DRC – not just the Kivus!

Although it’s the middle of May and this is far from my first posting, I’m sure there are still lots of you sitting at home wondering just what exactly does a logistician with MSF actually do!? I tried giving you a rough overview of my job in the “What is Logistics?” posting on January 12th . To paint you a clearer picture, I thought that for this entry I would list the highlights from my past week.

Supply, Supply, Supply

To start, this week was full of non-standard orders. Tools for my drivers and their cars, tiles for the operating room and lab floors and training booklets for the outreach team. By the time an order actually gets sent, it has been discussed with the project coordinator, approved by Lubumbashi, cross-checked with the budget and entered into our supply management program. A lot of planning and calculating goes into each order and, in the end, this is extremely time consuming.

I also finalized my yearly international logistics order. This is a big one and is really the only time I get to place an order from our procurement department in Amsterdam this year. Everything from a new generator to spare parts for our refrigerators to solar system controllers to printer cartridges…

We also produced a list of drugs that are running low in our stock. Although this is not a long list, logistics is often remembered for the 2 drugs that ruptured and not the 500 that didn’t. Regardless, we will work with the medical team, the other projects in the area and Lubumbashi to find solutions. The key to success in this area is to be proactive as an “urgent” order for drugs from Amsterdam can take up to 9 weeks to get here!!!

Finally, the lack of flights continues making fresh food for the expats increasingly hard to find. I actually hired a guy with a bicycle to make the 5-day round trip to Mitwaba to buy potatoes. 30 kilos of potatoes for $10 and an additional $15 for his efforts. Incredible. Mind blowing. Capitalism at work, I suppose… and now we have potatoes!!!

Photo: GrantA: Expat Potatoes

Logistics

Although the rainy season is technically over, we haven’t noticed yet as there was enough rain this week to cause the partial collapse of a latrine at the hospital. Although the pit is still intact, the upper building had to be rebuilt.

The compressor on one of my two ice-lined refrigerators, used for vaccines storage, failed Friday afternoon. Not good. An internal component of the compressor is loose and was causing a short circuit when the unit started up. It doesn’t look like we can fix it here so we installed a backup kerosene fridge and will send the entire unit to Lubumbashi (3 days by car!?) for repair.

Speaking of cold chain, I also started some trials on a new portable refrigerator that I’m testing for the procurement department back in Amsterdam. It is compact, connects to a car battery, comes with a sliding rack for easy access, has cooling and freezing modes and is meant to facilitate vaccine transport for outreach activities.

There are always lots of movements to coordinate, but this week was a bit extreme as we had to deal with 3 emergencies. Typically, someone arrives on a bicycle with a referral form from one of our health centers. I pick a car and find a driver, the hospital produces a nurse or mid-wife and off they go. All three cases this week were related to complications during birth…

We also signed the contract with the mason who will build our new Tuberculosis ward at the hospital. The plans are complete and approved, the material is already here or en route and, after months of discussions and planning, we finally broke ground this week!

Photo: GrantA: Foundations

Not Just Technical…

As the supervisor of 25 national staff, there is always my fair share of human resource issues as well. A written warning to one of the staff for trying to sneak very overweight bags on to his flight back to the project after his vacation. They just don’t seem to understand that a PLANE is not a MINIBUS!

A Director of Nursing who lost his cool, which led to a suspension without pay. A radio operator getting a raise without the knowledge of his supervisor (me) or the project coordinator! A driver in trouble with the police for apparently causing an accident.

We also had a great meeting with the community to get their support in making the 12,000 bricks we need for our upcoming construction projects. The village chief, pastors from the larger churches, our community health workers, representatives from the Ministry of Health and members from the committee in charge of managing the health services in Shamwana. All said, there were about 30 people and we left with a definite action plan. It is really wonderful to see a community truly committed to improving their situation and not just expecting handouts from NGOs!

Finally, I spent an afternoon reviewing the 2009 budget with the project coordinator and adjusting the cost centers to reflect the actual reality in the project.

…and, of course, all the little stuff. Maintenance on a printer. Receipts to sign. Fuel consumption tracking sheets to update. A termite infestation in an expat’s room. My weekly situational report. Shelves built for a storeroom. Vacation scheduled for my mechanic.

…so, how was your week?

I know that all of this may seem somewhat random, but that is what logistics is all about. I can go from deciding to cut the grass at the runway next week to reviewing driver overtime to an emergency order for ammoxicillan for a health center…all in the span of 10 minutes.

We do everything that the medics don’t do and more. In Shamwana, this “we” is a team of 25 national staff and includes drivers, guards, storekeepers, radio operators and senior assistants so I am definitely not alone. However, there isn’t a week that goes by where I’m not constantly amazed at what actually falls into my job description!

A comment posted to one of my entries asked why I choose MSF and what brought me to where I am now. Its not the first time I’ve been asked this question and, in reality, it’s a fair question. I left behind a pretty comfortable life. Good job, amazing girl, hot showers. My brother had a baby and I became an uncle for the first time. My sister is building a new house a mile from where we grew up. Wedding planning and ring shopping are all going on without me. These are just some of the things that I’ve left behind for MSF.

So… why?

Essentially, because I can. I have a family that supports me and a fiancée who truly believes in me in this environment. I have the unusual combination of technical ability, personal drive, flexibility and compassion that make me good at it. I am blessed to have come from a family, a country and overall circumstances that allowed me to follow a dream instead of struggle to survive.

