Half time - At the midpoint of my assignment in Lebanon

Nicole is working in the Bekaa Valley in Lebanon, an area close to the border with Syria. Her project mainly provides medical services for Lebanese and Syrian refugees in the area, and Nicole's focus is on ensuring the project has the staff and finance systems it needs to provide vital health care.

Nicole Bachtold and the MSF team in the car
Well, everything happens so fast that I already passed my half-time in the project. After an unexpected extended stay in Switzerland to get the appropriate medical treatment for all the unnecessary and disturbing bacteria in my digestive system (unfortunately it looks like Lebanese cuisine and me will never be friends), I’m finally back in the project to accomplish the last two months of my assignment.
It’s a scary feeling, knowing that there are only two months left.
When I arrived here in May, I had so many plans and ideas of things my team and I could improve on the administrative side. But time is passing so quickly that I’m afraid I won’t be able to finish it all (which leaves a very frustrating feeling…).
Nicole with some of the team
Me and some of the team. Photo: MSF
I came back from Switzerland just in time to work on the yearly plans for 2017. This means a heavy workload, with many meetings to discuss what MSF will do here in Lebanon's Bekaa Valley if the Syrian crisis persists over the next few years.
It is a very interesting and challenging exercise to rethink all the project's activities and ways of doing things, and a perfect opportunity to take a step back and analyse the needs of our patients. But it’s not easy at all, because it could mean that we might close a department or service and therefore have to let some employees go. When this happens we always try to reallocate employees to other services or departments, but unfortunately it’s not always possible. It’s a very difficult moment, and while I also had to do this in my old job, here the situation is different as the social security framework is less developed. 
 A friend of mine working in another MSF project in Africa had to close down the project as it was no longer needed. This is a good thing medically speaking, but on the HR side many employees lose their job as well. So it feels like it’s always a trade-off between the positivity of an improved medical situation and the emotional HR-side.

Kits for our patients The warehouse of medical supplies

These are medical supplies and kits for our patients. Getting the budget right is a vital part of ensuring our teams have the resources they need to provide health care where it's most needed.

Once all the activities for the upcoming year(s) are defined, we discuss which how many staff members and in which roles will be needed for each, and what budgets we need to allocate. So for example, if we can see that there are an increasing number of babies being born, we may need to expand our maternity services, which will require more specialist staff and equipment. This is very time-consuming, as I have to plan every single budget line with the corresponding accounting codes and split the forecasted spending by each month. Doing this for each position and with 150 employees in the Bekaa project means quite some work, but it's worth it to know our patients will get the care they need!
The proposed budgets and HR plans are then forwarded to the coordination team in the capital, Beirut, before they are sent to Geneva for final validation or modification. Having a bottom-up approach, based on the needs of the patients here in the project, is really something I appreciate a lot working for MSF. This allows us to be where we’re needed the most with the staff and resources that are really tailored to the situation here.
On the personal side, I am currently thinking about my next steps after my first mission here.  I would definitely like to continue working for MSF in another context and country, maybe something based more in an emergency context, which is actually the core of MSF.
I think that I will take some vacation first though, and explore some Asian countries backpacking again to escape the cold winter in Switzerland!
PS: Here is a photo from a weekend trip to the coastline of Lebanon around Jounieh and Batroun. Whilst we're working really hard to make sure the project continues to provide the care our patients need, it's also good to get a break when we can. Lebanon has a lot of beautiful sights!
The coastline of Lebanon in Jounieh and Batroun

All photos: Nicole Bachtold / MSF