Dr. Sophia Nur

Dr. Sophia A. Nur

Q: This is Sam Robson, here today with [Dr.] Sophia Nur. Today's date is April 12th, 2016, and we're here in the audio recording studio at CDC's [United States Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. I'm interviewing Sophia today as part of our CDC Ebola [Response] Oral History Project. Sophia, thank you for being here with me.

NUR: Thanks for having me.

Q: Of course. And for the record, could you please state your full name and current position with CDC?

A; Sure. My name's Sophia Nur. I am in the Division of Global Health Protection [DGHP] at the OD [Office of the Director] level with the communication and policy team--or communication and partnerships team, but we work with policy folks as well.

Q: Okay. Thank you. And can you tell me when and where you were born?

NUR: Wow. I was born in Kansas City, Missouri. Grew up in Kansas for most of my life, though. There's two Kansas Cities, one in Kansas and one in Missouri. I was born on the Missouri side but raised on the Kansas side, right on the state line.

Q: Gotcha. And can I ask when?

NUR: October 25th, 1980.

Q: Thank you. And so you grew up in Kansas City, Kansas.

NUR: In the suburbs of Kansas, yeah.

Q: In the suburbs.

NUR: Actually, truthfully, closer to Kansas City, Missouri.

Q: Oh, okay. Just tell me about that.

NUR: Kansas?

Q: Yeah.

NUR: Well, let's see. I'm first-generation American. My parents immigrated to the US and somehow found their way to Kansas. They were living in Florida. They came here to go to school and ended up living in Florida and doing their associate's degree. War broke out, and they couldn't go back, and they just decided, well, we'll just keep learning. Eventually--they had some friends that were living in the Midwest, and they encouraged them--I mean, I wish I was there for the conversation to move from Florida to the Midwest, but I wasn't. [laughs] But eventually they decided to move to Maryville, Missouri, to go to Northwest Missouri State University, and that's where they did their bachelor's. War was 00:02:00still happening, there was a coup in Ethiopia at the time. So they did their master's, as well. They both got their MBA [master of business administration]. They actually went to school--they got both degrees in about three and a half years. They went to school every single day, [laughs] like every single session that classes were offered, because they both weren't really sure when they were going to have to go back, and so they wanted to get as much done as possible.

Things didn't really get better in Ethiopia at the time, and so they ended up looking for work in the area. They moved to Kansas City and had me. Both started their careers there, actually, with Allstate [insurance company]. My dad was on the financial analyst side, and my mom started as an insurance broker, and stayed with Allstate for twenty-some-odd years, had two kids after that. My 00:03:00middle sister was born in '86, so I was six years old when she was born, and the dream team was broken up. [laughs] We went from the dream team of three to four. My mom jokes and says that I wanted a sister, but then I realized that they were permanent. [laughs] I had to kind of learn how to be around other kids that were in my house. But yeah. And then my youngest sister, we're ten years apart, actually. I kind of adopted the role as third parent and was more able and understanding of having another sibling at the time, so actively involved.

Kansas was, truthfully, a really cool place to grow up. I mean, I know I joke about wanting to live in Florida, but it was a great place to grow up. There was a small--I'm actually--I should have clarified--half-Ethiopian, half-Somali, but 00:04:00both of my parents grew up in Ethiopia. The community was primarily an Ethiopian community, quite small, and so we kind of all grew up as one unit. I had extended siblings and families from other groups, and we're all still very close today. So that was nice. Lived in a quaint little suburban area--all the kids played together, everybody knew each other, we all went to the same schools type of thing. That was nice. It's definitely a keep-your-doors-unlocked type of--if you leave the garage door open overnight, you're fine type of community. That was a great place, I think.

It was a little odd, I think, being first-generation in a community in the larger Kansas City area, where at the time there weren't a lot of immigrant communities. There were small pockets. By the time, I would say, like, in the 00:05:00nineties, late eighties, you started seeing a larger influx of people from other countries. There's really good refugee resettlement programs in Kansas City, and so you saw an uptick, which I think really enhanced people's understandings of the world and the differences in people and cultures. But as a kid growing up there weren't a lot of people that looked like us. But it was still a pretty warm and loving place.

My parents were very actively involved in community stuff and community service, and there were times when we didn't do Thanksgiving in our homes; we went to shelters and passed out food and things like that. So they were always very committed to this larger community aspect. Like, not just focusing on you or your family, but you and your family in the context of this larger society and community that you can be with and support and nourish. I think that's probably 00:06:00also related to the faith piece, growing up in a Muslim household. Islam is really characterized around looking out for your neighbor and your fellow human beings and people that aren't--animals, even, that are in need, and looking out for them. I think that they really nourished and fostered that perception within our home quite a bit. You can see it, truthfully. My parents both have their MBA, and they're very business-minded people. But then my sisters and I are all in public health or development. [laughs] My middle sister, she works for the World Bank and does environmental policy type stuff. My youngest sister's getting her MPH [master of public health] right now, and she's interested more in the maternal health type of work, and she's also done some work internationally in mental health. We're all kind of in that same environment in the work that we do. I mean, I think my parents were excited about that, but a 00:07:00little bit worried because that means that your kids are going to go all over the place. It's one thing when you want to build a global perception in your children, and then when they actually put it into practice and want to go around the world and help people, it's like, are you sure you want to do that? [laughs] We've been to the Middle East, to Central America, East Africa, West Africa, all over. And so I think that that stresses them out a little bit. But they make do, so to speak.

But yeah, growing up--I left Kansas after high school. Went to a really small, private school from junior high school through high school. Only about forty-five people in my graduating class. Large international population--you know, considering a class of forty-five. And then also it was diverse in 00:08:00socioeconomic status, in just demographics all around. I left in '99 and went to Occidental College for undergrad [undergraduate studies], which was a really small liberal arts college, like a little larger option or a larger transition from my high school, so to speak. Very student activist-focused and progressive and nurturing, and just a really great environment. They were really interested in ensuring and instilling in folks that whatever you learn here, again, is not just for you, but seeing yourself as global citizens and seeing yourselves as larger citizens in the world that we live in, and making sure that you are actively trying to contribute to the betterment of society, in no matter what realm, whether it's in the arts or if it's in urban policy or health or econ 00:09:00[economics], all of these different areas. That was a great transition. I studied diplomacy and world affairs there. African politics was my emphasis. Just really trying to get a good grasp on all of--I knew quite a bit, I would say, at the time, as it relates to--or, you know, relatively speaking--to what was taking place in Africa, just based on personal experience. But studying it helped me to get a broader understanding of what was happening in far more countries than I really knew about on the continent.

Then I moved to New York, [laughs] on a whim. I graduated from undergrad and 00:10:00worked at a program, a summer program, where we were basically working with incoming freshmen to help them transition into the undergraduate experience before they started formally. Took them on a cultural enrichment program throughout the city, but then also provided them with classes and helped them while they were on campus, before they started school. I guess I just got tired of LA [Los Angeles] and a friend of mine was moving to New York, and I had always had ideas of living in New York.

Q: Wait. So you--oh, okay. I didn't realize that Occidental was in LA.

NUR: Yeah, it's in LA.

Q: Okay.

NUR: Yeah, so I left Kansas City in '99 and moved to Los Angeles--

Q: Right.

NUR: --as a--for undergrad.

