Guiding spirit
For seven years Jennifer Duncombe worked as an epidemiologist for a humanitarian organisation, identifying and controlling disease outbreaks in countries such as Myanmar, Iraq and Nigeria. Here, she writes about witnessing unexpected glimpses of human strength during times of widespread suffering and recounts stories of resilience that have stayed with her.
I HAVE SPENT the past decade studying numbers, bugs and humans from various angles, and only scratched the surface of what there is to know. I am a humanitarian-idealist camouflaged as an epidemiologist. In 2007, I started my career as a 23-year-old at NSW Health, where I worked on outbreaks like swine flu (H1N1), but mostly we looked at chronic diseases: cancer, heart disease, diabetes. It was dull, and I wanted more.
I had seen sweaty medics in oversized white T-shirts working in Ethiopia on TV when I was in primary school. I was dismayed that the fear of blood and guts prevented me from studying medicine and joining them. Nevertheless, I was determined to usher the world toward peace somehow.
At a conference in Sydney in 2009, a jumpy, red-faced veterinarian demonstrated how he used geography and mathematics to predict the movement of outbreaks in East Africa. I was enthralled. Before I knew it, I was enrolled in a PhD program in infectious disease epidemiology. I collected mosquitoes and debated the merits of statistical methods that I barely understood. It was brutal and unforgiving. I hated it. I hated myself.
Following the unexpected death of a friend a couple of years later, I started hunting for meaning – for something profound. I abandoned my PhD and landed in northern Nigeria, where I managed endless cholera, measles and meningitis outbreaks. I also coordinated research on noma (an oral infection that causes severe facial disfigurement) and lead poisoning (children were ingesting contaminated soil). I sweated through every possible emotion during those 11 months in Nigeria, and I surfaced curiously elated and destabilised.
From 2013 to 2020, I worked in several countries, many of them more than once: Nigeria and South Sudan three times each, Myanmar and Sierra Leone twice each, Iraq, Turkey, Kenya, Ethiopia, Zimbabwe and the Ukraine. I chased ancient diseases that most people only read about in textbooks. I studied Islam, Buddhism and Christianity, and I grew to worship hot showers. But it was treading the seams of the human spirit that absorbed me. I was mesmerised by the resilience and generosity of people in the face of unimaginable adversity. I witnessed the very best of humanity in the very worst places.
It feels otherworldly to be back in my home town of Sydney, sitting in my apartment, watching Covid-19 spin and unravel around me, blazing a trail of change through our lives, spreading grief. This is the only major outbreak in the last decade that I haven’t been involved with in some way (my offers of help were declined). It is an adjustment. But, from the sidelines, I can observe. I see things I wouldn’t normally see, and pieces of a puzzle that I didn’t know I was solving seem to click together.
As we in Australia adapt to this new reality, I am drawn back into the shade of memories, heartbreaking stories of sorrow and misfortune. And yet, in each case, the human spirit prevailed. Hope triumphed. And it will for us, too. For hope is the cornerstone of humanity, the light that burns, unwavering, through the darkest hours.
October 2014: Sierra Leone, West Africa
Jay (not his real name) was in the high-risk zone of the Ebola Management Centre (EMC), removing the bodies of people who had died overnight, preparing them for burial. We got a call to say that Jay’s brother had died. We shouted to him over the fence, urging him to exit the EMC. He refused. I went over and spoke to him, explaining that we had some serious news. Jay shook his head, sweat dripping down his face and said: “I can’t leave these people like this. They deserve better than that. Whatever it is, it can wait.”
Jay was the first person we met when we arrived in Sierra Leone. He worked as a cleaner in a hospital prior to the outbreak, something his mother was embarrassed about. His brother was one of the country’s leading surgeons, and he was a cleaner. The hospital at which Jay worked was one of the worst affected by Ebola – more than half of the staff died in just a few weeks.
When we met him, Jay was at the back of the hospital surrounded by hundreds of dead bodies. There were used needles from various intravenous infusions and injections and rubbish everywhere. Jay told us that he had been working there non-stop for the last few weeks, even sleeping in the backyard, but the bodies and needles kept piling up and there was nowhere to put them. He had not eaten anything for days, because he was so worried about being infected. Jay wasn’t being paid and when we asked him why he was still there, he told us that his best friend had died at the start of the outbreak. Jay felt guilty that he wasn’t there for his friend, and sad that he couldn’t say goodbye. He felt that he needed to repay some kind of debt.
So it was no surprise to us when Jay refused to leave the bodies in the EMC that day. When we finally told him the news about his brother, he was, of course, devastated. He called his mum, and then he went straight back to work. We urged Jay to go home, to grieve, but he refused. He told us that his brother would have wanted him to stay and “keep fighting”. And so he did.
February 2016: Turkey, the Middle East.
Kneeling on a threadbare pillow in a ripped tent, a glass of untouched tea cooling beside me, I didn’t even notice the frigid wind as it screeched through the camp. I was preoccupied by the pair of elderly Syrians in front of me. They looked like shadows.
They had just fled for their lives, through knee-high snow while bombs and loved ones dropped around them. Rivers of tears were running down the man’s grey face, pouring over his wrinkles. When
I asked him to tell me what happened to them, he could only utter one sentence: “I see ghosts behind my eyes.” His wife told me that they lived in an area of Syria that was taken by the Islamic State (ISIS). They packed up their family – sons, daughters and grandchildren – and they fled to Turkey. The old man and his wife were the only survivors.
I had many more questions, but they seemed inconsequential. As the call to prayer rang out around us, its mournful strain whipped up by the wind, it seemed to signal the end to our conversation. But none of us wanted to leave. It was if we were tied together; invisible, indelible bonds of grief.
I had the same feeling with everyone I met during that trip to Turkey. It was short and I was there with two others – a Bangladeshi doctor and an Italian administrator – with the purpose of helping the displaced population however we could. In the months following, humanitarian teams set up medical clinics, provided mental health support, built playgrounds and hot water systems, started a soup kitchen, treated everyone for scabies, and supplied tents, blankets, pots and pans, nappies and shoes. Everywhere we looked there was sorrow and loss. But kindness overwhelmed the misery, and together we learned to turn our faces towards the sun.
March 2016: South Sudan, East Africa.
South Sudan is an ethereal and intoxicating country. However, I initially refused to go back there when I was asked to do a survey in early 2016. The purpose of the survey was to estimate the incidence of violence and death. I could not fathom going into people’s homes and asking them about such atrocities: it felt sleazy and disrespectful. The people of South Sudan have suffered beyond belief: I didn’t want to inflict more pain on them.
But when I went to the selected villages and spoke to the leaders, apologetically explaining what we would like to do, the women were jubilant. I repeated the aims of the survey, thinking that they had not understood me: we wanted to talk about violence and death, the war, their grief. They remained jubilant. I cautiously asked them why they were so happy. The tallest of the women, whose house we were in, looked up from where she was pounding grains with a club, and smiled. “If you write down what has happened here, people will read it and it might change our destiny,” she said. I protested, arguing that it might not have any impact at all. The tall woman eyed me wearily and said gently: “We want to talk. You don’t know what will happen … Let us dream a little.”
Everywhere we looked there was sorrow and loss. But kindness overwhelmed the misery, and together we learned to turn our faces towards the sun