Done and Done

July 8th, 2010 by Grant Assenheimer

We rolled in to Lubumbashi on June 15th after a grueling 2-day overland trip from Dubie, covered in dust and exhausted after successfully and completely handing over what was MSF-Dubie.

For the past 2 months, there was an increasing workload and ever-approaching deadline that pushed me to longer days and to even work the odd Sunday! In my end of mission evaluation, I got an “A” in quantity of work, but only a “B” in stress management as I was starting to wear out, as I’m sure my fellow teammates can attest to.

Working out the final details

Working out the final details

It wasn’t just me who was getting tired either. May 31st was the official end of MSF presence in the hospital and all of our medics were on a plane and flying back to Lubumbashi the next day. Not the same for the logistics team as the official departure of the medics meant that they could truly attack the closure in earnest. Radio antennas to remove, furniture from expat rooms to ship, electrical cables to recover (and candles to distribute!), stores to reallocate and donations to deliver.

And deliver we did! The 3-month drug donation that we left behind to help them get started is literally a mountain of boxes! Preparing THAT donation was a huge job for the logisticians and it is honestly to their credit – expats and national staff alike – that we were actually able to finish everything on time. Somehow they were able to stay motivated and to maintain both a high quality and a high quantity of work right to the very end, even though most of them were working themselves out of a job. Impressive.

3-month drug donation to the hospital

3-month drug donation to the hospital

I also have to give some credit to our handover partners, the ministry of health and the catholic sisters. We may have been busy closing the project and wrapping things up, but they were just as busy setting up a totally new system and trying to figure out how to run things without MSF looking over their shoulders. Receiving our donations was a significant, demanding and stressful experience in itself. Suddenly they have generators and cold chain to look after. They needed to figure out where to store things and who is responsible. While MSF commits to providing free health care while present, this is not a long term solution and, following the handover, they were also installing a user-fee system. Setting this up and dealing with the associated repercussions in the community involved a significant amount of time and planning on their part. Busy to say the least.

Three project partners at the End of Project celebration

Three project partners at the End of Project celebration

La Reference

It still feels pretty good 2 weeks later as I write this final entry. It’s Sunday evening and I’m now sitting in a café in Amsterdam, waiting to debrief in the MSF headquarters after spending 10 days in Lubumbashi tying up loose ends and writing my end of project report. Looking back, it is amazing at how well things went throughout the closure. Nothing went missing, staff motivation was good right to the end, we didn’t cut any corners and even our partner relations stayed positive. This is a closure to be proud of and, in all honestly, that isn’t always the case.

The sign included below was made a month before we closed and became a mantra that was repeated over and over by our national staff in team meetings, during goodbye parties and throughout daily activities. This desire to be an example to follow was inspiring and it held strong right to the very end.

Dubie – La Reference

Dubie – La Reference

Done and Done

It is also amazing at how long it takes for the weight of responsibility and commitment to slip from my shoulders. Every day now, my “To Do” list gets a little smaller and Canada seems a little closer…and (finally!) I am no longer wide awake at 5 am with my outstanding tasks and miscellaneous worries filling my head.

As I enjoy a cappuccino and relish the blues music in the background, I also note the simple fact that I no longer represent anything or anyone. Here, I’m just another guy in the café. I’m not a mazungo or the ‘white’ guy. I don’t represent MSF or Canada or expats in general. I am no longer ‘le grand chef’ or responsible for 92 staff or running a 120 bed hospital in the middle of the bush. I don’t have to carry a radio or to always be in touch and on call. I’m not longer a teammate or a leader or a manager.

…I’m just me. After an intense 6 months as Project Coordinator for the closure of Dubie, I’m ready to just be me for a while.

However, I’m sure it won’t last and before long I’ll be gearing up for the next project with its new context, its different team and its various challenges. MSF is a great organization and I am proud to be a part of it. I like where we work, what we do and how we do it. I feel privileged to have access to such eye-opening and impacting experiences and I truly value the opportunity to help those in need in such a direct and meaningful way.

While this may seem surprisingly positive following a closure, I am still able to see the big picture and my place within this crazy world of MSF. My staff and the community kept telling me not to worry…that everything with a start must also have an end and that this is the just the natural progress of things. In a way, they are right.

Thanks for reading!

Grant Assenheimer

Pré Avis

June 21st, 2010 by Grant Assenheimer

The direct translation of “Pré Avis” into English is “Notice” and I have been spending a lot of time giving Pré Avis in the Congo over the past months. Notice to our partners about how and when we would leave. Notice to the authorities in the village about the upcoming changes. Notice to our patients – the beneficiaries – about what will happen to them once we’re gone.

