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Image: Karin Eklund (2020)

COVID-19: the view from Rabat

Why would an American choose lockdown life under martial law in Morocco? A conversation with Iranian-American global health physician Nassim Assefi on different cultural approaches to COVID responses, coping as a single mother in quarantine, and navigating the precarious line between safety and sanity.

When the pandemic hit, Iranian-American physician and global health expert Dr Nassim Assefi actively chose to stay put in Rabat with her 8-year-old daughter rather than return home to Seattle, despite Morocco’s strictly enforced lockdown measures. The country’s major cities have seen the longest and strictest quarantines in the world: starting on March 16 and ending just a few days ago, on July 11.

As a self-described global nomad, Nassim has been to more than 60 countries, including to Iran for public health research, to Afghanistan to reduce maternal and infant mortality, and most recently to Rabat — where she was living at the time of this interview — to work with refugees and immigrants.

During the height of the pandemic last May, I called Nassim to get her uniquely global perspective on the crisis as a doctor — and as a fellow single mother trying to stay sane. An edited version of our conversation follows.

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How did you come to live in Morocco, and why did you choose to lock down there?

Morocco was a happy accident on a yearlong, midlife sabbatical that I took at age 45 to do a deep, reflective dive on my professional future. The plan was to spend a trimester each in Asia, Africa, and Europe, and I had lined up projects on each continent. Morocco was nowhere on the itinerary. Based on a letter from one friend in Rabat and a spontaneous decision, I decided to visit. Within a week of being there, my daughter and I fell in love with the place. Living there made sense on many levels.

My professional goal was to work with refugees and immigrants, particularly on refugee integration in Europe and in southern Spain. Morocco is physically proximate to those projects and also allowed me to study Arabic, which I’d always wanted to do. We found a good, international school for my daughter, where she was happy. When the pandemic struck, we decided to bet on Morocco.

How well has the Moroccan government handled the pandemic, in your view?

The king of Morocco and the Moroccan government are science driven, and they acted swiftly and decisively to enforce a strict sheltering in place order as soon as cases were soaring in Italy, Spain, and France (its principal European traffic). Moroccans respect their king and are a generally obedient population when the government makes decrees.

We have had one of the longest, most stringent lockdowns in the world. It will be 90 or so days by the time deconfinement comes (if it comes) June 11; Wuhan was 76 days in comparison.* We’re not allowed outside to exercise — even to take a walk. We’re only allowed outside to grocery shop, seek medical care, visit a pharmacy, or do essential work, and an official permission slip is required at all times. Violations are punishable by prison sentences of up to three months. Masks have been mandatory in public for some time now, and we’ve had a martial-law enforced curfew at 7pm (to be lifted post-Ramadan). Police are on every major intersection, stopping all cars and even pedestrians.

Though it’s a blunt tool to shut down most of society, it’s worked. According to the Ministry of Public Health, as of May 26, Morocco has around 7,500 cases with a 5.2% test positivity rate, which is amazing when you consider that our European neighbors have hundreds of thousands of cases. Morocco has also been producing its own masks and disinfecting gels, and even exporting these. Right now, testing is adequate, though I’m not sure of the future supply chain. I don’t know to what extent Morocco can do widespread testing, contact tracing, and isolation once we open up, but I do know we have a voluntary contact tracing app. Finally, the Moroccan government has acted expediently to financially support those whose businesses have suffered.

Nassim advised on this TED-Ed animation on coronavirus. As a physician and public health expert, she’s spent much of her lockdown time keeping on top of and disseminating accurate information on the pandemic.

How have you been spending your time during the pandemic?

Partially like a caged tiger, desperate to break out and help! I’m practicing clinician and internist in the States, but given I’m in Rabat under a tourist visa, it’s not so easy to work. I’ve found it incredibly frustrating to find myself unable to help at a time of emergency, when my skills could be deployed.

