First of all, there are no fields involved in my work. Not of the grassy variety anyway. ‘The Field’ is an interesting term that is bandied around a great deal in development and humanitarian circles, and it is interpreted differently depending on where you are when you say it*. Benson Hospital, despite being in the capital city, is considered to be The Field. At the project level, we have our own offices, our own vehicles, expat residence etc. MSF-Spain also has a coordination office in central Monrovia – their job is to support the teams in The Field, including Benson.
Sometimes, to avoid confusion, I introduce myself as a Hospital Director rather than a Field Coordinator. I always feel quite strange saying this. How can I be a Hospital Director? Most of my hospital experience before coming to Liberia was accompanying my dad to the hospital where he works every Christmas Day when I was a child. He used to wear a Father Christmas hat and carve turkey for those unlucky enough to be spending the festive season in the Royal Berks, Reading. My brothers and sisters and I, usually accompanied by a pet or two, used to pass around the Christmas dinner to the patients, and then wait angelically to be given stockings full of chocolate by the nurses (the real reason we were there, obviously).
Yet here I am, quite a few Christmases (and a LOT of chocolate) later, able to call myself a Hospital Director without being laughed at. I have my own office, a business card, and people call me ‘boss lady’. But, you’re probably wondering, what do I actually do?
Fortunately for me, my job is quite varied. I will describe some of the things I did last week and some of the things on my ‘to do’ list for the coming week.
Tuesday 7th July: on the day that Michael Jackson was buried, I spent the morning with a film crew from Britain who are currently in Liberia making a documentary (for Channel 4's 'Unreported World' series) about sexual violence against children. I am responsible for communication and representation for the Benson Hospital project, and was asked to connect the filmmakers with relevant local actors. I accompanied them to meet the staff at the THINK clinic for sexual violence, where they interviewed some victims – all young teenage girls. THINK is a Liberian organization that took over this service from Benson Hospital one year ago. They are one of the only organizations in Liberia providing comprehensive care to rape victims – including ‘PEP’ (post-exposure prophylaxis which can prevent the victim from contracting HIV), emergency contraception and counselling. We continue to provide them with their medical and non-medical supplies every month in order to keep the programme going.
Thursday 9th July: One of my most time-consuming responsibilities as a FieldCo is human resource management. As I mentioned in my first posting, we have over 200 Liberian staff at Benson and currently 6 expatriates. For each ward and category of staff there is a Supervisor, for example we have a Physician Assistant Supervisor (18 PAs), a Cleaner Supervisor (19 cleaners), a Supervisor for the Operating Theatre, for the Laboratory, etc. Last Thursday, I had several meetings relating to HRM. I held a meeting with all of the Supervisors (16 in total) to brief them about the new division of responsibilities in light of 2 expatriates recently leaving whose positions will not be replaced. There was what we call a ‘disciplinary action meeting’ involving a Nurse who had been spotted far from the hospital when she was on fact on duty… Finally, a meeting was held with our 26 Watchmen to discuss some recent breaches of security at the expatriate residence and how these can be prevented in future.
Sunday 12th July: Day of rest. I made a cake and played ping-pong with the Watchmen at our compound. In the afternoon I went to downtown Monrovia to find Dennis – a 16-year old lad who suffered from polio as a child and is wheelchair bound as a result. Dennis begs every Saturday night outside a bar that is popular with expats, and in June I lugged a set of crutches from a wedding in the Cotswolds all the way back to Liberia to give to him (very long story). Afterwards, I spent $16 on lunch with 2 British friends at a nearby posh hotel, which is probably more than Dennis earns begging in a month. Did that make me feel terrible? No. Is that wrong? I don’t know. But I never claimed to be a saint and I have always maintained that being an expat is a pretty odd kind of existence.
On my to do list for the coming week, let me see…
- (planning and reporting): write the situation report (in MSF lingo 'SitRep') for June!
- (project implementation): I need to write to JFK Memorial Hospital (Liberia’s main referral hospital) to inform them that from now on we will not be admitting ‘caustic soda patients’. These are normally young children who have ingested caustic soda (mistaking it for water), which causes their oesophagus to constrict, making it extremely difficult for them to swallow. To help them requires a surgical intervention known as oesophageal dilation, which widens their oesophagus. Depending on the severity of the case they may require several dilations before they can swallow normally again – this can be done here in Liberia but even this is often only a temporary relief. Surgery to provide these patients with a more hopeful future is not available in this country for want of a Paediatric Anaesthetist. Therefore we have taken the painful decision that from now on we will not accept these patients in order to liberate beds for children who have more chance of survival. I can and will write a whole separate posting about these patients if the interest is there (let me know).
- (HRM): I will spend a couple of hours doing a mid-term evaluation with our long-suffering Paediatrician from Germany, who is now over half way through her first mission with MSF. The expat Paediatrician at Benson never has an easy time of it, reading point 2 above you will understand why.
- (financial management): I will discuss with Victor, our Field Finance / Admin Assistant, a new method of paying salaries at project level (details top secret), which I’m pretty sure will go down like a lead balloon…(it involves banks, which are generally pretty unpopular in Liberia).
- (establish / maintain relations with local authorities): I will attend the monthly Montserrado County Health Team meeting on Thursday, to receive an update on the Ministry of Health upcoming plans and activities, and those of other NGOs.
- Finish this blog posting…
*If you’re in the European headquarters of an international NGO and someone says they are going to visit The Field, then it is well understood that they are heading to a country where that NGO is operating – let’s say Chad. Once in the capital, N’Djamena, those left behind in Europe will consider that this person is squarely in The Field. However, if the NGO in question is only running ‘coordination’-type activities in N’Djamena (for example, liasing with Chadian authorities, receiving supplies etc.), and the activities which benefit the population are happening elsewhere in the country, then N’Djamena is definitely not The Field. In this case, those in N’Djamena will consider those in the project sites to be in The Field. Nor does it end there; if the project has some remote activities, in MSF’s case mobile clinics, then only when you have driven 3 hours on terrible roads away from the project base and set up your clinic for the day in a shady area can you truly say you are In The Field (and probably, by this point, you actually are standing in a field).