giving thanks

I've been grumpy the last couple of days. Feeling disillusioned, questioning professionalism and effectiveness and purpose in this place. I made it to Bangui and back. Spent a weekend half composing stories to record or share but not finishing. One about Bangui, first impressions vs more than a year later, conspicuous and/or thoughtless consumption. Another about the New Year's Day incident, holding down that boy while the technicians pronged for the bullet in his foot, picking through bone fragments.

A long flight with several bumpy takeoffs and landings later, I came back to the project, had a quick, maintenance bite to eat and went to my bed only to emerge what felt like two days later, having been the next in line to catch whatever that virus was going around. Still grumpy.

But tonight, frustrated, searching for the floss the cleaning lady must have misplaced in her sincere effort to dust the nightstand, I came across a handwritten letter I'd found laying on my bed on my return from Bangui. I'd skimmed it at the time but deeming it not of urgent importance I put it aside. I read it for real tonight.

Translated from French, it reads:
MOTION OF THANKS TO MSF
We, the people of the four camps in Zemio for internally displaced people, united in a general assembly on 7 Jan 2012.
We address our sincere thanks to MSF for their health care assistance and for our protection since 2010 to 2012.
Happy New Year and keep up the good work.
Signed in Zemio, 7 Jan 2012
The Displaced

I don't feel so grumpy going to bed tonight.

Resolved

What if I just sneak back on here like I was never gone? Just as though I haven't been guiltily ignoring my burning desire to document and share my thoughts and experiences for the last year?

Today, in a near fit procrastination, I pushed though the haze of inaction to open up this site and write something down. I really should have been writing H's evaluation. She's leaving next week and I should have gotten to it earlier. No one is ever in a rush for an job evaluation, despite their incredible potential usefulness.  The Mboki report that never really got formalized could have also been done instead of this.  End of year report?  Solving the contract issue with the Kondo Health Post property; yeah, that too.  Probably not coincidentally, the deputy mayor happens to own that house. We don't want to move it, 'cause we've already invested in making it a health post. She wants to tear it town and build something she can rent for more money.

I could be revising the evacuation protocol to be better prepared for the onslaught of visitors in the coming months.  Or refining my topics list for next week's country management meeting. For some dumb reason we call it that as though we are the ones actually managing the country.  I can't think of a cleverer term right now but actually it's just me in this corner of the country and Tom up in the other corner.  Well, that and the pile of support coordinators at the capital.

So what's happened since that hopeful post in March, 2011?  I went to Somaliland all right.  An amazing place, totally not what I, or very many I came there with expected.  Cell phones, interenets, kids wearing shoes.  It's a pretty long story and one I regret not having more closely documented - I'd have liked to have read it myself in the future to remember.  To summarize, I wasn't happy with my job there. I had expected something different based on both my own prejudice and the info I got from my HR channels in accepting the job.  In the end, it turned out full of valuable lessons learned and experience gained.

And it lead to here.  I am back in the Central African Republic, this time as a full-time project coordinator in a totally different part of the country than last time.  There's this little town in the southeast of the country called Zemio.  The Lord's Resistance Army (google it) came into the region in late 2009/early 2010 and several thousand people ended up becoming displaced - meaning they fled their villages for bigger population centers, overwhelming the fragile infrastructure in those centers.  That's where MSF came in, to support the health center of Zemio.

Now we have a hospital with 26 beds, a maternity with 9 beds.  An outpatient clinic that sees between 200-300 people per week and a malaria health post on the other side of town.  A couple of months ago we started HIV and TB programs to treat those suffering most from the diseases.  We also support two health posts in two not-entirely-depopulated villages on the roads outside of Zemio as well as two health centers (a little bigger than health posts) in the two most neighboring towns to the north and east.  I manage 6 expat staff who in turn manage another 90 or so personnel. Our budget for 2012 is around €1.4 million.  I am responsible ultimately for the program direction, material and human resources, finance, and security.

This is the job I always wanted with MSF.  I think.  Everyone higher up says that PC (project coordinator) is totally their favorite job, even after they've surpassed it in responsibility.  For me, though, it doesn't come without lots of questions; the same ones I've been asking since I started with MSF about efficiency versus efficacy, development versus humanitarian aid, and general concern over the plight of people in poverty. Defining poverty itself.  Those are the kind of questions I would like to spend a little more time exploring but unfortunately, I do not feel at all qualified to talk too much about it. Barring the heavier discussions, hopefully I can dally with the little details of fine Zemiote cuisine or bike rides through the jungle paths.


