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!
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