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.
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