Finally, our closure has a huge impact on the 92 national staff currently working in Dubie and I have also been kept busy by giving notice letters to most of them over the past few months.

It is true that MSF experience looks great on a resume and makes our staff much more employable. It is also true that our severance package is good enough to help them through the next few months as they earnestly start a job search. But the reality is that most will be out work in a country where there really aren’t that many jobs.

I’ve highlighted the story of four people to help give you a better idea…

Jolie

Jolie

Jolie was expecting on the 28th of June so she was VERY pregnant by the handover date. This will be child number three and she figures that four should be enough…so only one more to go! She has been working for MSF since 2007 as a community liaison officer and spends most of her time sensitizing the population on general health issues, coordinating with local health committees and effectively providing the link between MSF and our beneficiaries that we simply cannot do without national staff.

She has a certain presence about her and when she speaks people are always nodding their heads and shouting out in agreement. Impressive. While she enjoys this work, her lifelong dream is to become a nurse so she has been saving up her money and is going to take advantage of the Dubie closure to go back to school. Very exciting! All the best Jolie.

Fanny

Fanny

Fanny

Fanny is a nurse and has been working with MSF since 2006, spending two years as part of our emergency response team and another two years as a member of the Dubie outreach team. It has been a long stint, especially considering that she comes from Lubumbashi and has spent the past four years away from her family, visiting only once per year during her annual leave.

This is a common story with most of our medical staff and, as Dubie closes, most are simply looking forward to going home, spending time with their families and hoping that something else within MSF will turn up. Fanny’s smile was even bigger than the one in this picture as she boarded the plane and left Dubie and her life from the past 4 years behind her.

Jacques

Jacques

Jacques

Jacques is the admin and finance assistant here in Dubie and, as such, he is my right-hand man. He is also one of 7 ‘Jacques’ working in Dubie so to avoid confusion he is always referred to as “Jacques Admin”. Starting with MSF in 2006 as a storekeeper, he quickly rose in the ranks to become one of the most senior national staff in the Dubie project.

Due to his hard work and good attitude, he joins the minority who will not actually lose their jobs but will be transferred to other projects in the mission. There is also a certain amount of luck involved as the Dubie closure happens to coincide with the opening of a new project in the northern part of Katanga. As with any other company, we cannot simply create jobs for our good staff…but it is great to have this opportunity to at least keep some!

Esther

Photo: Gisele Poirier |  Ester

Photo: Gisele Poirier | Ester

Esther is the cook for the expatriate team. To say this is not an easy job would be an understatement. Cooking food she has NEVER eaten for people of different ages from different countries and for a team that is in constant flux with expats coming and going.

In this entry, Esther represents the national staff who were hired locally and for who their notice letter really spells the end of the road. The cooks, cleaners and guards all face the same situation. Their current job is over and there is little chance for re-employment in Dubie. Most will return to older routines like collecting water, tending goats and tilling fields. Others will take their service record and try their luck at finding employment in one of the bigger centers.

Regardless, the closure of Dubie affects this group much more than the others so a big “Bon courage et bonne chance” to them all!

Mrs. Miano

June 18th, 2010 by Grant Assenheimer

Mike Miano is the logistician in the neighboring MSF project of Shamwana and his Mom is apparently a big fan of this blog and follows my stories religiously.

The mental health officer in Dubie was leaving on his first mission and, before flying to the middle of the bush for 12-months, he was able to read about my version of life out here and the work MSF is doing in Katanga. When we first met, it was like we had already knew each other and the shock of finding a 120 bed hospital in the middle of the bush is much less.

My parents read my entries in an attempt to grasp what it means to be on a fourth mission with MSF and just what exactly it is that I do for 12 hours a day, 6 days a week, in a land so far, far away. They love the pictures and eagerly share my news with family and friends, their pride shining through.

I get weekly comments from complete strangers…people just surfing the web or those who are looking for their passion or others who are simply interested in MSF and what we do. It is uplifting to be able to share my experiences and perspective with those who are back at home and eager to learn more about the world around them.

So this is why I spend my Sunday mornings writing entries and sharing my experiences…and this entry goes out to Mrs. Miano!

Hard Goodbyes

June 8th, 2010 by Grant Assenheimer

Remember Molaw? He was the boy with a cancerous growth I wrote about in one of my first entries after arriving in Dubie. He came by the office yesterday to say goodbye.

