History Urges Us to Do Better: Opportunities to Elevate Nurses in the Current Ebola Outbreak

Ebola, Uncategorized

This is a piece I wrote that was just published in the American Journal of Nursing. Take a look:

“Another Ebola Outbreak Provides an Occassion for Reflection”

As during the early days of HIV–AIDS, it was not just patients who were disrespected. Ebola nurses were mistreated, ridiculed, and stigmatized. U.S. quarantine policies were inconsistent from state to state and were determined, in some cases, by politicians and not scientists. Fear inspired aggression toward caregivers who volunteered to treat Ebola patients. We have not made substantial progress in the fight against infectious diseases when we let fear create stigma about caregivers doing their jobs. History urges us to do better, and we can.


Compassion in the Crevices


Opinion column in the Richmond Times Dispatch on sweating the small stuff:  “Compassion in the Crevices.”


From rubber gloves to rubber chickens

Clowns Without Borders, Ebola, Uncategorized

When I got in the Uber four days ago, my brand new red Converse were still untied. I was rushing as I often do. In the car, the radio played Toto’s “Africa.” You know, that  catchy tune from 1982 about a continent confused by many to be a country? (There are 54 countries in Africa). While Toto was busy blessing the rains down in Africa, my head was down as I tied my shoes and bit my tongue. Though that song sold millions of copies and its chorus gets stuck in your head for hours, its message is disturbing. It paints a general picture of suffering that highlights a common narrative about an immensely diverse continent. We are told that “Africans are poor, they are sick and they need to be saved.” When epidemics strike, like the recent Ebola epidemic that occurred from December 2013-March 2016 in West Africa (primarily Sierra Leone, Guinea and Liberia), the media condemns the whole continent. Headlines like “Ebola in Africa,” Famine in Africa,” “Malaria in Africa” are not untrue, but they are misleading, generalizing and most unfortunately, they are othering.

(Is that song still stuck in your head?)

“Othering” causes distancing; it allows us to unrelate from people, communities and those with differing points of view.  By separating ourselves from the “others”we become much less tuned into the world around us. “Othering” is easy though, it feels safe, it is a very human reaction. It is also dangerous.

Taking my mind off of Toto’s tune, I perserverated on what I had packed, afraid that I had forgotten something important. I thought about my clown gear, the people that had given me elements of it and those who had inspired me to take this trip. I had juggling clubs that Sam Lee gave me, rubber chickens from Sarah Foster, squeaker toys from B.B. Widdop, Jamie Lachman’s antique horn, George Lennox’s 1970’s ruffled tuxedo shirt, David Lichtenstein’s nose and a head full of clown routines I had learned from friends and mentors–Rudi, Moshe, Esther, Hilary, Pops and Peppe, to name a few. My clown character had become a compilation of gifts from extraordinary people. They all flashed through my head as that godforsaken song stopped. I was on my way to the airport, to fly to Sierra Leone, meet up with Eva and Malin, create a show and perform for street children and families affected by the Ebola epidemic.

This is my second time in Sierra Leone, the first was during that epidemic that took more than 11,000 lives and once again stigmatized a continent. Then, I was a nurse treating children with Ebola. Now I am a clown, treating no one, just playing. Then, the rule of law was ABC: Avoid Body Contact. Now, once again clinics, mosques, churches and markets are open, you are allowed to hold hands, hug, congregate and interact normally, like humans. Now the sounds of car horns overpower the then eerie drone of ambulances 24 hours a day. Now we can safely share a plate of “chop,” communal meals of fish, groundnut sauce and rice. Music, once again, is everywhere.

Eva, a musician and Malin, a clown and old friend of mine, both from Sweden, were invited with me to come and be ‘based’ at the Lotte Elf School in Portee. There we built our show and have been teaching music and clown workshops. It is from there that we travel to put on shows. Cars cannot drive to where we work without getting stuck or destroying their undercarriage because of the rocks, mud and holes. Our team carries our entire show with us in suitcases and backpacks. Usually we share the load, except for when we are in character and Malin’s clown, “Apple,” is tasked with schlepping all the gear while Eva and I warm up the audience with a song. Eva plays the quattro and I, my banjolele while Malin’s clown struggles with chaotic finesse to set up our stage.

