A Rainy Sunday

I haven’t mentioned the weather here much yet, but today weather dominated my activities, so I have it on the mind.

When I first got to Monrovia a month and a half ago, I was welcomed back to the tropics by the heat and humidity I had become used to in the Peten, in northeastern Guatemala. As we were on the ocean in Monrovia, we got nice breezes, and the temperature was quite mild. But still it was the kind of heat and humidity that makes you sweaty just five minutes after a shower.

The drive inland to Nimba County doesn’t really climb much, but for some reason the temperatures here are much milder. The humidity is still quite high, and when you are standing in full sun, it’s easy to remember that we are at only 9 degrees latitude. The sun rises high in the sky, and burns with a fierce intensity. Exercise between 10 AM and 4 PM is really not a good idea. Laborers who find themselves working a full day often have sweat running off them. Still, Liberians take only an hour lunch and don’t have any real rest time in the heat of the day like Spanish cultures do. My quiet time at lunch is from noon to 2 PM, and I try to make some time to lay down and read a bit, not so much to take a siesta but to force myself to take a break and stop running around. Some days I manage to fit in the break, some days not.

Another interesting thing about living in the tropics is that human skin is apparently evolved to live here. My skin is always soft here, and I never have problems with chapped hands or lips. Ladies, if you want to find the smoothest hands and the softest lips, come to Nimba (but don’t expect a shower when you get here).

One of the real drawbacks about living in the tropics is that the length of the days is almost always the same: 12 hours of light, and 12 hours of dark, sunrise and sunset are at 6. Savoring the long summer nights is one of those temperate zone pleasures that I missed out on this year, as I was already on my way to Liberia just a week after the summer solstice. The equal length days and nights have implications for security rules: sunset is always at 6 PM, so curfews related to sundown are never really shorter or longer. On the plus side, Liberians who live without electricity (that’s all of them) never have long winter nights to live through.

Today we’ve had constant slow rain with a few hours of sun in the middle of the day. Also several times this evening we have had really intense rain, the kind that makes the metal roof roar and makes conversation impossible. All you can do is walk to the door and look at the rain. It’s a favorite pastime here, during these short blasts of mega-rain.

During the sunny patch today I went out to the garden and weeded a bit. Our zucchini are already incredibly big after only a few weeks in the ground. We’re going to be one of those annoying neighbors who always comes over with too much zucchini.

I made a new bed for more seeds. The soil is sandy and rocky, so I decided to go out in search of the soil rich in vegetable matter to round out the soil composition. I walked downhill, figuring that down by the swamp stuff would be rotting and making good soil. I ended up out in the swamp on a new walkway a family is making down there to make a rice paddy. I dug into the swamp bottom and pulled up this stinky, nasty black mud. I brought back a wheelbarrow full of it, and mixed it into my garden. Hopefully it’s helpful. I planted mint, lettuce, sunflowers and some other bright cheery flowers Mom sent with me. Next, I went outside the compound carrying a cutlass, and the guard hurried after me, assuming I was going to chop my leg off with it. I was looking for a few sticks to make a little shelter over my freshly planted seeds because I knew the rains would come back with a vengeance. The guard wanted to cut the sticks for me, but I firmly (and somewhat politely, though not really politely enough) told him that working in the garden on Sundays is my relaxation time and that I would cut my own damn sticks. He discreetly disappeared after that and a few minutes later I came back in the compound beaming and showed him my two sticks with forks in them, and my one long one to go across them. I put my forking sticks on each end of my new bed, and then put the long one across them as a ridge pole. Finally I leaned palm branches up along the top pole to give the seeds some shelter from the rain. Later, when the rain got really crazy, I ran out with a piece of plastic sheeting to give them more protection.

While I was putting away the tools, I noticed a piece of split bamboo that would make a great gutter. I decided to put a gutter up over the door to the office. Luckily it started raining just as I started the project, so I got a chance to see it working. But the problem is that the rain comes off the corrugated iron roof at a different speed depending on the intensity of the rain. Which means that sometimes it overshoots and sometimes it undershoots the gutter. I have not really ever seen a satisfying low tech solution to this problem in the developing world, except the obvious one, which is to NOT USE GUTTERS. Next Sunday I will putter around and solve this once and for all. The current plan is to arrange for there to be something for the water rushing down the roof to hit and then drop into the gutter. We’ll see.

