y-shaped sticks.

march marches.

"may you live in interesting times" is one of the greatest curses. the measles vaccines have arrived. 43 000 doses. they sit in…wait, they should be in the fridge. so too the diluent. we must get on that.

march marches.

"may you live in interesting times" is one of the greatest curses. the measles vaccines have arrived. 43 000 doses. they sit in…wait, they should be in the fridge. so too the diluent. we must get on that.

while we were setting up traditional "recubras" for our measles patients, we were setting up tents for a vaccination campaign command post. three large tents. one for equipment, one to house the extra team members flown in from Geneva, and the other to plaster with maps and strategies. a plane arrived in Khartoum on Saturday carrying 4000 kg of cargo for the measles emergency. they arrived by car in abyei last night.

I just ran into the MD in charge of coordinating the vaccination effort. I asked him if he wanted some of our peanut butter based salad, or if he preferred the peanut butter spaghetti sauce. "no, I can't eat. I am too nervous. if I do, I'm going to be sick."

all week we have had members of the ministry of health, UNICEF, the World Health Organisation, Save the Children, and more, tour our compound, our measles HQ, and the measles patients. there were concerns about our data, our assessment of the problem, and our plan to intervene. some from members of our own team, some from the other NGO's. perhaps we should delay. "no, we start on Wednesday." but… "Wednesday." what if… "Wednesday."

tomorrow is Wednesday. interesting times. we have made it part of our campaign to screen all the children we vaccinate for malnutrition. one of my responsibilities (in addition to supervising the hospital and all the patients in it, being on call for emergencies 24 hours per day seven days a week, running the tuberculosis program, keeping statistics, and training staff) is the therapeutic feeding centre. the TFC. because the population has quadrupled in the past year, there is a food shortage. there is one harvest a year, and it happens at the end of the rainy season. that will be in September or October. abyei is about to enter its food gap, and starvation will worsen.

if we vaccinate 35 000 children in the next few weeks, and we find 1% severe malnutrition (a local NGO estimates it at 3%), that will mean 350 children, perhaps ½ under 5. we will offer all transport to hospital. if ½ are under five, and ½ refuse, we still might end up with 80 more children in the TFC. right now we have ten. interesting.

so, that's what MSF talks about over lunch, and that is why there is reason to be nervous. 80 children. it would double our current census, measles patients included. what about latrines? showers? kitchen? where would they sleep? who will take care of them?

right. the max capacity of latrines is 20 people per. we have five. we can build more. we'll send a car for more gas and stoves. build another shower. we shouldn't put them at the front of the hospital because they would be vulnerable to fighting or the chaos of a big accident. so they go in the back. away from the TB patients and the measled. ok. we'll set up some shade netting. no, they don't like. they like recubras, the huts. fine. big hut, back of the hospital, put starving kids in it. more latrines, a shower or too.

this could start tomorrow. Wednesday. ok. maybe we'll get there and the other NGO's data will be crap. everyone will be so stuffed they can't even waddle to the front of the vaccination line. so let's wait and see. then move fast if we have too.

our logitician spoke up. well, maybe one thing. those y-shaped sticks, you know the ones, that we use to make the recubra. they are hard to find. people have to travel to get them. we should go to the market right now and buy as many as we can so we are not scrambling tomorrow if we need them. I'll do it after lunch.

that's MSF. we'll sort it out as we need to. except for the y-shaped sticks. today it's all about the y-shaped sticks.

we are overflowing... with people running from place to place, so nervous they can't eat, but so too our showers. compound 2 has 20 people staying in it. one latrine. the WHO maximum, per latrine. today we starting calling it "camp 2". we mentioned all this to our logistician this morning and he added the requests to an already long list.

logisticians make things happen. if it wasn't for them, the rest of us would be standing knee deep in dust, waiting to get started but not sure exactly where we should begin nor how we would get there. we add things to their list, and put request forms on their desk. yesterday I put one on Gilbert's desk for "world's largest emerald". he didn't mention it today, so I hope it is on its way.

I am on my way. to a meeting about the feeding centre. here is how I am going to start it off: "so, what the hell are we going to do?". I'm going to use the "y-shaped sticks" idea that I stole from Gilbert at lunch as my contribution then shake my head disappointingly at other ideas. all md's secretly want to be logisticians.