What we do on a holiday

I got lots of stuff done on my “day off” yesterday due to the Liberian Independence Day. The threat of unrest on a national holiday meant that we were confined to the compound all day while the staff had the day off. Even though I had a day off to catch up, I had a really hectic morning with a thousand little problems to solve. The most embarrassing one is that we ran out of rice for the hospital. Last week we ran out of tea, which was a big crisis because the staff is so touchy about missing a tea break. Running out of rice and tea were basically both squarely my fault, but each time they were easy to fix, and I’m confident that we’ve got things set up right for August.

I got to meet the log from MSF Holland, Taj. He works in Sanniquille. He’s a really nice American guy from Seattle. He is halfway through his 9 month contract and really has the hang of working here. He invited me to come visit anytime, which I will be happy to do. The MSF sections in Liberia are really friendly, which is nice. Taj and I were grousing about not being able to find any girlfriends since we are not allowed to date Liberian women. Jerome and I have only Susan (the boss) and Lilian, who is married, to choose from (Emir, the remaining man, is married also). Taj said at Sanniquille, it is two guys about 30 and four 50 year old women. Which to me didn’t sound too bad, but he’s apparently not interested. I think I need to make a trip to Sanniquille!

Also a few days ago the newest member of the team arrived. Lilian is a nurse from the German speaking part of Switzerland. I haven’t learned about her background yet. She’s very different than Dima, but she will be a good member of the team, and the family. She is really down to earth and didn’t flinch at all when I showed her our bucket-flushed toilet and the shower which the cockroaches reluctantly let us share with them… they don’t even run when we turn the lights on anymore! I think it is time for a bottle of SpriGone, an insecticide from Dubai which Liberians use like air freshener. In fact, today I used some SpriGone on a termite nest out where I was installing the satellite phone antenna and I realized it was the same nice scent I’d noticed in my room each day after the house cleaner finishes tidying up. And all this time I thought it was just the fresh sheets she puts on every day. Actually, she has been helpfully spraying insecticide all around our rooms!

It is my after-lunch break, and I think I will go lay down and play with the shortwave radio I bought for USD 12 last week. It was supposed to cost 10, but I got them down from 15 to 12. It would have been better to send an African to buy it for me, but it was fun anyway and 2 dollars is not the end of the world. The traders in electronics are all Guineans who speak French, so we did the old calculator negotiation thing, then in the end the batteries he had were damaged, so I made him give me some LRD to go buy some batteries of my own. Jerome and I brought back a big bamboo pole from the bush and I put up an antenna, but I’m not sure it’s really better than the built-in one. I think it just picks up more noise. The national staff were all laughing as I walked around base with my big bamboo pole. They think it is hysterical when a white man tries to do any work with our hands. Leading by doing is difficult here because people just scramble to arrange for it to be impossible for you to exert yourself. If you are persistent and make it clear you’re going to get your hands dirty and work too, then they respect it, but their first assumption is that you shouldn’t be doing anything, like how a porter acts in a hotel.

Tomorrow we have a big workshop at the hospital to teach the national staff about the MSF movement they are part of. For many of them, it is difficult to grasp the worldwide significance of the movement, and what their place is in it. Liberians have a solid understanding of NGO’s, but it is somewhat colored by the type of NGO’s that dominate the economy here. The vast majority of their budgets come from governments, which makes them less frugal than us. We also have some staff who consider this just a job, and look at us like we are from Mars when we explain about concepts like duty, impartiality, witnessing, and so on. (Witnessing has a technical definition in the MSF world which is light years away from the Christian use of the word. Perhaps I will try to explain a little bit in another posting.) All of the expats have to attend the workshop, so my day will be somewhat less hectic tomorrow, at least once the meeting starts. Of course, the log is also the all purpose events planner, so I had some minor crises to work out today related to the event, and will be running around like a wedding planner (but with a VHF radio in my belt and riding in a Land Cruiser instead of a Camry).