The work week went by in a flash. I recall that I spent a whole lot of time using Microsoft Excel to plan both the food procurement for the hospital for the next 6 weeks, and the budget for a health post renovation that we are starting in a few days. I have my head around the food problem sufficiently now that I would be very surprised if we ran out again. However, there are a lot of things about this job that are very surprising, so we’ll just have to see about that.

The budget for the renovation is over by a factor of 2, which is a bit of a problem. It’s not really my fault, and no one is too mad at me for sending in a budget for USD 12000 for a project that is supposed to cost USD 6000. It seems like maybe the original budget was for a building that was much smaller. In any case, I know that we can come in under the current budget, but people are still uncomfortable with it, and want me to cut it. Cutting budgets is always a pain in the ass, because you get (un-)helpful suggestions like “can’t we use the extra nails from that other project?” that are hundred dollar decisions, not the thousand dollar decisions we need to be talking about to actually make a useful change to the budget. The donors don’t care if it costs USD 12100 or USD 12000. They want it to cost USD 6000, and no amount of cleverness related to the nails is going to get it there.

The other excitement this week was getting two suspected Lassa Fever cases. It is endemic to West Africa, and the health staff here are trained and prepared to handle it. But as a Viral Hemorrhagic Fever, you have to treat it with the same respect as things like Ebola and Marburg. Lassa Fever is spread two ways, by rodents and by contact with patients. That means that health care providers like us have to be really careful about how we handle the cases. The first one didn’t go to isolation for a while, because it is easy to miss Lassa Fever when the patient first arrives. We use virtually no laboratory tests here, since they are too expensive and difficult to do in the field. We have to send Lassa Fever suspect samples to Germany, where a biosafety level 4 laboratory does the screening. It takes a month to get the answer. By then, the patient has either been in the ground about 3 weeks, or has gotten better. So lab tests are not really useful out here on the edge of the medical system. When a suspected Lassa Fever patient dies, we have to bury them ourselves despite the wishes of the family. The negotiations around custody of the body get tense, but luckily that is not my department. Watsan (water and sanitation) is my department, so my guys have to quickly organize the decontamination of the body and arrange for the burial. It took us two days to finish this week, which was at least one day too many. I had a meeting about it and expressed my displeasure. We issued the grave diggers some more tools, so if the next one is a circus again, this time it will be time to give people a good talking to. With me, the first one is free, and you are allowed to ask for something that will help you do your job better. The second time, you catch hell.

Those who know me well are probably snickering right now, trying to imagine me putting on a stern administrative voice to deliver a lecture. I actually always feel like a bit of an impostor doing it.

The final bit of excitement this week revolves around three dead sheep. On Thursday, Jerome returned from the field with the surprising news that his driver had accidentally killed three pregnant sheep that morning. He explained that they were going quite slow, and came around a corner. They saw a flock of sheep to the left, which they were about to pass. Then another sheep came bounding out of the bush into the road. The rest of the flock followed and what might have been one close call with one sheep turned into a massacre, with three twitching sheep on the road behind the Land Cruiser. Jerome and the driver immediately stopped to see what they could do for the sheep. Jerome claims he even had the medical emergency kit in the Land Cruiser open, though I’m not sure what he was planning to do with it; we don’t stock sheep-sized airways. When it was clear that three of the sheep had died, Jerome and the driver got back in the vehicle and stopped at the next village in a few hundred meters. Jerome met with some elders and assured them that MSF always pays for livestock we kill (which was technically a baldfaced lie, since we’ve never killed any livestock before in Nimba). They told him that a sheep normally costs USD 50 in the marketplace. He assured them that while he didn’t have any money, he would send someone with money the next day.

Have I mentioned yet that being the financial administrator has certain downsides?

I heard once someplace that if you don’t do something weekly that scares you, you are not living your life right. Last week I was apparently living life to the fullest. I showed up in the village and asked for the chief. He showed me in to the palava, which is a thatched hut with open walls. It had benches all around the sides, and a table in front. I managed the trick of not getting assigned the chief’s seat this time, which is an improvement over the last time I ended up in a village meeting. I sat next to the chief and waited while various other elders appeared and settled into the benches. All told there were probably 15 elders there, plus a dozen or so other hangers on. I explained that MSF was sorry for the accident. Next, I explained that MSF wanted to compensate the owners of the sheep, and told them that because we had allowed the owners to keep the meat from the sheep, we would like to pay USD 40 for each sheep.

