Bushwacking

Day two of the explo, and I'm running in front of a huge, mud-spattered land cruiser with its engine roaring. I'm about 10 meters in front of it and it's gaining fast. It plows through a mud puddle, launching water all over the hood and halfway up the windshield, but that hardly slows it down.

It's not a nightmare, and I'm not scared. That's our team's car, and I'm scouting for the passable route through stagnant puddles along our "route pourri" to get to Sandoa. Yesterday, we traveled 102 kilometers in 6 hours before getting stuck in the mud. Today, we have 119 to go, and apparently we are just reaching the bad part.

After spending seven hours yesterday wading through the same mud puddle, swarming over our poor, stuck car, I am no longer hesitant to plunge into the muck. I need to remember to take an anti-parasite tonight. Already this morning I've waded into stagnant water with a thin green film on the top countless times. I've zipped off my pants into shorts to expose my bruised, pale legs. At least they'll get the chance to tan a bit to match my arms. The water sometimes reaches above my knees. That's about the limit, but it's not a hard limit. We'll go through water up to my thighs, but it depends on the bottom. Mud is a problem, but there's a lot of firm sand. That's OK. Hence the reving engine and charging land cruiser. It takes a lot if force to get through a puddle a meter deep.

The shockwave of recently-stagnant water hits me seconds after the car roars by, after I've jumped into the jungle growing right up to the thin two-track we call a road. Turbid, smelly water washes over my feet to the ankles, and I jog forward to congratulate the driver and scout the next puddle.

We've done 20 kilometers in 3 hours. Only a hundred more to go. We have 5 hours. I hope to sleep in a bed tonight...

Embourbé

I look to see what's brushing my leg. I saw a giant spider as I brushed my teeth. Not tarantula-quality, but it looked pretty competent none-the-less. My leg is assaulted by my T-shirt, not some killer bug from hell. Cool, now to get some sleep.

I'm squeezed into a small tent, pitched on the dirt road, a few meters in front of our car. We set off on an explo today, meaning we are going into a district MSF does not work in (currently) and checking things out. We will try to determine the population's access to health care and their need, if any. We are specifically looking at malaria, which is fortunate for us, since this is the start of the peak malaria season. We'll find plenty if patients, but the trick is looking deeper. We have many pages of parameters and evaluation criteria to help us with our final report, but we only have a loose idea of where to go and how to get there.

One thing we are sure of is that the main route between the district that we just vacated and the district we will be exploring, if you want to call it a main route, is terribly, inconveniently horrible. In French, "full of holes." Which is apropos, considering we just spent 7 hours getting our car out of a hole.  We are now camped 100 meters further down the road, which was the first flat, dry spot for the tents that we saw. We will restart tomorrow, but for tonight we tried to rub the sand off, stripped out of our soaked clothes (it's rainy season in the Congo. 7 hours does not pass without at least some rain), ate a cold dinner of tuna and crackers, and crawled into our beds to gain whatever sleep we could before we set off again tomorrow. Morning. Around 6am.

Since it is almost midnight, I'll leave it there. Goodnight.

Christmas in the Field, part 2

Still no response on the turkey, and we are two days away. It really doesn't feel like Christmas, since we are ramping up our closing activities. Tents will start coming down, the stock will be emptied out, and donations will be made.

We get the cargo list today for the plane that arrives tomorrow. We should be receiving our Christmas good order, that included chocolate, butter, wine, carrots, potatoes, lemons, cheese. The luxury items we can't find here.

There is a sheep screaming every minute or so outside of our compound, tied on a tether and awaiting Christmas. I guess lamb is plan B if the turkeys don't come through. The sheep is very unhappy with the idea, and lets us know, all day long. He's got grass and water, but he seems to want friends. Demanding sucker, he is. We'll eat him soon.

I'm off to give the plane briefing to the four people flying home to Lubumbashi tomorrow. Our team is slowly reducing from 30, until in a week and a half we will be 0.