A little excitement

I sat down to do my Sunday blog posting at about 10 pm but was immediately interrupted by our night watchman. He came to me to tell me that the hospital staff had an UNMIL (UN Mission in Liberia) vehicle there asking MSF staff to go with them out into the night to fetch an injured patient from the site of a motorcycle accident halfway to Tappita. I knew we probably couldn’t do it, because it breaks several rules (staff don’t leave the hospital to treat patients, we don’t travel at night, and we don’t ride in UNMIL vehicles), but I went and got a second opinion from the field coordinator, who is the most senior person on site. She agreed, so I had to give the hospital alternative instructions: give UNMIL dressings for one patient and instructions on how to stabilize them and transport them. I also got the guards on the radio and reminded them of their responsibilities with respect to UNMIL, which is that their vehicles must stay outside the hospital gates, no matter how insistent the driver or how urgent the situation seems. MSF staff may go out and carry in any patient that UNMIL drops off (no questions asked; it could be a soldier, as long as he’s unarmed). The watchmen know the drill, but emergencies get people excited, and sometimes people forget rules. I figured it was better for the voice of reason to remind them of the rules than to have someone make a bad decision and then have people talking tomorrow about how the new log lets UNMIL come in the hospital.

I posted one of our watchmen in the radio room to relay messages, since sometimes I can’t hear messages from the hospital in my room. I will stay up tonight to make sure things go smoothly. I’m really hoping that in an hour or so I hear that the patient arrived in stable condition… it will really suck if the patient dies and it was our security restrictions that prevented us from sending help. Note, “really suck” doesn’t mean it isn’t the right decision. Sometimes the right decision just really sucks. Let’s cross our fingers for the patient and hope UNMIL has someone trained in first aid on scene.

Update: At least one patient arrived in stable condition, with multiple open fractures of the tibia and fibula. He’s on pain killers for the night and we will decide what to do with him in the morning… he’s probably going on the truck to Monrovia, which was going anyway. There was no radio chatter about the second patient, hopefully that means the hospital staff were able to take care of him without the help of the expats.

The other big drama is a planned series of tasks next week to prepare better for evacuation. The threats to our project, however slight, have changed direction 180 degrees, so we have to redo the evacuation plan. Furthermore, we have been lax, so we are taking the occasion of the Liberian Independence Day next Wednesday to force ourselves to make and practice a better plan for evacuating. We will be on an increased security level next week, though in some ways even that is an exercise. The threat (rumors of an attack on Ganta) are just not credible, but there is a possibility that the rumors themselves could cause unrest.

Drama like this is rare. Usually the drama is restricted to firing people, or having their hours computed wrong or forgetting to take new contracts with me into the bush to have them signed. This is the administrative part of my job that takes up 70% of my time, and provides 90% of the frustrations. But even so, I manage to avoid the really annoying stuff and take up the fun stuff. Tonight, Susan and I counted the month’s salaries into 150 envelopes. The system we use was supposed to be foolproof, but we ended up off by a few hundred dollars at the end. The key when things like this happen is to stay calm and be methodical about tracking the error. I use lots of the systems I learned for tracking bugs in computer programs: keep records of what you are doing and why, set up experiments whose answer you know as a canary in the coal mine to catch errors early, and beware that two or more bugs (accounting errors) can compound to hide each other. Tonight there were three errors: I’d paid a salary early and not accounted for it because I was in a hurry. Second, Susan and I put five 10 dollar bills into the wrong place. Finally, I put one too many one hundred dollar bills into an envelope. The last one was the hardest to find, but by the time we found the first two errors, I was almost 100% certain the last error was an extra hundred dollar bill. The problem is that when you discover the error, you see the combined effect of the three (minus 243, plus 50, minus 100: thus minus 293) not the three actual errors.

Susan just rolled her eyes when I tried to explain that 10 years of tracking software bugs prepared me for accounting. But I’m convinced that it’s all the same skills, just with hundred dollar bills, Land Cruisers, radios, UNMIL, and really big bugs (the other kind: insects).