I reached out to international organizations here to see if I could volunteer. I’ve been offering free telemedicine consults, mostly for friends, family, neighbors, and friends of friends. I’ve been doing some COVID-19 content advising for some of the organizations and companies that I work with. (For example, I contributed to a TED-Ed lesson on the COVID-19 pandemic.) I’ve also been advising NGOs on the ground in other low-resourced countries and fragile settings. I’ve occasionally consulted with groups like the ventilatorproject.org that are trying to solve the shortage of ventilators in lower- and middle-income countries by hacking commonly available CPAP and BiPAP machines, which are used to treat sleep apnea.

Meanwhile, I’ve been reading COVID-19 science an average of four hours a day since this started. My fellow clinicians and public health workers who are on the front lines may not have as much time to read, so I’m trying to do as much as possible, while distilling, filtering, and curating the content for them and the public. I’ve been tweeting the best articles and the most impactful science that I’ve come across.

This is a wake-up call for us to promote scientific literacy, critical thinking, and a respectful engagement with those who may not trust or understand the science.

Lately I’ve been obsessed with the disinformation, misinformation, and conspiracy propagation that the UN has deemed an “infodemic” — a serious, dangerous casualty of the actual pandemic. This is a wake-up call for us to promote scientific literacy, critical thinking, and a respectful engagement with those who may not trust or understand the science.

As a clinician and student of science, watching the pandemic unfold has been a fascinating experience. Although the political response to COVID-19 has been bungled by major governments worldwide (most notably the US, the UK, and Brazil), global scientific cooperation has been quite strong. It’s been exciting to witness our rapid scientific progress in real time.

Do you feel safer from COVID-19 in Morocco than you would in the United States, both as a doctor and a mother?

Yes, I do. But this situation is not sustainable. It’s very, very difficult to be confined to an apartment for three months, no matter how nice it is, and not to be able to go outside. I have started running hundreds of laps a day on our small, shared rooftop, dodging the laundry. This pandemic, house-arrest experience has caused a totally new emotion for me: homesickness. So I’ve decided to return home to Seattle as soon as the borders open and air traffic resumes. Being back in Seattle will also allow me to do more professionally to fight COVID-19.

This pandemic, house-arrest experience has caused a totally new emotion for me: homesickness.

Washington State has many more cases than Morocco does. But despite gross federal incompetence in the United States, the Seattle response to COVID-19 has been excellent. It hasn’t run out of ICU beds or ventilators. Morale is pretty positive among health care workers. There has been great community cohesion. People are, for the most part, respecting physical distancing.

However, the United States, being non-authoritarian and quite individualistic in spirit, allows walking, running, and hiking as long as people maintain distance. People are seeing friends and family from a distance outdoors. There’s also no curfew. So it still leaves some room for personal-level decision making, which could put the community at greater risk than in Morocco. But at this point, that’s where I want to be — even with the risk of contracting COVID-19 through my travels.

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Karin Eklund (2020)

What is it like to be locked down as a single woman, and as especially as a single mother, in Morocco? Are you finding the culture welcoming?

Oh, yeah. I feel so at home in Morocco. I love the culture. It feels like the very best of my Iranian culture merged with Western European flavors. So it’s very warm, generous and caring, but at the same time, there’s a sense of privacy and tons of French bakeries! I feel very supported here. I started off in 2018 in Morocco with one friend, and now I have a little village’s worth of beloveds. So I feel incredibly blessed for that.

On the other hand, I’ve never struggled with being a single mother before. I’m in a position of privilege: I’m a single mother by choice, of means, with thriving health, and with a kid who has really never been sick in her life. I have a nanny part of the time, so that makes a huge difference. But being at home with my child 24/7 for over two months, all of the schooling and organization of her time falls on me, as well as her mental health. So I am feeling that responsibility acutely. And I’m finding it very difficult to be productive with work; I’m at about 50% efficacy pre-pandemic.

I intentionally curate joy and whimsy every day. Doing something delightful changes things up.

How do you maintain your mental health?

I intentionally curate joy and whimsy every day, not just for my daughter, but for our nanny as well. It’s incredibly helpful for maintaining our mental health when every day is like Groundhog Day. Doing something delightful changes things up.

