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.