A Goodbye to Minsk

Hilary reflects on three months spent working on addiction and tuberculosis in Belarus.

Hard to believe, but the final blog post in Minsk is happening. It’s snowing in Minsk, it’s cold, and that’s a sign that my mission is up! Three months have come and gone, and right now it’s time to handover to my replacement, Katherine, and wish her well in her upcoming adventures!

Katherine arrived last week around midnight and she’s from Halifax, Canada. After a midnight arrival, she then had to spend 2 days sitting in training watching me present in order to get a handle on the content and understanding of the goals of the training. I have to say, being required to sit in 2 days of training, jet lagged, listening to me talk for hours on end seemed like a terrible way to start a mission, but Katherine took it in stride and relied on the coffee!

Replacement MHO meets current MHO and delicious Belarusian chips are exchanged!

This week is now being spent wrapping things up. Nothing new is started, and the goal is to make sure that Katherine has the understanding and opportunity to ask questions relevant for moving the addiction component forward. This is also her first mission, and I’m finding it difficult to try and do handover in a logical, concise fashion that doesn’t just jump all over the place without making sense. This is also my first time giving or receiving in person handover! It’s never happened before for either of my missions. I am really having to check and restrain myself not to just start saying “Oh and that reminds me! Oh, another thing!” but to progress thoughtfully and logically in what we are saying. I can’t talk about the MSF addiction plan without first talking about addiction services in Belarus, and I can’t do that until I’ve described generally the medical system, and so on.

I am looking back on what I thought I would achieve when I arrived, what I thought would happen, and now what I realize was realistic in accomplishing. Like Pandora’s box, it always seems to be the case that when you think something is simple, but start to dig into it that you realize actually there are layers and layers, and for some reason I didn’t think much about this when I started. I remember thinking that I would have detox in the TB hospital up and started by the time I left, but I have no idea why I didn’t realize that it would take time and effort and groundwork to start that, and that realistically it would not happen in 3 months. On the other hand, I think if I had come in with a mentality that nothing would progress, then my outlook and results would have been much less then what I completed. Maybe every MSF mission needs a bit of unrealistic expectation to get through and cope with the actualities of the work.

I’m pretty happy with the final plan and the addiction proposal that has come together. I’m proud that it includes elements of harm reduction, sustainability, integration, and is focused on patient-centred care. I’m really pleased that MSF has supported trying new things, like anti-craving drugs, and recognized that we are treating addiction in the context of TB, which requires an outreach component and integrated rehab. I’m really happy that the project knows what those words means and understand how that impacts delivery of care! Perhaps I’m most happy that the Belarusian partners in the TB and addiction areas are on board with this, are willing to collaborate with us, and are so positive about trying new things.

And that plan now belongs to the project and to Katherine. On Friday when I hand over my office keys, my ability to influence and shape the plan is finished. MSF also includes this element – we spend a mission building, or sustaining, or creating something and then we hand it over completely and totally. We don’t move to another department in the same area, we don’t take on a supervisory role in the same organization, but can still see our old position grow or change or have influence on it. We hand it over, and we trust that it will move forward according to whatever the need of the project is. Expats are but a brief moment in what can be a long project. I’ve said this to staff in both projects I’ve been in – the expats are not the project, the staff and the patient care that continue and keep things moving are the backbone of the project and the delivery of care to patients.

MSF’s model of working has pros and cons, but people rotate and leave jobs all the time in other more “normal” jobs too. The difference here is that when we handover and leave, we are truly finished with our small part, and the project keeps moving and changing and growing long after we have left. And that’s great. The project has to be bigger than one person. The addiction plan I developed has to be bigger than me, and if it’s success hinged on me, the plan would have a huge, giant flaw in it and would be useless. I often get asked what it’s like to work in this way, and I usually respond that if something I started falls apart after I’ve left, then it probably had issues in it to begin with. So I hope I’ve left something that continues this time around, and if I didn’t, then it wasn’t meant to be.

And, for all the new missioners out there, or people that might be heading this way in the future, here are some thoughts more generally about this context.

  • Best thing about Minsk – The people and staff. Hands down, I have enjoyed working with and getting to know the great people, both inside and outside MSF.
  • Most challenging thing about Minsk – Not having recycling, food composting, and the prevalence of plastic bags. I found it very difficult to throw out paper, glass, and food waste.
  • Best thing I packed – Layers! In the absence of full blown winter gear (which I truly would have needed for about 1.5-2 weeks, making it not efficient to pack), my combination system of warm, thick hoodie, thermal shirt, down vest, and water proof shell has done me well in the snow, rain, and wind. Plus my toque.
  • Best thing I didn’t pack unless I was told to – my warm, knitted, inside socks. Brilliant
  • Unexpected surprise – the Minsk Freestyle Aquapark! Complete with ski jumping training, water slides, a lazy river, and many saunas, hot tubs, and a snow cave! A must see in Minsk.
  • Things I’m looking forward to eating when I get home – Quinoa, craft beer, and Bob Likes That.
  • What I would pack if I had 40kg of luggage and was here for a year – a fitted bed sheet. It’s small, but I toss and turn and pull the tucked in sheet out

So what’s next? It’s time to head to Berlin for debriefing, and then there is a few weeks of personal travel snuck in there before heading back home to Vancouver and back to work on Dec 23rd. I’m off for a trip overland from Dakar in Senegal to Freetown, Sierra Leone, with a stop in Cape Verde to take my PADI scuba course before heading to Dakar. Countries 45 to 50. I look forward to the warm, sunny weather before back to the winter in Vancouver. The trip home from Freetown will be long, with stops in Brussels and Frankfurt, and I hope the airports aren’t super crazy with the Christmas rush. Until next mission!