Come along.  Post comments and encourage me if you like what you read.  Send me facebook messages or emails when I fall off again.  Every week a story is my goal. My nine month mission is 2 months done and I still feel like I just got here.  The next 7 will slip by with only gmail chats and non-contextual facebook posts if I don't keep some kind of journal. 

return of the log blog

I am back. Fresh from a little more than 3 months vacation, a hardy helping of winter. Back in the field. It's extremely bright and surprisingly cool in the capital, the air far from what I'd expected except for the dryness.

This time the security question of the blog content is a little more pointed. I haven't yet figured out a format for story telling that will be compatible with this medium. No one I've talked to in the organization thinks it's an overly good idea, what with losing control of published info as soon as it's up. I think I will be able to handle it, but I'll have to be careful. Bear with me if I am vague about details and place names. In fact, I might never say where I am at all.

In any case, I will say that I will be working the same kind of job as last mission but with a little more emphasis on administration and security. The project is secondary health services, supporting a local hospital. The team is bigger than last time but the mission in the country smaller.

Seriously, it is so bright outside here. I was just staring out the window, a window half closed by curtains that leads to a covered balcony that looks over the western sky. The little bit of near white sky and the reflection of the yellow compound wall (that in my field of vision takes up about 1"×3" at arms length) is so blinding that I can't look out the window at all and return my gaze to the computer without a huge sunspot obstructing my vision. Impressive. I've not been many places brighter than Colorado, this place might be.

pavlog's log blog

I am a crappy blogger. Seriously. How come I can let this thing lie fallow for weeks and weeks at a time? Am I not self-important enough? Or am I too self-important?

 

I've got all these starts of blogs that I never got into finishing - some are just a sentence.

 

One is about this argument we were having over lunch one day regarding the community water committee for the well nearest the hospital. The Project Coordinator at the time was arguing that the well should be free for MSF to use since we provide free medical care to the community. However, the NGO (Action Contre Le Faim) that set up the well, and the committee, put in place a cost recovery system so that repairs to the pump in the future could be covered by the community and not rely on handouts from NGOs.  The argument that we were having struck right at the heart of our work here from the macro level and also illustrates how development can come to a head with emergency relief.  Clearly in an emergency you don’t need cost recovery, it’s an emergency – just give. In development the aim is for the people to become self-sustainable and move beyond relying on aid.  Here we seem to be always stuck right in between those places. Anyhow, I was advocating for reinforcing the cost-recovery system and offering to pay for our use of the well, just like the families in the neighborhood. Who cares if what we give is free – no one asked us to give it for free, our presence here shouldn’t hinder development, right?  The other side was arguing for the idea that people who offer free goods should be supported by the community. But what is free? Nothing. Even in the “freest” of universal health care, someone pays, and everyone is paid.  The guy that turns on the water every morning for the hospital in France/Japan/USA still gets a paycheck, right? The water company still has to support itself, right?  If I haven’t mentioned it in previous blogs (which I still can’t check from here because that story about the incoming internet connection turned out to be a big tease), then I’ll say that my stay here is constantly reinforcing certain capitalistic beliefs.

 

What’s another one… Oh, yeah – Fairness. There was this big long story I wanted to tell about fairness here in MRK. The battles I/we face on a daily basis to maintain a “fair” approach to every thing we do. For the community, for the employees.  And the uproar that happens the instant that something isn’t fair. All the expats talk about this all the time but I had this realization of how fairness is at home.  I seem to remember this world at home that is constantly reminding people of how the world is not fair and how to deal with it. But the result is often to accept the unfairness and work to bypass it.  Or to push everything into categories to explain the inequities. Sure the immediate human instict is to just feel that when good things happen to others and bad things happen to you, there is some sort of unfairness. But that instinct is childish and not productive, and our society puts a lot of effort into diminishing that – something I wouldn’t have thought of or noticed or I might have even disagreed with before living here. Of course life here in Markounda overall really is not fair. But tell that to the employees who didn’t get picked to go to the capital for the Field Management Course. Or the the two nurses to whom the last expat doctor just mailed some gifts (rather the people who didn’t get the gifts). I am going on vacation next month and I would love to bring some stuff back for a couple of my favorite and most helpful employees. But I can’t because of how it’d be perceived as unfair to the others – even just a small gift like a pocket knife or a pair of work gloves or a flashlight. I think that a healthly long essay could be dedicated to the sense of fairness in a massively impoverished community/country like this one.

