A day on the front line in Harare: the challenges of starting up clinical services and services supporting children in need of help after beign targest of sexual violence.

It’s daylight, so it’s probably time to get up. I look at the ancient Nokia cell phone that doubles as an alarm clock, and it’s five to six; time to get started. I cancel the alarm before it goes off, switch the phone off and chuck it in the drawer. Washed, dressed, breakfasted, two cups of tea, and I’m out of the door by 6:45. The walk to the office is about two miles – at a leisurely pace it takes just over thirty minutes. It’s an opportunity to think about the day ahead. I know I’ve got two appointments away from the office, and we’re hoping for good news about the negotiations to start clinical HIV services in a new location called Caledonia Farm – but we’ve been hoping for good news for a long time now, so it’s a matter of stoicism and perseverance, rather than a cause of optimism.

The majority of my walk takes me down Josiah Chinamano Avenue – Chinaman to the locals. It is in a central Harare suburb called The Avenues. It was obviously laid out in colonial times with streets running north south – I live in an apartment on Eighth Street – intersected in a grid pattern by wide avenues lined on both sides by jacaranda trees. It’s spring in Zimbabwe, and the jacarandas are in full flower. As I’m walking down Chinaman, I’m suddenly struck by the breathtaking splendour of the view; a violet carpet of fallen jacaranda blooms underfoot and an arched canopy of the most unearthly beauty. In an impulsive move, I whip out my MSF cell phone, and after a bit of fiddling about (I’ve only ever used it as a phone before), I take a snap. I review it on the tiny screen, and it looks OK. I’m sort of pleased with myself – my daughters would be proud of me – multi-tasking with a telephone!

Jacarandas on Chinaman

Jacarandas on Chinaman

Actually, the cell phone priorities are different in Zimbabwe. The one I have is a model previously unknown to me made by the Chinese company, ‘Baobab’. It does all the essential cell phone things like texts and calls and all that, but it also contains two SIMS. This is high on the list of priorities here, because the networks are somewhat unreliable due to factors that include the intermittent electricity supply across the country. As power goes off and on in different neighbourhoods, so do the cell phone transmitters; having access to two networks in one phone doubles my chances of staying in touch.

The early morning tour of the office includes a round of greetings – this is socially an important part of life and just plain good manners in Zimbabwe. I’ve already exchanged greetings with numerous people walking down Chinaman – newspaper boys, phone scratchcard sellers, street vendors setting out their tomatoes and bread rolls and bananas on their pavement stalls; “Hello, how are you?” How was the evening?” How is the morning?” Fine – how are you, too?” Along with the general greetings, staff compare notes on who had electricity last night, and who cooked the evening meal or breakfast or both by candlelight. I like this country – the politeness is genuine. People are truly considerate of each other, and however tough life is, people seem to be able to retain a positive outlook.

I jump into the car at about eleven, and exchange small talk with my colleague Philomena and the driver, on the way to our first appointment. This morning we’re meeting with Childline. It’s modelled on the Childline that I’m familiar with in the UK, and they are affiliated to the UK charity, but they’re an independent Zimbabwean organisation, managed by and for Zimbabweans.

Philomena knows the manager of Childline, and they chat about things in general, about a few mutual friends, and about recent meetings. Then we talk about what they’re doing in Harare and across the country. Their main activity is running a helpline for children to call and get some advice or support or just a sympathetic ear. The level of child abuse is alarmingly high; they receive thousands of calls per month. I’m shown the call centre – there are three people on phones, and it’s clear that just as one call ends, the telephonist takes another; it’s non-stop. In addition to the helpline, they also run drop-in centres for children, and this is what is of interest to MSF.

As part of our medical project in Epworth, we offer treatment to victims of sexual violence. This ties in with the theme of medical responses to HIV / AIDS, because if a rape victim is given the correct medication within 72 hours of surviving the attack, their chances of becoming infected with the HIV virus are greatly reduced. In a country with double digit percentage prevalence of HIV, this precautionary prophylaxis is essential. But putting rape survivors in contact with the medical services offered by MSF within 72 hours is a real challenge, and this is where Childline comes in. Through their helpline they have become well known to children and adolescents all across Harare, and especially in Epworth, which is part urban suburb, part encampment, part shantytown. It is an extremely poor neighbourhood, with all the associated social problems.