Q: Can you just very briefly tell me what that was like, that transition?

NUR: [laughs] Okay. I pretty much knew I wanted to move to California since middle school. I had an aunt--she immigrated--she was a refugee and immigrated 00:11:00to the US when I was born, essentially. She was the person that took care of me when my parents started going back to work. She worked at my daycare, and we were very close. I would visit her in the summer and stuff like that, and I actually went to--I thought I was going to go to UCLA [University of California, Los Angeles]. I just knew I was going to go to UCLA. And then I went there for a summer program--oh, and I was going to be a marine biologist. [laughs] I have a deep love of the ocean. Not deep enough to be a marine biologist, I learned very quickly. But I took a marine biology class and a Spanish class and went to UCLA for a summer, and then toured the different colleges in the area and really liked Occidental and met some great people there. Did not like UCLA after visiting. It was too big. They said some classes are a couple hundred, and you don't even have to go to class. My mom was like, "The hell you will just skip class if we're paying for it!" But I ended up really liking Occidental. They 00:12:00were one of the few schools in California that actually came to my high school to do info [information] sessions. And no one from my high school was interested in going to California. I really just got one-on-one opportunities to chat with the admissions people there, and applied early, in December, my senior year, and that was it. I was on my way to LA.

It was hard because I think most people in Kansas City go to school in Kansas City. And most Ethiopians or children of African parents stay in Kansas City. A lot of people were telling my parents, "Don't worry, she'll be back. She just wants to try it out. It's a phase." And I was like, "Uh-uh!" My mom was like, "I don't know. It seems pretty permanent! She's pretty stubborn." So, yeah. Moved to LA and lived there for my undergrad experience and then stayed one year after graduation working at really odd jobs.

Q: Like, what's an example?

NUR: Oh, gosh. I worked at an Enterprise Rent-A-Car for a period of time. I worked for a staffing agency that primarily found kind of entry-level jobs, like factory jobs, for people with different citizenship status. It was an office of two people, me and then the director of the staffing agency. I just did a series of things that year. I worked at a refugee resettlement organization for one year that did not do well. It turned out that the woman may have been doing not-so-great things with the government's money, so I immediately left that situation because I was against that type of behavior in general. I mean, you're supposed to be providing a service for people that really need it. And even the idea that you would not, that you would also be stealing federal funds, I was 00:14:00like, I got to go.

Q: This was also in LA?

NUR: Yeah.

Q: Oh, wow.

NUR: Yeah. I remember being really, like--I don't know if I just wore rosy glasses throughout, but the idea that someone would actually misuse federal funds is one thing, but misuse federal funds for refugee communities just blew my mind. My mom was like, "Soph, there are bad people in this world" type of thing. But I was like, "This kind of bad?"

Then I got a job at a staffing agency, and then I got another job at Enterprise Rent-A-Car, and then eventually I said, "I can do odd jobs anywhere. I might as well move to New York."

Q: Right. And I want to pick up with that. But I also want to ask you, because you mentioned that you've done a lot of extensive international travel, had you up to that point done a lot of travel?

NUR: Yes. With my mom's job--she was in sales. She did really well, and so they would always have these annual international trips with Allstate, and my parents 00:15:00were really big on bringing us along. When it was the dream team, it was much easier, when it was just three of us. But then when my sister came, they managed. They really did. My mom was real--both my parents, really, were adamant about while they're doing all of their social sales-related stuff, that we did have really educational experiences and cultural experiences in the countries. We would sometimes go a little early on the trip, or we would stay a little bit later and actually go and see the historic sites. By the time--gosh, I think I had a passport at one. But we went to Japan, Singapore, Geneva--I mean, Switzerland--Austria, all over. We went to Japan. Hong Kong. China. A lot of those trips, we didn't do the normal tourist things that the group was doing. 00:16:00They would ask the hotel or ask people in the community, "Where do you think we should see?" or "Where should we take the kids?" We went to temples, Buddhist temples. We went to a fishing village to see what the fishing community looks like, to see what schools look like in those areas. That, I feel really grateful for, because I think that seeing something like that early on in your life really reinforces the fact that the world is much bigger than just you as an individual, and that you appreciate the diversity that's all around you. But then you also realize that if you have a contribution to make, look beyond your four walls or your immediate community, that there are opportunities to help, learn from others and to also allow them to learn from you, no matter where you go. It was just really interesting to have those experiences early on and see different places. We'd also gone to Ethiopia. I think the first time I went I 00:17:00was fifteen or something, and it was the first time my mom went back in a long time, like fifteen--twenty years? Twenty-five years? Twenty years, something like that. It had been a while for her as well. So, yeah. We got to do a lot of that. Unfortunately, when my youngest sister was born, we didn't go on as many trips. Her first international trip was Cancun, which she's really bitter about, [laughs] and I think she was fifteen at the time. But yeah, we were still really involved in a lot of--my parents started an interfaith organization at one point, and so we were really involved in a lot of interfaith and diverse groups and societies and community groups in our area. Exposure was important, yeah.

Q: Gotcha. Cool. So eventually you find yourself in New York.

NUR: Yes. Without a job, but an apartment. [laughs] So I had a place to lay my 00:18:00head, and I think I had enough for the next month's rent. So I had enough time to figure it out, so to speak. I got a job with the Children's Aid Society. They're basically a program that started a long time ago--it was over one hundred fifty years ago--in New York to help provide after-school programming for kids, quote-unquote "latchkey" kids. It evolved into this--I don't know what his background is, if it's a--I can't remember, but his name is, I think, Dr. [Michael A.] Carrera. He started this model to help with the teen pregnancy rate that was taking place in New York. There was a spike in teen pregnancy, and he really wanted to do something in this after-school program to be able to provide kind of family life and sex ed [education] resources for students so that they could get their homework done, do extracurricular activities, but also learn 00:19:00about these different elements to help them make better decisions throughout their elementary, junior high school, and high school programs. I stumbled into it, worked with them.

It was great because I was trying to get into the health--I should also mention that I got interested in the public health side of things just at the end of--at the end of undergrad, I started taking some health classes as they relate to African health policy and things like that. And then I lost a family member. My dad's brother passed away from HIV-related [human immunodeficiency virus] illness, and no one knew that he was sick. That whole experience was very interesting for a number of reasons. There was a lot of cultural stigma associated around--still, in a lot of places--around HIV. They were not interested in really calling it what it was for a while. I think the first thing that a family member said was that it was cancer, and I was like, well, that 00:20:00doesn't make any sense. Eventually, shortly thereafter, I had a really honest conversation with my mom, and we talked about it. I was like, how is this possible? I started researching a lot as it relates to HIV and public health in general, and ended up working at this organization in New York that really connected the dots for me. Because we were working--we really provided a health-related service to kids. Whether it's education, but also taking them to their health visits. It was a really holistic model that they had to help support children throughout their academic cycle in New York public schools.

Q: Can I ask, did you know your uncle very well?