 

Note that when I talk about poverty here – it’s not like any poverty I have ever seen before. In the sense that you don’t really even need money to survive here, it’s so poor. People grow their own food (everyone grows almost all of their own food). People build their houses out of local material – mud bricks and straw roofs. Of course the poverty comes into play when faced with the commodities of the modern world. The fact that a sheet metal roof is better than straw in 100 ways.  Growing your own food leaves you vulnerable to starvation from almost anything that would prevent you from doing making it to the field or anything that would make your field not produce. The modern world offers so many solutions to many problems that we don’t usually even think of as problems. But here in Markounda, modernity only peeks in just a little bit. In a way that after a while makes it seem less poor sometimes.

 

And then there was the story about the “promotion.”  About 6 weeks ago the project coordinator (PC) left the project.  The coordination in the capital gave me the title and the responsibilities and I have been the PC since.  Not ideal since no one came in to help out with the job duties I had before the “promotion.” It’s one of my excuses for not writing… it’s been a lot of work. Take that task list I posted a few entries ago – everything that I said “partially” I am now doing fully. And then some. But the flip side of the work is that it is also a ton of fun. I always wanted to solve problems for a living... Anyhow...

 

Questions and comments and encouragement is always welcome at msfh-markounda-log-sat @ field.amsterdam.msf.org  Same rules as mentioned in the previous post about emailing here apply.

Doctors without Borders

After getting a few emails from people, I realize that I never really explained in this blog what I exactly I do here in Markounda.  Funny enough, it's only 6 months into my mission here that I feel like I could adequately tell you.  The last month and a half we've hosted quite a few visitors and I have given several tours of our operation and even a couple of detailed security briefings - I ended up getting asked questions that I didn't know the answers to, but after a little digging around, now I might be in a place to explain. Any of the following information could certainly be improved or might even disputed by someone who knows better, but this is what I think I know.

 

MSF has several operational centers that oversee projects in different countries around the world (more on that at MSF.org).  I work for MSF Holland but for reasons long and political, the Central African Republic (CAR) is overseen by the local office in Berlin.  MSF Holland has been in CAR since 2005.  Our project here in Markounda started around 2006 as a little health post to provide basic medical care to a population that had been displaced due to conflict in the area. A high percentage of the population at the time was living in the bush as their villages had been targeted by government forces looking to suppress an anti-government insurgency.  Many were also living as refugees across the river/border in Chad.  As time went on, the political and security situation stabilized a little, people started moving back to Markounda and rebuilding the village.  The ministry of health had long since left this area and the catholic mission that had been providing health care had stopped for the same reasons of conflict that caused people to flee.  After people started coming back, MSF was the only source for health care in the region and our little health post grew and stabilized.

 

As it stands now, we operate an outpatient clinic (OPD) and an inpatient clinic (IPD) as well as several health posts on the roads between our other projects.  The OPD serves about 300 patients a week treating mostly for malaria, diarrhea, respiratory infections, basic wound dressings.  We have a pre-natal care clinic once a week and give vaccines once a week. 

 

The IPD has 28 beds, treating for the more severe cases of the above as well as having a delivery room and a small malnutrition program.  Most of the beds are full most of the time, sometimes we overflow a bit and sometimes we wonder where all the sick people went.  The most severe cases, like surgery candidates, c-sections, etc. we refer to a bigger project, sometimes sending patients by motorbike, sometimes transporting them ourselves.  Patients stay with us for an average of 6 or 7 days. They are allowed for a caretaker to stay with them, usually there are a handful of children that accompany the caretaker or the patient or both. We provide food and water to the patients and their caretakers while they are in hospital and we have a fulltime kitchen and food stock devoted to this task.