He had made drawings of all the expats and was handing them out, clutching the coloring book and crayons that the expat doctor had given him in his other hand. The drawing of me is included below. We were all holding back tears.

This is the hardest part for me. Of a closure. Of my job. Of the absolute inequality in which I currently live. I get to go home in a few weeks to hot showers, a big steak and a health care system that will care for me regardless of what illness I have or how long it takes to treat it.

Molaw will get drugs to manage his pain for a month. But while some of his treatment is still available at the hospital, the Ministry of Health will install a user fee putting this largely out of reach for an orphan living with his great aunt. And that’s it. He waves and then climbs into the landcruiser that takes him back home.

Goodbye Molaw…

Photo: Grant A |  Drawing Grant by Molaw

Photo: Grant A. | Drawing Grant by Molaw

Thanks for the Chickens

June 2nd, 2010 by Grant Assenheimer

If you are given 1 chicken, it is a sign of appreciation. If you are given a pair – a rooster and hen so they can mate – that has real value and you must be extra special. If you are given 5 CHICKENS, it is really just too much!!!

…that is what was explained to me as I accepted a box full of chickens on behalf of MSF following a community meeting in the village of Katonta a few weeks ago. Seriously…5 chickens in a box! Check out these pictures.

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Photo: Grant A. | Receiving chickens

Community Support

Over the past months, I have invested a lot of time trying to ensure that the reasons for which MSF is leaving are clear to our partners, local authorities and the community in general. This takes many forms…informal discussions with staff at the hospital, official meetings with the village authorities and, of course, community meetings.

These are never easy. Essentially the equivalent of a town hall meeting, it involves at least 2 hours in a hot and sweaty school room answering questions and trying to explain to the community why they are losing their free health care. Imagine the uproar if you were to do this in Canada! Everyone is invited: the local health committees, Ministry of Health (MoH) nurses from the health center, MSF community outreach workers, the village chief, traditional birth attendants, the local Red Cross, school principles, priests, traditional healers.

Photo: Grant A  |  Community meeting in Katonta – 70 people present!

Photo: Grant A | Community meeting in Katonta – 70 people present!

Since I called the meeting, I sit up front and face the crowd. As many can’t speak French, my translator starts to convert my message into the local dialect and off we go. I’ve given this speech a few times, so now it comes a bit easier.

We talk about how things have changed over the past 5 years. How there is no longer war, the displaced population has all gone home and we have entered a developmental stage. How MSF is an emergency relief organization and this doesn’t fit our mandate. How the MoH is now present, trained and will take over as of May 31st.

How the free care that MSF provides is not sustainable. How the MoH will install a user fee system. How we will make a 3 month drug donation to help in this transition period. How it is THEIR village, THEIR health centre, THEIR family…and that it is time for them to step up and take ownership.

Not my favorite part

This is a pretty tough message when I know that the level of care will drop. That the MoH is present but is not nearly as effective as MSF. That even a nominal user fee (20 cents for a consultation!) will exclude a large portion of the population and that a C-section will cost an astronomical and unobtainable $30. That emergency referrals from the health centre to the hospital will be by bicycle and take half a day. That there will be more drug ruptures and the MoH staff will not be paid as well or as often, or at all.

From my perspective, these are the poorest people I have ever seen and most really have nothing. Yet it is all relative and while it might seem like a pretty desperate situation to me, this population has known much worst and not so long ago. The fact that there is a Ministry of Health, that they are present and that they are willing to take over, is a huge sign of progress.

So far, my message seems to be getting through as people know that we are leaving, understand why and have an idea about how things will look after we are gone. Everyone is sad and wishes we could stay…but people are not angry. I ask them to think of this as not only an end, but a new beginning. The beginning of a more sustainable system, a truely Congolese system. They understand that health care is not normally free and they are thankful to have had MSF come to their community in their time of need.

…and giving me 5 chickens is their way of showing this.

Update from the field

May 21st, 2010 by Grant Assenheimer

Hello Readers!

Over the weekend, MSF hosted our official Project End party. Around 270 people – from staff to village chiefs to local suppliers – came out and it was a huge success. This is also a significant milestone as it officially started a 2 week countdown to the official handover date of May 31st. As such, I was asked to write a brief update for the folks back in our Amsterdam headquarters and thought that you might also be interested to hear how things are going.

