It’s Tuesday about 3pm in Paoua. We did nine operations at the Bloc today, beginning with some simple, fast things and ending with a more complicated abdominal operation to remove a man’s spleen after trauma. But that’s a story for another day. Today I will talk about our living conditions.
The MSF base is a series of three compounds about 10 or 15 minutes by foot depending on your pace and whether you cut through the fields on the foot paths (pros: a little faster to cut through and fewer “moto-taxis” to watch out for. Cons: the foot path can be a bit muddy after a rain plus a slight increased risk for snake bite if you don’t watch where you step). The bases are set out like a short “L” with the residential compound at the top, the bulk of the pharmacy at the corner turn and the main office compound, including the logistics store at the foot. The residential compound, where all the ex-pats stay (“ex-pat” is the term used here for the MSF workers not from the CAR…citizens of the CAR are “in-pats”) is about 50 yards by 70 yards comprised of eight buildings, all single story and either concrete or clay block and mortar with stucco. The compound is surrounded by a seven-foot block and mortar wall with glass and metal embedded on the top, with access to the base, either by car or foot, through a plate metal door. This all sounds impressive until you realize that virtually every compound I have seen so far in the CAR has stone and concrete walls up to 20 feet high topped with everything from steel barbs to razor wire to broken bottles. By comparison, our compound is relatively low key. Even though the security alert level in Paoua when I arrived was at the lowest on the MSF scale, we do have watchmen round the clock, much like a gated community in the US. Regarding security, we can walk to the hospital or anywhere in town during the day but at night can only walk between the three bases, not even to the hospital. The issue with walking after dark isn’t so much about crime but that it is real, real dark at night on the road. Light pollution isn't a big issue in Paoua. It’s been a while since I've seen so many stars at night.
Back to the residential compound. There are three buildings with residential rooms. I'm in the middle building in terms of geography and desirability. There is an aspect of first come first serve to the room choice here but it is also related to how long one is staying. The ex-pats who are here for longer terms of three to six months get larger rooms, maybe twice the size of mine or the anesthesiologist’s. As I will only be here for five weeks, my room is about 10 feet by 7 feet with a single window. The ceiling is about 10 feet high so it’s not too claustrophobic. I have a frame bed with a foam mattress (not quite the pillow top mattress I am used to at home) with a mosquito net, a bookcase with three open shelves for a dresser, a rattan three by five foot rug and a rotating electric fan. The other buildings include the kitchen, a small laundry building, two toilet/shower buildings with a total of three toilets and three showers plus two buildings for pharmacy storage requiring refrigeration. Electricity is supplied by an on-site generator that runs about 12 hours a day, shutting down somewhere between 11pm and midnight depending on the day.
Food is communal. Everyone puts in the same amount, about 4,000 CFA of their 6,000 CFA daily per diem, and you eat whatever and however much you want. We get a monthly shipment from Bangui with non-perishables including rice, pasta, cooking oil, boxed milk and juice, tea, coffee, spices and a variety of treats. It just arrived last Friday so compared to my first two weeks here we have a veritable cornucopia of things like Pringles, cookies, juices and even a little chocolate that lasted a day. There appears to be an informal honor system that you don’t eat much more than your share of the good things and it seems to work about as well as most work place honor systems do. We also have a cook, a young man named R. who lives in Paoua. He and his assistant are responsible for buying all the local food including perishables, drinks and beer plus providing us with three meals a day. Breakfast is either chocolate muesli or (my choice) semi-fresh baguette baked the day before and whatever you can find to put on it (butter, jam, cheese, nutella), tea or coffee plus the intermittent grapefruit (fairly dry and even more work to eat than an American grapefruit) and fruit juice while it lasts. Lunch and dinner are at 1pm and 7pm respectively, always hot and relatively monotonous (rice, pasta or couscous with some type of stew/goulash with local vegetables and some type of meat) although last week we had fried chicken and French-fried potatoes one lunch and cheeseburgers for dinner on a different night (considering R. has never had one himself, they were impressively close to an American style cheeseburger). After eating, we put our dishes in the sink and R. and his assistant wash them by hand along with the pots and pans.
