment to help you readjust and get acclimated and rest. It was a little bit of a shock because it was kind of cold here, but it was nice to 00:02:00come home. My friends were really welcoming and I think just being back and being able to be close to my friends and family was nice. It was a little bit of a shock because I was so used to working long hours seven days a week, that the amount of idle time was a little bit jarring. I spent one of those administrative days just on the couch watching my DVR [digital video recorder] and catching up on shows. I remember thinking, this is so bizarre because there's so much still happening in-country and I'm just kind of removed from it. I remember before I left, they were talking about how it's really important that when you're in-country that you focus on the work you're doing while you're there and improving in any way you can while you're there, but that you probably will get requests from people that were just returning back to headquarters and 00:03:00maybe worked on some of the projects, and to try to focus on continuing with the projects and not really get bogged down with status updates that people want to know. I also had to be mindful of not reaching out to people when I first got back to say, hey, did everything work out okay with the next iteration of the Big Idea? Or what's the status of that training that we talked about, or the survivor interviews we were planning on conducting? So that was hard, too. It's like a hard stop. You're going, going, going, and then you're just home. Then a couple of days later you're back in your original office, and that was also really interesting because I work in HIV [human immunodeficiency virus], or was working in HIV, domestic at the time, and it's an interesting--I don't know if "high profile" is the right word, but it is a little bit provocative in the sense that it deals with sex and drugs and all these things. There's a lot of scrutiny and a lot of visibility around it and so it's pretty fast paced, but 00:04:00it's in no way in comparison to working in an outbreak setting. Getting back into the swing of my work, the politics of where I worked and the personalities was a little tough at first. People were asking for things, and I remember I had to do like a self-check. People were asking for things in probably the way they would've always asked for them, but there was a sense of urgency for things that just didn't really feel that urgent. I just remember being like, I don't know if I can do this for much longer. There's something about working during the Ebola response that in a lot of instances you can, in some cases, see direct impact from the work that you're doing. But when you're working in domestic HIV at a large government agency, you rely on partners to do a lot of that work, and so you may not see direct impact or have any--you're dealing with the coordination 00:05:00of efforts versus actual implementation. I think that was tough to grapple with when I first got back. I was sensitive to outside-of-work life. I was sensitive to not scheduling health appointments and things like that, even though I had some that were previously scheduled. I rescheduled them just because I'm returning from an Ebola-affected country and I know there was still a lot of misinformation and fear around that. I kept myself out of those situations. My friends and family weren't really worried. I think I was really clear about CDC's role from a technical guidance perspective versus providing any type of care, direct care. They were--although some made jokes--pretty comfortable with 00:06:00being around me.

So I went back to work and really had to readjust to the difference in pace and work environment and the overall work itself and impact. That took a little bit, but it did kind of light the fire that I did want to get back into global-related health work, and so I started actively applying for jobs, and also I was getting a lot of requests to redeploy. Unfortunately, at the time, my team lead was supportive but my branch chief wasn't. For whatever reasons he wasn't allowing us to redeploy, which was kind of frustrating because I was hearing stories of people that were deploying that weren't having great experiences and coming back early or that it wasn't a good fit. It felt like I 00:07:00knew of a couple of people that really wanted to redeploy, that had the skillsets, that were doing great work while we were there, but weren't able to. That was kind of frustrating. There was also a small HIV-related outbreak in Indiana in the summer of 2015, and our division and center was responsible for deployment there. So I offered. I was like, I'll go to Indiana and Sierra Leone, whatever you need. But it didn't quite work out that way until Dr. [Thomas R.] Frieden actually sent a pretty strong email saying, there's still a need, this is still ongoing, we understand that everybody across the agency, a lot of offices have provided support in a variety of ways whether deployments or the EOC [Emergency Operations Center] or internationally, but it's not over. So my branch chief came back around and asked if I was still interested, and I said 00:08:00yes. I sent an email to the health promotion team letting them know that I was available as early as August 1st. I didn't think that through because I think it was late July when I sent them that email, and then they were like, perfect. Then I got an itinerary that said August 1st departure date, and I was like, oh, crap. Okay. I got about ten business days to get my life in order and make sure my medical stuff is up-to-date and things like that.

