IH CONNECT

Trauma
The inauguration was on a Monday, and the onslaught began soon after. This is what I wrote in my journal the following Sunday:

And just like that, the new administration has robbed me of the joy and excitement of this experience.
We have been bombarded nonstop. With executive orders, memos, OPM emails that look like phishing. With news stories. And rumors. So many rumors.
The executive order ending remote work came down Tuesday night. Some say it (and all the others) were written using AI. I cried in my hotel room and spiraled and cried some more. I cried to [my husband] and to my mother…I wrote a text essentially telling [my boss] goodbye and thanking him for hiring me, and cried some more.

I got an email from CDC’s responder resiliency program. “Please reach out to us if you or someone you know may benefit from meeting with one of our mental health clinicians.” I wanted to reach out but was afraid my emails were being monitored, and that requesting a meeting might result in me being pulled back. On Thursday, we found out that travel for the people who had been rostered to backfill us had been canceled, and that we would not be replaced. My team lead was scheduled to fly back the following Tuesday. I would be the only response team member in country.

I got an email saying that my travel to San Francisco for the Conference on Retroviruses and Opportunistic Infections (CROI), the premier conference for HIV research in the U.S., had been canceled due to the administration’s pause in funding. I called my mother in tears to tell her that we could no longer meet up there.

On Sunday, the embassy sent out a security alert advising us to work from home the next day. “We are aware of calls for protests tomorrow at the U.S. Embassy and other foreign embassies.” CDC’s DRC country team canceled their planned retreat and returned to the city. We had an accountability drill the next morning. “Please respond immediately with the following: Name, Status (safe, etc), Location.” Disease Detective, Safe, Hilton, I replied. The embassy asked me to find my team lead and have him respond as well. I was pulled into a meeting to develop a justification for my work so that my deployment would not be cut short. “They are only approving deployments related to the imminent protection of life, safety or public property related to the Mpox outbreak response,” wrote the response deputy chief of staff. “Please send us a statement that describes how each of these deployments meets these criteria.” I was asked if I had any “WHO engagements,” as we had been told that we could no longer collaborate with them. I explained that there were personnel from WHO on every single team and in every single meeting of the response. No one could tell me what to do. “Response can draft the statement about the critical nature of your deployment,” my contact told me. I imagined packing up a month’s worth of clothes and shoes and tea and supplies, leaving the work I had yearned to do my entire career. I wondered what else the administration would take from me.

When the embassy gave the all-clear that afternoon, I left the hotel to walk two blocks to a nearby Catholic church. As I made my way down the broken sidewalks, I tried to ignore the stares from the people all around me. Of course people are going to stare, I reasoned. I am clearly a foreigner, and a type they do not see often at all. I myself had never seen a white person walking around at any point driving through town. The church complex was beautiful, if a bit run down, and blessedly empty of people save for a few contractors and a vendor stall. I walked over to ask the price of an offertory candle. “You need to be careful with everything going on,” the woman warned me. “You should not be here.” I nodded and thanked her, confused. I would not understand until the next day the fervor of the anti-Western sentiment among the people in response to the invading M23 militia, a paramilitary group funded by the Rwandan government. I had been so overwhelmed with what was happening in the response that I could not see what was happening in front of my eyes. I wandered the grounds and, on a whim, picked up a black feather from the ground.

This is the third installment of a multi-part series on a Section member’s deployment to, and evacuation from, the Democratic Republic of the Congo while on an emergency response assignment with the CDC. All views expressed here are the author’s own personal perspective and do not reflect the position of their employer or the U.S. government.

Arrival

After two days of travel, I arrived at the hotel in Kinshasa just before midnight. The next day I slept in until noon, missing multiple emails from my team lead. I scrambled to get dressed and get to the emergency operations center, where I was hastily introduced to the country team, which was in the middle of a working meeting. I sat off to the side, trying to follow the conversation on an empty stomach. Someone brought shwarma for lunch around 2 p.m. On the way back to the hotel, we stopped at a fried chicken place. I tried to stay focused on my team lead, with many years of experience working on deployments and multi-year global health assignments, as my mind reeled from the juxtaposition of chaotic city streets with a Western-style fast food restaurant.

My in-country security briefing with the embassy Regional Security Officer was the following week. Until then, I had been operating under the assumption that most capital cities in the world had a baseline level of infrastructure and emergency services. My top question walking into the briefing was what the DRC version of 911 was, to call in case of an emergency. I learned immediately that there was no 911. We were strongly discouraged from driving and explicitly told NOT to exit the vehicle in case of a car accident. If the police arrived, we were instructed to drive away. I was given a laminated card to show through the car window explaining that I was a diplomat going to the embassy. The hospitals were poorly equipped to handle health emergencies; “Health conditions that are manageable in other places can be fatal in the DRC,” one slide warned. The UN handled fire response but often took several hours to arrive. We were explicitly prohibited from going anywhere outside the green zone. “If you have any kind of problem at all,” the RSO warned, “call Post One.” The embassy was our only emergency response.

