Libassa Ecolodge

It still feels so weird to be writing from home...this weekend I was supposed to be flying out of Liberia to Accra in Ghana (for visa reasons), and Peter had booked this crazy flight itinerary just to see me for 3 days. Instead we've been together, in Boston, for the past 2 weeks, and ironically while his job has thrown him into a deep dive of Covid-19 data to help with the response, I am currently on backup at home until late next week. It especially feels weird knowing I have friends being pulled to the front lines of this...an outpatient GP working as a hospitalist for the first time in over a year, an undergraduate pre-med friend in psychiatry deployed by the military to work a field hospital in Manhattan. I am sure my time will come too, but have to admit there's a little guilt knowing so many friends and colleagues are risking their lives daily while I am home safe. That being said, I am sure my turn will come.

Since I am waiting on my next batch of data to enter for Liberia, I thought I'd share these photos from Libassa Ecolodge. It's this really amazing place a short drive from Robertsfield Airport. Think a cozy, laidback beach resort that is working towards becoming zero-waste. That is truly an amazing accomplishment in a place like Liberia, where there can be many barriers towards sustainable practices.

We arrived late on a Friday night to discover we were one of only 2 couples there. Due to a gasoline shortage, most people had canceled their trip...definitely not great for business/Liberia at large, but we admittedly loved having the whole place to ourselves to explore. And there is a lot to explore...apart from the beach there is a multi-level pool deck with a lazy river, a great bar and restaurant, a lagoon with kayaks for rent and even an animal sanctuary.

The efforts they have made to reduce their impact on the environment really are impressive. Room electricity is limited to 200 watts each, with solar-power lighting for exterior areas. For every tree taken down to build the lodge, another tree was planted. They aren't plastic free (I think this would be quite difficult to manage, but a solid future goal) but minimize use of plastics and recycle both plastics and paper as much as possible. They also use well water as much as possible for cooking, and compost food waste when appropriate.

You can probably tell from the photos how secluded and quiet the place was the weekend we went...it is usually a pretty popular day trip from Monrovia. We really enjoyed having the place to ourselves. 

The pool deck is broken into 3 levels connected by stairs and a waterfall. This is the largest pool. Peter loves to actually swim so this was his favorite spot. I don't know if it's an English thing but he had never come across a shallow lounge pool until we stayed at the Palazzo in Vegas on our cross-country road trip. He actually tried to swim laps in it, which was kind of amazing 😂 Unfortunate for him, it didn't work out...

This is the lagoon side, where you can rent kayaks, lounge and swim. There is also a bar on this end and you can have lunch overlooking the lagoon. We only took a short kayak trip (lazy as hell + strong currents = bad combo) but loved seeing tropical birds and some monkeys swinging in the trees.

They had the most amazing all natural smoothies...this one was pineapple. Still miss enjoying a Savanna cider on a hot day at the beach. 

The shared deck of our palaver hut. I didn't take any photos inside because we are messy humans and the room was a disaster from the moment we dropped our stuff off. But the space was clean, cozy, and well designed. Water was heated by the sun so you could take a warm shower by 5-6 pm (to be honest a cold shower probably feels amazing during the dry season- it gets so hot!) There was no AC but we were pretty comfortable with the fan on overnight. Because of the 200 watt limit, the room was on the darker side, which helps keep things cool during the intense dry season.

We stayed in a Palaver hut, a traditional house built with local materials. There are also larger spaces available directly looking over the ocean and lagoon.

I *think* the LED lights are low watt? Made for some fun lighting. We came here to watch the sunsets. The first photo on this posts shows what a beautiful view you get.

So tan. So happy :) This was our first weekend together in over a month. I am really, really really thankful that Peter got to see how beautiful Liberia is before this Covid-19 outbreak. We had so many plans for his next trip, from exploring Mount Nimba to Robertsport to visiting the National Park, but all of that is up in the air now. Obviously there are way more important challenges in life right now. But I am glad we got to make some fun memories together here.

One more pic of this dress since it's pretty much my favorite :) from Nani Pani (linked. Not sponsored.)

One of the coolest things about Libassa is their animal sanctuary. Unlike some of the organizations highlighted in Tiger King (looking at you, 'Doc' Antle...ugh), this one was founded purely as a place for exotic animals originally bought as pets to either be rehabilitated for the wild or live as comfortably as possible in a more natural environment. We got to see monkeys, a crocodile, and even pangolins (which are native to Liberia) before Covid-19 brought them to the international spotlight.