 

Our health posts are staffed by MSF trained local population paramedics who treat mostly for malaria and help gather statistics on the health of the surrounding population.  We frequently receive referrals from the health posts. The MSF expat nurse supervises the health posts about once a week or so. Occasionally we do vaccination campaigns based out of the health posts.

 

According to our demographic information, the town of Markounda is about 3,500 people and the surrounding populations are a few times that.  I’ve read somewhere that we serve an area of some 30,000 people but I think that number might be a little inflated. The security situation in this region of the country is tense but currently there is not any active fighting and most of the actors get along though everyone worries that the peace is shaky. Banditry and general lawlessness is a bit of a problem.

 

My title here in this project is Logistician (or Log).  I was originally hired as a Tech Log to oversee a big rehabilitation project that, shortly after my arrival, was revised and no longer needed full time supervision. A little reshuffling of personnel later, I took over the position of the administrative Log in addition to my “tech” duties and for the last 3 and a half months have been the all-around Log.  So, that means that I supervise:

-    Medical and non-medical supply management. Ordering, receiving, warehousing, distributing medication, equipment, fuel, food, pretty much anything that comes or goes in or out of the project.

-    Movement of expats and staff. Landing the plane, supervising the vehicle maintenance, drivers, informing the rest of the mission (other projects and the capital support team) of our movement intentions and needs.

-    Electrical systems. Generators, charging systems, etc.

-    ICT. I keep the computers running, supposedly.

-    Cold chain. Certain all vaccines and certain medications and lab material needs to be kept cold. This can be a bit of a challenge in the 100°F heat that we get pretty much every day. We have both solar and kerosene fridges, the latter of which I recently upgraded to jet fuel and they seem to be much happier.

-    Communications. We have a few different methods of satellite communication (this thin little email connection to the server in Amsterdam) and a host of HF and VHF radios in the base and the cars.

-    Construction. We ended up doing that rehab anyhow… There are a couple of bridges in the area we need to address before the rainy season kicks into high gear.

-    Basic maintenance and repair of anything and everything that might break that we can’t just replace.

 

Uuh. What else. Oh, yeah:

 

-    Finance and administration. I am the guy who orders and counts the money and stuff, signs the paychecks, supervises the accounting.

-    Certain parts of HR, mostly involving stuff like contract and vacation dates, sick leave, maternity leave, schedules of the employees related to the above tasks.

-    Certain aspects of security. Guards mostly, and the above mentioned movements and communications. In fact, everything has a little bit of a security aspect to it.

-    I almost forgot, certain aspects of water and sanitation. Maintaining the water collection and distribution chain, chlorination, latrines, drainage. We’re in the process of handing over quite a bit of all that to the medical team who is probably more qualified than I am to supervise hygiene but I still have my finger in that pie. Is that the wrong metaphor when talking about hygiene?

 

Well, I’m sure that there is more and I am just forgetting it.  I was actually looking for my job description for some time and when I complained a little about it, I was given the task to write it myself.  The above is the closest I have come to doing so.  Funny, when you write it all down, it seems like a lot and frankly it is. It’s probably a good thing that there isn’t anything to do around here at night otherwise I’d never find time to write anyone anything. But I have a pretty good staff (about 23 people, 6 directly under me) and they are really the ones running the place – the supervisor (my position) changes out every 6-9 months, so you can imagine how that adds to efficiency.

 

So in many ways, my job here is just a regular office job with meetings and to-do lists, dead-lines, conflicts with co-workers about this little thing and that.  But we’re doing it all in a 3000 BC farming village meets bizzaro Mad Max land, 1000 miles from anything most people in the US would consider a city but less than 70 miles from what has recently been determined to be the exact geographical center of Africa (ask me about the centroid sometime). You know, it’s a job… And not a bad one at that.

 

 

 

3 o'clock high

I never blog in the day time.  It’s 15h00.  The reports that I didn’t want to do last week are done – the MSR, the TSR, the KPIs, the VFU sheet, my project equipment inventory list, and the 8 page narrative report that ties it all together.  Apparently, we do this every 4 months.  You’d figure that giving things away, charity, should be simple.