We exercise. We have dance parties and play piano duets. One day we did laugh yoga. The other day we did a little showing of old videos of when she was a baby. We do crazy cooking experiments. The latest is beet juice, lemon juice, cinnamon and hot pepper kombucha. We put on comedy shows and turn pillows into stuffed animals. We cut up clothes and make purses and masks. Anything funny, fun, and creative.

By the way, I’m probably the least talented arts and crafts person I know! But I have found some refuge in this, and certainly my artsy daughter loves it.

Given that you’ve lived within so many different cultures and societies, how would you characterize the social inequities that this pandemic is revealing?

Unfortunately, pandemics exacerbate the inequalities that were already there. Almost only the privileged can afford to shelter in place, and it’s the privileged who are more likely to be able to work from home. It’s the privileged who have savings and don’t even necessarily have to work while they are sheltering in place. It’s the privileged who can pause, take sabbaticals, and reflect upon who they are, how they want to move forward through this, how they might contribute. The less privileged are just trying to survive.

There are potential silver linings. On my brighter days, I try to focus on those. The pandemic has illuminated how fragile we all are in the face of this crisis. We could consider a universal basic income, universal health care coverage — which we should have had in the US years ago. We could democratize education, internet access, and a whole host of other basic infrastructure. It has become painfully clear what is and what isn’t essential.

However, the potential to create a more equitable society, and one that’s friendlier to the Earth, is more likely to be in countries wealthy enough to afford economic stimulus plans. In countries suffering the ravages of war, embargoes, sanctions, and political strife on top of a pandemic — I’m thinking about my native country of Iran, in particular — I think those will likely come out of this experience weaker and more fragile.

What do you think life after the pandemic will look like for the world? Will there be such a thing as returning to normal?

That’s a hard question to answer. It’s going to depend on different contexts and populations. In general, we may become hyperlocal for a time until there’s a widely distributed vaccine. We won’t take travel for granted anymore, or big concerts and sports events and in-person conferences. Any large gathering of people, particularly indoors, will now come with a very real risk of spreading the virus. So we may not widely engage in these activities for some time. And then there is the global economic depression that’s to come.

Shakespeare may have written his best work during a pandemic — but a woman sheltering with others will likely be doing the bulk of cooking, cleaning, remote schooling, and childcare.

What should we, as women of color, be doing and thinking about during this time as we prepare for a post-pandemic world?

Women are more vulnerable to the effects of COVID-19 in general, though men are more likely to die if they become ill. Women are more likely to be the care-givers, frontline workers, less economically self-sufficient. Shakespeare may have written his best work during a pandemic — but a woman sheltering with others will likely be doing the bulk of cooking, cleaning, remote schooling, and childcare. We’re also more likely to suffer consequences of domestic violence during a pandemic. Meanwhile, people of color in the US and Europe (we don’t have that equivalent here in Morocco) have been at higher risk of getting and dying from COVID-19 — partly because they’re less likely to be able to shelter in place, have more comorbidities (including the physical and mental effects of racism) and fewer economic safety nets — though may have more community relations.

For women of color with privilege, I hope we use every platform we have to speak out on behalf of those who don’t have as loud a voice, help each other out, and remember that, while pandemic stress is not a competition, some people are suffering more than others. As an Iranian-American woman who’s been given a very privileged and wonderful life, I feel a responsibility and existential need to help those who are less fortunate than me, particularly vulnerable women.

*Update: as of 17 July 2020: “Morocco has increased its testing and decreased its positivity rate: of almost a million tests, there is 1.75% positivity as of 17 July 2020,” says Nassim. “These numbers are a tenth of Morocco’s closest neighbors in Europe — with far fewer deaths. The whole country of 35 million has 3x fewer cases than Washington State, which has 7 million — and 6x fewer deaths.”

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POSTSCRIPT: Since our conversation, Nassim chose to return to Seattle. While she would like to return to Rabat in the fall, that may no longer be possible given that Morocco is only allowing citizens and those with residency permits.

Subscribe to Nassim’s vetted, evidence-based sources for COVID-19 globally: https://twitter.com/i/lists/1238811564095963142

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organic unidirectional time machine // writer + artist // aka oculardelusion // karenfranceseng.com

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