Preparation for Primary Departure

To my huge relief at the airport gate for my flight to Bonn I bump into Tony. Tony is a friendly logistician I had met in the MSF London office a few weeks ago, and is also on his way to the ‘Preparation for Primary Departure Course’.

To my huge relief at the airport gate for my flight to Bonn I bump into Tony. Tony is a friendly logistician I had met in the MSF London office a few weeks ago, and is also on his way to the ‘Preparation for Primary Departure Course’. Not only does this mean company, but help with my extraordinary amount of heavy luggage. In total, I must be carrying over 50kg, as I’m flying direct from Bonn to my mission in Uzbekistan.

So much effort has gone into packing my main backpack in the most condensed manner that I fear if it gets searched by customs I will have to remain in the airport for the following three days trying to repack it. I’m too embarrassed to let Tony carry my rucksack (which he is now convinced contains bricks) so we develop a strange ritual where, whenever I pick it up (for example at the luggage carousel or boarding buses in Bonn) he helps it onto my back and then helps me stand from a squatting position.

Fifty per cent of the time I slowly roll backwards and end-up with my arms and legs flailing in the air like a stranded tortoise, until Tony frees me from the straps. All my visions of my being a brilliant yet remarkably cool and subtly sexy humanitarian doctor evaporate before I have even received my MSF T-shirt. I am a clumsy geek wearing practical trousers and for the greatest adventure of my life yet, I have packed a year’s supply of Yorkshire tea. The English, female, NGO equivalent to George Clooney I am sadly not. We arrive at our final destination, the bus stop for the Bonn youth hostel, and my rucksack and I get wedged between handrails and the bus doors slam shut before I can disembark. At this rate, I now doubt whether I will actually make it to Uzbekistan. “Achtung! Bitte stoppen. Bitte öffnen Sie die Türen!” Aged 30, I have finally put my German GCSE to unimaginable good use. Thank you Frau Kühn.

I rapidly realise that the PPD in Bonn is going to be something very special indeed. The course is seven days, minimum twelve hours a day, intensive, basic, training on every aspect of life as a MSF worker in the field. With the 45 other brand-new shiny and enthusiastic recruits to MSF Operation Centre Amsterdam (OCA), I receive instruction on the history of humanitarianism, the MSF charter and principles, MSF’s code of conduct and how to convey information to the media in a crisis situation whilst maintaining neutrality.

I learn how to plan the layout of a basic hospital from scratch, including how to keep the kids in the re-feeding programme from catching cholera or TB from the adult admissions. I learn how to prioritise medical provision for a refugee camp of thousands where there is no other formal healthcare provision. I now know where to find MSF’s protocol on amputating limbs with limited equipment and how to order spare parts for a Toyota land-cruiser. There are key medical lectures on subjects including malaria, HIV and TB. With my experience as an Infectious Diseases doctor en route to a multi-drug resistant TB programme, I hijack the TB lecture and start instructing my colleagues.The facilitator, a German doctor with many years experience running TB programmes in Africa patiently lets me speak.

Practising malaria rapid diagnostic tests © Emily Wise

Practising malaria rapid diagnostic tests © Emily Wise

I am itching to start seeing patients in the field. A four-hour session, led by Spanish MSF veteran David, is dedicated to discussing security, clearly a main focus of the week. No illusion is painted about the reality of the risks that we may potentially face. The eager and excited grins of us naïve newbie’s are wiped off our faces when we are slapped with sobering photos of MSF workers dodging bullets whilst running with stretchers through Liberian streets (David does not recommend our doing this), a blasted laptop with the MSF sticker on it (the result of a grenade thrown into the compound) and intoxicated child-soldiers carrying AK-47s manning a check-point.

For me, the highlight of the week was our ‘orienteering’ night, were we were sent to roam the nearby forest in small groups until 2am, pretending to be a MSF exploration and information-gathering mission, burdened with heavy equipment and jerry-cans full of water. Intermittently we are met by the course facilitators, acting as ‘nationals’ and we have to negotiate with the Forest Ministry of Health, persuade Forest local health workers on strike to help us test the water quality and hide behind trees from the Forest Rebels.