NUR: Oh yeah. Yeah. He was my dad's youngest brother, and he came to the US around the same time as the aunt--my mom's sister that took care of me, or 00:21:00shortly thereafter, so he'd always kind of been around. In our family, we pretty much always had a family member living with us at some point in our household, whether it's immediate, like my parents' siblings, or cousins and things like that. He lived with us for a period of time. So we were particularly close. I think we had even just visited. He was living in Atlanta, and we had just visited Atlanta at some point and spent time with him. It was a shocking experience. Because it's one thing to not know someone's sick and then they pass away, and then to hear what they passed away from, it was just kind of an unsettling thing. There's still a lot of uncertainty about all of the dynamics of his illness. But I think for me it was more so the idea that he may have 00:22:00known that he was sick for a period of time, didn't say anything because of stigma and all of these perceptions around HIV and transmission and whatever, and then essentially passed away, and that's when we learned that he had not been well for so long. Just the idea of that was so--it was really difficult. It was really difficult. Yeah. I think it really fueled my desire to learn more and find a way to contribute.

I stayed in New York for about a year, still working very closely with the program, and ended up applying to grad [graduate] school. I was looking for something in African studies or--that allowed me to have this relationship with health and do some type of health-related work. I eventually settled on getting my master's in public policy from Howard [University]. Well, it's African 00:23:00studies and public policy and development at Howard. I focused my research on HIV, particularly in Ethiopia. Looking around, like, what type of resources are they allocating at the government level towards expenditures around military, defense, health? And then also, in those priorities, knowing that we were seeing this uptick in Ethiopia as it relates to HIV prevalence and incidence. And then taking a closer look at human security in that regard. That's what I studied while I was there.

Then, I don't even know how I got into the communications side of things, but I think part of it was in my research, during my master's, learning about how difficult it is for people to receive health-related information--or how much care and consideration needs to go into developing and crafting messages as they 00:24:00relate to health. And that there are instances we've seen where, for example, fear tactics, like in the eighties, they had all of those smoking ads and showing, "this is what your lungs look like," and fear tactics don't really work. You still see people smoking, kids, whatever. And really looking at, as it relates to HIV and the culture and perceptions as they relate to HIV and the stigma and all of these different things, how they impact how we communicate about HIV, and how it impacts how healthcare workers treat people when they come in for testing or treatment or care. So, yeah. That's kind of how it evolved in that way.

Q: Gotcha. My monitor just went blank for--

NUR: Let's pause.

Q: A second, so I'm going to--yeah.

NUR: Okay.

[break]

Q: Okay, so we're back. And Sophia, you were telling me how you weren't really 00:25:00sure exactly how you got into communications. But how concretely did you? Was it a position you found, or--

NUR: It was. So, I knew that I wanted to get my PhD. I was in a program that essentially really could have been an MA/PhD program. When I looked at how the transition would be from master's to PhD, there wasn't a lot of diversity in the coursework. I was looking for some way to get more health-related experience or education. I found the--in the School of C, actually, the School of Communications, had a health communication--the program is called Communication and Culture. I was like, okay, that's actually what I'm interested in, how culture can impact communication and vice versa. I ended up meeting with some of 00:26:00the professors there and really just enjoyed--it was a very interdisciplinary program, so I took classes from the public health school, from medical anthropology, medical sociology, all of those different areas--history--wherever I could find it. I felt like that gave me the best experience for a PhD that I was looking for. So I ended up transitioning for my PhD to the Communication and Culture program and getting my PhD in health communication and intercultural communication. It was great. It was a small program, and they didn't really have a lot of people doing international work, which was good, because they let me kind of do my own thing, but then challenging because there were certain factors that impact whether or not you can quickly do a study in a country that no one had really tried before. I was lucky in that my professors were really flexible, 00:27:00but at the same time, they weren't able to offer me a lot of guidance. It was a lot of trial and error, learn by doing type of thing.

I knew I wanted to focus my research on Ethiopia, and I'd found a particular program out of Johns Hopkins [University] that basically they have a comic book that they use. It's called the MARCH Project, Modeling and Reinforcement to Combat HIV. They basically take this comic book that they've created for three target audiences: university students, the federal police, and the military, or the police force and the military. And they use the comic book as a model of how certain behaviors can protect you or keep you safe from HIV. They're relevant to the day-to-day life of a student, or to a military person on a base, or to the 00:28:00police officers. They then come back and have these different either group discussions about the comic book or activities on the university campus that really support and reinforce the behavior change that they want to reinforce. I had researched that project and I was like, this is what I'm interested in learning more about. So I did a lot of my preliminary writing in my courses on this topic, which helped, because then by the time I was starting my dissertation research I already had the first couple of chapters of my dissertation ready.

I ended up going to Ethiopia a number of times. I actually had a fellowship with an HIV/AIDS organization in [Washington], DC, that had a global component. They were really flexible and really supportive and allowed me to go to Ethiopia and work, still as a fellow, in their Ethiopia office, and then do my dissertation 00:29:00research as well. That was an awesome experience, just being able to learn, like, IRB [institutional review board] processes and who to talk to. I didn't have a lot of time because I put a crazy deadline on myself, my school was also looking for results from me. But it forced me to be really creative. I would try to set up coffees with different professors at the Ethiopian university or the organization that I was going to be working out of, and then I'd also bring my documents over coffee after we got to a comfortable place. "Now, can you just take a look at my research?" [laughs] "Now that I have you." It was great.

I did my research, collected my data, came back and defended it, and then I was just trying to find a job. I ended up finishing up my fellowship with the HIV 00:30:00organization, and randomly, someone suggested that I email my CV [curriculum vitae] to the Hopkins group, the Center for Communication Programs, that actually developed or helped spearhead the dissemination of MARCH in Ethiopia. I did, and I just thought, I'll email them. Didn't hear anything. Went about my way, decided I was going to go to Ethiopia for a month and just kind of celebrate the end of my dissertation. And they emailed me and asked to meet a couple weeks before I was leaving. I went to Baltimore and talked with them and told them about my experience and what I was interested in, told them that I was going, and they suggested I meet with someone in the office, their kind of in-house Hopkins person. So I met with this woman. She was like, "When can you start?" I had no idea that it was an interview or an opportunity. [laughs] I just thought that I was--I brought--I packed a month's worth of clothes. [laughs] And basically I went to Ethiopia on vacation and stayed for almost two 00:31:00years, working. I worked with the Hopkins group for a little over a year on a prevention of mother-to-child transmission national campaign that they were looking to start. They also had a radio program that I helped out with. But that was really the main activity. And then worked with some other Ethiopian national organizations in-country, doing this behavior change communication type work for them.

I ended up there, and then contracts ended, and I was kind of tired of the hustle to find your next gig, so I came back to the US in January of 2012 and randomly applied for a job at CDC. I like to say that I cold-called the CDC and somebody actually answered. I went on USAJobs [government website] and applied, 00:32:00and surprisingly, after submitting probably a hundred USAJobs applications I got one email back that--after I was told I made the cert [certificate]--that they'd like to interview me. I ended up moving here in May to start at the Division of HIV/AIDS Prevention in NCHHSTP [National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention]. I've been at CDC ever since. I managed our Latino and men who have sex with men [MSM] portfolio--or LGBT portfolio, but most of our stuff was around MSM. Particularly as it relates to the dissemination of some of the national campaigns out of the division, or out of my branch, that we were putting out, and working with national partners that we fund to do HIV prevention work, like [National] Urban League, NAACP [National Association for the Advancement of Colored People], those type of partners. I did that for a number of years before leaving at the beginning of this year to come to DGHP.

Q: What prompted that move?