Merry Christmas, Kapanga.

Christmas in the Field, Part 1

I'm searching for a turkey. Two, to be exact.

I've gone the 8km into the administrative center of the district, because, believe it or not, I've seen two turkeys there. I guide the driver with vague hand gestures. Were they there, or down by the river... The need to scrape my memory disolves as two huge turkeys appear in the road in front of us.

Found em.

Gla gla la la la!

They call a greeting as we show up, searching for their owners. We ask a few policemen who are lounging around. Can we buy these turkeys?

I explain that in the culter where I come from, we eat turkeys for special occasions. Christmas is coming! We want a turkey dinner!

The owner is apparently the district administrator, and he has returned to Lubumbashi for the holidays. We cannot buy these turkeys. We ask if they know of any other turkeys in the area. They point us to the Sisters at Ntita.

Off we go.

5 kilometers later, we pull up to a sprawling campus with huge brick buildings soaring over graceful arcades. The gate us opened by enthusiastic children as we approach, and we walk into a quiet, clean courtyard with the sounds of a student choir echoing out of a nearby building. We walk into the nearest occupied room and state our mission. They point us to the headmistress's office.

We shuffle in, not wanting to interrupt, but everything stops when I enter. Oops. Chairs are brought and we ask after turkeys. She laughs and wracks her memory. No turkeys here, and there haven't been any for a long time. Are there any turkeys for sale in the area? She thinks and calls to her colleagues. We are encouraged to buy a cow instead, but after insisting in turkeys, they recommend a place in town.

5 more kilometers later, just a few hundred meters from our front door, we ask the trucking agent for turkeys. He knows two people with turkeys, and he'll get in contact with them today. We can come back in the evening and check if they are willing to sell.

A lukewarm lead, but better than nothing.

We head to the market and ask if anyone has heard of turkeys for sale. We get pointed to a place around the corner and ask there. Dead end. We head back via a restaurant with a very nice owner and ask her. No luck either.

Content that we have gotten the word out sufficiently, its time to wait.

Our wild turkey chase has turned up nothing so far, but we shall see what Monday brings.

Heart of Darkness

I'm in Kapanga, which is a zone in the Democratic Republic of Congo's southern Katanga region. It's my first time in Congo, and it's living up to the stories. I've heard it is beautiful with friendly, proud people. I'm not in the deep jungle, but it is hillier and greener than anywhere else I've been in Africa.

We are closing our project after investigating the epidemic status of the measles outbreak.  We opened here in early November, with the intention of closing on December 31st.  With a few weeks to go, we will meet this goal.  These last few weeks are filled with meetings, finalizing plannings and schedules, back-and-forth emails with the coordination team, and lots of questioning why we are leaving.

It feels bad to be closing our doors on a pediatric unit that is just starting to become flooded with patients, but it is the end of our mission, the measles epidemic is over, and our long-foreseen depart is almost upon us.  That doesn't make us feel much better as we brief the teams and prepare the final trainings for a handover with the Ministry of Health.

I'm making up the packing list of unused materials that we will start to send back on the plane next week, to start the 3-week long closing process.  Staff will start leaving on Monday, first in a trickle, then in a flood.  There are many things to do, logistically.  But there is still time to enjoy the scenery.

Here vs There

It's been another trip back, another time warp and culture shock.  I left the field on Thursday, September 10th, then stopped in Juba, Paris, and New York before returning to San Francisco.  I had a full weekend in Paris, taking my first hot shower and walking alone.  I re-learned how to cross streets, enjoyed the convenience of supermarkets and reveled in the abundance of the farmer's market.  Then it was on to New York, with a one-week pause to see family and friends.  I ended up sleeping in a different place every night for 8 nights running, which was a bit of an adventure.  Then it was back to the West Coast, adding another few hours onto the jetlag, and increasing my already-six-month-long sleep debt.  Time for some relaxation.