MSF is just like any other organization and is full of acronyms. To help you out:

  • MoH = Ministry of Health
  • Inpats = people who are working in the project but were hired somewhere else.

Here in Dubie, we could not find many qualified medics locally so many have been hired in Lubumbashi and then sent to Dubie to work. Now, at the end of their contract, we have to transport them all back home.

Cheers,
Grant

———————————-

While I can’t say that it hasn’t been without the odd hiccup, the handover of our project in Dubie is progressing well and things are largely on track. Outreach activities are officially over as we spent the first two weeks of May on final visits to each MSF supported health center. We have also started to re-align services in the hospital to match the current Ministry of Health staffing and the anticipated drop in patient numbers. Here in Dubie, we could not find many qualified medics locally so many have been hired in Lubumbashi who were then sent to Dubie to work. Now, at the end of their contract, we have to transport them all back home. Our first set departs on May 18th and a steady stream will follow until our official handover date of May 31st.

In all outreach sites, the MoH will assume responsibility after our departure. However, here in Dubie, the hospital and health center will be run in partnership between the Ministry of Health and the Catholic Sisters. In theory, at least, as it is not yet clear if they have come to an agreement. To avoid taking sides, MSF will be donating everything to the “health structure”, as represented by the MoH and the Sisters. While all sides have officially agreed to this and I do not anticipate any huge problems, things continue to brew below the surface so only time will tell.

Over this past weekend, we held our project closure party…Shamwana vs. Dubie soccer match on Friday, National Staff tombola on Saturday morning, followed by a very successful party with 270 people in attendance and dancing until 3:00 am!

On a final note, our HIV program will not be handed over and will continue to be managed through support from the Shamwana project. As was done in Kilwa, no new patients will be added and an MSF national staff nurse will stay in Dubie to manage the cohort. Quality control will be maintained through bi-monthly expat visits.

Photo: Grant A. |  Anne Marie Loof, Head of Mission, giving the handover speech

Photo: Grant A. | Anne Marie Loof, Head of Mission, giving the handover speech

Mr. Coordinator

May 6th, 2010 by Grant Assenheimer

As the project coordinator, I am the official representative of MSF in the field.  I like this part of the job as it gets me out in the community, gives me a better perspective and allows me to develop a deeper understanding of the context.  It also means that I spend a lot of time going to meetings, receiving visitors and reading letters addressed to “Monsieur le Coordinateur du Project Dubie”

Over the past few weeks, I have met with a pretty large variety of people for a number of reasons.  I was invited to an official meeting with the territorial administrator – the federal government representative for the region – about why we’re closing and who will replace us.

A courtesy visit to the customary village chief to discuss the image of MSF in the community.  The first birthday party of the son of the Director of the Dubie hospital.  A meeting with the local police commandant to explain again why MSF is leaving and to ask how he thinks the community will react in the coming weeks.

Discussions on road conditions and 2010 programming with the coordinator of Concern Worldwide, the other international NGO present in Dubie.  Meetings with the UNHAS (United Nations Humanitarian Air Service) flight coordinator on the possibility to have their plane land again in Dubie.

“Journée de L’Ensignement”

My latest event was an official invitation to come celebrate “Teachers Day” with the Catholic Sisters who run the secondary school in Dubie.  It was scheduled for April 30th and a quick check on the internet shows International Teachers Day on October 5th…but who am I to question!?  Gathering at 7:30 am, procession at 9:00 and then some music and theater, with refreshments served afterwards!

OK.   It was scheduled for a Friday and my To-Do list is getting longer every day, but this is the sort of thing that you just need to make time for.  After my morning team meeting and getting everyone started for the day, I arrived just before things were getting going.

There was a bunch of desk arranged in a U-shape with 15 wooden chairs up front for the distinguished guests.  I found the chair with “MSFH PC Dubie” on it and settled in for the show.

Theatrical

It started with a procession of the various classes.  Some marched by, saluting and arms swinging as if they were soldiers.  Others stopped to sing or dance in unison.  One class sang the national anthem.

There were a few poems and some dancing, but it was the theater skits that were my favorites.  They were quite well done and had themes that absolutely reminded of where, in fact, I was!

The first skit was about teen pregnancy and had “stay in school” as its main message.  A girl dropped out of school, starting hanging around with the guys in the market, got pregnant and died during childbirth.  A pretty direct message to the young girls watching –  MOST women in this region have their first child when they are only 15 or 16 years old…but it was nice to see the school AND the church supporting this message.