NUR: It's so funny. The first time I did my PMAP [Performance Management Appraisal Program]--I knew I always wanted to get back into global health. So when I did my performance review, despite the fact that my mom was encouraging me to put down on my three-to-five-year plan Dr. [Thomas R.] Frieden's job [laughs] after five years. She was like, "What's the top guy's name?" I was like, "Dr. Frieden." She was like, "Yes. Five years you want his job." I was like, "I don't think that's how it works." [laughs] But I always wanted to get back into global health. I was really actively seeking--after I learned CDC a little bit more, and I took the--I had two deployments for the Ebola response, I was just like, now's the time. I really need to get back into actively seeking this transition back to global health. Domestic is great, and I learned a lot, but I think global is really where my interests are and where my skill sets are 00:34:00better used. I applied like crazy and finally ended up in DGHP. It's been really interesting, a great learning experience so far. But yeah. The deployments really helped. It turned on that light switch yet again, "you need to be back in the field!" That type of stuff.

Q: Okay. Well, let's get into that. So how did you get involved in the Ebola response?

NUR: I saw that CDC was enhancing their presence in--I guess it was summer/spring 2014--and really starting to actively seek deployers. I mentioned it to my branch chief, and he was open to the idea. Then he was suggested or requested and went on a deployment. When he returned, he offered to support anybody that was interested in going. I signed up and said that I'd be interested in helping in any way I can. There's a language barrier, so really it 00:35:00was Sierra Leone or Liberia. He had relationships with Sierra Leone, and so he was really--he really encouraged us to look to support the response there. I had a hunch that during the holiday season there would be a little bit of an exodus during the response. People wanted to come home and be with their families. I'm Muslim, I don't celebrate Christmas, and so I was going to be in the office during December and January anyway, and so to help support that transition I offered to go in the December 2014 timeframe.

My family was not really--they were concerned. I think the media hyped up what was happening, and there was a lot of fear and uncertainty and a lot of unknowns when it came to Ebola. My parents are really big on--they're businesspeople, 00:36:00right? They both have their MBAs. Even when we were kids and we wanted to do something, we kind of had to draft a proposal and explain to them why this makes sense and get a cost-benefit analysis, [laughs] you know what I mean? I'm talking, like, seven years old, why I want to take dance class. I had to sign a contract committing that I was not going to miss dance class because it was an investment. I mean, it worked. It encourages commitment. So I had mentioned--I started to warm them up to the idea in October time, that I was interested. I went home for Thanksgiving, and we had a family meeting, and I just explained to them, "They sent me an email back saying that they'd love to have me, and this is what it looks like, and this is what I think I'll be doing and where I think I will be," and tried to give them as much of a debrief on Ebola as I could at the time. Admittedly, I didn't know too much about it, outside of what I was reading and some internal documents--or on CDC's website, I should say. But I 00:37:00just really felt like it was something I had to do. I felt like it was a public health emergency that I had a skill set that I could respond to. There wasn't a language barrier. There was a need to really make sure that people had proper information, that it was conveyed to them in a thoughtful manner and in a way that was appropriate to them. I really knew that I could do that type of work, and I wanted to do that type of work, and I was willing to go. I had an understanding of what risk levels there were and things like that. You don't really know until you get into certain situations. But I felt like it's something I had to do.

I went home and talked to them about it, and my mom told our mosque, and the people made blessings and things like that. At first, I think she was actually really apprehensive about telling anyone that her kid was going to support the 00:38:00Ebola response, because--I don't know if she thought that then people would think she had Ebola--I couldn't really understand what it was. I was like, it's such a distal relationship. I don't even live in your home. But I think there was just a lot of fear that encompassed the entire outbreak, that was so interesting to me because my parents live in Kansas. [laughs] Understanding that migration does happen, and quite frequently, but as risks are concerned, Kansas City International Airport is not a hub of people and transportation. People are going to get checked and screened at different stops along the way before they ever get there. But their risk perception was very high. They thought they were next.

I ended up deploying early December. I guess mid-December. One of my colleagues was actually going with me. I think the part that I underestimated the most was 00:39:00the travel there. Sierra Leone's not an easy place to get to, especially at that time where a lot of airlines were pulling their flights. We had limited ways to get around. I also was traveling with a woman who was going on her probably second or third deployment, and there was a doctor, a physician, in Sierra Leone that was exposed to Ebola. They asked her a few days before we left to travel with a box of ZMapp, which didn't sound like a lot at the time, but it was an enormous box that had all the refrigeration components necessary and all that type of stuff. Me and this woman and this other person from the Ohio CDC office had to take this long-haul journey with this box, making sure that--we kind of rotated carrying it and keeping an eye on it on the plane. At one point we were 00:40:00like--the Brussels flight is almost like the Greyhound of the sky. It stopped so many times before we got to Sierra Leone. We were in Brussels for a while, and then we ended up stopping I think in Dakar, and then we stopped at Conakry. Every single time people were getting on and off, we had to identify the box as ours, because they kept going, "Is anybody--there's a box here in the front," and we're, "It's us." But there was this anxiety around this box and that this person was ill--we didn't know what the status of this person was as we were traveling, but that we had something that could help someone. When we got there, we were told that Dr. [Austin] Demby, who was from HHS [US Department of Health and Human Services], was there. He was waiting for us on the tarmac, ready to collect this box and take it so that they could administer it to this person. 00:41:00But the gentleman actually ended up passing away. We learned that maybe a couple days after we got there. That was kind of the first hit when we got in-country.

It was just a really fast-paced environment. I'd never worked for the federal government in another country, number one, so there were a lot of restrictions that I was trying to process, and rules.

Q: Like what?

NUR: Like, we could only ride in certain cars. You had to basically let people know where you were, especially in the eve--like, checking in. There were also a lot of reporters around, so not having conversations about our work outside of certain areas. A lot of things to take into consideration while we're there. On top of that, getting up to speed and acclimated with what's currently happening within country as it relates to whatever your respective field is. And then 00:42:00meeting all of these new people.

There was a challenge around CDC staffing because we could only do these short-term deployments. I'm sure you've heard this. Every time we went to meet someone that was either more long-term staff from an international agency or a national or a local agency, it was like, oh, you're only going to be here for a certain--and so we had to reassure them that I may not be here for that long, but I'm here to do whatever you need me to do, and I promise to support in the best way that I can type of thing. There was a lot of partnerships and relationship-building and sustaining that went along with it, along with the jet lag. To get to Sierra Leone, you have to take two planes, a bus, a boat, and a car. The only thing missing is a train. [laughs] You're on this path, and when you finally get there, you're kind of thrown into something. It really requires you to tap into a different energy source that you may not have had to use in 00:43:00your normal day-to-day life and work. The team was also very small. A lot of people were leaving. Not many people were coming in at that time, which was tough because what was one person's job--one person ended up with the work of four or five people. On the one end, it was very taxing, but on the other end, we were a small group and we were very close. We were able to lean on each other a lot.

Q: Who were some of the people in your group?

NUR: My team lead at the time was Sara [A.] Clements. She's actually in the GHS [Global Health Security] office. She was great. They were coming off the heels of a Dr. Frieden visit, so I think everybody was coming down from the high of running around and putting all that stuff together. Apophia Namageyo-Funa was the person I was supposed to replace, but she actually extended. Mike [James M.] 00:44:00Waldmiller was there, and Kathie [Kathleen M.] Fazekas. That was the team. And me. Mike left a couple days after I got there, and then Euna [M.] August, who I worked with in my branch, came. That was kind of our little team. We were responsible for a lot of really intense and rewarding and exciting work. We also worked with the Peace Corps. The Peace Corps supported our activity. We had locally employed staff from the Peace Corps, so Sierra Leoneans that we worked very closely with.

