Should I stay or should I go now?

Lucy Lafferty (28) from Drumalee, Co. Cavan, is a health and nutrition advisor in Niger, West Africa with Irish aid agency Concern Worldwide. Lucy explains here why she decided to stay in Niger – with just 20 ventilators for 22 million people -- so she could help with the charity’s COVID-19 response.

Entering my tenth week of working and living from the team house in Niamey, the hot and dusty capital of Niger in West Africa, I have become accustomed with my new routine, my new normal.

My colleagues and I left Concern’s office in Niamey in mid-March following a team meeting when it was decided that it was prudent for us to self-isolate for two weeks, given our proximity to one of the first confirmed cases in Niger.

Swift actions from the government ensued, the airport closed and contact tracing began. Naively, or optimistically, we hoped that within those two weeks the situation would be under control.

I did not have to go far with the team house being just 300m from the office. I am living there with one colleague. The house can hold up to five staff or visitors, so we are lucky that we have lots of space and can work in separate rooms.

Simultaneously, I was anxiously watching the evolution of the situation at home in Ireland; the significant daily increase in cases, strict social distancing rules and the impressive mobilisation of health care staff through the ‘Ireland's Call’ campaign.

I recall speaking with my mum, Clare, in the first week of self-isolation. She is a retired nurse, now back working in a local COVID-19 testing centre in Cavan. She explained the extensive personal protective equipment she carefully wore when working her shifts.

This put my mind at ease that her risk of contracting the disease at work would be low, but it made me reflect on the unimaginable challenges we would face in Niger if disease transmission increased. With a weak health system, a high burden of other diseases, widespread food insecurity and malnutrition, a large proportion of the population lacking access to basic water and sanitation facilities, my head and heart ached for my colleagues, the local population with whom we work, and myself.

Concern has been in Niger for 17 years with a focus on helping its poorest, especially its malnourished children and their caregivers. It is estimated that 15% of children are acutely malnourished in Niger and that 47.8% are affected by stunting – while over 70% of children under five are anaemic. Concern also dedicates itself to improving overall nutrition, education and livelihood opportunities for as many people as possible.

Niger is one of the poorest countries on the planet. The 2019 Human Development Index, which measures the wealth (measuring the money earned by each nations’ people and businesses), life expectancy and the expected years of schooling in 189 countries. Niger came last in 189th place. It has a life expectancy of just 62 with the expected years of schooling at a mere 6.5 and where the average gross national income per person is $912 (€831). This is in stark contrast to Ireland, which is ranked 3rd, with a life expectancy of 82, expected years of schooling at 18.8 and where the average gross national income per person is $55,660 (€50,705).

Since the start of the lockdown, my days have been filled with learning about this new disease to adapt Concern’s existing projects to ensure that we build community awareness on COVID-19 and create an enabling environment (distributing soap and handwashing stations) to protect our teams and the local population with whom we work.

I have also been busy writing proposals for the crucial funding that we need to meet the increased needs at this time. Like so many, I have been getting used to the challenges of remote working; the endless calls, the frequent power cuts and fragile WIFI.

Within weeks, I was given the option of leaving here and going back to my family in Ireland. The fragility of where I am – one of the world’s poorest countries – was to the forefront of my mind as I weighed up what to do.

That opportunity came one Tuesday evening in an email from the French Embassy, informing me of a flight to Paris leaving that Thursday. My brain whirled about what to do. I could hear the echoes of questions from my family and friends: ‘When are you coming home? When will the airport be open again?’

With over 600 confirmed cases at the time and likely many more undiagnosed (the total confirmed number of cases as of May 20 is 914 and 55 dead), I wondered when would be my next opportunity to fly home? Most cases were in the capital, but community transmission had already appeared in Concern’s programme areas. The situation was clearly worsening. It was unlikely the airport would be open to commercial flights any time soon.

I thought about what I might do if my parents or brother fell ill. What if I got sick? Not only would I be another patient burdening an already swamped health system, but I was also acutely aware that the available treatments and resources were a fraction of what I would have at home.

Would it be irresponsible to leave? Would it be irresponsible to travel through at least three airports, inevitably come into contact with hundreds of people and potentially increase the risk of transmission or of contracting COVID-19?

I reflected on the reasons why I chose this career. Working from home in Niamey or Cavan, what would the differences be? Where would I be most useful? No question has a simple answer.

I have always been aware of my distance from home, but never more so than now. I had been in the privileged situation that, if necessary, I could probably get home within 48 hours.

Once this freedom was gone, it instilled anxiety. I voice this fear, with my dad, Peadar. He rationally pointed out that in some ways life is more low-risk now than ever before. Fewer car journeys, no pubs open, home cooked meals and a very simple life. I know that both my parents understand what I do and why I do it, having themselves worked with Concern in Bangladesh in the early 1980s.

Every country is facing the same battle, but with different people and resources. My colleagues in the field are doing critical, lifesaving work, and I want to support them as best as I can. I will always be cheering for team Ireland from home or away, but for the moment I am staying in Niger.

This may change with the ever-changing situation. My family and colleagues and my physical and mental health will be my guide.

The Concern team here have been very busy making very poor and remote communities aware of COVID-19 and how they can prevent themselves from getting it. We have also been providing essential resources in communities and health facilities.

We are in a public health pandemic, and as a public health professional, I don’t think there is a right or wrong answer to go or stay. All I know now, is that as I enter another week working in Niger, over 7,000km from Ireland, I am content with my decision.