It is clear that we could probably be of use to each other. Childline have contact with some of the most vulnerable children and young adults in our area, and MSF has the knowledge, expertise and capacity to offer medical support to rape survivors. As the conversation continues, I realise that we have similar approaches. Both organisations share a clear vision of what needs to be done to support the most vulnerable people in society; their clients are our patients and vice versa. We need to collaborate.

But it’s not just the similarities between the two organisations that strike me during the meeting; it’s the differences as well. As we’re getting into the car, I comment on this to Philomena. We’re so lucky in MSF – we are able to turn our full focus onto the patients, because our funding is independent. The manager of Childline has to do the rounds from embassy to UN meeting, talking to representatives of international donors and crafting her projects and reporting formats to fit in with their political agendas or development priorities or the current ‘flavour of the month’ dictated by the foreign policies of the governments that offer the funding. Due to our high profile internationally, and the depth and breadth of individual donor support, and due also to the very principles of MSF, my job doesn’t include doing the rounds in Harare touting for funding.

We chat about which came first; independence of action or financial independence. That’s one for the MSF historians. I know that in the 70s doctors worked for nothing because they sought independence; they reacted against the received wisdom that humanitarian aid was delivered in silence, so the first MSF doctors struggled by whatever means to treat patients and bear witness at the same time. I am very pleased with the results of MSF’s history because, due to our insistence on sticking to our principles in the past, I’m not tied to the agenda of any international funders, and my time is focussed on managing the programme and finding the best angle of approach for our patients.

The next meeting is with an international organisation. It’s a reception for a new head of office, and it’s been in my diary for a couple of weeks since the invitation arrived. I think about my priorities; they do not include meeting with all the representatives and ambassadors and charity executives that will no doubt look on a Friday lunchtime reception as an opportunity for an early weekend. There’s a lot still to do this week, so we decide to cut the meeting and head straight back to the office. Anyway, while we were in the meeting, I received a text that there was news about our planned project on Caledonia Farm. Maybe we’ve finally broken through the bureaucracy and received the OK to set up the new clinic.

Back at the office and the anticipation of good news was again premature. We had originally approached the project, as always, from the perspective on need. This is a settlement of approaching twenty-five thousand people that has no clinic, so our argument was that they needed health services as a priority. The original suggestion was to start as a satellite to Epworth, some three or four miles away, but this wasn’t acceptable. The local council wanted their own dedicated services in a purpose-built clinic, but City authorities were nervous of the interpretation that could come from offering formal healthcare in an informal settlement. The good news is that the local council had agreed to MSF starting clinical services in a temporary building – a pre-fabricated two roomed hut could be in place within a week, so we’re getting quite excited about the prospect of start-up. But still the excitement is premature – another round of phone calls reveals that a temporary structure needs different permits and certificates, so we start the next round of negotiations, which continue until the City offices close for the weekend at five pm.

It’s dark by the time I get home. Time enough to rattle out a record of the day on the computer and while it’s on, I hook up the cell phone that took the picture of the jacarandas. I can see from the results that, as a camera, it’s only really good for making phone calls. Oh well, I’d better not get too boastful about my mastery of technology!

The two SIM Chinese phone is on the bedside table – great for staying in touch 24-7, but now I know it’s no good as a camera. I get my old faithful Nokia out of the drawer, switch it on and set the alarm. It beeps immediately – there’s a text. It’s my emergency means of contact with home – a UK mobile that’s cheap to receive texts – how exciting – a text from the family, perhaps. I switch the light back on, find my glasses and display the text. It seems that O2 are offering me a special deal on tickets for the Olympics if I top up regularly – no thanks!

It’s been a funny sort of day – room for optimism, a chance to meet people, some small excitement and a little disappointment. Sadly, as a manager in MSF, it’s not always about meeting the patients and seeing the direct benefit every day, but it’s still gratifying that I’m working for an organisation that places the vast majority of its volunteers on the front line in the clinics and hospitals and facing patients in need every day. I believe in what we do, I relish the independence that MSF enjoys, and the role that I have ensures that the MSF doctors and nurses do exactly what we promise our supporters. I’m very happy to be working for an organisation in which I can believe.