Speaking of radios, I also set up a fun experiment today (Sunday has turned into “fix the radio” day, which I consider a fun enough job to do on my day off). The HF radio in Turtle 4 is failing to tune, which means that the big fancy antenna is inefficient and the 35 watt radio might as well be a 2 watt one. (Long ago, I suspect T4 stood for Truck 4, but we call them Turtles now.) It is a royal pain in the ass to change the tuner out on these radios because they are externally mounted, as part of the antenna assembly. The tuner is the big black pedestal that the antenna is sitting up on. It is usually in front of the passenger, on the front bumper. I asked the driver to park a Land Cruiser with a working tuner (T13) within inches of T4’s tuner. I then used the slack in the antenna cable to plug T4’s radio into T13’s tuner and antenna. T4’s radio immediately tuned right up, so I knew that T4’s tuner is broken. I pointed to the two cars joined by the fragile antenna cable and told the driver not to move either truck… he laughed and understood the consequences… if we were lucky it would only destroy the good tuner and not also rip the good radio out of the truck! We disentangled the mating turtles and sent them back to their parking spots. Tomorrow I will order a replacement tuner. Because one in three cars in Monrovia is a UN or other NGO vehicle with an HF radio on it, and we all use Codan radios, it will be easy to find spare parts. The funny thing is in the US it would probably take 6 weeks to get a replacement, since they are made in Australia. But in Monrovia, the Codan guy will just ride over in a taxi and drop the thing off, probably taking cash payment for it.

One thing they tell you over and over again in Logistician School is that stepping down out of a Land Cruiser to a crowd of cheering children makes you feel like a god and that you should be careful to not act like an ass as a result of being treated like a god all the time. It’s all true. You get treated like a god, and as an experienced logistician told me, “There’s not really anything out in the bush other than your own conscience to keep you from going off the rails. And there are a lot of temptations.” What they DO NOT tell you in Logistician School is that Land Cruisers are quite possibly the most uncomfortable way to ride, topping even Chicken Buses for sheer unpleasantness. There is too little leg room, so your knee is always against the window crank. If you put up the window a bit to move the crank a few degrees, you now have a narrow piece of glass poking the underside of your arm (which you are jauntily hanging out the window, like the god you are). The seats are nothing to write home about, and they don’t even have faded graffiti from American junior high schoolers to read, like the Chicken Buses do. We often plan things efficiently enough that the vehicle is loaded full, which means that two expats are crammed in the front seat next to the driver, and the back is full of patients and caretakers with a significantly different cultural understanding of hygiene than those of us from Europe and North America.

I paid a salary early this week because one of my drivers came to me looking pale and sick as a dog. An employee comes to me several times a week looking like this, and usually it is malaria, which means drugs from MSF and three days rest. Before I could ask him what was wrong he explained that he is bereaved. His 16 year old son died that night. In the days before, MSF had referred him to Ganta, and Ganta had in turn referred him to Phebe. I don’t know what the son died of, but it is fairly rare to have 16 year olds die except from accidents (or wars, which are mercifully not happening right now in West Africa). Pregnant women, children under five, and people over 40 are the majority of our fatalities, not 16 year old men. It is a terrible tragedy for his family and my heart went out to him. Luckily, MSF’s policies in this case are quite humane. He gets 7 days off, and because payday would fall during his family leave, I decided on the spot to send him out of the office with not only his family leave approved, but his month’s pay too. It’s a shallow gesture to send someone out the door with USD 243, but in a society where pretty much everyone lives paycheck to paycheck (and there are no banks, and so, come to think of it, no paychecks), even getting paid three days early is a significant help.

So, there’s some positive things to getting to be a god. When you are the god of money, you sometimes get to do the right thing.

The key to this job is making sure that once every week (preferably several times a week) you notice something and think, “I’ve got the best job on the planet.” This week’s moments included sunrise over the jungle, performing in the quiplu comedy hour at the market as I tried to buy ingredients for cassava leaf soup, and scaring a bunch of kids half to death by jumping at them, then doing high fives all around when they realized the stories they have been told about quiplus eating babies are all bullshit and that white guys just like to clown around like 5 year olds.

In case I haven’t done a good enough job of recruiting, consider this… MSF is currently redoing their salary structure, and many experienced professionals are finding that their existing work experience plus their MSF experience (after their first mission) is resulting in pay that rivals “real life”. As a first mission person, I will remain at CHF 1500 a month (about USD 1200). All that and you get reminded several times a week that you have the best job on the planet. Go surf over to the MSF “putting your principles into practice” web page to find out how to come out and see me so we can scare some more African kids to death then do high fives all around.

A day in the life of a log

I figured I should give people an idea what exactly a logistician does. The glib answer is that we do everything the medical team either cannot or do not want to do. But actually in this project, at this time, it is a combination of upper management (meetings and signatures on slips of paper) and construction planning and management.