The second skit was about corruption and how it doesn’t do anyone any good.  A $10 bride was paid to a teacher to get good grades on a test.  For the next dozen scenes, this same $10 bribe passed hands to get a son out of trouble with the police, to get a new job, to bribe a soccer referee…and eventually returned to the original person.

The final skit was about a teacher who asked a girl to marry him.  As is customary here, the man needs the approval of the father before the marriage can take place.  However, since the teacher had not been paid for the past 3 months, the father refused!  The message?  Teachers are undervalued and suffer because of their non-functioning government.  A message to finish off the “Teachers day” celebrations I thought!

Afterwards, I was invited by the Sister’s for refreshments and shared some pretty toxic homemade mango wine with the village chief and the commandant of the police.  After a few quick sips, a piece of cake and discussions on the upcoming end of the rainy season and the progress of our closure plans, I headed back across the street to my office and another hectic Friday.  It was a nice way to start my day and a pretty good insight into some of the cultural issues faced by the Dubie population today.

1 Month to go

May 1st, 2010 by Grant Assenheimer

At one point in a project, you wake up and realize that time is running out! That happened to me last week and although I’m not sure where the past 3 months have gone, we have started to count by weeks until the closure and not months!

It is Sunday afternoon and I’m sitting in my office working on a few emails and catching up on blog entries. I’m also staring at a calendar that I presented to the expat team yesterday to help coordinate the coming weeks. Written on a flip chart, the calendar includes expat evaluation and end-of-mission dates, a final donation schedule and our project closure party. For me, it also drives home the point that our closure date – May 31st 2010 – is not so far away anymore.

Making Progress

Our team has been busy with the thousands of tiny details that need to be taken care of before we leave.  Additional trainings for the Ministry of Health staff.  Another round of visits to village authorities.  Sorting out administrative details for final payments.  Stock counts, inventory list updates and discharge of liability forms.

This list is in a spreadsheet that is 6 pages long!

On the medical side, we have also been scaling back our operations.  The outreach team finished their final round of supervision visits to the health centers.  Our mental health councilors have stopped taking on new patients and are busy trying to close their existing files.  Since the Ministry of Health is not able to take over our feeding center, we have started to incorporate any new malnourished children into the pediatrics ward of the hospital.

Donations

As pat of the handover, we will also make a donation that will, in theory, allow operations to continue for 3 months after our departure.  While this certainly includes a 3-month supply of drugs, it also includes everything from pens to fuel for lanterns to medical forms.  Everything must be calculated, compared to current stocks, ordered, transported, sorted and prepared before it can be delivered to its final destination.

While all of this work is part of the regular activities that we do on a monthly basis, you have to multiply the amount (and volume!) by three and, at the same time, eliminate the buffer stock that normally covers for emergency needs or sudden changes in consumption.

We will also donate most of the items currently found in the health structures.  If MSF needs these articles to run a hospital, certainly the Ministry of Health will need these items after our departure!  These inventory lists need to be reviewed, converted into an official donation form and then presented to the Ministry of Health in an official ceremony.

…what about the rest?

We also have a fully functioning office, a garage and a fleet of 6 land cruisers, various storerooms, expat living quarters, etc., etc.!  These are items needed by MSF to run a project, but not to run the hospital itself.  As you can imagine, this is a pretty long and varied list.

To help you get an idea of the magnitude of these ‘details’, I will go through the contents of my small office and explain the plan for each item:

  • My wooden desk and chair will be returned to the Sisters.   It was one of the items listed on the original contract we signed when we rented the school from them and promptly converted it into an office.
  • The small printer will be donated to the ministry of health, as per our Memorandum of Understanding signed in 2009.
  • My laptop will be returned to LBB, kept as a backup or sent to one of the other operational projects in Katanga.
  • A small, poorly constructed cabinet will be added to what our national staff call a “Tambula”.  In essence, this is a lottery in which our staff ‘draw’ items for which we cannot find another suitable home.  Everything from old car batteries to used mattresses to broken TVs.  It may seem like junk, but in this resource poor setting the batteries will be hooked up to solar panels, you can’t even buy a mattress and the TV will certainly be fixed and used as the local version of a cinema.   The empty powdered milk tin I use to hold my pens, my paper trays and the curtains will also be added!
  • The two wooden chairs where my visitors sit will be sent to Shamwana just before we close, along with the power bar and the garbage can.
  • The 2 dozen binders will have to be emptied, with some documents being sent to LBB and others to the waste zone to be burnt.