I was truthfully hoping I'd be able to support the efforts both in response and recovery, but they were still dealing with some sporadic cases in-country, not necessarily linked to--I guess when I got there they were--but not necessarily 00:09:00linked to active transmission chains, but more so these cases related to bio-persistence or something. I was thinking that I was going to be there during the time of recovery, and it wasn't. That ended up being okay. It was a very different second deployment. Some of my colleagues from my first deployment were actually in-country at the time. One of my colleagues was actually the team lead for the health promotion team, and I'd mentioned to her that I was really excited to be back and willing to do whatever. Given that I already had relationships with partners and other agencies in the Western District, I'd love to help out there, and they didn't have--I don't know if you're familiar with the structure, but there are different District Ebola Response Centers. There are like seven districts, seven or eight districts. Anyway, it's basically like 00:10:00county response centers. I don't know if that's the best way to describe it, but the Western Area one involved Freetown, but then areas outside of and surrounding Freetown. That response center didn't have a representative from the health promotion team because, again, they were dealing with staffing challenges in Sierra Leone for the response, and so I was able to fill that gap. The epi [epidemiology] team in the Western Area DERC [District Ebola Response Center] was also short, and so I ended up kind of splitting my time between doing field epi work and health promotion work, and it was awesome. I don't even know--I just felt really fortunate. It was an opportunity to develop a skillset that I hadn't really been able to utilize before, like doing field epi work.

The way that it worked out was that for the western region, the western region 00:11:00was divided into, like, sub-counties, and with those there was a surveillance officer, a health person that was responsible for a certain number of sub-counties within the larger district. Anytime there was a call about a sick person or a dead person or any questionable activities, they would call their district surveillance officer. They would call 1-1-7, which was the call center number. That's kind of the 9-1-1. They would call 1-1-7 to report it, but then that would dispatch to the appropriate surveillance officer. But the epis [epidemiologists] also were responsible for supervising surveillance officers and their sub-counties or whatever, and so that was awesome because I got to work with some really bright and exceptional surveillance officers that were either med [medical] students, they were just graduating or about to graduate 00:12:00before Ebola, or they were working at a healthcare facility at some point in the rural areas--it was Western Area but in the rural portion of Western Area. The district kind of is expanding.

Because they kept seeing these flare-ups in the district, they decided to implement an active house-to-house search where basically they brought in surveillance officers, contact tracers, taskforce--which are like community watch members so to speak, like your neighborhood watch--community members, and social mobilizers. Basically, they implemented these teams, and these teams would go out every single day and go from house to house in these sub-counties looking for sick people and providing them with access to healthcare by calling 00:13:00an ambulance to take them. If they met the case definition for Ebola, they would call an ambulance for them and take them for testing and treatment. But it was the rainy season, and so you can imagine, people were enthusiastic. It was really a last-ditch effort to help end--you know, people weren't really coming out and--I don't want to say that they were people that were hiding sick people, because I don't necessarily think that was it. I think that people were just not necessarily going to the healthcare facilities when they weren't well. Instead of waiting for them to do that or to die, we went to the homes to find people. It was an opportunity to really get to know communities and get to know people. We were walking in small groups throughout these very congested neighborhoods, checking in on people and keeping track of how many people were there, how many 00:14:00people we saw, how many residents, how many people were well, how many people needed healthcare, and identifying if there were potential people that met case definition that might need to be tested. Most of what we saw, because it was rainy season, was related to malaria and other illnesses, not Ebola. But it was for me a really amazing experience to see--particularly for the surveillance officers. They basically lost periods of time in their education or in their careers, and they were just so committed with these groups they were working with, actively trying to stamp out Ebola in their communities. They lived in these areas we were walking around in, and so you could see that there was a level of commitment and desire to help their community, but also put an end to 00:15:00this. A lot of people we came across, they had Ebola fatigue. They were tired of talking about it, they were tired of people coming to their homes asking them questions. We would rely on the social mobilizers to help smooth things over, but then also provide some information and sensitization to remind people, Ebola is not over, unfortunately, and it really is up to each one of us to remain vigilant to make sure that this finally comes to an end in our community. And that yes, it's malaria season and malaria symptoms can mirror Ebola symptoms, but we shouldn't just assume it's malaria, we should treat everything seriously so that we can make sure we don't end up missing something. It was one of those things where every day there was a new learning experience happening. Number one, it was rainy season, and each one of the people that were in the group that 00:16:00did the active case search throughout these neighborhoods, each surveillance officer approached the active case search in their community differently, but for the most part there were small teams that went out together every day. Each team was funded, organized or coordinated by a different entity in-country, so there was a little bit of a disconnect in access to resources among all of them. Some had raingear, some didn't have raingear, some were volunteers, some were paid. But you're expecting all of these people to do the exact same work, like walk for hours talking to people and assessing whether or not folks are okay. That came with just like--there was a lot of diplomacy taking place during that time, and advocating on behalf of different people in the group, because with any type of response of this size and scale, there's going to be anything from 00:17:00materials that don't arrive on time to payments that are late to people that are supposed to be on a team and don't show up. There's just a series of factors that happen, and so every day you just don't know what you're going to get, but you know that you have to be there in order to do the work. For the most part, everybody showed up and everybody worked as hard as they could to figure out what was happening in their respective communities. There were some scary instances of people that we met that were really sick that needed help.

