This is my second mission with MSF and it’s amazing how everything seems to be a comparison. Maybe it’s because I only spent a short 10 days in Canada between missions and it is still fresh in my head. But it might also be because everything is so completely different in the DRC than it was in Bangladesh.
In my head, I’m constantly comparing…trying to figure out why it is done differently and to decide which way is better. That is where the national staff come in. For them, I’m their 7th logistician and, almost without fail, they have already done it ‘the other way’ because the last logistician thought their idea was better. Now it’s my turn and the constant struggle to avoid this trap is one of the most difficult things to manage as I throw myself into this new culture and context.
I also have to be a bit careful not to go on and on about this with my colleagues. I personally find it a bit much when the dinner conversation is constantly about where you’ve been and who you know there and how was soooo different than it is here. Yet, in my head, I can’t stop doing it myself!!! To give my fellow expats a break, I’ve included a couple of these very same comparisons for you to digest.
In Bangladesh, we called it our “villa”. It was a beautiful 2-story building made of concrete and ‘designed’ by an ‘architect’ (…all relative, of course). We had our own bathrooms, there were ceiling fans in each room and I had a nice view from my bedroom window. Things like running water, electricity, a ‘real’ toilet and the ability to walk around barefoot were definitely taken for granted.
Here, in the DRC, it is a bit like summer camp! My tukul is 2 x 2 meters, has a concrete floor, walls of bricks and a straw roof. The only power comes from our generator and a few solar panels…so most of the evenings we are left with headlamps and candles. We use squat latrines and our shower is an elevated barrel with a shower nozzle coming out the bottom. Due to recent snake spotting, we have to walk with closed shoes and a light at night. Our common area feels a bit like a kitchen in a Canadian campground (thatch roof of course), we cook with charcoal and use kerosene refrigerators. It always feels like you are outside and, in reality, you are!
This is also a completely different story. I could buy EVERYTHING locally in Bangladesh. Even the drugs were purchased in Dhaka and could be delivered within the week in case of an emergency. If I needed something for the outposts, all I had to do was hop a rickshaw and visit my favorite hardware store. We could find lots of great things like ice cream, chocolate bars and cold soft drinks in town. The market was absolutely bustling with dozens of shops and, relatively speaking, an absolutely great selection.
In Shamwana, we (essentially) have no market and the only local supply is bamboo, reeds and charcoal. That’s not entirely true as you can buy dried fish and warm coca-cola is always available…but at twice the price as it arrives on bicycle from who knows where. Literally everything – from scrub brushes to carrots to tires to concrete to printer paper – comes in by plane on an MSF built and operated runway. Crazy to think that one of my new responsibilities here is to maintain an airstrip and keep the goats away while the plane is landing.
…and all the drugs come from Amsterdam and take at least 4 months to arrive. Suddenly supply management has a whole new meaning!!
Then there is, of course, the difference in our actual operations. The project in Bangladesh was an emergency response to a nutrition crisis. We opened, operated and closed 9 health centers in a 6-months intervention and were involved in running feeding programs and providing really basic care. Our national staff doctors were constantly complaining that their patients weren’t really that sick and that they spent too much time prescribing multi-vitamins. With that said, we did treat over 1200 children for moderate malnourishment and likely saved the lives of the 52 severe cases that came into our program.
In Shamwana, we are literally saving the lives of people every day. MSF is supporting 5 remote health centers and running a 60-bed hospital to which all serious cases are referred. On average, the outposts see one birth per day and the maternity wards are always full. Lots of cute little black babies!!! Lots of complications as well and our operating theater is kept busy with C-sections. There are also mental health programs, a large water and sanitation component (well drilling, bed net distribution, health education), TB treatment and a weekly allotment for elective surgeries.
In my first week here, 2 pre-mature babies died and we lost a rabies patient… and those are only the ones that I - the logistician - heard about. It feels so much more real and more urgent then in Bangladesh and when someone shows up at your gate on Sunday morning at 7:00 am on his bicycle to tell you that his wife had trouble giving birth and is still bleeding…you bet I can find a car to pick her up and that I’ll make sure there is a doctor waiting at the hospital when she gets there.