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.