For our first show, the stage was in a ruddy intersection, its backdrop, an electric blue passenger van with dilapidated windows and a yellow racing stripe. More than 100 people waited for us in the Sunday morning sun. As the show ensued the crowd doubled in size. Children in bright colored formal clothes and men in white tunics cheered us on while we introduced each character with eccentric dance moves in our oversized outfits. An elderly woman in a maroon and purple dress, a complex lappa design resembling lightening bolts and cracked ice with a pristine matching hat, stood in the front of the crowd singing with us as if she knew the words to all of our songs. A man in nothing but shorts came out of his home–perhaps he had just woken from a long Saturday night–he scrutinized our magic tricks and tried to explain them to other audience members. The crowd clapped and cheered, mesmerized by the duet played by Eva and I on the flute and musical saw and always ready to cheer on Malin as her clown, the “number three” character (think Groucho Marx), stole the show.

Early on in the show we play a routine in which we fight over who gets to read a newspaper. The fight builds in ridiculousness, tempo and intensity to the point at which the newspaper rips and we turn the now halved paper into a pair of binoculars. We look into the audience, like children having completely forgotten about our argument and we are immediately distracted by who we see in the crowd. We see a child and we go to shake his hand. Each clown wants to give the best handshake and so the three of us end up running circles in front of the child taking our turn to give the funniest, most formal or most ridiculous shake. We invite him on our stage then and do a routine in which, while holding his hands, we try to figure out how we can all bow together.

The child we picked in our first show was thrilled to be the center of attention. He grasped our hands laughing while Malin and I tried to figure out to make us all three face forward.  I’ve done this routine hundreds of times in at least 10 different countries; it gets similar laughs for its simple absurdity. But this time on this day it was particularly powerful. I realized that there in my red nose and black tuxedo that I could hold a hand with no fear of contagion. There was no risk that this child or anyone that I shook hands with would infect me with anything more than a sense of friendship. I still carry the trauma of holding the hands of the dead and dying in this country not long ago. Covered in latex gloves and Tyvek suits, we sat with countless people, each sick, each with a unique story and name, cut short. But then, with that child, I realized all of that was over. With a tear in my eye, I wondered what it was like when the ABC rule was lifted in Sierra Leone and the fear of contact dissipated.


Clowns learning how to bow

The show was a hit and much of the crowd followed us back to the school from where we started it all. At the entrance of the school three of us sweaty, dirty and happily exhausted said, “goodbye.” We rested for about two hours and then climbed to the roof of the building to host a music and clown workshop for about 50 children.

Eva took the lead on the workshop after I opened with a short warm-up call and response song called “Flea.” She taught a group of 55 fourth graders a song that she had written in Krio. It is a sweet tune that requires each child in the group to say their name. One at a time, a child speaks and then the whole group sings the chorus featuring that child’s name. We stood in a circle and each child’s name resonated through the group, survivors of Ebola, survivors of living in the streets, and survivors of the world’s indifference, these children, each child, had a unique chance to shine.


The classroom where we ran our workshop at the top of the school

Our contribution is small, we would say “small small” in Krio. But what we can do and what we strive to do with Clowns Without Borders is to elevate the child, the individual child, to learn a part of her story and share it. As individuals we all desire, in one way or another, for our name to be sung in a song’s chorus. And too, that we are all a compilation of individual gifts and inspirations, that when our name is celebrated, we are actually celebrating a much larger whole.


A child turns me into an air pump to blow up a balloon

Our show ended as so many of our shows have, in which we invite a child to come on stage and dance with us. A young boy joined us and mimicked the pose of a circus side-show “strong man.” He flexed his muscles over and over again.  He then climbed to my shoulders and stood there, flexed one more time and cheered. He was the tallest and strongest person in town.