We found that there were still looming fears around healthcare facilities, looming fears around ambulances. There was one instance where we went to this community that really didn't have a lot of cases of Ebola, so I don't think they 00:18:00received a lot of social mobiliz--like there wasn't a lot of community engagement efforts as they relate to ambulances. Ambulances were historically a terrifying thing. There were very few in the country prior to Ebola, and then more showed up to help transport people and to transport bodies and things like that. But if you really think about what ambulances do, a lot of people saw ambulances pick up their loved ones, go, and then their loved ones never came back, and then ambulances also have those big doors that close on people, there are sirens involved. People were really, really uncomfortable with the sirens. There were a couple of studies that took place that helped to understand why there was a level of discomfort or fear associated with the ambulance. It just wasn't--for us it's kind of like the norm. We think of ambulances, we think of safety is coming versus ambulances taking people away and them not coming back. This particular com--it was very important and I think CDC was pretty 00:19:00instrumental in instituting ambulance exhibits. They would take an ambulance into a community and open it up and show people and let them get--let leaders get inside, community leaders, to show it's not a scary thing. To show them that they knew the ambulances were cleaned with bleach solutions, chlorine solution. They knew that, but you give people enough time and rumors would start, like you get in the ambulance and some fume or bleach-related thing can kill you while you're in there. They actively went into communities, CDC went into communities or worked with partners to help sensitize. Well, this community didn't have a lot of Ebola cases, so there was less attention provided to them when it came to 00:20:00doing an ambulance exhibit, and we found that out the hard way. [laughs]

Q: What do you mean?

NUR: I was working with a district surveillance officer, and he let me know there was a suspect case at a home, and that he called the ambulance and he left part of the team, the contact tracers were there checking in on the contacts of this potential sick person and setting things up, and they were going to wait for the ambulance. Typically, you're supposed to wait for the ambulance to come and once the ambulance picks the person up, then you can go to the next case. But in this particular day there were a number of cases that were coming through, and so he asked me to meet him at the second case. We went to the second case and the person was ill but didn't quite meet case definition, so there were additional follow-ups. He asked me to meet him there to meet with the family and discuss some things. Then we received a call from the 1-1-7 dispatch 00:21:00that said the person from House One, when the ambulance came, fled. Basically, what the person described as their symptoms were quite alarming, like there were liquid--"wet" symptoms is what they call it, and that was concerning. I went to House One to try to figure out what happened and it turned out that the person that was ill was an identical twin. When the ambulance came, she was very fearful, and so she told the ambulance driver that they were looking for her sister and that she would go get her, and then she left. Then her twin sister showed up and they were very confused. Both women had children the same age on their backs. So it was one of those situations where everybody was completely befuddled, like, are you sure you're not the--like, what is happening? The 00:22:00mother was trying to call the daughter to tell her to come back and the sister was trying to call her and she was fearful and she literally thought that if she got into the ambulance she would die. Finally, after hours of conversation and easing her concerns, she comes back. She comes back but is still very reluctant and explained that, yes, she's not feeling well but she may have over embellished. We don't know if she's scaling back her symptoms, because she really doesn't want to get into this ambulance. But we spent time reassuring her that for the sake of your health and your child's health and your family, it's really important that you get checked out. So she was willing to wait. That day was particularly busy for the ambulance drivers, and so it took them a long time 00:23:00to get there. She also explained to me that the sirens--she doesn't like the way the sirens sound, like it really made her uncomfortable. I had part of the team wait with her at the house and continue to talk her and her family through things because they also didn't want her to get into the ambulance alone, and to help do some community engagement around discussions around what actually happens with the ambulance and what type of treatment she'll receive and what she can expect, to help them feel better. I waited at the street further away from the home to stop the ambulance because they weren't supposed to be--the guidance after a while was they shouldn't be using the sirens, to make sure they drive in slowly, turn off sirens, make everybody feel comfortable. I'm waiting at this hill. looking down the street. waiting for the ambulance to come. and everybody's kind of in position. My colleagues and some of the community members 00:24:00are down talking to the woman. Time is passing, so people are tired of waiting, and so we want to go and socialize. I'm seeing the woman walking away, so I'm trying to watch the street but make sure she's not running away anymore. I call my colleague and I'm like, "Where is she, I see her walking, do you see her, is she in your eyesight?" Talking to her mom and the mom is yelling at the girl to come back and stay put. It was a series of things, and then, of course, the ambulance shows up with the sirens on and I'm just waving my hands like turn it off, turn it off. They bring the ambulance very slowly into the community, and luckily there was a woman there that was in the ambulance accompanying the ambulance driver who had some experience in social mobilization and community engagement. Before she did anything, she opened everything up and let everybody 00:25:00see it. At this point we have like thirty people around the ambulance, staring at it, wanting to see what's in there and making little comments about, I heard when you get in, da da da da da, this happens. You can hear the chitchat. The woman, the potential suspect case, is slowly starting to get more nervous now that the ambulance is actually here, and then her mom is getting upset because--I just told her, "You can't go in the ambulance with her. We can try to get an okada ride, like a motorcycle for you to ride on. You guys can go together." She wasn't really happy with that. But the end result was she actually got in the ambulance and went and we coordinated for her mom to be able to accompany her on a motorbike next to her and they went together. That was 00:26:00part of the epi work, like actually finding--active case finding and helping people that are not well get to the treatment centers and find out what's wrong.

