The fear of home
The road between Khatmandu and Dhukali leaves the flatness of the valley and starts to climb steeply about twenty kilometres from town. 
The road between Khatmandu and Dhukali leaves the flatness of the valley and starts to climb steeply about twenty kilometres from town. 
A few weeks earlier this countryside had been shaken side to side much as you would shake a sieve, by an earthquake that had reduced half a million people`s homes to ruins. A couple of weeks later, on the morning I was leaving England to support the MSF response team, a second major quake lifted the land and bounced it up and down.
People here for both quakes talk of the distinctly different motions of the two quakes. For many buildings weakened by the first, the second was too much.
Myself and another logistician were heading to the town of Dhukali to seek out possible helicopter landing spots and get permission to use them for our program of NFI distribution. NFI stands for Non Food Items. In our case, this involved one large packet containing a 4m x 6m waterproof sheet, blankets, rope, a collapsible water canister and sleeping mats, and a second, smaller, hygiene kit which contained cloths, towels, lots of soap and washing powder, a bowl and other bathroom items. In the villages identified by our earlier assessment teams, each household should receive both packs - together weighing about fifteen kilos. 
Logistics covers a multitude of roles within MSF, and our logisticians (logs, for short) are expected to be flexible enough to adapt to a wide diversity of tasks. In my own sporadic MSF career I had been given the logistics roles of All-round Log, Log/Admin, Log/Admin/Team Leader, Base Log, and  Water and Sanitation Log (WatSan).
In Nepal I was to be an NFI Distribution Log (Dis Log). Being a Dis Log in Nepal meant day after day in helicopters flying all around the Himalayas. My last mission had involved spending a month up to my knees in mud, water and faeces, covered in sweat in a desperately overcrowded camp for 40 000 people in the middle of a gruesome conflict. It was not glamourous.
Flying helicopters in Nepal for a month, in contrast, is the sort of job which, however much other work is involved, is not going to have anyone offering you sympathy! Happiness had been conferred on me. In fact, it turns out that practically every member of the team in Nepal had formerly worked in one project or other in South Sudan. We all look back fondly on our time there, but the word `difficult` is always used when talking about those projects.
The word applied to working in Nepal is `nice`. It is very unusual for MSF to do such large scale air operations. The cost of helicopters is considerable and we only have limited time with them. In the training manuals, distributions are usually done with large teams, days of preparation on the ground to sensitise the people and ensure equitable, calm, efficient distribution.
Men are kept away and items are handed to women in well fenced areas with flow management, good security, accurate data and lots of consultation with the authorities and the population. But in Nepal roads were blocked by landslides, the higher villages had no road access anyway, and the monsoon season was approaching with ominous rapidity. We had to get people under shelter  fast and on a considerable scale, or we could anticipate a very unhappy health situation for them in the coming year. 
It is important to make every moment count. Time really is money when helicopters are involved, but too much haste leads to waste. Working by helicopter, we would have a single Dis Log on the ground for about ten to fifteen minutes during the first cargo delivery to explain the whole plan and principles to the target community, and about three minutes to discharge each subsequent load.  
In this short time we locate the best English speakers and the community leaders, we try to communicate our principles and our plan, explain our preferred methods, and we try to get them to repeat that to the community at large so there is no secrecy or misunderstanding. We then ask them to take charge of the delivered items until we have brought the total amount for that location, and then run the distribution themselves. 
The dynamics of a community and the respect given to the organisers  is normally apparent quite quickly. If I have doubts, I stay to  watch the first moments of the distributions. I have observed them to then do this with some surprising characteristics - sometimes very innovative, other times less than ideal, but we have to accept that there is more than one way to achieve the same ends.
As long as the end result is inclusive and fair and the whole population accepts it as such, then I do not intervene. The smiles and waves and gratitude the people show as we lift off into the sky is intended not just for the pilot and me, but the whole chain of supply that begins with the donors and continues through the purchasers, administrators, co-ordinators,  packers, warehouse staff, transporters, loaders, and the entire MSF structure. It is my privilage to receive this thanks on behalf of everyone who has contributed to this final moment. 
We also bring a medic at the same time as we bring the first cargo.  This will not be the first time the villagers have been visited by one since the first earthquake, so it is usually only moderate problems that they find. But they make an assessment, and also give tetanus vaccinations for pregnant women, and if they feel more intervention is necessary that is arranged.
To hear one day of a man attacked by a bear made the medical report more interesting.
MSF mental health and WATSAN teams are also available. Landslides have muddied water sources and smashed pipe networks. People are understandably traumatised by the levelling of their villages, which look like they have passed through a garden shredder, and by the very valid fear of further landslides and quakes. Even those with buildings that still stand, far from the epicentre, sleep under plastic outside. And many villages, having observed the new cracks in the mountains above them, fear that the effect of rain or aftershocks will bring the mountains down upon them. In some cases it is sure to happen.
To fear mountains when you live among the Himalayas is more difficult than a flatlander can understand. The stress of living under such threats is a terrible strain. Food supplies are also running short. We cannot solve all this, but we fly sortie after sortie, ten or twenty times a day, to do what little we can to bring some relief. And while I am in the air in between loading and unloading, and when I have finished making notes and calculations  ready for the next cargo, I can look through the hazy blue air and see snow clad Mount Guari Shankar, Cho Oyu, and once even Mount Everest.
And down below I watch the terraced hillsides, the winding mountain paths and roads, the rugged forest, the landslide scars, the devastated villages and the people picking apart the debris of their homes to reuse the wood, the tiles, the stone, and excavators picking at the landslides. It can feel wrong to be enjoying my work so much in the midst of such wreckage, but the Nepalese in the villages smile a lot too, even while they show you all that they have lost.
It is they, not us, who will have to spend the next years rebuilding. MSF`s focus for now is just to assist them through the first few months.