To learn more about this project and the work of Clowns Without Borders, look here and here.



The Four Express train is always full.  It transports us from South Bronx through Manhattan and into the heart of Brooklyn.  People from all races, nations and socio-economic statuses are forced to press upon each while commuting to work and home, escaping to another place.  On the train, you are an accidental member of the world’s most transient community.

Don’t crowd me! This is my space, bitch!

 I did not squeeze onto the first train that passed, so with my suitcase and messenger bag stuffed with clothes and work, I edged towards the next train—you could hear the shouts over its rumble.

I don’t care who you are!

The young white men, dressed in summer checkered shirts and tight fitting slacks with a line of matching square patterns protruding from the back pockets, shoved in front of me. It seemed important that they catch the train.

A voice pitched in fear was camouflaged by the plethora of faces. I could track what side of the train it was coming from, but it wasn’t until I stood just two people away from her until I saw who it was. Two people shoved me from behind and a third crammed his arm into the door, interrupting: Stand clear of the closing doors please.

You want to come over here?  Take another picture of my child?

A woman leaned against the train door while it accelerated from the 59th street station.  Her knuckles white as she held the handles of a worn plastic stroller.  She lifted the rear wheels of the stroller and then slammed them down.  The sound effects emphasized her word—bitch. She stared towards the middle of the train.  Her child, two-years old by my estimate, looked up, mouth wide and exposing unusually pale lips.

C’mon, you want this?  You want to take another picture?  Nobody is taking my child!

The focus of her ire was a tall white woman with long blond hair and an iPhone 6 in her hand.  The woman had blue eyes and an Australian accent.

I have a photo here.

The woman chuckled—she knew nothing else to do– and turned away, faux-ignoring the mother, a petit but broad shouldered black woman, wearing a ripped mono-tone t-shirt and dark blue bonnet.

You have no idea.  No idea!  You take another photo and I will break your phone. 

 People crammed against each other and away from the protagonist, clearing a path for projectiles, whether they be fists, spit or other sundries. And then the mother let go of her stroller, lunged and swung her fists in rapid fire succession at the woman who nearly doubled her in height.  There was a groan from onlookers on the train.  Because it was an express train, the next stop was still minutes away.  A swirl of fists.  And then, like breath, those of us not involved moved further away and then somehow, back in, collectively filling the via violencia with bodies.  I don’t know if we were pushed by people further down the train or if there was the human instinct to crowd the soon-to-be brawlers with our bodies to decrease the impact, for everyone.

My left shoulder stood between the women now.

Come here give me your phone.


 Delete the fucking picture!


 Fear again, now anger and now power.  Both voices trembled in higher pitch, tea kettles about to explode.

Shouts from within the train car broke apart the confrontation telling the tall woman to delete the photos.  Repetitive calls to “just delete the photo” from nameless by-standers.  The mother lunged again and I leaned my shoulder into her body as if having been jolted by a braking train; she backed away.  The white woman looked at me and said, I didn’t actually take a photo.

I told her to act like she was deleting a photo then.  Someone else told her to do the same.  She brought the phone away from her body as if she could use a pair of reading glasses and then the mother took her advantage.  She grabbed the iPhone with both of her hands.

I will break your phone; you CANNOT have a picture of my child.

As an emergency department nurse I have learned through trial and painful error how to restrain aggressive patients and how to minimize the the risk of injury to all.  My hands were now controlling the wrists of the mother who clawed into the phone.  The white woman pulled back, now yelling at the mother to return her phone, her eyes welling with tears.

I will fucking kill you.  I will strangle you with my headphones, I don’t care.  You do NOT take pictures of my child.  This is MY SPACE!  I will punch you, I will BEAT you!

Yet, no more fists were to fly.  The mother was not foolish; she knew she would not assault this woman.  She was a lioness wisely protecting her pride.  I felt a sensation of release in her tense arms when I grabbed hold of her.  I told her calmly, Let go of the phone, she will delete the photos. Let go of the phone.