I get up each work day at 6:45 am. I spend 15 minutes or so getting awake, and then I meet my assistant and chat about how the day is going to go. The drivers are arriving at 7 am and getting their vehicles ready. Sometimes they arrive late, so they are put away dirty, so there are people washing cars, checking oil and other fluids, etc. The stock keeper, who is responsible for the fuel store, is fueling vehicles. Once I have a general idea that things are going according to plan and which vehicles will be ready to work that day, I head in to share breakfast with the team.

We make our own tea and toast, and to keep it interesting I eat it with Nutella some days, peanut butter others. We also have this really excellent marmalade, the best I have ever had. It comes from Iran, I think. The supermarkets in Monrovia appear to be randomly stocked with shipping containers full of stuff imported from Europe, the United States, and Saudi Arabia. It’s a little disorienting trying to shop there, since beside the Kellog’s Frosted Flakes, you might find a package of dates who’s label is written entirely in Arabic script, and over in the refrigerated section, Dutch yogurt.

The rest of the expat and national staff team starts at 8 am. The medical staff need to be at the hospital for an 8 am meeting each morning, so that’s the first car to leave. On Tuesday mornings, there’s a flurry of packing as the mobile outreach team leaves. They stay out in the bush for four days, returning on Friday night. Sometimes during the week they will call in on the HF radio with a request to refer a patient to the hospital. Then we send a vehicle out to meet them. The vehicle carries a jerrycan of diesel to the outreach clinic to replace the diesel they used to meet us halfway with the patient. There’s no filling stations in the bush, and their budget for fuel for the week is pretty tight as it is.

During the day, I work most of the time at the office, but I take trips to the refugee camp where the hospital is, and also to other sites in town. Last week I visited the cemetery where MSF buries bodies of people whose family cannot afford to transport them back to their home village. Depending on the beliefs of the family, in fact, sometimes after we inform them that a patient has expired, they simply pack up and start walking home, leaving us with the body. It was a minor shock to me the first time my colleagues started talking about a patient expiring, but I quickly realized that it’s the simple truth of life at a hospital – you don’t save them all, and when you lose a patient, there’s work to be done: taking care of the body, cleaning the room, and taking care of the next patient (hopefully with a better outcome).

Some days I plan all-day trips to one of the outlying health posts to supervise the construction there. On a day like that we leave the base about 9 am, depending on a hundred other interruptions and competing demands for the vehicle in the morning. Once we set off, it is a 2 hour drive to Lepula. I spend a couple hours there, paying workers, reviewing progress made, taking down lists of missing materials, discussing priorities for the next week’s work, then return home (leaving no later than 4 pm, in order to avoid traveling at night). This kind of remote management has been going on at Lepula for months, and it is a pretty inefficient way of doing things. Because there is no cell phone service that far out in the bush, and no HF radio, if there is a hold up during the week, we don’t find out about it until one week later. I’m contemplating what I’m going to change to make the next health post refurbishment go a little smoother. Right now I am considering a hybrid solution, where I live there two days a week, and leave an HF radio for them the other days. The HF radio runs off a 12 volt battery that we can hopefully charge during my visits using the Land Cruiser’s alternator. It is a low power radio, and so it depends on a very good antenna. I’m kind of looking forward to rigging that up.

In general, construction in the bush is difficult and time consuming because not only does it take a week to find out about a missing hinge or screw, but then the nearest hardware store is a 2 hour round trip away, in Ganta (away from the bush, towards the capital… a common topology in the developing world). Most sizable construction materials including plywood, zinc roofing sheets, pressed fiber board for ceilings, and rebar for concrete has to come from Monrovia. The capital staff takes my orders and arranges to send them to me via a rented truck. The truck takes several hours to load in the morning and about 10 hours to make the journey, so it invariably arrives at midnight. We let it park in the compound and then unload it in the morning. The trucks that make the trip from Monrovia are too big to go on the dirt roads into the bush, so we have to move the goods onto a smaller truck. Of course all handling is by hand, not with forklifts, which means things get beat up along the way. This is why brand new things in the developing world usually look about 10 years old by the time they are installed. And then day to day life on a refrigerator or door handle is tough. Finally, the majority of goods here are extremely low quality Chinese imports, which means that sometimes the day after you install them they are already broken.