Through the week our class meets many remarkable and inspirational MSF members. Each facilitator begins their talk with where they have previously been on missions with MSF and my colleagues and I sit slack-jawed and wide-eyed, hanging on their every word. We then follow them like puppies during the coffee breaks, where they continue to hold court. We are introduced to a German surgeon who has just returned from Syria, where MSF have covertly set up a hospital in a cave. A bloody cave! Sean, an Australian advocacy officer, tells us the DRC is not his forte and he only has a barebones understanding of the situation there, and then proceeds to speak brilliantly and eloquently on the current situation in Goma and the different military factions. We dote on the main course organiser, Andreas, a German nurse who has countless hilarious anecdotes about situations in which he’s found himself. The MSF family consists of passionate but practical, experienced and principled characters. I feel truly inspired and a little bit brainwashed.

My classmates are doctors, nurses, midwives, laboratory technicians, pharmacists, psychotherapists, logisticians and financial and human resources administrators. They come from all the countries that feed into the OCA, from Canada to Taiwan, Sweden to India. Approximately half of us have already been assigned our missions, the other half anxiously wait to hear where they will be deployed. There is frantic checking of emails in between sessions.

Intermittently, the hostel receptionist comes to the class door to pull someone to speak to HR or the field on the phone and everyone holds their breath in anticipation of who it will be. Aoife, my Irish doctor roommate, excitedly tell me she’ll be posted in a refugee camp in Ethiopia; Sarah, an English psychotherapist, will be in Iraq on a Syrian Refugee mental health programme in the New Year; Lillith, a German Obstetrician, patiently waits to hear where she will be going. I fall in love with my peers. They are clever and gregarious, passionate and brilliant. We sit up until the early hours in the hostel bar sharing reasons for why we joined MSF and giving each other third-rate relationship advice. We long that we were being posted together and make drunken promises to meet up in Zanzibar during our R&R time, regardless of which continent we are headed to. By the end of the week it strikes me that one of the most important things I am learning on the course is how to live and work with my peers 24 hours a day, albeit in this temporary, totally protected environment.

The Bonn PPD Crew © Emily Wise

The Bonn PPD Crew © Emily Wise

In our final session on the course there is a huge symbolic moment: we each receive an MSF T-shirt. Myself and Martijn, a technical logistician from Holland, who has spent the last four years working to gain enough experience to join MSF, grin at each other and I pull my T-shirt on over my top: a good feeling we agree. David and Andreas end the course by singing to the group ‘I will survive’ with specially adapted words:

With ARV’s and TFC’s

Lets hope your IDP’s will no longer be on their knees

Your CMT and new PC

All have seen your bright CV

They are waiting in the field

So you should leave ASAP

So you’ll survive, yes you will survive,

As long as you know how to count

Those drugs will be supplied

There’s sharp pits to be made

And babies to be weighed

You will survive

Yes, you’ll survive

(ARV = anti-retroviral [drugs for HIV], TFC = therapeutic feeding centre, IDP = internally displaced people, CMT = country medical team, PC = project coordinator)

On the final night we organise a goodbye party. I am on the party organisation committee and am made Minister for Party Games. We hold a ‘Most likely to’ poll and categories to vote on include most likely to become president of MSF [Abdullah], most likely to get lost in rebel territory [Geneviève], and most likely to blag you through a check point [Andy]. David hijacks the laptop DJing and Spanish music is played for the majority of the night.

On Saturday morning everyone else either flies home, onto Amsterdam for their pre-departure briefing at head office or straight onto the field. The next flight to Uzbekistan isn’t for another 24 hours and I have a strange and lonely day all by myself in the hostel missing my new PPD pals and mentally preparing myself for what is to come.

In the ‘Most likely to’ poll I won the category ‘most likely to be a future PPD facilitator’. I am chuffed, what a compliment, given how in awe I am of my PPD facilitators.