Though she did not let go, she did not continue to fight.  I watched her arms, legs, teeth and mouth, knowing that I needed to assess any part of her body that she could use to strike out at me or anyone around.  In nurse mode, my brain focused on staying one step ahead ready to catch or at least deflect the next fist that was to fly.  I prepared to be spit in the face, perhaps because too much experience working with patients in the midst of psychotic breaks, drug overdoses or simply overcome by the fear of a medical system not designed for properly treat the resource poor.

A white woman, who sounded like a therapist, like the one I had seen years ago near Union Square, stood next to the mother and with all good intentions, failed to calm the woman:  I know you are in pain. We see that.  Let go of the phone and tell me about your pain.

It was comic relief for that protracted subway ride; gallows humor—a missionary kind of model when the “with too much” tries to soothe the pain of the one without.  We still had not arrived at 42nd street.

I held her wrists, controlling her fists, two of her weapons secondary only to the power of her words.

No one knows about my child but me.  You will not take her away.

Her child cried and she released the phone.  I held her wrists a second longer until she gently pulled them away from me.  We looked at each other, then she reached for her child.  She had no intention to cause harm, she had no intention to stage a scrappy battle on the subway—so long as she, and her child felt safe.

The white woman quaked.  I let one of my bags fall to the floor and stood squarely between the mother and the photographer.  With both women in my peripheral view, I asked the white woman quietly what her next stop was.  She said 42nd Street as they train decelerated.  I told her that when the train stopped she was to walk in front of me so I would make it harder for the mother to swing at her on her way off the train.

The train stops, doors open to a crowd of people hustling to get on, many who just missed the previous train.

I will kill you if you try to take a photo.  I will strangle you with this cord.  You no nothing about me or my child!

 Tears streaked the face of the woman with the phone.  I do not know if she actually took a photo, I have no idea what she said or did to inspire such wrath.

Stand clear of the closing doors please.

And she disappeared, her life interrupted by this exchange.

Everybody hear that? this is MY space. 

The mother’s eyes welled with tears.  Someone offered to give her a seat and she declined.

I’m FINE, thank you. You have no idea.

 She was right, we had no idea.

It was nine o’clock in the morning when I got off the train at 14th Street.  The woman with the child stayed on the train, she stared at the passengers like a caged animal—no one would take her space.  She had won, she had to win, she would do anything to win. But what did she win?  What was she fighting for?

At Union Square, the sky opened with scattered clouds.  The late summer humidity was just bearable and the people shopping at the farmer’s market walked briskly to work after buying flowers and fruit.  There was kale and fresh meat, stores of iron all priced beyond nutritional value but at a rate the elite would afford.  Above the subway was access to nutrition, for a price.  I bought flowers and coffee for my lover, just a few dollars short of twenty total.

In New York City, for $2.75 you can travel to almost every corner of the metropolis.  Anyone, regardless of race or socioeconomic status (if you can spare the $2.75) has access to this city, and yet the access remains limited.  What is hidden in the crowded subway cars, in the remote boroughs, that has been pushed away from the central neighborhoods by gentrification, by fear and by urban “development,” is a growing community, a global community of people with exponentially less while their ousters gain exponentially more.  And in this I too am complicit.  In this, as a nurse, one who has helped remove abusive parents from children in an emergency department, who has faced off with patients wielding knives, fists and words, desperately protecting themselves from a medical system not designed to meet their needs—from a medical system, in the U.S., that historically ran experiments their community—on their families—tortured the poor to develop drugs for the rich.  It is this growing chasm between the resource wealthy and resource poor that is a fundamental deterioration of our global community.  It is the lack of acknowledgement of the behemoth that allows us not to see the other side.  When it surfaces, we pick sides according to race and socioeconomic class and judge the other, though we may have only witnessed it for the duration of two subway stops.

What is not seen is most dangerous when it erupts.

