One of the important responsibilities of an MSF'er in my opinion is the control of the medical and logistical stock. In a poor country, if you don't keep a careful watch over the resources of MSF they will walk off. Even if you do keep a good watch it is still hard. People are abjectly poor, jobs are hard to find and the resources of MSF can be readily sold in the local market. My job is to make sure the latter does not happen. As impartial actors, our job is to make sure the humanitarian aid gets to the most affected.
As an emergency physician, I inherently trust patients and families. I can't practice medicine if I don't begin at that point. But an old adage in my profession is also "trust no one, believe nothing". In this spirit, the last
few weeks in my mission have been about planning how to better institute procedures to protect the resources of MSF. I think the prior teams here have been just too run off their feet in my opinion to be able to do that well before. Now was the time.
So today, our logistician, expat nurse and I emptied the entire in-patient pharmacy. We then restocked it based on our best estimation of what was really needed. We then put in place a daily ordering system of medications so that only one day's medications and medical materials were available to the general staff. Then we locked the medical cabinets and plan to hold one of our national staff responsible for controlling what goes in and what goes out of the medical stock and pharmacy. Trust is not enough. You have to put in procedures to be better than trust.
As we undertook this important procedure in this sleeping sickness sub-base, I helped the pharmacist (he's not really a pharmacist, but can read and write). I read off the medications the other physician and I had ordered during morning rounds and he prepared them for the following day. One of the medications was 88 tablets of acetaminophen. Another was 2 ampoules of ceftriaxone. Another was 16 doses of Plumpy Nut ready-to-use therapeutic food. It felt good to me that each pill that comes from the money of our donors was ordered, tabulated on a tally sheet, put in a bag, labeled and judiciously made available.
Back home, I see people standing on a street corner in the cold canvassing for MSF. I know the employees of MSF don't earn the top dollars in the charitable and humanitarian sector. I know our medical and logistical
volunteers take cuts in pay to be in the field. But most importantly, I know it is regular, every-day people who work hard to give to MSF. In respect of all of this, and that fact that our medicines and efforts must go to those who most need them, I am glad I helped us give out 88 tablets of acetaminophen today. Not 87 and not 89. 88.
Warm wishes from the Central African Republic,