While I was in-country I did the national communication work, coordinating with the National Ebola Response Center and then working with different--they had communication pillars and different groups responsible for different activities. It was a group that would come together and talk about how they can--CDC was 00:45:00really providing technical assistance and guidance wherever we could. That's what I was working on. We had a radio program that I helped out on. We also were tasked with really--while we were there, they were starting to see an uptick in healthcare worker exposure in Ebola cases. They wanted to better understand from survivors and then from healthcare workers some of the risk perceptions and behaviors that exposed them to Ebola and better understand their understanding of things and their perceptions of things. We did a lot of interviews and focus groups that were really moving, and we couldn't have done it without our Peace Corps guys. They did all the translation. We got to work together to come up with questions we wanted to ask and meet with people.

We met some really dynamic healthcare workers that--they were going to work 00:46:00every day, doing their job, whether it was in the delivery ward as a nurse, and someone doesn't tell you that they have any other symptoms, and you find out that you've been exposed to Ebola by just doing your day-to-day tasks of supporting a woman during delivery or miscarriage or whatever. And seeing your coworkers become ill, and then becoming the person that has to take care of them. Then coming home and seeing your neighbors being ill. It was really hard. A lot of them talked about how they could do all they wanted around infection prevention and control at work, but then when they go home, people know that they're--there's fear associated with the hospitals and healthcare centers, and so people knew them as people with medical backgrounds or health backgrounds. They would come to their homes and say, "I'm not well." So they were experiencing exposure in communities. It was a really interesting experience to see. We know that healthcare workers are exceptionally committed--nurses, doctors--to do what they do. But that they really are the ones that are willing 00:47:00to put themselves in harm's way for the betterment of their fellow human, so to speak. I think that to hear their stories and see just how strong they were, it was like--I don't know if I could have witnessed my--I got exposed, my husband got exposed, my husband is ill, I'm ill, my husband passes away, my coworker's ill, I'm taking care of them. And people becoming exposed by just doing their day-to-day work. There's a trauma associated with that. And understanding their role. And then also in communities, there were some communities that we would go out in, and you can see, when you're driving down the road, the markings on the homes that identify that people were here or sick people were here or whatever, and watching it move through an area.

Q: There were markings?

NUR: Well, in some instances, yeah. They would have to kind of let people know. For example, my first--I don't know, first--or second? No, probably like my second or third day in Sierra Leone, they really were encouraging us to go out with an epi [epidemiology] person to get a better situational awareness of what's taking place on the ground and the processes with surveillance and contact tracing and case identification. The first thing that we went to in the Western Rural Area was a woman left the house--a pregnant woman was ill, left to go seek care, basically didn't make it, but to the main road. People went to assist her, because--Ebola goes against your basic human instinct of helping. It compromises that. People went to help this woman, and by the time the ambulance 00:49:00got there, she died. And they found out that she had tested positive for Ebola. She left her child at home, and I think the husband might have fled because he heard that she died or tested positive, and he didn't want to end up in an ETU [Ebola treatment unit]. And then the child ultimately died. So the first day was going to pick up the body of a child who had died in the home. The neighbors are just sitting there, they're just struck because maybe they saw their kids playing with that child a couple weeks or days prior. They're kind of clammed up, not wanting to talk about potential risks and not being associated with it. You just saw this dynamic within the community where there was a fear that it was going to happen to them, but a greater fear of, if I say it, if I--we don't know what happens. All we know is that people are getting sick, and they're 00:50:00going, and they don't come back. Not understanding that the longer you wait to go seek care and treatment and all these things, the more of an issue it becomes for you.

[break]

Q: Okay, back again after a little pause. I know that you had in your studies studied a lot of African politics and culture. What did you know about West Africa, prior to going to West Africa?

NUR: I knew a little bit through my studies. I knew about civil wars that were taking place in West Africa. I knew about certain health concerns, like their cholera outbreaks and things like that. But as it relates to actual experience traveling to those areas, I'd only really been to Ghana. There was a UN [United Nations] meeting that I participated in, in Accra. That was really my first time in West Africa. That was my only real experience on the ground. And just in 00:51:00general, knowing about kind of the political landscape and some of the history for the different countries. Sierra Leone, not as much, admittedly. There were certain things that were obviously shown in movies and things like that, but not necessarily a reference for what's happening in a country. But yeah, outside of war and certain large health issues, not a lot. [laughs] Not a lot of personal experience, yeah.

Q: So was there a lot of studying that went on before you went?

NUR: I did. I read a little bit. I was really curious about infrastructure, only because in Ethiopia there wasn't necessarily a history of--there was no colonial history, really, in the country. It was very limited. There's an element of the culture where it's very insular, and so there's not a lot of external influence within the country. You see infrastructure is that--the development is at a different rate than a lot of countries that had a lot of foreign relationships 00:52:00for a long period of time. So I was curious about that part of it, because from buildings to roads to health facilities and access to care and things like that. I did a little bit of research in that regard to understand the landscape. But there wasn't a lot of time before I deployed to be able to do more. I talked to some people and I think that just confused things a little bit more. I learned very quickly that with an outbreak response, what was relevant three weeks ago or four weeks ago is no longer relevant when you get there, or that things change so quickly that you really just have to focus on getting acclimated in that moment and getting your own situational awareness and understanding what's happening on the ground and just go from there. I was trying to communicate to people before I left, talking about next steps. But I told them, "This may be 00:53:00thrown out next week. We may need to do something different next week for this particular request." That was just the reality of the situation.

Q: Yeah. I mean, I've talked to people who say that what they planned to do before going over is not really related to what they ended up doing.

NUR: Exactly.

Q: Was that your experience, or--so what did you plan to do, and then what were you doing in the first few weeks?

NUR: [laughs] I had a general idea of the existing response structures and CDC's role. And I knew that we had a radio program that they had kind of facilitated to get free airtime, and CDC could have--identify a spokesperson to come in. So I knew that there was a radio program. I knew there was this national messaging. There was this thing called the Ebola Big Idea of the Week that was started. I was under the impression that I would be implementing that, and then maybe also, 00:54:00depending on--no, implementing that. That's what I thought I'd be doing. When I got there, I found out that I would also have to staff for the radio program. I didn't know anybody. [laughs] I was like, who am I going to staff here that speaks--that is in the community, that would be good? I don't know who's in the community that would be good that speaks Creole, that can talk about things that are--will know how to navigate the conversation in case sensitive topics come up. So I learned very quickly--I was lucky that there were two Sierra Leoneans working on the response at the time that had backgrounds that they could talk on the radio program. But then after they left I had to figure out other stuff.