This microcosm in this city is a metaphor for evolving global circumstances—war, poverty-driven contagion, religious fanaticism and nationalism.  All deterrents to peace that are fueled by ignorance of the other.  Sometimes we only get a glimpse of that other, and if we are not prepared, if we are not educated with some modicum of tolerance that comes from inspiration to learn about what we do not know, thus purposefully placing ourselves outside of our comfort zones, looking through the nebulae that our own cultures have created, we have nothing to offer.  We make dry attempts at hollow compassion that ultimately only serves ourselves and we remain ignorant to the root.

There is no simple fix.  There is no formula to address this chasm. And yet, if it does not remain clearly in the forefront of health care education, on the agendas of of transcultural powers in politics and health, then we will continue to fuel a losing battle.  Income and health inequity, globally, will tear down the weak scaffolding of “development” and attempts at peace.

When I arrived at my partner’s apartment, not far from Union Square, she had a headache.  I walked a block to a pharmacy on the corner to buy acetaminophen for her.  In front of me, a woman in a sundress purchased baby formula with government issued food stamps.  Across her exposed back were words tattooed between her scapulae:

My witness is the empty sky.

A Case for Clowns: Ebola

Clowns Without Borders, Ebola, Uncategorized

Why Clowns Without Borders Works

Tortell pirouettes quickly and the microphone swings around behind him; it has a life of its own.  The centrifugal force of the windscreen pulls the instrument around his arms and legs, making his clown blazer flop poetic in the wind.  The crowd’s eyes are wide with surprise when he catches the mic just before it hits him in the face—Tortell’s eyes matching the eyes of the 100 children and families in the audience.  His relief, their laughter.

He has just spent the first 10 minutes of the show warming up the audience, a master street artist who draws the crowd in as he sets the stage.  It is more than 100 degrees Fahrenheit, pushing 105 even.  The audience and clowns from Spain stand in the shadow of a two-story colonial building with stone archways and wooden doors. Its tile portico is cool to the bare feet of some of the audience, the West African designs deflect the heat of the pounding sun.  It is about three in the afternoon, Tortell and his clowns have already performed two shows in Freetown and now they are presenting their final show of the day before heading further east.

This is the first day of Clowns Without Borders shows in Sierra Leone since the Ebola epidemic began in late 2013.  It is now early 2015, February.  This is also the first Clowns Without Borders show that I have ever seen as an audience member. This is the first time I’ve seen healthy children and families play, dance and be together since I had arrived in Sierra Leone eight weeks prior.

Once Tortell regained control of his rogue microphone he announced the opening of the show—acrobats and movement artists entreated the audience to a spectacle that consisted of partner juggling while standing on the ground and on shoulders.  The performers danced with fantastic and impossible objects—a giant fabric butterfly and streamers. All the while Tortell interjected the finessed scenes with mischievous intrigue, he tried (and always failed) to recreate what the movement artists had just performed, he filled the space with magic tricks winning over the audience with his glorious, comedic bungles.

I stuck out as an audience member, the only white person in the crowd. And though I tried to stand back from the front row, away from children and among the adults, parents turned to me and asked me when I would go and join the clowns.

“I’m not in the show.”

“Yes, but you must be.” An audience member grabbed my arm and pulled me toward the stage.

I froze, not playfully, but with a sense of deep, reactionary discomfort.

“No no, I am not in the show.  They are my friends there, I know them, but I am not in the show.”

I had not been touched for almost nine weeks, by a stranger, that is.  We were not supposed to.

The government of Sierra Leone had set a national edict—ABC: Avoid Body Contact.  When the woman from the audience touched my arm and I felt a surge of adrenaline, then fear.  It was fight or flight.  I was breaking the rules; they had been broken on me.  I felt like, for a fleeting moment, a victim.  Had I been contaminated?

The woman then laughed out loud, seeing my awkward reaction to her touch “OK, but I think you are a clown too! Look at them, they are so amazing!”

