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My work life has changed dramatically in the last week.

My work life has changed dramatically in the last week.

My department is SSP (Soins de Santé Primarie, or Primary Care), the first line of patient care. SSP works through the Centres de Santé, improving access to the hospital, and through sensibilization (health promotion and education).

The head of our department is Sophie. She is Swedish and stereotypically so. Ever been to Sweden? Everything in our office is clean, absolutely on time (in a country where very little is ever on time), and efficient (in a place where everything is inefficient). She is strict and demands excellence. Not a bad boss in my book. In real life, Sophie is an Intensive Care nurse. She departs a week from today. I'll be sad to see her go.

Working side by side with Sophie is Alphonsine. She is being groomed to eventually take over Sophie's position. Together they are responsible for all of the Centres de Santé in the Lubutu health district, the sixteen run by the government and the two run by MSF.

Except the two run by MSF are my turf.

Sophie and Alphonsine go out to all of the government-run Centres de Santé and offer advice to their Consultants. They encourage the government-run clinics to refer patients to the hospital in Lubutu. They are also in charge of a huge team of sensibilateurs (pronounced sahn-see-beel-ah-tour, they are health educators) who daily disperse across the four main roads leading out of Lubutu. Sophie and Alphonsine help choose the educational topics. Recently we had an outbreak of monkey pox caused by eating undercooked simians. Thus recent messages have included tips on cultural preparation of monkeys. The gamut of topics is wide- basic hygiene, need for immunization, or contraception and family planning. This work is very important here where the level of health knowledge in the general population is low.

Me, I am in charge of the two MSF-run Centres de Santé, Kalibatete and Mungele. Analogous to Sophie's relationship with Alphonsine, I have Joseph Nyembo, a Congolese person working side by side with me. Only Joseph and I don't work together; we work in parallel. If I'm at Kalibatete, he is at Mungele, and vice-versa. This arrangement has been disappointing for both of us. I can't train Joseph to do my job as we never work together. We have to have one of us in both places each day. It's a challenge. With my time remaining, our geographical separation must change. Neither MSF nor I will be here forever and Joseph needs to learn how to manage a Centre de Santé.

The first two months I was here, I worked exclusively to improve the quality of care being given by everyone at Mungele and Kalibatete — the Consultants, the midwife, the people doing bandages and suturing, the staff taking vital signs and registering people, the guardians and the cleaning ladies. I have talked to and worked with them all. In addition I learned some administrative tasks ranging from management of the pharmacy to gathering and calculating statistics. I learned how to beg other departments to mend roofs, make photocopies, supply us with soap, or a myriad of other tasks necessary to keep the doors open.

October has been a shocker. Joseph is on vacation for the entire month. Sophie departs in seven days. Since the first of the month my work has transformed from 95% clinical to 95% administrative. I'm hardly seeing patients anymore. As a change, I suppose I don't mind being an administrator. If I wasn't here who would be crazed enough to run his butt off travelling daily between Mungele and Kalibatete, writing lectures and other teaching lessons, and begging for cleaning supplies? I volunteered knowing I would do some administrative work, just not quite this much.

Joseph will be back on November 1st. Why does October have to have thirty-one days?