The health promotion part happened afterwards. We went back, like I checked on the case, and then we ended up going back to that community because we found out that they just didn't have a lot of exposure to ambulances and definitely not in an informative or educational way, and went back and talked to the woman after she returned from the treatment center to find out what happened. She talked very positively about her experience with the health promotion team. There were larger KAP studies that were done, knowledge, attitudes and practices--I think I mentioned this before--that were taking place that kind of gave us like this larger national perspective on the current state of knowledge, attitudes, and practices as they relate to Ebola during the different phases of the outbreak. But we were also given the opportunity to do rapid behavioral assessments to get 00:27:00more honed-in ideas as to what was happening in particular communities. That's what we went back to do with this woman. We went back and talked to her and just got her perspective on what her concerns were, why was she so apprehensive, why did she flee when the ambulance came, why did she come back, how was her experience in the treatment center. It was so interesting to hear. She really thought if she got in that ambulance she was going to die. But then she ultimately got in it, which the way she described it, she was just like, well, if this is what my fate is, it's what my fate is. That was so sad to me that that was what she thought was going to happen to her, and ultimately felt like this was just what she has to do. Luckily, obviously, she survived. She got treatment for what was ailing her and had a positive experience. She said everybody in the treatment center was very nice from the moment she got there, they looked after her, other women were helping her that were in there to 00:28:00encourage her and keep her motivated and happy. It was a positive thing. We talked about whether or not she'd had conversations with others, and she said she had. That's kind of how it works. You have this person that has a positive experience that can explain to her community. But then we met with the community leaders and said, would you guys want an ambulance exhibit to take place in your community? They said yes. So we partnered with Red Cross and UNICEF and WHO [World Health Organization] and did--they were already doing ambulance exhibits, but they stopped for a period of time I think. The rainy season can make it a little difficult, it's unpredictable, but then also with the active case finding or the house-to-house search, it helped find communities that maybe were missed or weren't included in the original exhibit schedule, and so this was one of them and so they said, yeah, we'd be interested. We had an amazing day where 00:29:00school kids, community elders came out, community members came out. The woman, our original case that got it all started, she came by and talked about her experience. There was media involved. Basically, this community had the chance to learn about what ambulances are and that they're not these scary things and they are taking you to health and safety. It ended up being an exhausting but really positive--it also rained intermittently during the entire time, so we were standing outside like dry, hot, and then it's rainy hot and then dry hot again. And everybody's just standing in the rain talking to each other. But it ended up being a great experience, and I think one of those things that really shows how, with this type of work, A) you have to be exceptionally flexible and B) everything is a learning experience, never take anything for face value. And 00:30:00that there is a real need to link the epi with the health promotion or social mobilization, and that's pretty much what I did for most of my time there. If there were instances while we were doing these active case findings and the house-to-house search, during that time period I always had my health promotion hat on trying to figure out what the needs are of the different communities that we're walking into, and what are some of the concerns they have or what's the information they have. Some just needed social mobilizers to come and talk to them and explain what they need to be doing and what the current status of things are. So that's what I pretty much did.