…and that is just my office!  Extrapolate for an entire base, a fully functional hospital and 7 supported and fully stocked rural health centers and you start to get some pretty big lists.  The logistics team has been busy making these lists and then trying to find homes for each and every item.  Not small task, for sure!

Never a dull moment

April 26th, 2010 by Grant Assenheimer

Whenever you leave the base for any kind of road trip, there is bound to be some excitement. The destination was the Town of Kilwa and the goal was to meet Dr. Wilma…the “Médecin Chef du Zone” for the health region where Dubie is located. As the guy responsible for medical activities in most of the health structures where we work, he is my most important counterpart and this visit was already a bit overdue.

Although Kilwa is only 130 km away, the roads really are nothing more then glorified footpaths. It is literally impossible to picture what it would have been like in the Belgian era where cars could travel these EXACT SAME ROADS at 80 km/hr. This trip took us a grueling 11 hours and did not disappoint in terms of excitement along the way!

Photo: G. Assenheimer | A typical road in Katanga.

Photo: G. Assenheimer | A typical road in Katanga.

Breakdown

It started at 6:00 am on a Tuesday morning. Travelling with me was a nurse heading back from a training session, the driver and a ‘convoyeur’. While it may seem a bit excessive, a convoyeur is a guy who comes along specifically to help in case there are problems along the way.

We had to jump-start the car (i.e. 4 guys pushing from behind to get the car rolling and then the driver pops the clutch) so that never bodes well…but the driver assured me we’d be fine once we had driven for a bit and the battery had had a chance to charge. A bit fishy, but its 6:00 am and we need to go so I let it slide.

Not even an hour from the base, we encountered our first obstacle. A pretty big tree had fallen across the road and we had to find another way around. Our driver paused for a bit and, as if out of a commercial advertising landcruisers, he slowly backed up, took a sharp right and climbed up on to the bank beside the road in an attempt to get around the log.

It was rough, he was all over the place and there simply wasn’t enough clearance. Sure enough, halfway through the maneuver he stalled and, as feared, the car wouldn’t even turn over. So…stuck one hour from base with a car that wouldn’t start!

Photo: G. Assenheimer | Road blocked... now what?!

Photo: G. Assenheimer | Road blocked... now what?!

We used our radio to call for a rescue car and one was dispatched from the base right away. We were really quite stuck and the handful of people who came from a nearby village to check us out couldn’t help. So we wait. In the meantime, the convoyeur lit a fire under the log to weaken it in the middle and to allow us to at least clear the path for our return trip.

An hour later, our rescue car arrives. The fire had burnt through a big part of the log and we were able to pull it apart and roll it out of the way. Once we had freed the car and got it started again, we swapped vehicles and, as we continued along in car number two, the first car limped back to the base and the waiting mechanic.

Photo: G. Assenheimer | Getting a boost from the rescue car.

Photo: G. Assenheimer | Getting a boost from the rescue car.

Stuck

Not even another hour along the way, it started to rain and we came across a deep puddle. Our driver carefully switched to 4×4, placed it in first gear and started slowly through the muck. Unfortunately, he missed the “normal” path, sunk into a bit of a hole and suddenly the wheels were spinning.

Everyone gets out and both the driver and convoyeur jumped into action. Up to their knees in water, they were busy jacking up the back end and placing logs under the tires to fill the hole and to make a bit of a ramp. This was obviously not the first time that they’ve done this and we were back on the road in less then 30 minutes.

Photo: G. Assenheimer | Stuck again!

Photo: G. Assenheimer | Stuck again!

Village after Village

The normal, more direct route to Kilwa is currently not passable due to the rainy season. Forced to use an alternative route, the detour doubles the travel time. Following the shores of Lake Mwero and passing through countless small fishing villages along the way, it really is a beautiful drive. At times, the horizon opens up displaying a spectacular vista – lush green hills flanking each side of a red earth path snaking away in some version of a road. The lake is huge and, in places, you can’t even see across!

Photo: G. Assenheimer |  The fishing village of Lewanza.

Photo: G. Assenheimer | The fishing village of Lewanza.

However, for the most part, this beautiful scenery is obscured by the 10 foot tall grasses growing along the side of the road. We bounce along at a painful 20-30 km/hr and slowly, slowly approach the destination. Lewanza, Lukenzolwa, Kongolo, Lusalala… and many others that even our drivers have a hard time remembering. My job on trips like is radio the base with our position every hour and to wave back at the people who greet us as we drive though. Each village is similar and, as we approach, the tall grasses give way to towering mango trees and adobe huts lining each side of the road.