While they try to release as many animals back into the wild as possible, some animals, like this juvenile monkey, won't survive in their natural environment as they've never been exposed to anything besides an unnatural human habitat. They will likely spend most of their lives here. :(

I think that's a wrap! FYI I was not sponsored to write this post. My blog does not have that kind of readership, haha (insert self-deprecating joke here 😋) We had a great time, and I was totally impressed with the Libassa Ecolodge model for sustainability and efforts to have a neutral to positive impact on the local community and environment. You can find more information here on their website.

I have to say, we've been lucky enough to visit a lot of truly beautiful, tropical places, from where I grew up in Florida to where we met in Greece (Crete, Santorini, I'm looking at you!) to the absolutely stunning and tropical Hawaii, but this was easily one of the most beautiful, peaceful, relaxing weekends we have had in a long time. If you are ever in Liberia, I highly recommend a visit. Be prepared to pay with cash as they are pretty remote, and credit card machines only work intermittently. Also bring plenty of bug spray! Mosquito nets are provided in each room.

Hope you enjoyed! Stay safe and healthy, folks.

Look for the Helpers.

Well I’ve been home a week today, and besides sleeping very well at night, I’m feeling sort of useless. As of right now I’m not needed back until next week, and until our new data collection system is up and running, there won’t be much I can do remotely to help my colleagues overseas. While I’m insanely thankful to be home, with my husband, who still has his job and brings me oat milk lattes every morning (the real MVP,) as someone with an medical degree I’m feeling pretty restless right now, wanting to help out but not sure where to go from here.

So I decided to come up with a short list of ways to help from home during this pandemic. I’m sure this list isn’t exhaustive, and it certainly isn’t much of a contribution compared to those on the frontlines of this crisis (not just nurses and doctors, but those keeping the grocery stores stocked, delivering much-needed supplies, running tests, organizing response logistics…the list goes on…) I’m pretty sure its better than binge-watching the rest of Mad Men on Netflix.

Stay home. This cannot be emphasized enough. And I think most people get it. We’re starting to sound like broken records at this point. But to the Evangeline Lilys of the world, who think this is some thinly veiled mechanism to slowly redact our freedoms…just stop. If you care more about your freedom than the life of your immuno-compromised friend, your elderly parent, the physicians, nurses and other health workers who risk their lives for us every day…. Then I don’t think there’s anything anyone can say to make you listen. But if those people matter even one iota to you, please stay home.

 Donate your masks and protective equipment. Hospitals in New York, Boston, and pretty much anywhere with a lot of Covid-19 cases are running critically low on masks and other personal protective equipment. Currently at my job we are being rationed one mask per shift, and other hospitals only have enough for one mask per week per health worker. Please help us help you, and donate any unused masks or protective equipment you may have to the nearest hospital.

Donate to support others in need. Global crises always have a way of disproportionately harming society’s most vulnerable groups. School closures and job disruptions have left even more people than usual going hungry both in the United States and Globally. Food banks can help safely deliver needed supplies to those who are most in need (check out feedingamerica.org to see how you can help,) and WHO provides much-needed supplies and support to Covid-19 responses in low-income countries. Check out the Covid-19 Solidarity Response Fund for more details.

Shop small. It’s probably no surprise to anyone that small businesses are suffering. If your budget allows, ordering a gift card, or having food delivered from your favorite local restaurant, can help keep places going while their business has otherwise screeched to a halt. Don’t forget to tip well; those in the service industry have just lost the majority of their income (maybe a sign that the tipping culture in the U.S. is an epic fail, and we need to pay everyone a fair wage? What a novel idea…) If you know any artists, makers or musicians, consider ordering from their online shop if they have one, or venmoing a few bucks in exchange for a virtual serenade (I did this with @Castroviolin who plays beautifully in both famous halls and the NYC subway and it was lovely.)