The second deployment was really different because I was in the field almost every single day working with surveillance officers, responding to live alerts or death alerts. There were a lot of death alerts unfortunately from things that 00:31:00are beyond us, beyond my knowledge, but those were hard for a number of reasons. Every morning we would get up and have our morning 8:00 am meeting to talk about what the stats [statistics] are, live alerts from the night before, death alerts, contacts we need to check in on, cases we need to check in on, and then we would go out into the field for the whole day. Obviously, the live alerts were the ones you could actually talk to people and figure things out and find ways to support the community, and the death alerts were just--yeah, those were really hard.

This is probably one of the hardest days I've had. There was one case where--what was the name--Waterloo Clinic, or one of the health facilities in 00:32:00Waterloo. We were just there dropping off some stuff and left, and then someone came--I don't know how the person got there but they arrived at the health clinic and died, like literally just fell out on the side of the driveway. Typically, there were people, epi leads, responsible for death alerts. Because there were staffing shortages, we were responding to both death and live alerts at that time based on wherever we were. I was with a colleague of mine who was an actual epi, and we went to--I remember pulling up and there was just like--I was trying to figure out what was happening. There were just people under the 00:33:00awning of the clinic staring out across the driveway, and we pulled up, and I just happened to look out of the driver's side--I was in the back riding with my colleague--and there was a body just face down. I was like, what is going on? While we were there, we found out that the burial teams were on strike that day, so we were not able to get in contact. There were surveillance officers that were responsible for just death burials and making sure that--you know, it's really important, especially with Ebola, that all dead bodies are swabbed and tested. That's a critical part to the response, and to find out that day that they had gone on strike because they weren't paid and then they had been threatening this for some time. I think it happened on and off a number of times during the response, and I think, again, that's just the nature of something 00:34:00this size and scale. But that day, that day with that person. We're sitting there trying to talk to 1-1-7, and the Western Area DERC office leadership, and even trying to talk to the burial folks to ask them, can you please come and at least swab the body? Come and at least take the body? Then family starts to show up, and so family members are starting to show up and they're obviously grief-stricken and crying out, and we're in this very awkward place because we don't know anything about this person and the family wants--you know, their loved one is just lying there. We were in a position where we didn't know--all we knew was that this body needed to be swabbed and properly picked up. But it's hard to negotiate with a grieving family that just sees their family member 00:35:00lying there, and they were obviously after--and it went on for a while. They obviously wanted to take the body and properly go through their burial process, which I'm sure you've heard that with burials during that time--there were so many sensitivities, and they worked so hard throughout the response to really encourage safe burials and promote safe burials and provide systems and structures that would enable safe burials to take place to prevent reemergence or transmission of the virus. It was imperative that they don't take the body. Then the person happened to be a police officer, and so the police were--people were talking about, oh, we're going to call his colleagues and they're going to step in. I remember then it started to rain, and I was, of course it's going to rain. This person's body is here, and so someone I think at some point from the 00:36:00health facility put something over the body because it was bad. It was just a really disheartening situation to be in. I understand that people are frustrated about not getting payment, but to hear people actually say--almost like they were trying to make an example out of this person, it was bad. It took hours before the actual--I mean like, five-plus hours before the actual burial team showed up and went through the process. The family members had to be--we had to talk to the family members and let them know what the status is and what the plan is and also track it, but it was just one of those things where you felt 00:37:00completely helpless. There's a human life there. There's somebody that's lost their life. We don't know what happened, we don't know if it's in any way related to Ebola, and the folks that could help answer that don't want to because of issues that they're having with their payment and things like that. And a family that's grieving. It was just this mixture of people and feelings and experiences that was really difficult. I remember going back that night and just being like, straight into the bed. We have evening meetings after we come back to the DERC, and kind of regroup and touch base and talk about any serious issues which we talked about. You know, somebody needs to pay the burial team immediately or figure out an alternative plan while their payment is being figured out because that can't happen anymore. Everyday, somebody's going to 00:38:00pass away, but we need to have a mechanism in place to respectfully handle people that have passed. Then we went to that meeting, I spoke my piece, and then crawled into bed and just hoped that tomorrow would be a better day. Again, it was one of those things where I think that the house-to-house search we did and walking through really remote communities, despite being so close to the capital, if you just drive off the main road, deep into different neighborhoods, you'll find such a variation of people. But that was so inspiring, and then to experience some of the death. It was like, man, I guess there's this part of it, 00:39:00too. I mean, all of it was a learning experience, but I think those are the things that stick with you as well.