Every time I return, I'm struck by certain differences.  Last time, the technological gap seemed to me like time travel.  This time, I'm really noticing the fashion and beauty standards of the two very disparate places that I live.  Coming back, I feel that everyone here tries to be the same.  As I take the bus in San Francisco, up into the Marina District, the stereotypical Marina Girl populates the bus.  They have tight black yoga pants, a slouchy I-don't-care shirt, long gorgeous brown hair that costs a lot of money, a trendy phone in a cute case, ear phones, and makeup.  I see them in a row, and I wonder what the story of each of their lives is like.  I cannot fathom that they are each individuals.  It's shocking to see this drive to homogeneity, in a society teaching every millennial "you're special," "you're unique," "you're a pretty snowflake."  And many millennials strive toward the current flavor of beauty or perfection, turning themselves into indistinguishable dolls.

Coming back from Aweil, South Sudan, this is shocking to me.  In Aweil, many people have never seen themselves.  Open water is too muddy to provide a clear reflection.  There aren't too many mirrors.  Our security rules prohibited the taking of photos, but for my work, I needed to take pictures of construction works.  I would try to avoid taking pictures of any person, since getting their permission is time-consuming.  I'm just trying to take a picture of that latrine pit, excuse me.  Sometimes, though, children would see us taking pictures of construction works, and clamor for a picture.  They would grab the phone and turn it around and stare at it.  When I took a picture of the progress of a pit being dug, the workers asked me to print out the picture.  I brought it the next day and gave it to them.  Eight grown men stopped work and clustered around.  They stared at themselves.

People live a difficult life, and it is apparent in their appearance.  Aside from being gaunt, they are scarred (many ritually, with tribal identification scarification) and sometimes disfigured.  Missing eyes or limbs are not extraordinarily uncommon.  People are stamped with the journey of their life.  They are individuals, and show on their faces the times they have been through.  They are self-conscious to different beauty standards.  Much stake is given to someone's appearance and clothes. Shoe-shine boys wander the streets, making their living in polishing the population's shoes.  Everyone has their shoes shined.  Men wear button-down shirts, neatly pressed and laundered.  Perhaps they are threadbare and torn at the seam, but they are clean and neat.  Women wear clothes with a vibrant and colorful fabric wrap tied around their shoulders, adding splashes of color to the market.  They do their hair and style it, or wear wigs and keep their head shaved for convenience.  But no one is fixing their face.  No one is changing their appearance to look more like a beauty standard of the country.  There is no body sculpting, no plastic surgery, no make up.  No journey towards a perfect beauty standard to make everyone homogeneous.

But maybe that's because they don't yet have the resources for it?

I'd say to show your scars, be yourself.  You're beautiful the way you are.

This Week Requires Documentation

Many of my posts are day-in-the-life posts, which I write after a particularly crazy stretch of activity.  Sometimes I'm struck with the thought, "This is too crazy; I have to tell someone."  Sometimes those days are memorable, like when key personnel were on vacation, a team got stuck on the other side of the river as the ferry broke down, and a cholera outbreak was just announced in the western part of the country; or when riding along on a vaccination campaign.  Sometimes, they're not particularly memorable but distill the amount of activity of a project into one encapsulated story.

This week was an example of ludicrously high levels of activity, where I kept asking, "Is this a joke?  Candid camera? The Truman Show?  It's a test.  It's gotta be a test."

Some background: I'm the logistics referent at a project in South Sudan for MSF.  I coordinate the logistic activities (operations, maintenance, infrastructure, engineering, supply, this sort of thing) for a 200-bed hospital, including warehouse/pharmacy complex, office, and housing for 25 expats.  My team is divided into 3 branches (base, hospital, and supply).  We're 100 logistic staff, all together.  We have been short one manager for the past 5 months.  Sometimes that's a base manager, sometimes it's a hospital manager, sometimes it's a supply manager.  The team here has had to fill gaps for a long time, and since supervisors are responsible for keeping the day-to-day activities running, it falls to me to replace the managers.  After all, I'm here in pure support.  I do quality control, training, and coordination, but no actual management or tasks.  In my job as log ref, I don't actually do work, I like to say.