Show your kind side. It sounds dumb but I really do believe our attitudes and behavior can impact others in small and meaningful ways. Thank the grocery store workers who are showing up to make sure you can buy food and toilet paper for the week. Facetime with a friend you haven’t seen in a while, and check up on family members who may live alone and feel especially isolated and vulnerable right now. If you’re able, Venmo a few dollars to friends or family in the healthcare workforce to get themselves a coffee or a snack during this stressful time. And make sure you’re being kind to yourself- eat well, drink plenty of water, exercise indoors if you can, and allow yourself the space to process this crazy new world we live in however helps you best. Just be sure to reach out to loved ones or a trusted mental health provider if you feel like its getting to be too much.

Thoughts? Any other ideas about how to help during these strange times? Let me know!

Stay safe and healthy,

Staying Warm in Winter

Boston after an insane snowstorm, 2016

So my sister, who constitutes 33% of my readership (pretty sure the other 66% is my Mom and Dad) matched at her number one choice for pediatrics in New England! I imagine she is one of many soon to be doctors who will be living up North for the first time. Speaking from personal experience, the transition isn’t easy, especially if you come from somewhere where the worst of winter is around 40 degrees Fahrenheit. That being said, I’d like to think after 5 years in the Northeast I am doing ok. After all, I haven’t lost any fingers or toes to frostbite, lol. So when my Mom asked me to help my sister get some winter gear, I was happy to help (and post it on the internet in the name of oversharing.) Below are a handful of things I’ve found either essential or super helpful to live in a place where it’s pretty cold for more than half of the year. None of this content is sponsored because my readership is wicked small. Lolz.

[Sidebar: I also want to acknowledge that I’m writing this from a place of complete and total privilege in the midst of a pandemic that is having devastating on so many. As a healthcare worker I understand the gravity of this outbreak, especially on those who don’t have the privilege or resources that I have as a white person with a stable income, shelter and other resources. For now, writing is one of the ways I stay calm and remove myself from the constant flow of news and media. There’s a lot of information on coronavirus available on blogs and social media, both good and bad, so for the time being, I am personally choosing not to produce more content besides sharing WHO and CDC-based information. At some point this week I may post about ways to help, but for now, distracting content it is.]

Me getting way too excited at how warm my first down coat was, 2015

Invest in a super warm coat. I used to think this meant a cute wool peacoat. I quickly learned during interview season how wrong I was about this. I settled for an plain down coat (link here) with excellent reviews from Patagonia and have never loved an unattractive item of clothing so much in my life. This thing is amazing. It keeps you warm and dry during long snowy winters, is sustainably made, and has lasted beautifully for 5 years. The best part about it? Patagonia will repair any damage at their stores for free. Amazing. 10/10. [Sidebar: you can get a slightly more attractive and much more expensive coat from Canada Goose. I’ve heard great things but preferred Patagonia’s business model and also not spending hundreds of dollars more for a label.]

Layer, layer, then layer some more. My first month of residency I spent 90% of my night float shivering, either curled up in a creaky twin bed in the intern call room or while wandering the floors and ER seeing patients. Hospital-issued scrubs are flimsy (and hospitals are super cold!) By August I had started wearing leggings underneath my scrubs, and I pretty much never stopped. Now I rarely wear jeans in the winter without leggings and an under shirt, and never go to work without leggings on, even in at the peak of summer. And that’s just the beginning! Use multiple layers with a nice long sleeve shirt or sweater over the top. Turtlenecks will become your new best friend. (Also worth noting: everyone and their Mom who works at a hospital wear Patagonia fleeces with their hospital name inscribed on them. Many residency programs give them out as gifts which is awesome, and I live in mine at work.) This post has links to some great gear to help stay warm using layers. I don't own any smart wool (my leggings and undershirts are from Pact with a few old pieces from target) but I bet its worth the money.

Our toes living their best life in Patagonia, Argentina

Keep your toes cozy. It would not be an exaggeration to say that apart from when I shower I basically live in socks during the winter. And not all socks are created equal. Thick wool socks will keep toes dry and cozy and last a lot longer than cheaply made socks sold at the nearest department store. I even have a few pairs of moisture wicking hiking socks from REI that I tend to use anytime I can, and of course there are plenty of sustainably made options out there as well. 

That being said, I think the hardest lesson I learned after 2 or 3 winters up North was how important good shoes are. I basically had to cross a parking lot to get to work my first few winters, so I would mostly suck it up and wade across a couple of snowbanks in my nice-ish leather boots or sneakers. While it didn’t completely ruin my shoes, it definitely damaged them quite a bit and I had to replace them much sooner than if I had used proper gear. On truly snowy days, most people will wear boots like these ones to commute, and leave a pair of work shoes in their office or locker. I will say I don’t own a pair of L.L. Bean boots yet, but they pretty much have a cult following up here and I will probably be getting a pair before next winter.