But in the end, most of the work that I was able to do during that time, that was as close to seeing a direct impact as I think I've ever gotten in my public health career, and also just the relationships you build during that time. I'm still in conversation with the surveillance officers I worked with, and I think I mentioned before, CDC had some Peace Corps language and cross-cultural and facilitators we worked with, and we were side by side every single day. They were the ones that were keeping tabs on the woman that was trying to run away from the ambulance and things like that. They were a great part of the team and 00:40:00helped keep the sanity and keep the enthusiasm going to keep doing the work despite however tired you may be.

Q: Do you remember one thing that someone particularly did which made things a little more lighthearted?

NUR: I can honestly say that despite civil war, cholera, Ebola, all of these things that Sierra Leonean people have experienced, they are some of the most positive, upbeat and funny people I've ever met. Like when everything was really, really bad, either the driver, Big Med [Mohamed], or Hindolo [John Langba], the LCF [language and cross-cultural facilitator] that I worked with, we would get in the car and I would just be really upset about something that happened, and they would crack a joke that would just have me dying. It really 00:41:00did speak to just how ridiculous some of the situations we were in. [laughing] They would make a joke about seeing me running down the hill, trying to get to the woman who was trying to run away, or running towards the ambulance, waving my hands, and making jokes like, "that community is going to be talking about"--the other thing is being of East African descent, I think, a lot of people don't know that and assume that I'm Indian. So they would make jokes about how this community is going to talk about the Indian woman that was screaming and running around all the time in this rural town, and stuff like that.

But once you step away from it and take yourself out of the fact of all that's happening around you and just see like, yeah, we've been in some pretty ridiculous situations together, like a kid that had malaria and the parents didn't really have the time or resources to take the kid for treatment. We 00:42:00happened to stumble across this kid during our house-to-house search, and a neighbor was watching him and they were very clear that he had malaria, but they hadn't gone back for either medicine or a follow-up, but that the doctors had told them that it's probably malaria, and he was not doing well. We had to get confirmation from the actual healthcare facility that it was because he met the case definition for Ebola because the symptoms were similar, but we had to call--the neighbor called the mom and the uncle and they showed up furious, like don't you dare even think about taking our child. It turned into this larger kind of--but the team, I'm not even joking, the team that I worked with was one of the best groups of people for situations like this. They kept their cool, 00:43:00they talked in a very--I don't even know how to describe it. It was almost as though they were talking to their own friends and family, like this is what you really need to do, he's not okay, we're going to make sure that he stays safe but he's not well. Hindolo was a teacher, and so he also had a way of explaining things that I think was really comprehensible and people just got it. But he had a kid too, and so he was able to personalize it and empathize and say, I'd be scared, too, if somebody called me and said an ambulance is coming to get your kid. But at the same time, if my kid is sick, that would worry me more. Again, another impromptu ambulance demo [demonstration] had to take place for people to feel comfortable about it. But you had the mom's friend saying like, don't you do it, I heard so-and-so got in an ambulance and--you know, trying to dispel 00:44:00these rumors and side stories that were trying to prevent people from seeking help. But the team itself, they just really knew how to handle and do sincere and empathetic community engagement in a way that folks, although things might've gotten a little tense, they were able to diffuse in a way that I haven't--I was just really glad to see. But I remember the driver, Big Med, he always parked close and had his own system of making sure that he parked in a place where he could see us and make sure that if we needed anything, blah blah blah. But he saw the way the mom was coming down the hill towards us, and it looked like she was ready to spank someone. [laughs] That's exactly what it is. She looked like a mom coming to lay down the law when it came to her kid. I think at the end of the day people appreciated and respected that we were really 00:45:00there to help and take care of fellow community members in the best way that we could.

Q: Did you ever hear someone express that?

NUR: Yes. When we went back to the community where the woman ran away from the ambulance, when we went back to talk to her. We talked to her mom. The mom was really worried because she felt like in that moment there was a lot of attention brought to her family, and their landlord was giving them a hard time afterwards. She said like, you guys are troublesome, we don't want any trouble around here type of thing, because they lived in almost a U-shaped block of single homes, single rooms that they stayed in, and the landlord lives in one of them. We came back and talked to her, and then Hindolo talked to the landlord a little bit to explain and then also invited the landlord to the ambulance 00:46:00exhibit that took place afterwards. They were really appreciative. She didn't expect to see us again after she got into the ambulance, and so when she saw us, she was like, "You're back?" "Yeah, we just want to know how you're doing." She was like, "Okay." She seemed kind of surprised. She was preparing a meal, and so we just sat down with her and we're like, "Can we talk to you and see how things went?" She was like, "Sure." She was just busy cutting greens and talking to us about her experience. I think she was surprised to see us and said she was appreciative and thanked us for coming back, and the mom, too. I think she was nervous and kind of pissed at her daughter for the theatrics of it all, but it ended up being fine and they came to the ambulance exhibit and it was a good experience.