For me, the laundry building is where I drop off my dirty clothes and linen or pick up the clean ones. The laundress (yes, I am a bit chagrined to admit that I have watchmen, cooks and a laundress, but the idea is that the ex-pats are here to work at their specific jobs so everything else in terms of daily activities is done for us) washes the clothes by hand in the back on a classic washboard, dries everything outside on the clothes line between downpours and irons everything from the shirts to the underwear, partly because nothing quite dries 100 percent on the clothes line.
When it comes to hygiene, the showers are the best, the toilets not as bad as you would think. For the shower you get a) a four-foot by five-foot room with a drain in the concrete floor, a wood pallet to stand on and a mirror, b) a large plastic bucket to fill up with your own personal mixture of hot and cold water to just the right individual temperature (I'll tell you in a moment where the hot water comes from) and, c) a smaller bucket with a handle to dump water from the larger bucket over your head after you've soaped up. It's actually a pretty satisfying and effective shower, more so than I expected when I first saw them. There are large drums of water outside the shower houses that get cleaned once a week and filled daily by the compound watchmen. Part of the duty of the night watch is to heat water on an open fire at night and fill one of the water tanks with hot water for the morning; if you shower in the morning you have hot water. In the afternoon there is no hot water but as the temperature here in the afternoon averages between 85 and 89 degrees farenheit, the “cold” water is both warm enough for comfort but cool enough to be refreshing.
Finally, about the toilets. They are squat toilets (ugh) but the nicest ones I've ever seen (hard plastic floors with raised footsteps, all with a working vent and plenty of TP) and appear to get pumped out regularly. To paraphrase Chilly Palmer, the Elmore Leonard character from Get Shorty, these are “the Cadillac of squat toilets” and I find that I miss a comfortable bed more than I miss a flush toilet.
Yes, the accommodations have worked out pretty well for me and it has been a bit of a personal relief that I am fairly comfortable here. One of my worries about this trip was that I would find “rustic”conditions that would have been easily tolerated in my youth, now intolerable. Readers who are closer to my age will understand that no matter how many times you hear that 50 is the new 40, sometimes your back or your knees tell you a different story.
What strikes me the most about my accommodations is that compared to how the average person in Paoua lives, my residential compound is like staying at a five star luxury hotel in New York or Paris. As far as I can tell, no one in Paoua has electricity in their home. Unlike me, they can’t charge up the lithium battery in their REI headlamp during the day to use at night when they go to the bathroom. No one here has hot water in the morning, let alone running water. They haul water by hand from one of the many local wells maintained by the variety of NGOs here. There are no government sponsored utilities. I’ve found estimates of the average per capita income in the CAR ranging between the equivalent of 200 USD and 700 USD per year and I'm spending the equivalent of 8 USD per day on food. There is no doubt about it; daily life is hard for the average person in Paoua, much harder than my daily life in Paoua and umpteen magnitudes harder than the average person’s life in the US.
Yet, despite the magnitude of that difference, people here seem relatively happy. I realize there may be no way to quantify the strain caused by the hardships and insecurity of life in Paoua plus I have only been here three weeks, working in the hospital most of that time and it is pretty presumptuous of me to try to make an estimate of some sort of “average quotient of happiness” in Paoua. But when I walk along the street, children are playing, people smiling and laughing much as they do at home. When I walk to town on the weekends I see and hear gatherings of people in and around the village. I don’t know whether they are weddings or family parties or the CAR equivalent of urban street fairs and block parties but the atmosphere is reminiscent of celebrations and gatherings at home between family, friends, neighbors and acquaintances. I am a newcomer to Paoua, but given what I see here, if there was a direct correlation between “happiness” and the degree of personal physical comfort, availability of health care and sanitation, and food security, then almost everyone in the US would be euphoric 24/7. And having lived in the US for over 50 years, I can tell you that we aren’t that happy.
Happiness is a complex and multi-layered concept that I may take up here another day. The internet connection at the office has been down today and we can’t figure out why. If it is back up tomorrow, I will read and send emails to family and friends and send off this posting. At least I know I can count on there being hot water for my morning shower.