Protect your vulnerable areas. It took me a while to figure out that if it’s really cold out, covering a few key areas is key to staying warm. That includes your neck, hands/wrists and head. Wool and cashmere are great options (love this beanie and Everlane also has some great options,) but it can be nice to have sturdy weather-proof gloves if you’re going to be spending a lot of time outside. We also got a box of these our first Christmas up North and I am basically obsessed with them. I don’t know the environmental impact of them (they’re single use so I have held off on buying more,) but if you are planning to spend most of your day outside, these are a great option for keeping hands and toes warm.

And that’s it! Any other Northerners out there? Comment with your favorite tricks for staying warm. And if you’re looking for some ways to keep busy when its cold out, here’s an old post I wrote about some things we did to have fun during our very first winter in the cold. Hope everyone stays safe and healthy this week.

Well, I'm Back

I wasn’t expecting to be writing my next post from outside of Liberia, but here we are. The plans changed slowly and suddenly at the same time. That may sound strange but it’s true. First, just under 2 weeks ago, a supervisor’s visit was cut short by Covid-19. Before she left we talked about the possibility of me leaving early and what it would entail, but nothing was set in stone. Then the craziest week of my life went down (can’t go into details but I have never been more stressed out in my entire life…) All the while I felt torn in two by the decision to stay and continue my work in Liberia or go home. Even with plans on the ground getting canceled left and right, and lots of fear of the unknown, there was still so much work to be done. I had finally fallen into a good workflow, become friends with my colleagues in Liberia, and felt like I was making progress in the right direction with our research goals. Ultimately the decision wasn’t in my hands and I was recalled by my program.

And then I left. It took 2 of 3 bookings getting canceled (all made within 24 hours of each other because airlines were changing routes and canceling things left and right,) a night spent hurriedly doing as much data entry as I could before leaving, and 2 last minute visits to a tailor (priorities, right?) before I was en route to the airport, starting the long journey home.

I didn’t sleep the night before my flight. Once the decision was made my mind began to torture me with all the possibilities for things to go wrong- delays, crowds and cancelations, running out of cash (I was already short due to an emergency the week before I departed,) running a fever before boarding the plane. I donned a surgical mask for the flight, anticipating dense crowds at the airports, but Roberstfield was calm and eerily empty. I think I was part of the last wave of foreigners to leave. I had one last cassava leaf at the airport café before boarding a half-empty flight to Accra, where I waited in a quiet airport lounge before boarding the flight that would deposit me at Dulles. Most people donned masks but were feeling uncommonly jovial and friendly- perhaps relieved knowing soon they’d be home and not stranded far from family during a global pandemic.

A few people coughed on the 11 hour flight back to the U.S. I tried not to worry about it too much, but couldn’t help but notice how gaping the openings were in my ill-fitting surgical mask. I was expecting mass chaos, crowding and long waits once we arrived in Dulles, but even with my border agent pausing every 10 seconds to check with his neighbor that he was asking me the right screening questions, there was absolutely no line or delays. I missed my flight anyways but was promptly booked onto another half empty flight back to Boston. From there it was surreal how fast everything happened. Less than 2 hours later as we deplaned I almost immediately exited the terminal, nearly blowing past my husband because I had left the secure area. I thought I would cry, or laugh, or be overwhelmed with emotion, but I was to numb with surprise and shock. He took my bag, handed me my coat and we headed back home on an uncharacteristically empty Storrow drive.

I am both relieve and disappointed at the same time. Despite having some health issues in Liberia, I really was having an incredible experience. The specialists, consultants and residents and I had all gotten to known each other, I had figured out where I fit into their system, their world. Up until the week before I left, some really great projects were going to be ramped up. One of the pediatricians had taken me with her to visit waterside market, and she I had plans to make pepper sauce before I went back.