Q: You talked the first time about closing the loop and the importance of that.

NUR: And coming back around, absolutely. Despite it being exceptionally stressful, it was great. I will say also there were times when we were doing the house-to-house search where we'd go to one door and the next door and the next door, and it was rainy season, so we're standing there under an umbrella or not, just water coming down, trying to fill out forms and write down people's contact information and let them know if there's people we need to follow up or things like that. People are like, do you want to come inside? We couldn't go inside because that was against the guidance in case there was anybody that's sick. We have to make sure everybody's safe. But there were times while we were doing that where people were like, wow, you're standing out here in the rain, thanks for doing this. Although it looked kind of crazy I'm sure, but they knew that we 00:48:00were there to get a job done so to speak. That was deployment number two. That was pretty much like the run of show.

We did a lot of work with the DSOs [district surveillance officers] to help build their capacity. There was really just a lot of coordination with the team at different times, different groups or members of the team needed support or weren't able to attend. So really just making sure logistically the--and the active case search was supposed to be two weeks, and it extended for like thirty days, so we were doing that for most of that second deployment. Then I had the opportunity, because of staffing shortages, to do some of the previous work and connect with people from my first deployment. So doing more national-level 00:49:00communications work, and that was also really nice because I was so entrenched in doing the Western Area DERC activities that I hadn't been able to reconnect with some of the national folks that I'd worked with. It was good to be able to do that as well. I think some were surprised. They were like, oh, you're back! I think they appreciate that because they're so used to seeing CDC folks cycle in and cycle out, that they really appreciate when people return. I was able to work with them and practice my Kriol as best as I can in certain instances. Then that one came to a close. I was there for about forty-five days or forty-six days for the second deployment.

Q: When was it in the year?

NUR: This was like August, September.

Q: 2015.

NUR: Yeah. I left like the first or midway through the second week of September, 00:50:00just before the flood happened. There was a major flood that happened in that region or in Sierra Leone at the time that decimated and required emergency response in a very different way. That was hard too, because again, you leave, you're back into your job and the work that you're doing, and then you find out. You can't check in with the people you worked with in-country because they're continuing the work, and you want to respect--you don't to impede anything. Even though they were really good about checking in on me to see how I was doing. But then the flood came and it was just heartbreaking to be so separated and not be able to help in any way. It really freaked a lot of people out as it relates to 00:51:00Ebola because there was a huge amount of displacement. People were exposed to all kinds of water-related potential--illnesses and sickness were rampant. It was gross. That was another difficult part of returning, but with my current work I am able to support some of the Atlanta-based communication activities with Ebola, so that's helped me at least in some capacity be involved in the recovery efforts and help maintain attention on Ebola with competing things like Zika, even though it shouldn't be competing. I didn't expect my work, recovery-related, to look like this, but I appreciate being able to do this type of work.

Q: Can you describe more about what you're doing right now?

NUR: Yeah. Basically, there's an Ebola-Affected Countries Office that is in my 00:52:00division. I work in the Division of Global Health Protection at the OD [Office of the Director] level on the communication partnerships team, and we look at the different programs within our division as "clients," quote-unquote, and each one of us is responsible for providing communication support. Some of what I've been able to do so far is help triage when we get media inquiries and questions as they relate to--if there's new clusters or flare-ups of Ebola, responding to those type of inquiries. If there's new literature or research, reviewing that, and preparing if there's going to be a flurry of media conversations around it to help us have reactive talking points and things like that to prepare, or proactive talking points. Also, most recently, finding ways to document some of 00:53:00the success stories and showing a lot--there are success stories in each one of these countries. When you look at where things started to where they are now and the infrastructure and the capacity that's been built, both with human resources and material resources, it's amazing. Being able to document a "then and now" type of thing. That's very recent and I'm just pulling together some stories right now. I'd love to do some on people that I've worked with and what they've been able to accomplish or what their process was like and document that. That's the current--

Q: You emphasized the importance of the district surveillance officers and your work with them. I'm wondering if you can describe one or two of them who 00:54:00especially stand out in your memory.