I also knew that I would be implementing the Ebola Big Idea of the Week. It was basically taking these messages that were preexisting, and then making modifications based on current need. If they saw that there were challenges around burial practices and safe burials, that maybe this one week's message was 00:55:00around that. There was a really integrated approach of it being a radio, the radio messages, they could be crafted for newsprint, they could be crafted for healthcare workers, if people wanted to do interviews--it was really for journalists to be able to take this and use it as a guide to develop how they were going to communicate about Ebola that week. I was lucky in that the person that was there left me with I think two or three weeks' worth of content. But then I was asked to develop the next four to six weeks of content. It was a good experience, but it was a little challenging because there's a cultural element to it, right? I need to know what's happening. They have different holidays or cultural celebrations or national celebrations that take place, and making sure that what we're encouraging people to do, like trying to discourage mass gatherings for a national--Independence Day. That's not the example, but for the 00:56:00sake of this conversation, an Independence Day celebration, and reinforcing the health precautions around mass gatherings and things. So, yeah. There was a lot that I learned while I was there. There was a whole conversation about infection prevention as it relates to chlorine and the right mixture for handwashing versus cleaning. I don't know. But you learn who your points of contact are and who you can work with, and you really have to stay on your toes. I remember somebody said that when you deploy, you might go over thinking that you're going to make bread, and you end up having to fix cars. You just have to be prepared for whatever you're asked to do. It should be skills-based, but you may get on-the-job training. I hadn't had a lot of field epi, but I was working with people that I could learn what they wanted me to do for case investigation and 00:57:00things like that.

That was the first deployment experience. It started off really intense, with going out into the field and seeing kind of the reality of the outbreak and how it's impacting people in communities--and in seeing some of the challenges. Seeing the dynamic between a sick parent and a sick child, or a sick neighbor, a sick spouse. People really having to mitigate and process and determine on their own how they're going to--we were trying to educate them, like, this is how you can properly stay safe while you wait type of thing. Like, keep a distance! But if your three-year-old is wailing because they don't feel good, you're not going to walk away. So really understanding the human element of the outbreak, I think, was the first couple weeks of my deployment. And then really getting into 00:58:00being thoughtful about how we communicated about--there was another KAP [knowledge, attitudes, and practices] study that was coming out at that time--I think it was KAP--we were between KAP Two and KAP Three--and using that information to better understand and seeing the progression of people's understanding of Ebola and the reality of it and their perceptions and their risk perceptions and where they're getting their information, all of that type of stuff, that really informed how we did our work. I started to get a handle on things about the fourth week. [laughs] No--no. And ended up extending for a little bit. It was quiet at headquarters, so my boss let me extend and was able to transition. We started seeing a trickle back of people coming back in-country to support the response, so our team grew. I was able to transition my projects to a lot of different people, which was great. We were able to put people back in the districts to help provide more local response needs as they relate to 00:59:00health promotion.

Q: That would have been, like, in January that that's happening?

NUR: Yeah. Yeah. And that was also the time that they were implementing the Western Area Surge. Basically, they were trying to get a handle on the uptick of cases in Freetown--well, in the Western Area, both Rural and Urban. They were doing active case searches, house-to-house active case searches, and different surveillance activities to identify potential suspect cases, probable cases, and helping people find their way towards treatment centers and testing. That was starting up as I was transitioning out--which was so hard. It felt like for the first time I could see a direct impact or implication to the work that we're doing, and then it's like you go back to your regular jobs, and it's a much slower pace. It was a tough transition back to reality a little bit.

Q: Let's stay on the first deployment for just a little bit. I had a question. You had mentioned that when you arrived--like, these short deployments meant that when you met with partners, they were kind of used to all of this transition happening and kind of greeted you with a little skepticism, like, oh, you're going to be gone soon anyway. Can you give me an example of when that happened?

NUR: Yeah. Yes. There was the social mobilization--no. Social mobilization pillar? It wasn't the social mobilization pillar, it was the social mobilization communications group. It was basically--within the communications side of things, it was a mix of a few international partners, CDC, and a lot of national partners that were responsible for some of the social mobilization efforts, but really controlling the messaging that the social mobilizers were using when they 01:01:00would go out to educate the community. It was at a time where there was a lot of inconsistencies or lack of clarity on chlorine and how it should be used. They were asking for guidance on that. But there was this back and forth where national groups that worked in prevention control or something had ideas of how it should look, and then some folks wanted CDC to provide feedback, and so there was a little bit of a lag in that response being addressed--or that need being responded to. When I got there, the person that had been working on it was leaving. He took me to the first meeting to introduce me, like, "She'll be here," and the first thing out of the leader of the group's mouth--who we ended up being good friends, but he was like, "So when do you leave?" [laughs] I 01:02:00said--what did I say? I responded with something along the lines of, "It depends, but you have me for now, and so let's get to work" type of thing. He kind of laughed about it, and I said, "I need to know exactly what it is that you need right now. I'm going to have a response to you by tomorrow," or something. I think that was really what they wanted. They wanted to see people showing up but also circling back, closing the loop. Even if the answer was we're still figuring it out, but we should have something--you know, letting them know in the process, we sent it to Atlanta, Atlanta is determining what the best practice is, whatever. They just wanted to be in the loop. I think that's the least we can do, and at any type of partner engagement or partner development, you want to make sure that both parties feel like they are actively 01:03:00involved in keeping the momentum going in the relationship.

Q: How did you know that people thought that they were left out of that?

NUR: When he said, "When are you leaving?" and I made the comment, and he was like, "You CDC people don't want to be here." And I said, "That's not true." I said, "A lot of us want to be here. There are limitations on how long we can be here, but we're hoping that that will change." And I said, "What's been"--and he said--not the person that preceded me, who was there, but previous people, they just came, and they came to a few meetings and then they never came back, number one. Or they came to the meetings and made promises and then just got on the plane and went back home. And so they didn't follow up. And I mean, Sierra Leoneans are not shy when it comes to discussing this, at least in my experience. That's why I was like, "I need you to just tell me exactly what it is that you need. I can't promise that I'll be able to do all of it, but I can definitely try to facilitate and get the ball rolling or closing the loop on 01:04:00some of these things."

Q: He was like a ministry official, or--

NUR: Yes. He was the--Lansanah Conteh is his name. Quite a character. I can't remember which ministry he's out of. I want to say it's education. Or social welfare. Either one of them. Yeah. And I get it. When you are there day in and day out, working on this outbreak in your country, and all you see are people that--and everybody at that point had different onboarding experiences. Some people just showed up, and there was a lag in time. For example, when I--well, I'll tell you about that later. But there are opportunities where there are some people that, when they arrive, there was no one that they were replacing. There had been a one or two-week lag. All of a sudden a CDC person shows back up to the meeting, and they're like, so much has happened in the last two weeks. We 01:05:00can't necessarily bring you up to speed. So it brings challenges. That's to no fault of anyone's, outside of everybody was doing the best they can to support the response with whatever means they had at the time. If there was a lapse or a gap of support, we just had to keep moving.

Q: Of course. And you mentioned something about--were you going to talk more about a lag in time? You mentioned, "Oh, I'll talk about that later."

NUR: Well, that was about the second deployment.

Q: Oh, that's about the--okay. You were right. Let's save that. [laughter] The sense that I'm getting is that you said, okay, then I need to close the loop. So you were probably, what, attending meetings more regularly? Or just keeping in more regular contact with them?