As you near the center of town, there is usually some sort of market. While the selection depends on the size of the village, there is always something for sale. This could be as simple as a table selling bananas or a small stall with batteries, cigarettes, pots and flip-flops. In the larger centers, it could even be a real ‘store’ with a bit more variety and even a door that could be locked.

Photo: G. Assenheimer |  The main market in Lekenzolwa.

Photo: G. Assenheimer | The main market in Lekenzolwa.

Photo: G. Assenheimer |  Roadside stall – we stopped to buy mushrooms and tomatoes for dinner.

Photo: G. Assenheimer | Roadside stall – we stopped to buy mushrooms and tomatoes for dinner.

Opps!

There are always people around. Women (young girls usually!?) pounding manioc, men making fishing nets and children screaming “Mzungu, Mzungu!!!” and rushing out to greet the car as we continue on. There also seems to be lots of animals around. Goats, chickens, guinea fowl, pigs. A definite sign of improved stability and a return to normalcy in Katanga, this is also the reason for the next unplanned stop.

We were slowly passing through one of the villages when a goat decided that instead of running away from the car, he would try to run under it! Not a great idea and we got him with our rear tire. Yup…ran over a goat…
Our driver stopped, checked his review mirror, sighed and got out of the car. The villagers were already starting to gather and clearly this wasn’t going to well for him. The driver, not MSF, is totally responsible in cases like this. According to the local law, the driver is only at fault if you run something over with the front tire. In this case, it was the rear tire so he should not have had to pay anything.

A discussion continued, money exchanged hands, we continued on and the villagers feasted on goat that night. In the end, he did run over a goat and felt responsible for compensating the owner, regardless of who was at fault! This is NOT the sort of thing you get in your MSF training courses!

Belgian Bridges

Another hour longer, we get to a spectacular bridge that had clearly been built by the Belgians before independence of the DRC. While the metal structure was in seemingly good shape, the years had not been as kind to the wooden slats that are needed to ensure safe passage. Some had been stolen and others had just rotted away and had been replaced by small logs. One word – Sketchy.

Most of the time, the driver just pushes forward, trying to avoid the largest holes and get to the other side without falling through. Although I’m not usually too concerned about this sort of thing, even my gut clenched a bit. The bridge in the picture below was especially bad. In this case, the driver actually had to rearrange the sticks and use his sand plates to cover a pretty big hole towards the far end.

Photo: G. Assenheimer | Where is the maintenance crew?

Photo: G. Assenheimer | Where is the maintenance crew?

The way back

…and THAT was all on the way there!

The meeting with the Doctor was quite productive and definitely made the trip worthwhile. I had almost 20 issues to discuss and we were able to come to agreements on most of them, with both of us leaving with action items. .

The way back was no less interesting. We had to drop off letters at a few of the health centers and ended up transferring a small boy with severe malaria / anemia to one of the small regional hospitals. That was a stressful ride and whenever he stopped crying I held my breath until he started again…as at least this way I knew he was still alive.

Since my meeting went a bit long, we left a bit late and had to spend the second night with the Sisters in a small town halfway back to Dubie. Although nothing is free, they fed us, provided rooms for myself the driver and our convoyeur and even found us some breakfast the next morning.

As per the heading for this entry…NEVER a dull moment!

Photo: G. Assenheimer | Nice view!

Photo: G. Assenheimer | Nice view!

Always Late

April 13th, 2010 by Grant Assenheimer

Hello Everyone! My last entry has been a few weeks ago and I feel like I haven’t been so consistent to all my readers back home. Sorry about that…but it is definitely not from a lack of things to write about. Quite the opposite as my last few weeks have been absolutely action packed and I have either been on the road, too busy or simply too exhausted to go back to my computer after dinner and to organize my thoughts into a blog entry!

Highlights include a 3 day road trip to Kilwa to meet the “Medecin Chef du Zone”. As the Ministry of Health doctor responsible for all of the medical activities in the health zone where we work, he is my direct counterpart and one of the most important contacts/relationships I need to maintain. The meeting was good…but the road trip in itself was incredible.

I was also busy hosting community meetings in 5 of the villages where we currently support the local Ministry of Health clinic. In principle, this is a ‘town hall’ meeting where MSF explains our reasons for leaving, describes what the actual handover process will look like and gives the village leaders a chance to ask questions. In practice, this has me sitting in a sweaty classroom for 3 hours telling 50 people that they are losing their free health care and that now is the time to step up and to start working with the Ministry of Health to take responsibly for the health care in their community. Interesting. Important. Draining.