I also like the adventure and relish the opportunity to learn on so many levels (about management, cultures, geo-political issues, myself, the world of relief work). Finally, while I had done some reading on development and relief, I truly believe that the best way to learn is simply to GO. With my skill set, personality, support and a strong desire to help those who are truly in need, the question really became how could I not…

More Specifically

There are 2 events that really specifically helped to shape this desire.

The first was watching the aftermath of the 2005 earthquake in Pakistan. All the news channels were reporting that relief workers were walking for hours – sometimes days – to bring urgently needed supplies and medical care to remote villages. The needs were great, the challenges were enormous and I thought to myself, “I can do that…I can totally do that!”

The second was reading “Another Day in Paradise” by Carol Bergman (2003). This is a book of short stories about humanitarians working in the field on a variety of projects from disaster relief to war zones to feeding centers. I read the book twice and still remember feeling totally inspired by what these people were actually doing.

Naturally MSF

I had been a donor to MSF for a few years and the more I learned about the organization, the more I came to admire what they did and where they worked and how they did it. I was simply fascinated by ‘these people’ who were doing such great things in remote corners of the world largely forgotten by our western media.

…and here I am. Helping those truly in need, directly supporting a great organization and absolutely living a dream.

Post-Conflict

Just what does Post-Conflict mean? For me, it sometimes looks and feels much more like international development as there isn’t the same sense of urgency you might find in conflict zones. The ‘just do it’ of an emergency is replaced by budget constraints and planning and proper paperwork. The problems and contextual issues are no longer so obvious and I have to go looking to find them.

Sometimes it also feels a bit more like a job and I feel a bit less like a humanitarian in action. I can spend entire days sorting out overtime hours or writing monthly reports or counting pills and this certainly doesn’t feel like savings lives or alleviating suffering, as in the MSF mandate. It is even possible to go days without leaving the compound or actually seeing any patients or feeling a sense of urgency in what we do.

However, it is all so relevant. Without MSF, the health care in the area would be very limited. No surgery. No patient transfers. No blood transfusions. No free medicine. No testing.  No treatment.  And the population really has nothing. They survive in grass huts on subsistence agriculture. The mosquito net distributed by MSF is one of very few possessions. So many more people would die if MSF was not working here.  Post-conflict medical support is critical to ease the continued vulnerability of the population, to enhance their productivity and facilitate the rebuilding process.

Post-conflict work seems to find its way into the gray zone between international development and humanitarian relief work. It may not catch as many headlines but it is a big part of MSF and plays a vital and often forget role in international assistance. It is also what I am experiencing for the first time here in Shamwana.

Waiting for the dry season

A comment posted to one of my blog entries asked me just what does a logistician with MSF actually do?  That is a fair question and I thought that I could maybe elaborate a bit.

When I tell people that I work for MSF, it is often assumed that I must, therefore, be a doctor.  Here in Shamwana, we do have a doctor but that definitely isn’t me.  His name is Auguste, he’s from Congo Brazzaville and on top of emergency surgeries, doing rounds and being on call from time to time, he is responsible for running a 60 bed hospital in, lets say, less then ideal conditions.  He started his Sunday ‘off’ at 5:00 am with an emergency C-section and followed that by discharging 10 patients from the hospital because it’s malaria season and we just don’t have enough beds.  That was all before noon and that is definitely NOT what I do.

…but MSF is more than just doctors.  To complete the Shamwana expat team, we have an outreach nurse, a project coordinator, a mental health advisor, a lab technician, a water and sanitation specialist and me…the project logistician.  In fact, almost 40% of expat positions in MSF are non-medical.

MSF is an independent international medical relief organization and logistics is there to support the medical programs.  In theory, I do everything that is needed so that the medics can do their jobs.  The reality is that MSF doesn’t have a ‘logistics’ program on its own; however, without logistics the medical programs would simply grind to a halt.

It really is a wide range of things that fall under my responsibility.  Communications include VHF antennas and satellite phones.  I manage a medical stock worth a considerable amount of money with approximately 500 items all having different expiry dates and consumption rates.  We have 5 cars that need to be maintained, scheduled and, finally, driven.  The supply chain in Katanga starts in Amsterdam, involves sea freight, takes 4 months to arrive and is more than just a little headache.  We have refrigerators and coolers to keep vaccines cold.  We are way off the grid and use generators, solar panels and battery backup systems for power and lighting.  We have 7 laptops that seem to fail all too often and an expat team that knows relatively little about proper computer use.  We also plan to construct a tuberculosis ward, a new fuel store and a water tower in the coming months.

As you can imagine, my To Do list is literally 3 pages long and there aren’t many days without something in them to keep things exciting!

In practice, it is more about management than anything else.  Of the 68 national staff in the project, 25 fall under me.  This is not only the guards and drivers, but also storekeepers, a construction manager, a mechanic, my supply wizard and a radio operator.  I spent much more time delegating tasks and writing reports than actually getting grease on my hands and human resource management is a huge part of my job.

To borrow the words of a previous supervisor, it is my job to “get ‘er done”!  If the pumps breaks (as it did yesterday!) and I can fix it, that’s great.  If I can’t fix it then it is my job to find someone who can fix it…just get the damn pump working again!  That, in a nutshell, is what logistics is all about.