NUR: Yeah, and also reaching out to the IPC [infection prevention and control] folks, Sarah [D.] Bennett, to get a better understanding of the chlorine solution needs for handwashing versus cleaning of homes and things like that. 01:06:00Then I found out that actually the board of health people had already created resources. So there was just the need to kind of make sure that we're covering all our bases and staying in the loop as CDC responders. A lot of times people were just out and doing and supporting, but it was helpful to come back to our office and talk to people and find out, oh, okay, so you already have a chlorine solution document that you've been trying to clear. Can I look at it? Is it going to be something that they can use in the community? Maybe. But maybe I can help modify it a little bit. As long as we have the numbers down of what part chlorine, what part water we need to be using, and that we can display it in an image that is culturally appropriate or relevant. I think we got one thing once where we asked for images--the border people asked for images--to help show 01:07:00water-to-chlorine ratio. I think they used a two-liter bottle of Coke, but there is not really a two-liter bottle--people use glass Coke bottles, and the bucket is not--there's no standard. We had to come up with standard ways of showing these measurements. Like, how many glass bottles of Coke would it take? [laughs] And the buckets were not the everyday small, little buckets. They had big ones. That type of stuff. Connecting those dots with the CDC team and being able to provide that intel and information back to our national Sierra Leonean partners and other folks on the social mobilization communication group was great. I think everybody had the same end goal in mind. It was a matter of making sure that everybody was aware of what was happening, and then making sure that--you 01:08:00know, it got to a point where we talked about whether or not giving community members chlorine-related information, was that the best option? What's the margin for error when it comes to making these mixes, and how are people actually going to use them in the home? That behavioral piece. Are they going to try to do their own cleanup that could potentially--are there risk factors associated with providing them with this information? Eventually, they thought it through and decided that maybe they didn't want to provide just general community-level folks--unless we could clearly articulate what the formula was. What are the risks associated with that, and do we really want people to have that type of information? Are there other groups that can be responsible for it that can better ensure that the chlorine solution is appropriate and correct and accurate?

Q: I mean, the sense that I'm getting, it's cool. I mean, you went over as a communicator, and my initial--and maybe most people's initial--assumption is 01:09:00that mostly you're communicating to Sierra Leoneans about how to be safe. But, no, what you're talking about is improving communication within the response, improving understanding of how Sierra Leoneans understand things so you can communicate better in the first place.

NUR: Absolutely. I mean, everything we created was--either the impetus, the idea came from a Sierra Leonean, whether it was someone from the ministry, and then we kind of put something to the paper. Every time--for example, let's say the Big Idea of the Week--we would have to take it to these different meetings and shop it around. Like, okay, what do you think of this? And vet it by all of these different groups to make sure that it's in line. Not just with our national partners, but with the international agencies like MSF [Medecins Sans Frontieres] and WHO [World Health Organization]--and to make sure that it's in line with how they're communicating about how to stay safe and prevention measures and things like that. It was a very collaborative effort. I think, again, CDC, we really were the technical experts, but we relied heavily on the 01:10:00expertise and cultural intel that the national partners had. They could tell us, "We would never say this," or "People would never do this," and things like that.

There was a holiday--and I'll never forget this, because it was such a testament to really making sure that whatever you create reflects the diversity of the country that you're working in. Is this information transferable across the different districts? And someone was pushing for this one message to be around. At New Year's, I think, the Creole people, or the people in Freetown, they go to remember the dead at their gravesites. And gravesites, I think, were closed and were being reopened or something. There were concerns about mass gatherings happening at some of the gravesites, and really wanting people to keep safe distance. A message that was a national message was created, but folks came back 01:11:00and said, "This is really--it's already out, it's fine, but this really is only representative of one group." And the only way we would have known that is if we did our due diligence to make sure that everybody gave us feedback. It was one of those, like, we already have this created, let's just use it and then continue to create these new ones. But it was definitely a great lesson learned for us.

Q: That's a really good example. Thank you for providing that. And I'm wondering if you can go into more detail--was it during your first deployment that you were working on staffing the radio, etcetera?

NUR: Yes.

Q: Can you tell me just more about your radio work?

NUR: Yeah. Airtel--no, is that right? No, Africell--Africell Radio--basically, BBC [British Broadcasting Corporation] Media Action gave us a slot. There was a gentleman named Joe Abbas who was responsible for hosting the show, and then we 01:12:00would provide guests that would come and talk about anything from burial practices, new--there were all kinds of national policies that were being implemented, that were trying to dissuade people from gathering en masse, to making sure that there were handwashing stations, and keep them informed about checkpoints. From the KAP study they learned that radio was the way people preferred to gain information. We had an opportunity to have the ear of a lot of people. It's Monday nights at 7:00 pm, 7:00 to 8:00, and then it would re-air, I think, early on Tuesday mornings. We had some folks in the CDC response that were from Sierra Leone that joined and could dispel any myths that were kind of circulating, talk about what's currently taking place in the response, like when the Western Area Surge was happening, to let people know what that's all about 01:13:00and what they can expect.

The radio program, we usually got there, and Joe had--they all had the updated numbers, the sit-rep [situation report] that told them what the current case counts were and locations. His voice almost made it sound like this competition to get to zero, like, who's getting there? Who's doing the best job of getting to zero, you know what I mean? I don't know if it was intentional, but it was a little bit motivating, like "who's going to get rid of Ebola first in their district" type of thing to encourage communities to feel more empowered and actively involved. Very dynamic guy. Very well-informed. Read the news. They had a section on the program where they would read about current hot topics in the news that may be controversial that we needed to address. They would also, if there was a new cluster or a hot spot, they had reporters that would go and call 01:14:00in live and talk about what is happening in that area, how people are responding, what's the current status. Then we also had a section where people could send text messages through a national system. They would text their statements, questions, whatever, thoughts, and it would come up on a screen. At CDC, that was part of the data that we gathered to get a better understanding of what people were thinking. Most of it was really motivational, like, "We need to stick together as Salone [Sierra Leone] people to kick Ebola out," and "Thank you, Joe, for having this show." Then there were myths about, "We heard that Ebola came from this," and whatever the myths that were out there at the time, or, "Shaking hands isn't dangerous. Can you talk about that?" The co-host would filter through the topics or questions that came in most frequently and write 01:15:00them out and then present them, and our speaker would have to respond and help people understand or dispel some of the myths and rumors that were out there. It was a really dynamic show. We have the recordings. It's a very popular radio program or station itself, so they got a lot of participation from across the country for folks wanting to just chime in and give their two cents and their vote to kick Ebola out from--you know what I mean? This, "I'm going to do my part." And also, a lot of anti-stigma messaging, like, "We've got to love our survivors." There's a lot of stigma around survivors at that time, and so it was like, we need to support them, we need to do our part, and thank you to the healthcare workers that are doing this. It was a really great program. Hard to staff at times, [laughter] but it was fun to see how people got involved.

Q: Circling back to this other thing, you mentioned that you worked with Peace Corps people who were locally employed.

NUR: Yeah.

Q: Can you describe some of them?

NUR: Yes. My two main guys that I worked with were Mike, who also went by Fadda, and Hindolo [John Langba]. Mike and Hindolo worked closely with our team. They were kind of seconded to our team, so to speak, to do any type of community engagement work we needed to do. Hindolo is an English teacher in Sierra Leone. When they closed schools, he had to find an alternative way to support himself and his family, and he wanted to support the response. He got a job with Peace Corps, along with Mike. They knew each other--I think they went to boys' school together from whatever district they were from. I think it was Bo. And they reconnected. They were really our arms and our--I mean, our mouths. They were 01:17:00the people that talked to the community, and they were the ones that when we needed to do interviews and survivor interviews or healthcare worker focus groups, they led the discussion. They had a strong understanding of CDC's role. They had a strong understanding of health promotion, just given the length of time--I think they started pretty early on in the response, I would say like summer of 2014. And their contracts just ended recently, like January of '16, I think. That included going out into the districts--we had some in the districts as well.