This week was the perfect storm of ridiculousness.  Last week was the visit of the Logistics Coordinator from the capital, and the Logistics Supervisor from headquarters.  It's a big visit, so I was preoccupied with them.  There is no hospital log at the moment, so I was covering that position, plus doing my job, plus hosting those two.  Needless to say, this took a lot of energy, and the team was tired from a big visit, plus pulling more weight than usual.  We also had my going-away party on Saturday, since I'm leaving (inchallah) in another couple of weeks, which was another load on our department.

Monday starts with dismantling tents and recovering from the party, but quickly escalates.  The AC technician flying in from Juba, for his quarterly maintenance of the project's air conditioners.  Also, a flying radio technician arrives from Paris, to do inventory and evaluation of the project.  He doesn't speak any English, and I don't know what his objectives are.  I learned about him from the movement plan, rather than getting briefed on why he's coming.  I don't know what to do with him, and only the Supply Log and I can speak French in the whole department.

Tuesday ups the ante, because the Supply Log leaves for vacation.  Vacation was planned a long time ago, and he is dragged kicking and screaming (metaphorically) onto the plane.  He knows it's a ridiculous week, and he doesn't want to leave us alone.  He has to go anyway.

Also leaving on Tuesday is the biomedical/electrical technician, to make his quarterly visit to a sister project.  He was taking care of the AC technician, so in absence of the biomed electrician, and the hospital log, I'm the one to follow the AC technician.

So we're left with only one French speaker (me), minus a biomed focal point, with a couple of technicians running around, poking into corners.  Then two more visitors arrive.  The country mechanic, from the sister project, arrives to install the gear box on the vehicle that's out of commission.  We had received the gear box from the capital the week before, and have been renting a car to cover for the out-of-commission vehicle.  Also arriving with the country mechanic is the generator technician, from the company supplying our generators.

I forgot to mention that one of the hospital's generators stopped producing electricity a week ago, so we've been running without backup for a week.  We did a marathon wiring session on Friday afternoon, involving 4 electricians working side-by-side for an hour, to get the old MoH generator hooked up as a temporary backup.  Monday, the only working generator ran out of fuel (because I didn't keep track of the fuel consumption and forgot to check that morning; did I mention I'm a bit overloaded?), so we fired up the MoH generator, only to find that phase 3 doesn't output any power.  Also, it keeps tripping its breaker because it's too small to support the whole hospital.

So at least the technician is here to look into that, but since the biomed/electrician has just left, again it falls to me to follow the repairs.  Maybe the country mechanic can help a bit too.

There are no flights on Wednesday, so I can't lose any more people, or gain any more repairmen who need to be followed.  But instead fuel arrives, and they get impounded in customs, with the government trying to extort money.  I'm in the middle of negotiations to sell an unused generator, so the project coordinator takes over and talks with customs.  A full morning of negotiations later, the fuel is released.  It takes me an hour to get the counters calibrated and fueling started, then I recruit the first person I see (a medical consultant here for a week to help with data collection and analysis) to supervise the end of the pumping.  After a rapid induction into the order of Log, I leave her to supervise.  I hurry to the hospital with the other tanker, to unload the fuel there.  I explain the amounts of fuel to go in which 3 tanks, writing the numbers in the dust on the tanks.  I'm glad I learned arabic numerals.  I call a watchman to supervise the fueling, since I have to go to a monthly meeting of all sanitation officers, since I'm the acting Log Hospital.

Thursday was the most ridiculous day of them all, with the famed arrival of the cargo plane.  In the morning, the AC technician did a whirlwind tour just before leaving to the airport, where I typed his report for him in a last-minute blitz of documentation.  Due to a miscommunication, he didn't know he was supposed to remount a compressor, but the compressor mount we had installed was in the wrong place.  We frantically searched for a welder, but had to stop the work just as the welder got started, in order for the technician to catch the plane.  The near miss was very disheartening, since the work was completed 30 minutes after his departure, and we could have had it all sorted if there was someone here following the technician.