 

I am mostly caught up on supply papers. Still procrastinating a couple of receptions but I’ll have to get to them before the generator goes off with the printer.  And the fan.  It’s hot and I just figured out, on close examination of the fan (that only runs when the generator is running otherwise it’d suck the batteries dry) that there’s actually a fair chance that those whirling stamped sheet metal blades could just come down from the ceiling with little to no notice and cause some pretty serious damage.  Would cut your head off or anything but could result in some stitches, certainly some triple antibiotic ointment (which we don’t have, funny enough – only antiseptics) and would probably result in a broken laptop screen. The fan is attached to the ceiling with a bent 10 penny nail.

 

Water and Sanitation advisor from Amsterdam passed through here yesterday/today.  Learned all kinds of things that I would have thought I knew but didn’t really.  At the last minute he ran a test that I think might have just solved out team diarrhea problem we’ve been having off and on for the last couple of weeks.  Turns out that when concentrated chlorine is exposed to high humidity, it absorbs the moisture and begins to break down, becoming less potent.  Didn’t know that.  I had followed up on chlorination procedures recently, suspecting hygiene myself but everything added up as it should – I didn’t account for bad chlorine.  Rainy season stuck it’s foot in the door just about a couple of weeks ago and the ambient humidity been high ever since.  Switched out our chlorine concentrate for smaller, less susceptible to contamination containers. I’ll run the tests tomorrow and see if we’re back to normal on the chlorine side.  Total sum of the visit? A bucket of HTH chlorine, a couple of cases of soap, and a little hygiene awareness campaign would fix at least as many problems as a whole warehouse full of drugs can.

 

Landed a plane today. Not as a pilot, but as the air traffic controller.  Pretty easy since there’s no air traffic – you just keep the cows and little kids off the runway and speak little airplane talk – Red526, runway two one clear for landing, wind two zero, speed five to ten.  Actually, it’s totally routine now, plane comes twice a week.  Anyhow, today, right after landing, the military jeep the base in town rolled into the airstrip full of soldiers and with the big swivel gun obviously loaded (it’s not usually). Rolled in like they meant business.  No business, just looking.  Scared the crap out of me for about .5 seconds. Then I saw the lieutenant was wearing camouflage hot pants. Awesome.  We don’t get enough hot pants around here.

 

 

 

 

 

oblahdee

I have been procrastinating writing the narrative for my 4M report for days. I just don't want to. Now I am right up to the deadline and I am going to have to pull an all-nighter to get it done.

 

Walked to the market today. I don't leave the compound very often lately.  Sunday afternoon and there's a lot of seemingly angry drunks about... I kind of get the feeling like there are plenty of people in this town who would kill us if they thought they could get away with it.  The fate of people who do wrong here in the eyes of the community is not usually too nice.  Kill - get killed. Rape - get killed.  Steal someone's cows - get killed.  I can only imagine what the community punishment for driving away the only source for medical care would be (free medical care at that).  Does that mean that I am an unwitting beneficiary of frontier justice?  We make it a point to not get involved in or at least be very careful in how we get involved in any sort of even potentially criminal matter.  Just treat the patients and stay neutral...

 

I am kind of bored lately.  Right now it's just 3 expats in the project and it looks like it is going to stay that way for at least a few more weeks.  It can be a little tiring.  Sometimes I wish that this blog thing should work backwards once in a while and I could hear what people I know are up to.  And hey, why shouldn't it?  I am going to do something horribly foolish and give you guys my email address here - I trust that you'll act responsibly with it and not add it to your spam list or your joke of the day list or whatever.  But if you want to send me some news or say hi, it could be pretty awesome. I could even entertain topic suggestions for the blog, answer questions.  Right now, I can’t read the blog comments from here so it’s currently a very one-way means of communication.

 

OK, Here are the rules:

 

1. Text only - that means no pictures, no links, no attachments, no fancy HTML, etc. Bandwidth is scarce and even internally we have a 100k limit.

2. Put my name in the subject – this is not my email address, it belongs to my position here, if ever I am out of the project or change jobs, this email is no longer going to go to me.

3. Delete this email address from your system when I post that I’ll no longer be here – same reason as above.

 

Msfh-markounda-log-sat at field dot Amsterdam dot msf dot org

 

I spell it out because I am deathly afraid of spam and our ability to combat viruses is as limited as our internet connection (which is none) – we get a CD from the capital every 6-8 weeks with an update…

 

Is it a deal?