When I go to a remote construction site, I take a briefcase full of cash to pay the daily hire workers. The driver and I sit at a little table and he calls them through one by one as I count out their pay. Sometimes they say thank you to me, and it makes me feel pretty good to say “you’re welcome” on behalf of MSF. It certainly makes up for the other kinds of conversations, when daily workers corner me and ask for work and I have to explain that when there is work, the construction supervisor will hire them, but today there is none. An unskilled worker makes 300 LRD, about 5 USD. A skilled worker makes about a dollar more. Unemployment here is over 70%, so people who don’t have salaried jobs really have to scramble to get enough work to support their families, which are huge for a hundred reasons I won’t go into now (but the US-backed policy of abstinence as a family planning method is certainly not very helpful).

When I am working around the office it’s typical office work. I use a computer (though we all share them, moving files around on memory sticks). I do backups and anti-virus warfare on the computers. I’m asked to review and sign an endless stream of paperwork from my staff and the rest of the project as well. I print things, then sign them, then zealously stamp them with the MSF seal like the third world bureaucrat I have become. One thing’s not like a typical office: I had to literally debug a toner cartridge that wouldn’t print by pulling the remains of a big wasp out of it!

Because the logistics team is currently running like a well oiled machine, I am spending most of my attention devoted to logistics on questions of new construction, renovation, and maintenance. I am currently planning a new office building and an increase in bedrooms at the base. I need to schedule a visit to a health post in Zekepa to investigate some concrete work we owe them. And finally, I need to start the Diallah health post renovation, which will be my major construction task while I am here.

I started out trying to describe a day in my life, but it’s so varied that I got lost along the way. So let me just finish with the end of the day… travel restrictions cause the rest of the expat team to filter back in to base around 5 pm. It’s the end of the work day, so someone usually pops open a Club Beer (simultaneously the best, worst, cheapest, and only beer in Liberia) and we sit down to relax. Mary, our cook, puts dinner on the table, but it’s usually between 6 and 7 before we are in the mood for it. We sometimes eat together like a family, and sometimes just grab a plate one or two at a time when we feel like it. Sometimes conversation lingers, sometimes people disappear to entertain themselves with books, personal email, etc. Once in a while, a full fledged party breaks out. But it can’t go too late, because the next morning I get up at 6:45 am and do it all again… until Sunday, which is our day off.

My first week in Nimba

Well, I survived my first week as the log/admin for the Nimba project!

The big event this week was me taking over financial responsibility for the safes and all the cash in the project. At the same time, I also helped close the books for June. We had a troublesome 281 USD to track down, but thanks to my training in Geneva, which happened to cover the precise tricky bit accounting we were having trouble with, I got it fixed. Of course, the majority of the work to prepare for closing the books was done by my assistant, Mr. Toe. He brings me the books ready to go, and I review them. He tried his hardest to get them to balance, but this time it was up to me to find the remaining errors.

For the Liberian dollar accounts, it is almost impossible to make them balance. We just handle way too many bills, and the possibility that a stack of 100 bills will be short by one bill when we receive it is always there. To give you an idea of the problem, the exchange rate is 1 USD = 56 LRD. The bills are 20 LRD and 50 LRD, so if we were paying someone about 100 USD (5600 LRD), we could be handling as many as 280 bills. And a few of those are going to get miscounted.

So you can see that the administrative side of my job is dominated by shuffling papers, both currency and receipts, invoices, etc. Thankfully Mr. Toe handles much of this, and it is up to me to handle the final checks on things, as at the end of the day it my signature, not Mr. Toe’s, on the books.

The other half of my job is logistics, which is much more interesting and varied. This week I got a tour of the water treatment plant. Walker, my head watsan guy showed me where the raw water comes from, how it settles, and how he calculates the chlorine to add. He’s received really good training from previous expats, so he is completely self-contained. Even so, he wants more training still, and it is up to me to figure out what training resources we have and make them available to him. Walker invited other people to watch as he demonstrated for me, so it turned into a little class. It was really fascinating to see Walker do and talk about what I’d read a bunch about, both in training with RedR in London, and on my own. I was able to add some explanations for the mysterious parts of the process based on Frosh Chem, the hellish chemistry course that almost killed me during my first semester of college.