We had been discussing for weeks the arrival of a huge shipment of medical material.  We had been tracking it from its arrival in Nairobi to its sporadic journey by refrigerated truck overland to Juba, through customs and checkpoints, to arrive at Juba airport.  The orginal plan was for it to arrive on the 21st.  Then it was pushed to the 24th.  Then we heard on the 24th that it was coming on Thursday.  With the signing of the peace agreement in Juba on Wednesday, we almost cancelled the whole thing, since the airport was closed and we couldn't get our trucks in.  We finally got word on Wednesday night that we were on for Thursday afternoon.  This meant that our offload time collapsed from 5 hours to less than 2 hours.

The Log Supply was devastated that he was going to miss the plane.  So was I.  Without him, it fell to me to organize the offloading and transporting of 13 tonnes of medical cargo.  He had already done all of the preparation, of clearing the space in the warehouse to temporarily store the drugs, of finding and negotiating with the truck drivers, of estimating daily worker needs, of planning the work flow.  I just had to step in and execute, and the logistics team here surged into the gap.  We had trucks, we had workers, we had pallets, we had water, and luckily, we had good weather.

The plane landed at 2:14pm.  When the engine stopped and the doors opened, the captain asked me if he could take off at 4pm.  We did the math and determined 4:30pm was the drop-dead maximum needed to leave Aweil.  We agreed we'd try to have them gone at 4pm.  A mere hour and a half after the first truck will pull up to the cargo door.

What followed was a gleeful execution of a large-scale logistical plan, reminding me why I do my job, why I love it, and how much fun it can be.  It was exhausting, but invigorating.  Twenty loaders formed constantly fluctuating lines to various vehicles, stacking boxes, throwing medications, and calling to each other with observations and jokes.  With two trucks having to come back after they unloaded at the pharmacy, we stripped the Antonov-12 of 13 tonnes of medical cargo in 90 minutes.  A stressful last-minute explanation of MSF policy led to 100 disappointed people who wanted to hitch a ride on the plane back to Juba, but we got the Antonov airborne at 4:08pm.

That was only half the story, with landing fee negotiations followed by a fierce rainstorm, followed by the final unloading of the backlogged trucks at the warehouse.  We had over 30 loaders at that point, but it still took longer to unload than load, since we had to stack boxes in piles that at least made a cursory nod to safety.  With the warehouse reorganized, cleaned, stacked, and stuffed, we finished just shy of 7pm.  We'll pay tomorrow.

Friday ended a week with a gearbox not repaired, a generator disassembled and waiting on a part from Juba, a car rental extended, several contracts for final rehabilitation at the hospital signed, materials lacking for the two new sleeping huts we are building in the compound, and a running hospital.  The radio referent left, with much kerfuffle of not having his ticket and not speaking English.  The generator technician promised to come back in a week or two to fix the generator, but he helped to repair the current backup.  At the end of the day, I did a final walkthrough with the electrician on contract for some small repairs, since no one else was available to follow him.  I frantically got the signed release of payment in to the administration just at the 5pm deadline.  Success!

The week had ended, and we had cleaned all compounds, completed supply and purchasing, and kept the hospital (mostly) running.  There were countless small HR questions, meetings, negotiations, emails, and little crises that were solved or smoothed over in the course of a normal working day.  We had 4 visiting technicians running around, tracked by a 5-person team covering 8 positions.  It was the craziest confluence of events leading up to the most desperately busy week of normal operation I have heard of.  There was no emergency, no crisis, but everything seemed to happen this week.  Everything that needed to happen over the course of a month, or even a quarter, seemed to be distilled into one quintessential MSF week.

Now my replacement arrives on Monday, and I can start the handover process.  Inchallah.