There was another woman, Lucian [Fahnbulleh], who was on the vaccine team, and she helped. They provided kind of that cultural element, too. When I was responsible for developing the Big Idea messages, I really looked to them, like, are there any holidays--religious or national or whatever--that are coming up, 01:18:00to make sure that we are providing a message that is relevant to current activities that people may be engaging in. And they were our springboard. We bounced ideas off of them and made sure that things were all right. When we were doing, let's say, healthcare worker interviews or healthcare worker focus groups, they told us, okay, if you really want people, there has to be transportation provided or supported. You can't invite people to do something like this and open up their hearts and tell you their stories and not feed them. They really helped us to make sure that we were doing things that were appropriate in-country and helped, if there were any type of questions that we had. We traveled through the districts together and things like that. They did all the transcriptions and translations and wrote up little mini-reports. They did media monitoring, read all the newspapers and listened to programs and told 01:19:00us if things came up on the news.

They were also very actively involved in their communities. WhatsApp is so hot in Sierra Leone. They have all these WhatsApp groups. They're basically like little APs out there, little Associated Press journalists out there. Whenever something comes out, a message will come out--there were times when cases or clusters or hotspots would be identified, and we would be getting this sensitive, confidential--there's word that there's a flare-up in this area. And the next morning Hindolo would tell me, "Yeah, I heard about it." I'm like, "Through what? Through what?" He's like, "WhatsApp." [laughs] They were very well-informed too. There was some information that we got, and I would cross-reference, "What did you hear?" And he's like, "Oh, I heard that it was a traditional healer that--da da da da da." Sometimes it was accurate, sometimes it was just rumor, but still, they had the pulse of the country, or at least the 01:20:00communities that they were working in. So that was great.

Q: They sound totally invaluable. That's awesome.

NUR: Oh, completely! I guess I managed them for both my deployments, although Mike wasn't there the second time. I advocated strongly that CDC consider hiring them to some degree or keeping them on as long as they can. Because there were some instances where I couldn't imagine doing the work without them, truthfully.

Q: Do you know if that's happened?

NUR: They stayed on. I think once their contract with Peace Corps ended, CDC helped them stay on board for much longer. Then once they started to deactivate the response and also deactivate the response center in-country, they transitioned to finding other opportunities, yeah.

Q: Right. Okay. Gotcha. You've also mentioned doing these interviews with people. Were you doing that throughout your first deployment, or was it early 01:21:00on, later?

NUR: Later in the first deployment.

Q: It was later in the first deployment. Okay. And can you describe just how you structured the interviews and what you asked people?

NUR: There was a lot of stigma around survivors towards the latter half of my deployment. We were trying to gain a better understanding of what survivors are experiencing and what their experiences are. We also wanted to get stories that we could share on the radio, sound bites that we could share in kind of this mini-campaign around survivor support. We worked with Partners in Health, who had a large--they're an NGO [nongovernmental organization] but they had a large survivor support network. Basically, they employed a lot of survivors to help them in the response. They were a huge asset in identifying people that would be interested in telling their story. We met at the stadium. We worked with WHO. 01:22:00WHO was doing a healthcare worker training on infection prevention. They had a mini-ETU set up at the stadium, and so they let us use one of the classrooms that they weren't using to do interviews and focus groups. We had survivors that we interviewed and gathered information from and then healthcare workers that we gathered infor--and we did it in three districts--or three areas: in Freetown, in Port Loko, and Makeni. The survivor--just the general audience survivors, that was really to help understand what their experiences were. And then also to create these radio bites that we could share and they could really create that human element to their experience so that people can understand, we mustn't fear them. This is the reality of what a survivor is and how they became exposed to 01:23:00Ebola and what type of things they've experienced. There was significant loss of family members. One guy lost his entire--parents, siblings, aunts, uncles, cousins. It was just him. So part of his healing was also coming to terms with the fact that why him. Why was he the one that survived? And realizing that there's got to be a reason for him to be here, so he wants to help in any way. And so really humanizing that these folks could be anybody in our community, and we really need to support them, and we really need to be there for them and treat them with dignity--and particularly with healthcare workers. I mean, they were providing a service. Their career, to a certain extent, puts them at a different risk level than the general population. We hope not, with prevention control measures, but stuff happens. It was really putting those pieces together too. I think a report came out for the healthcare worker one that they used with 01:24:00the IPC team. But with transitions of team members, I don't know really what happened with the survivor stories. I know some sound bites were made, but I don't know if they wrote up a report or anything on it.

Q: Right. Thank you. You've already listed a bunch of them, but I'm wondering if you can actually list just a few of the Big Ideas that you guys did.

NUR: Oh man. The Big Idea of the Week?

Q: Yeah.

NUR: Let's see. Well, they were all around the core messages of the Act Against Ebola messaging guide. It was like, stay safe while you wait, practice safe burials. One was Ebola is real, but that one was--it was more like reinforcing people's understandings of Ebola. And then respecting survivors, I think? Or support--survivor support. Those were some of the main ones that I worked on. 01:25:00Again, survivors were really going through a tough time. A lot of isolation. They were iced out of communities, and there were a lot of rumors and misperceptions and misunderstandings as they relate to risks with interacting with survivors. Stories that get fabricated and somehow make their way across cities that you see. But that was a big one.

Safe burials was another one as well. There was a lot of death taking place at that time. They were working to enhance and increase their ability to respond and pick up bodies, but a lot of people lost a loved one and had the body there for days. With the cultural practice, at least in Muslim culture, when somebody 01:26:00dies, if it's a female, the female family members wash the body. If it's a male, the male family members wash the body. Here are these people that are going against their religious and cultural practices of mourning and grief and handling the dead. Because in some cultures, the way that you're handled after death, it's almost like that's how you're--it can be perceived that that's--someone has a responsibility to make sure you get to heaven in the best way. And we were asking people, "Don't touch them, don't wash them, don't do these things that you've been taught that it's the word of God that you should do this," and then we're also leaving you with the agony of having a family member that's no longer alive, present for days. That was really hard as well. Transmission from a dead body, from what I understand, the quote-unquote "amount 01:27:00of Ebola" that is in your body or the ability to be transmitted is heightened from a dead body. And people wanted to take care of their dead. They wanted to make sure that someone died with dignity. It was hard.

I think that that safe burial piece was complicated, because there were also, in some cities and communities, implications or taxes or things that were dropped on people that went against the safe burial practice. People were doing things more hidden. They were disposing of bodies in different ways. Then they have secret societies who have their methods of how they handle dead bodies. It was a very dynamic time to try to then just tell people, "This is what a safe burial 01:28:00looks like, and this is"--and convince people that this is what you should do with such a culturally diverse process for handling the dead. So that was--that was tough.

Q: No doubt. Okay. Let's take another quick break--

NUR: Okay.

Q: --because my computer was doing that thing again. Sorry.

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