Another man near us noticed our commotion and he then held my hand as he explained to me why Tortell’s magic plastic bag bit was so funny.  He described in detail how he thought the magic trick was happening, and having done the gag before myself, I can say that he was mostly correct.

“But look at the children!  Look at them! They love this so much!” Another man chimed in.

Around us, scrambling to the top of adults’ shoulders were kids who clambered to get closer to the clowns.  Their laughter was silenced to a vibrant, low chatter only when the clowns presented movement pieces of silks flying through the air and then then thunder released again when Tortell entered and tripped over a brick on the rough strewn road.  Like waves of the ocean, their laughter came and went.  Laughter like this, according to the host who welcomed the clowns from a small German NGO, had not been heard for some time.

I came to Sierra Leone, like hundreds of others, to work as a nurse. From 2013-2016 the Ebola epidemic, first in Guinea, then Liberia and Sierra Leone took the lives of more than 11,000 people.  Children (under the age of five) who were infected had a 20% chance of survival when the disease prevalence was near its peak.  As a pediatric nurse, I still find it hard to describe the heartbreak of losing eight out of every ten pediatric patients we treated with Ebola.  The rate of survival for older children increased with their age, as did fear; as did depression; and as did withdrawal from play and community.

The unfathomable psychological destruction of the Ebola crisis reared its ugly head every day to those of us who worked in the “hot zone,” constantly desperate for supplies, more human power and for a cure. Children who survived the disease appeared frightened to leave our treatment units and return home—we learned very quickly that community members were often not welcomed home after surviving Ebola because of stigma born of fear and misunderstanding the nature of the contagion.  People separated themselves from others, people were afraid to interact like before, people were judged and communities fractured.  Children no longer played.

Towards the end of the clown show, one of the acrobats found a red, triangular flag and showed it to the audience, which had doubled in size and by now had formed a complete circle around the artists.  The clown waved the flag proudly in the air.  Tortell snatched it, then invited an audience member to come to the stage.  A grown man stepped forward much to the pleasure of the audience.  The clowns made the red flag disappear, then appear again from places like the man’s ear or from inside of his shirt.  Then a clown made the cloth disappear and reached into Tortell’s waistband to retrieve it.  Instead of the cloth coming forth, a long strip of plastic, red and white caution tape, like that used at the site of a crime scene appeared as the clown ran from Tortell revealing its full length.  The tape had red and white vertical stripes—the same tape used throughout Sierra Leone to quarantine homes with people suspected of having Ebola.  The clowns ran around the audience member with the tape and they all became entangled in a picturesque finale for that bit.  The audience, especially the man they volunteered were beside themselves with laughter.  A man near me, who still did not believe that I was not in the show held my arm and leaned against me for a better view.  For a moment, we were all limitless in our laughter.

I looked through the audience and for the first time since I had arrived in Sierra Leone, there was not a face that showed fear.  People were not stymied to stand with each other and accompany each other in playfulness.  Everyone was together.  Everyone looked normal.

War, poverty and disease trigger the worst of humanity.  They create a “new normal” of suffering, stigma and division.  What the clowns did on this excruciatingly hot day was provide a platform whereby normalcy reigned again.  The laughter broke the hold of stigma—even if it was just for a moment—and through the ridiculousness of the clowns, people saw each other not through the lens of disease but through that of a common humanity.

Read more about this amazing organization, Clowns Without Borders. If you like what you read and want to Support Us, feel free!








“Don’t wash my dishes! I need to wash them myself. I wash them every night at midnight and they help me remember my day.”  My friend and mentor about all things important told me that one night after drinking bourbon and chatting about love.  She was 80 when she told me about the practice of washing dishes at midnight.

In August, 2015 she died a peaceful death after 95 long years.  She believed in story-telling, in questioning your values and finding humanity in everything that comes along.

She wondered and as she got older her mind wandered, her musings profound and entertaining.  This blog collects stories about people, events and this strange world we live in, honoring Mrs. R.