Finally, as we have less then 2 months before the actual handover date, I have also been busy giving notice letters to many of my staff. I have done about half…which means that I have had individual meetings with over 50 staff members where I give them their pink slip, explain their final payment details and discuss their plans for ‘after MSF’. I’ve had some interesting responses that I thought I could share.

After 20 straight days on the go, I was finally able to take my Sunday off! Over this next week, my schedule is a bit less hectic so I plan on writing about each of the topics above. However, for today, I want to leave you with a description of my visit last week to see a traditional healer in action…

They Are Only Roots

Witch doctor? Fetisheur? Shaman? Traditional healer? I suppose all of these would be an acceptable way to describe the man to which I was currently being introduced. Although barefoot, he was wearing a green and black striped golf shirt with grey slacks and was quite presentable. His eyes were shinning and he seemed genuinely impressed to receive a Mazungo as he invited me to join him in the shade of one of the huts that were scattered around his yard.

Here I am, sitting in my white MSF T-shirt and representing all forms of western medicine. Not only does this contradict his beliefs and those that he tries to install in his clients, it also represents a direct competition to his business of healing.

So, as you can imagine, this conversation was going to be a bit awkward and an invitation to sit with him in the shade was a good start. We (I was here with the expat nurse in charge of the outreach team and one of her Congolese staff) were not just dropping in either…we had heard that there were a few patients in pretty bad shape that really needed to be transferred to the Ministry of Health clinic and we were hoping to take a look.

The Pharmacy?

After introductions, I started by asking about his patients and how things were going. He confirmed that he had a couple of difficult cases with fevers but that his treatment seemed to be helping. Curious, I asked what, exactly, was his treatment for a fever. A bit surprised, he asked if I wanted to see his pharmacy. Of course…so off we go.

Rounding the corner of one of the small huts, we arrive. There is an axe, a few small piles of roots and various chunks of wood obviously from different trees. Oh…this is the pharmacy!? It really looked more like an empty wood chopping pile. He then proceeded to pass me different pieces of wood explaining that this one is for fever, this is in case a woman cannot get pregnant, this one is for worms. You just boil them for a bit and sometimes you drink it or sometimes it has to be injected. It depends.

And your patients with fever? Sure…come take a look.

We walk over to another small hut and the outreach nurse ducks her head and enters to examine a one year old boy that is clearly in the late stages of severe malaria. His eyes were rolled back, he was clearly anemic and he was in desperate need of a blood transfusion…not more of the root concoction.

Now the negotiations start. If we aren’t able to convince the traditional healer that this boy needs to go to the health center, there isn’t much we can do. If he tells the parents to go, they go. If he tells them to stay, they stay. If he tells them that their son has offended the evil spirits and will die, they accept. That is the kind of power he holds.

Follow up

In this case, we were successful. The parents quickly collect their things – a pot, blanket and a few pieces of manioc – and carry their son to the waiting landcruiser. It is hard to know why the traditional healer accepted. Maybe he was trying to put on a good show for the foreigners. Maybe he knew that the boy was going to die anyway. Maybe he honestly cares about the health of his patients…

We arrive a few minutes later at the health center, quickly confirm that it is malaria and give some medication to try to stabilize him. You need a fully function lab to do blood transfusions so the outreach team prepares to transfer him to the hospital. The parents pick up their child, climb back in the car and are joined by a Congolese nurse who will do what she can during the painful 3 hour trip back to the hospital.

He died halfway there.

Always too late

Although we are pretty good at saving lives, it is certainly not always the case. One of the main reasons patients die in our health centers is that they simply show up too late. There was really nothing that we could have done for the boy. If he had arrived a few hours earlier, he would probably still be alive.

Sometimes, they don’t even realize that their child is sick until it is too late. Sometimes they have to walk for hours – or even days – to reach the health center. Sometimes they simply think that there is nothing we can anyway and don’t bother.

However, more often then not, they simply trust their traditional healer and his pile of roots. We do what we can to educate and sensitize, but we are going up against hundreds of years of tradition and that is not easy. MSF does not pretend to address sorcery or think that all of these traditional remedies are useless; while there really is a time and a place for these beliefs, it is just NOT when a child is suffering from severe malaria.

Sometimes the realities in the field are pretty hard to take.