'Should I stay or should I go now? Working with Concern in Niger, I'm facing tough decisions'

Living in West Africa, Lucy has always been aware of her distance from home but since the outbreak of Covid-19 she has had to ask herself, where can she make the most difference - Cavan or Niger?
'Should I stay or should I go now? Working with Concern in Niger, I'm facing tough decisions'
Lucy Lafferty (28) from Co. Cavan, is a health and nutrition advisor in Niger, West Africa with Irish aid agency Concern Worldwide.

Lucy Lafferty, 28, from 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.

It has been a long and eventful four months working and living from the Concern team house in Niamey, the hot and dusty capital of Niger in West Africa, over 7,000km from Ireland. 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. Simultaneously, I was anxiously watching the evolution of the situation at home in Ireland; the significant daily increase in cases and the impressive mobilisation of health care staff through the ‘Ireland’s Call’ campaign.

I spoke to my mum, Clare, in the first week of self-isolation. She is a retired nurse, who returned to work in a local COVID-19 testing centre in Cavan. She explained the extensive personal protective equipment she carefully wore when working. This put my mind at ease that her risk of contracting the disease at work would be low, but it made me reflect early in lockdown on the unimaginable challenges we would face in Niger if disease transmissions increased.

With a weak health system, a high burden of other diseases, widespread food insecurity, a large proportion of the population lacking access to basic water and sanitation facilities, and around 20 ventilators for a population of 22.4 million, my head and heart ached for my colleagues, the local population with whom we work, and myself.

Since then, my days have been filled writing proposals for the crucial funding needed and 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. 

Within weeks, I was given the option of leaving and going back to my family in Ireland. The fragility of Niger – 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 June 28 was 1,059 and 67 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 reopen for 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 1980s.

Weighing up my options, I decided to stay in Niger where I felt I was better placed to support my colleagues who are doing the critical work. Every country was faced with the same battle of trying to minimise COVID-19 transmission and now many are navigating coming out of lockdown, however in very different contexts and with varying resources. 

Over this period, the Concern Niger team have been building awareness of COVID-19 in very poor and remote communities, focusing on how to reduce the risk of disease spread. We have also been providing essential resources (soap, handwashing stations, etc.) in communities and health facilities.

‘Now over 15 weeks later, the number of confirmed COVID-19 cases in Niger has remained low (1,075, 1 June 2020) – I am hopeful that this continues to be the case.

The world remains a public health pandemic, and as a public health professional, I do not think there is a right or wrong answer, to go or to stay. All I know is that I am content with the decision I made to at the time to stay and help.

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