Well, that went over like a lead balloon, and I was afraid they would start throwing rotting papaya at me. A chorus of voices rose and eventually the chief quieted them, then told me the sheep were pregnant, and were about to have their babies, so that each sheep was really worth USD 100 or 150. I’d taken USD 200 with me (and had authorization from my boss to spend it all if I had to) so was ready to raise our offer. I decided to tell a little white lie in order to save face, and said, “Well, I had no idea the sheep were pregnant, and in that case, clearly we have to pay more. MSF will pay USD 150 for all three sheep.” This used two tricks I learned in Senegal. The first is that if you simply bump your offer because the other guy is too high, then he will expect you to do it again and again, meeting you in the middle. It’s a sure way to pay too much. But if you can reframe the negotiation with some new piece of info you can keep from signaling quite so baldly that you are willing to get into the “meet in the middle” thing. Also, you can make your increment sound higher by multiplying it out. I said USD 40 first, then next said USD 150 for three sheep. Which of those is a better deal? How much better is the second deal? OK, easy: USD 10 per sheep. But how long did you have to think to know it? And how much have your emotions swung in my favor during those extra few moments you were considering how much extra you just made off of me? Finally, I used the salesman’s trick of assuming the close: you don’t ask “is this price good?”, you tell them the price, and ask who to make the check to in the same breath.

Then I discovered I’d made a tactical error when taking out the money from the safe. I’d taken fifties and some twenties to be able to pay the USD 120 I was hoping to pay. But I was not able to pay USD 150 without getting change. And getting change, while it is rarely the huge problem in Liberia that it was in Senegal, is a real problem out in a village in the bush. My driver took off with the twenty and a man from the village in search of change. I was left to make small talk with a entire palava of elders. I decided to do a little MSF education and tried to talk with them about the importance of bringing caretakers to the hospital. But this backfired when they said, “Ok, but how do our caretakers and their patients get to the hospital, your vehicles never stop, and we don’t know the phone number to call your ambulance anyway”. They don’t know the number because there is no ambulance service. We carry patients once we have accepted them as our own, because they have presented themselves at one of our clinics. I explained that they have to get themselves to Saclepea somehow, and then if they need to go to Ganta or Monrovia for treatment, MSF will carry them. Then they asked why they can’t have a clinic right there in their town. I danced around this one a while. Luckily someone interrupted and brought the topic back to MSF vehicles and asked why sometimes we did pick up people from their village. The answer is that when we see someone who we are confident will be admitted as a patient, and we are already going that direction, then we take them in the vehicle. We do this because their status has changed from “a random Liberian who wants a free ride” to “a patient”. And patients come first. I even saw a case where we left a construction worker behind in Lepula because he got bumped by another construction worker who was visibly sick and was thus a patient. (Ever seen a black person who was visibly pale? It is not a pretty picture. This guy had malaria so bad it was a wonder he was even standing.)

After a while my driver returned with a new plan. One of the villagers would ride in with us to Saclepea because he had business there tonight. We’d change the twenty to two tens and send one home with him. This guy was lucky, because he was getting a LRD 300 ride to Saclepea for free, and we were happy because he solved our change problem. I had the chief sign the receipt, and off we went back home, having saved MSF’s image in the little village of Loyee.

Later the head driver asked me how much of the USD 150 the driver who killed the sheep had to pay. This was serious business, because USD 150 is a little over half a month’s wages. I was pleased to tell him that we knew our drivers were careful because this had never happened before, and that MSF’s administration understood that paying for dead animals once every couple years was simply a cost of operating a vehicle. He was visibly relieved that his guy wasn’t going to have to pay for the sheep, and it made me feel good to know that Susan and I made the right call. Not only did we leave the village elders with a good feeling about MSF, but we left the drivers knowing that we trust them, stand behind them, and won’t leave them hung out to dry when something happens that is not their fault.

My uber-boss from Geneva is here this week, and I asked her for advice on how to put the dead sheep money into the accounting system. She considered it seriously for a moment and then said that I could choose between “vehicle operating costs”, and “MSF identification and community relations”. I’m thinking of splitting it between the two, just because I’m now such an accounting whiz I know about stuff like splitting vouchers across accounts. Right now, my little sister, who is a REAL accountant, is probably rolling her eyes about how clueless her big brother is about all this sheep killing business.

Stay tuned next week for an update on the hammock being made by the leprosy patients in Ganta. I know it sounds like some sick medical joke, but I swear it’s true: people with lots of missing fingers are making us a new hammock, and the expat team is really excited about testing it out!

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