Apart from all this, I definitely feel some guilt as well. Guilt that I am home, on my couch, unpacking, with my husband only a few feet away, in a country with an ICU, with ventilators, with intensivists, and with way more capacity to handle a surge in cases of Covid-19. Guilt that my friends and colleagues are still in Liberia, facing uncertainty and a disease that has been shown to cause serious illness in healthcare workers. I still feel the decision to leave was the right one- both due to my health and because I would hate for my job to spend hundreds of thousands of dollars evacuating me in the event of a medical emergency when that money could be better spent elsewhere.

I’ve spent the last couple of days since getting home sleeping, unpacking and trying to wrap my head around Covid-19’s impact on Boston. Soon I’ll meet with my team to devise a game plan for work these next few months. Hopefully it will make me feel less helpless. In the meantime I’ll keep reading the situation reports from WHO and prepping myself mentally for whatever lies ahead the next few months. Hope everyone is staying safe and healthy these days. 

Untitled (just call it insomnia.)

During my first year of residency, I cared for a little girl named Z*. She had been on the oncology ward for months, fighting an aggressive blood cancer that hadn’t remitted despite several courses of chemotherapy, each regiment more aggressive than the last. She was on my patient panel for most of my month of heme/onc, and during the entire time she was miserable and in incredible amounts of pain. The only things that seemed to soothe her were sips of water, leg rubs from her mother, and watching Frozen on repeat. By the time I was caring for Z, her mom had a newborn and couldn’t spend nights in the room alongside her daughter anymore. I remember spending a good chunk of my week of night float sitting quietly next to her, watching Elsa sing ‘Let it Go’ over and over and over again, while she cried and asked where her mother was.

Z passed away while I was home one night in between shifts. It was pretty fast - within a few hours of becoming unstable and being transferred to the ICU, she was gone. It was the first time I was up close to a child passing away. I had seen death before, both in medical school and in residency. But I hadn’t seen suffering- not like this, anyway- in such a young and vulnerable child. It was completely heartbreaking. Sometimes you reach a point in caring for a patient when you feel helpless- like your interventions aren’t helping, and maybe by prolonging suffering they are causing more harm to the patient than good. I felt like we had failed her- not because she died, but because she was in terrible pain during much of the end of her life, and maybe instead of fighting her cancer so aggressively, we could have done more to make the end of her life peaceful and less painful.

I didn’t know it at the time, but I was experiencing my first real bout of moral distress. It is broadly defined as a scenario when a healthcare professional feels that they know the morally correct action to take to care for the patient, but are restricted in some way from taking that action (more on the topic of moral distress can be found here, if you’re interested.)

Now all these years later, as I adjusted to working as a pediatrician in a very busy, very high-acuity unit in a low resource setting, I began thinking about this case again. Nearly every day, choices have to be made that bring back those unnerving feelings of discomfort. They don’t all revolve around death, but all revolve around struggling with knowing the right course of action, and not being able to execute it properly. The child we send home who may need a few more days of antibiotics, because there’s no more space in the unit and we need to make room for the next sick child; the infant who goes days without getting the correct antibiotic as the family scrounges together the few resources they have to pay for it; the patient we can’t put on CPAP or oxygen because the only supply available is being shared among several other patients at once. Moreover, when our ability to test and find a cause for a patient’s illness, decision making can become a lot harder (this is related to another type of moral distress related to uncertainty.)

These are challenges I was peripherally aware of during my time in U.S.; they came up rarely, as most of my patients were healthy and resource allocation is not a challenge you have to deal with often. My colleagues here have faced this every day for years. They have incredible knowledge, perseverance and compassion, but underneath the surface is a palpable frustration- a feeling of helplessness, of uncertainty of what exactly needs to be done to tackle some of the systemic challenges we face.

I started writing this in the middle of the night, during a bout of insomnia, but initially struggled to find a satisfactory conclusion, some enlightened wisdom to wrap this thing up in a neat little bow and end on a positive note. A few weeks is not enough time to unpack things, to pick apart the machinery to find the pieces that are broken, and its certainly not enough time to know how to fix them. People who have lived and worked in this environment this every day don’t have all the answers, so how on earth can a Western pediatrician with a few weeks of working here have them in such a short time? I suppose the best I can do is use this feeling of discomfort to keep trying, every day, piece by piece, to understand the fabric, the strengths and the failures of the system here, and support in whatever small ways I can. In the meantime, I suppose I’ll have to get used to this strange discomfort- after all, everyone else here has been dealing with it for years.

*name has been changed.