Growing pains….

"MSF is largely funded by private donors worldwide and transparency and accountability are vital from the remote corners where we work"

This week has been all strategy. We have reviewed our plans for the upcoming months discussing pros, cons, costs, forecasts, budgets, risks, and the implications of our work in the region for the short- to mid-term (as an emergency relief aid organization, the long-term doesn’t fall within the scope of our work but is nonetheless very present as we look after the overall health).

Since our work is spearheaded by the health needs of the refugees/returnees, my medical colleagues lead the strategy conversations. My role has been to dissect each new activity to extract the financial and human resources implications in order to make it happen within the specified time frame and (preferably) within our budget. Given the population we serve (~17,000), our proposals involve a good amount of logistics, recruiting, training, coordination and negotiation with local partners – all of which require as detailed accounting rigor and legal framework as any I have seen in my previous corporate world encounters.

MSF is largely funded by private donors worldwide and transparency and accountability are vital from the remote corners where we work to European headquarters and satellite offices across the world. At first I couldn’t quite understand the feasibility of such reporting given the remoteness and at times unstable contexts, but now, after three weeks of sweating over my laptop, files, scanner, countless signatures and double signing paperwork, and tracking down daily workers throughout the forest for payment and receipt signatures, I see the procedures and resources in place to ensure our accountability is flawless, and I am partly responsible for upholding the reputation.

Strategy is defined jointly by our team and our supervising colleagues in the coordination office in Ndjamena. As MSF’s eyes on the field, we provide the first hand account of our patients and latest developments, while coordination ensures our activities fall within the scope of work, provides supplies, facilitates negotiations with participating organizations, and clears further decision-making with headquarters. Most importantly, Ndjamena has a bigger picture view of MSF’s work in the region and briefs us on important matters to mitigate and/or anticipate complications. This week we welcomed our Head of Mission and Medical Coordinator from Ndjamena to provide guidance as we fine tune our proposals. Collaborating with them I have learned plenty of various epidemiological diagnosis, prevention strategies, and population statistics. I have also understood the struggles of drawing the line of what constitutes a medical emergency, an outbreak, being at the brink of either, and decision-making with little to imperfect data. The need for as solid population and epidemiological data as possible is a constant throughout our initiatives. As any venture, it is difficult to determine an avenue of action without the research to back it up.

Unlike my previous job, we don’t have syndicated Nielsen data or marketing agencies to rely on to conduct surveys/interviews/focus groups to fully understand our ‘clients’. In our situation, it’s up to us to go through hoops and ladders collecting reliable data throughout several locations to ensure we understand the full picture and that our proposals will address the underlying ailments of our distressed populations.

This dilemma makes us revisit our proposals once and again as we balance the nature of our emergency relief charter with what needs to be done in the mid- to long-term to ensure the displaced populations see brighter times. Not an easy task to accomplish and the source of plenty sleepless nights yet exhilarating mornings as we hustle back to work.

Aside from strategy brainstorming meetings, lively debate about how to onboard partner organizations, and plenty of awkward group silence after realizing much-NEW-work-to-finish-within-a-week stares around the room, it’s fun to host visitors! Living together brings back memories from university dorm-living as work and life naturally become part of dinner table conversation and weekends. During such conversations I have learned the interconnectedness among expats working with MSF.

While my colleagues didn’t know each other beforehand, it’s been common to hear stories from memorable characters, meals, vacations, and humbling experiences from previous missions in Haiti, Congo, South Sudan, CAR, and Mali. A handful of the best, without spoiling the plot, have included the river boat mobile clinic going through rapids with patients on board, ‘fun’ weekends in Timbuktu, steering clear of pick pocketers in Cameroon while on break, house life during a mission with over 20 expats, exploration missions, and ingenious negotiating tactics with all sorts of local authorities. Time will tell what type of stories Goré and our team will accumulate to share over missions to come.

(So far, seems like my hammock might trigger some stories…got requests for leaving it behind already; no need for expensive factory mosquito net when we were able to adapt our own to ensure sound and cool outdoor sleeping, our PC pictured)

Outdoor anti-mosquito hammock napping © J.J. Téllez

Outdoor anti-mosquito hammock napping