It is a common problem in the developing world that even when a local person masters a complex task with coaching from someone trained in the developed world, they focus on how to do it and not on why they have been trained to do it that way. That’s no problem as long as they keep doing it right, but their superficial knowledge prevents them from effectively teaching their coworkers, or adapting the knowledge if the conditions change. The leverage you hope to get by teaching supervisors and having them teach their staff is lost. I don’t claim that in my first six months working in Liberia I’ll have any chance of solving this problem that’s been afflicting Africa for 100 years, but hopefully since I’ve already seen it with my own two eyes, I can consider what to do to minimize it.

I also took another trip to Lepula, where we are building a health post. It is almost done now, so we took the furniture for the building out from where it was built and stockpiled in Saclepea. The expat team is planning final details to get the place open. Susan, the Field Coordinator (fieldco) met with the town chief to plan an opening ceremony. Jerome put in a big order for little stuff like trash cans, mattresses, etc to fill the place up. I worked with the supervisor on how to solve a problem with a door that was made the wrong size. I also surveyed a warehouse that the community has loaned to us to hold construction materials, and agreed with their request to donate some materials to the community to fix up the warehouse as a thank you for letting us use it.

We moved a fair amount of freight back and forth this week. We had construction supplies coming in from Monrovia, we had to send some therapeutic food down to Benson Hospital, and we had parts of our expat food order, and monthly project order trickle in. It always makes me feel like Santa Claus to get to tell someone that their order has arrived, particularly when the order is something critical like tomatoes or canned asparagus (a real favorite of the boss). Because we have construction projects downstream from us in the supply chain, there’s some planning to be done to make sure that inbound items can be transferred to smaller trucks and sent into the bush without delay. This is the essence of supply chain management, and Roger (my logistics assistant) showed me how it’s done this week by having the little truck ready for direct trans-loading when the big truck arrived.

The week was also filled with various types of meetings. I interviewed a new taxi driver, met with representatives from the World Food Programme, sat in on the delivery of a warning letter to a staff member, held a meeting with a subordinate about creeping staffing levels, and attended my first expat staff meeting. Susan and I also had a nice meeting to welcome me and give me the context of the project, though I had picked it up pretty much by context by the time we had time for the meeting!

The other crisis we dealt with this week was due to a dead computer. Thanks to excellent IT support from Geneva I was able to fix things up using just what we had on hand here. It’s not pretty, but everyone seems happy with the new setup. Mom, thanks for the 1 gigabyte memory stick, I used it to move stuff around from the dying computer in its death throes.

Today I started a garden. During the week I arranged for some fertile soil to be delivered, because the soil in the compound here is said to have too little sand and too much iron. I put the soil into egg cups and planted seeds to get them to germinate. Later we’ll transplant the seedlings into some beds the gardener will make for us.

Today we are going in to town to watch the World Cup final between Italy and France. My teammate Jerome is an anyone-but-France fan, so I think I’ll go with the flow and support Italy. We watch the matches at a little bar called Farmer’s Friend. The Cokes are cold, and only 30 LRD. The beers are a fair price at 100 LRD for a 750 ml bottle (consider that for a second the next time you pay 6 USD for a pint in California). The owner of Farmer’s Friend knows it’s our favorite hangout for games, so often we arrive to find seats with signs that say, “reserved for MSF”. It is nice to be known in the city like this, but it can also be a problem. We are in a fishbowl, and everything we do is reported on the bush telegraph (the rumor mill) far and wide.

Next week, we have a huge amount of contract printing and signing to get through due to a big contract change that’s in progress. We also have to start planning some trips to survey some upcoming construction work in the bush. Finally, the team will be adjusting to the loss of two expats, and the arrival of several others (some visiting from Monrovia, some coming to stay). Dima will be returning to Geneva on Monday (assuming I’ve got the logistics right) and Dr. Emir has just left for a 2 week vacation.

Made it to Nimba County

On Friday, Jerome and I made the drive up to Nimba County. We took 2 patients, their 2 caregivers, and a baby. In Africa, hospitals budget for two people for every admitted patient. The second person is a caregiver, who is responsible for feeding and washing the patient. This doubles the amount of logistical needs related to patients (food, transport, etc) but it dramatically reduces the per-patient workload of the skilled nursing labor, which means the few nurses the countries have go farther. But the downside is that the families are more profoundly disrupted by someone going to the hospital, since typically the wife/mother is the caregiver. That means the older children at home have to do the work their mom was doing (gathering firewood, farming, doing the laundry) which may mean they leave school temporarily. So you can see that the ripple effects go out and out when MSF decides to admit a patient.