NUR: There were three, actually. They represented wards that I visited the first week of my first deployment. That first week of my first deployment, when we responded to an alert, and it was basically a dead child. That's where I met one of the DSOs that I ended up working closely with on my second deployment. It was funny because, you know when you see someone and you recognize them or they look familiar and you don't know why? I went to meet with them and I was like, God, this all looks so familiar. All of a sudden they're like, oh, you're back. Like yes I am, yes I am. I know you guys. So there were three that I worked very closely with. One was Osman Sow. He was a medical student. I think he had 00:55:00graduated or was about to graduate. Him and Abubakar both were I think recent graduates or about to graduate and were working in their community health offices. Then there was an older gentleman, Mr. Tomeh, who was also a DSO, and responsible for wards within the area I worked in. He was the leprosy point of contact for the Ministry [of Health and Sanitation]. He was always interesting because he, despite it being an outbreak setting and doing the active casework and things like that, he was older, so he I think had a strong command I should say of the different teams that worked with him. But he also managed to sometimes--it was hard to pin him down sometimes. I'm asking him, "Are you going to go check on this suspect case that your team called in?" He's like, "Oh, but I have a leprosy case I need to check in on, too." But he was really great and 00:56:00always positive and enthusiastic and managed to make sure that his team and the direction of the work was always there.

Osman, just the kindest person ever, exceptionally meticulous. The case identification form was not the easiest form to use, especially in the rain, but no matter what, no matter if it took us standing in the rain for an additional thirty minutes, he went through and filled everything out. And there weren't duplicate forms, you had to rewrite it. So he would rewrite the entire form because we had to keep one, and then we gave one to the ambulance driver. It was just this process. He was a very meticulous and process-oriented person and no 00:57:00matter what, if he got a call that was on one side of town, he would be there. If it came to a call on another side of town,--he was just always available and always there to do the extra work. I think with Abubakar, I can definitely say the same.

They were just three people that worked the same kind of general area together for over a year. There were a lot of DSOs that were brought on early in the response that had either left or been let go because of the scale of the response. Things scaling back. But these three, they remained there, and they were so organized together and looked out for each other. If Osman couldn't make it, he would call Abubakar to ask him to go check on something. I really appreciated that because that really does enhance your work when you are able to 00:58:00have this collaborative and team approach to it. It wasn't like, hey, this is my district, anything that happens here is my responsibility. They looked out for each other, and I think that community members started to recognize them. They were also working, again, in the community they lived in, so I think that really enhanced the experience. But those three were great people to work with. Mr. Tomeh, I don't know what, if it was just by chance, but every single time I went with him--because there were some days when we would go with one DSO on all their alerts and support them and provide any guidance if things popped up. For some reason, the two or three times that I went out exclusively with Mr. Tomeh, it was death alert after death alert after death alert. I was like, Mr. Tomeh, what is going on in your community? But I think it was just by chance. But for 00:59:00people that had been working those type of hours for that long, to still be enthusiastic and positive and supportive and encouraging one another, it was just amazing to see. Those three, those are my guys.

Q: Thank you. When you look back at your experience and you reflect on it, is there anything else that we haven't talked about that you want to make sure that we have on the record?

NUR: I was thinking about this, actually, the other day. Prior to coming to CDC, I worked mostly as a contractor, taking public health, global health contracts and doing work internationally. One of the things that really influenced or 01:00:00encouraged me to look more actively at jobs at CDC were opportunities to provide and work in different countries where my skillsets were needed. I think that CDC is just such an amazing place to work in that regard. The EOC and the GDD ops [Global Disease Detection operations] center, the way that they track diseases around the world and are part of this larger supportive network of agencies that respond to public health needs, it's just great to be able to be in an agency where you can do that and support countries that--I probably would've never traveled to Sierra Leone had something like this not happened. It was unfortunate that it was related to Ebola, but I feel very fortunate to have been 01:01:00able to travel there to do this work despite how exhausting it may have been at times or whatever. It just felt like an opportunity where if you're in a system where you don't necessarily see direct impact, to actually be able to go in and work with people and build partnerships and build relationships and provide services in different communities, it's just an amazing opportunity and I just feel so fortunate to have been a part of it. That's my two cents.

Q: Thank you so much, Sophia. It's been a pleasure.

NUR: It's been great. Thanks, Sam. I appreciate it.

Q: Of course.

END