I was in Kinshasa for two weeks. I worked six days per week, and the days were long: response work during business hours plus emails and calls in the evening with stateside colleagues on Eastern time. All communication was done through WhatsApp. The schedule was always fluid: meetings started late and ran long, and we often had last-minute invites to other meetings we had not even been aware of the previous day. I quickly realized that the work would not look anything like how I imagined, but that somehow all those years on the periphery of the global health profession had not been wasted. Let the local professionals take the lead. Listen more than you talk. Practice cultural humility. I kept a running list of technical terms and their French translations in a Notepad document: file, folder, update, sample, collection. I was relieved to see an Albanian colleague from WHO with a Google translate tab open in her browser. I learned that you can use WhatsApp in a browser, that DRC does not have its own government web domain, and that it is considered rude to bring your own food to eat without sharing. I reached out to colleagues who had deployed before me to learn about the response history, and to my father-in-law, who had worked as a doctor in Zimbabwe, to learn about cultural norms.

I stayed at the Hilton, a five-star hotel by the Congo River. I figured out after a few days that the alarm clock was not reliable, because frequent power outages reset the time several times per day. On weekdays, I ate breakfast at the hotel buffet and brought Ziplock bags down to store food for my lunch as well, per advice from a previous deployer. Dinner was usually room service, though half the items on the menu were unavailable. Sundays were off days. I wandered the hotel to check out the amenities and journaled while sitting by the rooftop pool. I boiled water in my hotel room, let it cool, and stored it in my Nalgenes and used plastic water bottles that I hoarded like a lemur. I washed my laundry in the shower with shampoo and hung it up all over the room to dry. After I had the “Do Not Disturb” doorknob tag on for several days, I got a call from the manager of guest services. Was my stay satisfactory? Did I need anything from the hotel? Was I alright? He explained that the hotel had a policy of checking on guests who asked not to be disturbed for more than three consecutive days – to verify that they were not being held hostage. There had been incidents in other hotels, he explained. “We take security very seriously.”

But still, despite the newness and the strangeness and the loneliness, I started to gain my footing. I found myself able to follow the conversations between my colleagues more easily. I scribbled notes about the history and evolution of the response, the structure and schedule, who was in charge, who knew what was actually going on, who understood the data and could answer questions. I came to understand that my primary responsibility was to serve as the eyes and ears of the agency. I got to know people and contributed where I could. A future in which I might do this work began to take shape. I could do this.

This is the second installment of a multi-part series on a Section member’s deployment to, and evacuation from, the Democratic Republic of the Congo while on an emergency response assignment with the CDC. All views expressed here are the author’s own personal perspective and do not reflect the position of their employer or the U.S. government.

Clearance

Just over one year ago, I was evacuated from the Democratic Republic of the Congo. I deployed there as part of the U.S. government’s global mpox emergency response. It was my first international assignment as an epidemiologist, something that I had been striving and preparing for over the course of my entire career. I was supposed to be there for one month but wound up having to leave after just 15 days. What happened to me was stressful, but not unheard of – crises happen, whether natural or manmade, and diplomatic and emergency response personnel are evacuated in ordered departures all over the world. Simply being evacuated does not make my experience unique, nor is that fact of particular interest to members of the APHA International Health Section or to the global health and development professional community writ large. Rather, what makes my experience relevant was the fact that it occurred in tandem with the dismantling of USAID, as well as the sustained assault on CDC.

I accepted the assignment and was rostered at the beginning of October, with my arrival scheduled for early January. Initially I assumed that this would be plenty of time, but simply getting clearance to travel with CDC was a massive undertaking that I was not prepared for. I had to do a French language assessment to demonstrate my fluency. I had to complete a battery of trainings unlike anything I had ever experienced. I watched videos on how to crawl out of a burning building, how to shelter from gunfire, how to ram a car. I did battle with CVS to fill prescriptions for antimalarials, antiparasitics, and antibiotics for traveler’s diarrhea. I could not book a flight until I had a visa, and I could not get a visa without proof of yellow fever vaccination, and I could not get vaccinated for yellow fever until 28 days until after I had gotten a varicella booster, because I did not know that you cannot receive a live vaccine within 28 days of a previous one. I had a phone call with a CDC medical officer who told me I could not drink any water that had not been boiled or any food that had not been cooked. I learned that there are typhoid vaccine pills. I got a varicella titer from Labcorp, at which point I realized that I did not even need the varicella booster, because my titer had been measured as part of the battery of tests my doctor ordered after my third miscarriage in 2022. I had to resubmit the global travel request four separate times, because I screwed up something different on each attempt.

All of this was done against the backdrop of the 2024 election. Donald Trump would be returning to the White House. While everyone around me at work wondered what this would mean for the federal workforce and HIV prevention work, I felt the urgency to get my travel approved morph into a sense of panic. I knew that if I waited until the administration turned over, I would lose my chance to do overseas work. I knew I had to be on the ground before the inauguration. My flight was rescheduled from January 6 to the 13th and then again to the 15th due to delays caused by a winter storm in the DC area. But finally I had everything I needed. I boarded a flight to Paris on January 15, feeling triumphant. I could do this. Finally, a lifelong dream was about to come true.

This is the first installment of a multi-part series on a Section member’s deployment to, and evacuation from, the Democratic Republic of the Congo while on an emergency response assignment with the CDC. All views expressed here are the author’s own personal perspective and do not reflect the position of their employer or the U.S. government.