Though we had a slow start, the roads were in fine shape all the way to Saclepea, and we got in around 5:30 pm after about a 6 hour trip. It was really amazing to see a UNHCR refugee camp in real life after learning about them for so long. It was also interesting to see things with my own eyes that Kenneth, the previous log/admin had drawn maps of, or described from digital pictures. My first reaction to the MSF hospital at Saclepea was that it is SO BIG! There are buildings made of poles and plastic sheeting going out in every direction from the gate. We only made a quick visit to drop off the patients. I will be back on Monday to tour the place and learn about the tasks we need to do. UNHCR has asked us to move the gate to simplify movement of people, so that will probably be a high priority.

After stopping at the hospital, we continued to our base, where we live and have our offices. I got to meet the remaining two members of the team. We had dinner (meat in red sauce on top of rice) and they toasted my arrival. The magazines I brought from Heathrow were welcome, none more than a celebrity gossip rag called Hello. The funny thing was it was an impulse purchase after I’d already picked out a hefty stack of magazines. Further proof of a lesson that several MSF logisticians have been teaching me: trust your instincts and you’ll do fine.

I’ve had a tiny amount of management to do so far with my staff, mostly just meeting people and making broad declarations about how good Kenneth says they are, and how I’m not here to change anything, that it is important that they complete their tasks and talk to their supervisor about problems just like they always have. The same platitudes that always drove me nuts when a new boss arrived in Silicon Valley. Sigh. I did get up in the night the first night and check the night watchmen. I found 1 out of 3 asleep, which I suppose is good enough. The sleeping one knows that I know, though, and that’s the important thing. I suspect he’ll fix the problem on his own.

On Saturday, Susan and I went to Lepula, where MSF has been building a big shiny new health post for some time. This project is stuck in the rut of “just one more week”. It’s not really anyone’s fault… just a matter of details not getting done. We paid the staff for last week, talked with the foreman about next week’s work, and then brought back some masons from Saclepea whose work was done. Of course, when it came time to load the 6 people, the Land Cruiser mysteriously had 8 people in it, so Susan gave me a quick lesson in crowd control. The community wanted to keep one of the young men, and a certain young lady (maybe about 15) was embarrassed, laughing, and hiding behind a friend. I have no idea what the story was, but between the community’s desire to unload one guy and some other negotiations related to a painter who needed to go to the hospital, we got the passengers loaded and off we went. The drive to Lepula is bone-jarring, and lasts about 2 hours. It’s not really too much worse than 4×4 tracks I have seen in the United States, except the design they use for their bridges leaves out a lot of the details that make them feel safer, like railings and decking that you can’t see through. MSF rehabilitated some of those bridges. Kenneth showed me before and after pictures…. it was one of the times when I thought, “You’ve got to be kidding me, I’m supposed to be in charge of bridge rehab too!?!”

Today is Sunday, which we have off. This Sunday a few of us will work on a special paperwork-heavy project this afternoon related to new contracts for the staff. It’s no problem for me, since my time in Monrovia was not very intensive, but generally I am going to be very careful not to work on Sunday. I have also already decided to change something the previous log/admin did, which was to keep his radio on at night. I’ve instructed the guards to come get me for help any time, but not to expect me to listen to the radio. (I think I’ll probably keep one in my room anyway, but turned off.)

I’m really happy I’ve achieved my goal and gotten myself here. Day by day, I learn things and react to things in ways that make me think this mission will probably go OK, but I still worry that this first MSF mission will be like Harvey Mudd College was: much harder to get OUT of successfully than to get into!

Finally, I owe a HUGE thank you to everyone in my family (and Karl!) that helped find Kat a new home. During the last few days before I left for Liberia, one backup plan after another fell through and Kat was facing the death chamber. (Don’t worry, there was never a chance we would have let that happen, but we did end up scrambling a bit.) Karl kept Kat a few more days and then Mom and my grandma drove down to pick her up. They took Kat back up to Roseburg and got an article placed in the local newspaper about Kat’s story. A huge number of leads turned up, but the obvious choice was to send Kat back to her home in California. A family from Santa Cruz who was visiting relatives in Roseburg adopted Kat. They’ve even asked me to come see them when I am next in Santa Cruz. Looking forward to it!