Merry Christmas

I returned Wednesday from Zanzibar. It was a wonderful break. I didn’t do much this time – only a trip to the Prison Island (which never served as a prison),some snorkelling and a beach party. Zanzibar is an island province off the coast of Tanzania. Originally, it was part of the Sultanate of Oman and Zanzibar. It has been governed by the Portuguese, Germans, and English at various times. Just after it’s independence in the 60’s, it joined with Tanzanika to form the country Tanzania. It’s really a nice place, with some of the most beautiful beaches in the world. I spent most of my time in Stonetown, the largest town, and on the northern tip at Nungwi and Kendwa.

Most of my time was spent with some people I met last year who live and work there. We walked around, drank some beers, talked a lot, and generally enjoyed ourselves. It was pleasant and got my mind off Congo.

Now I’m back and it is hectic. We have 22 expats leaving this month, and 27 arriving! This planning is taking a lot of my time. There are also quite a few changes in the programs.

Fortunately, Laurence from Paris did some great work to advance our salary study. I must finalize it and make a tour to announce the changes in both the salary and function scales. And Anne, the person who will be picking up the finances, arrived Wednesday. This is going to change my life!

This will be the 4th year that I spend Christmas on mission and I love it. We are all away from home, but with each other. This year we should be around 13 at the house for the event. I think that I bought enough gifts in Zanzibar for everyone. If not, I will find some things here – being a primarily Christian country, the shops are already decorated for Christmas. And I will probably go crazy fixing food as I did the other years. It is relatively quiet in Congo for the moment. I hope that it remains like this so that we can enjoy the holidays. I really am an old child!

Time for a Break

Since my last posting, MSF-France in Congo has changed a bit – we now work under the Emergency Department rather than under a regular management scheme. In practice, this gives us some resources we wouldn’t have otherwise – a management team in Paris experienced in handling emergencies, medical and logistics stocks already pre-positioned in Nairobi, and a pool of expatriates with emergency experience who can help us out here.

I was already having trouble doing everything I had to do before the conflicts broke out in September. Since then, it has been even worse. A colleague from Paris arrived a week ago to help advance some of the larger tasks (pay scale review, job function review, 2009 budget preparation, etc). I am really grateful. And we have also decided to cut my job into two positions - I will handle the human resources, and someone is coming in another week to take over the finance (budget and accounting). This should help a lot. I felt that I could take either one of the posts, but they have a harder time finding someone to handle HR than finance, so I took that one.
We are supposed to take a break every 3 months. I have now been here 4 months. So I am leaving tomorrow for a week in Zanzibar (again). I am looking forward to the rest, and I am pleased that my colleague from Paris can replace me for that time. When I come back, there will be a lot of changes in our team. The person for finance should arrive a day before me, our new head of mission arrives tomorrow, our medical coordinator leaves around the 16th of December, and our logistics coordinator leaves around the 20th of December. I will be the oldest member of the coordination team!

What a day!

Yesterday was an incredible day .

An American surgeon who had finished his mission left at 7:00am for the Kigali airport. He had his ticket for Kigali > New York, but not yet the ticket New York > Phoenix. Since it was Saturday, there was no one in either the Paris or New York office who could give us the ticket info, so he left for the airport not knowing how he would be travelling from New York on Sunday. I went straight to the office and found his ticket which had arrived Friday evening at 10:00pm on our email address (with the security situation for the moment, we must all leave the office for the house at 7:00pm and we don’t move from there until the next morning). At 7:45am I was able to communicate his flight details by telephone and I sent the ticket to his hotmail address.

And we are cutting short the mission of quite a few expats, due to the insecurity in the region. Yesterday we sent off 3 people from Butembo up north. The commercial plane that arrived to pick them up first offloaded a lot of arms, apparently for the local militia. Our people decided not to take the plane. Good choice – planes supplying the various armed groups tend to become targets. We will no longer be using this airline. We loaded them and 2 others who should fly out on Tuesday into a car to go to the Entebbe airport near Kampala. It was a long shot - it is a very long drive and it wasn’t certain that they would arrive in time to take their 11:55pm flight.

Before leaving, the Angolan doctor informed me by phone that he had his visa to get into France for his debriefing, but not yet have his return ticket from Paris to Angola. The French immigration service probably wouldn’t let an African into the country unless he had proof that he would be leaving afterwards. So I got onto my crappy internet connection in the office, bought a ticket for him on my credit card and then communicated the ticket details to him by cell phone and sent a copy to our office in Kampala. The administrator there would print it and send a copy by taxi to the airport which is an hour outside of town.

Then I got a call that one of the nurses leaving Tuesday had not yet received her ticket from Entebbe to Paris. She and the other person scheduled to leave Tuesday wanted to see if they could get onto the same flight as the other 3, so she needed it. After scrounging around on a few computers here in the office, I found her ticket and sent it off as well to the Kampala office. The poor administrator in Kampala had just left after sending off the other ticket in a taxi. She had to return to do the same thing for this one.

Friday in Rwanda, there were demonstrations against France due to the arrest of a high-ranking Rwanda official on an international French warrant. So Friday evening we changed the arrival for one of my contacts in Paris from Kigali to Kampala. But now we had to get her from Kampala to here. And we had a local staff member we needed to send to Kampala who was booked on the aforementioned gun supplier airlines for whom we needed to change his flight. I was able to get a reservation for both of them on the only other approved airlines available to us.

Next problem: For our staff working at one site and who have families living in other towns, we do money transfers into financial cooperatives in those towns. Usually, it works – we deposit money here in Goma, and the affiliate in the other towns distributes the money locally to the recipient. The problem is that these cooperatives depend on local deposits to do the distribution. With the unstable climate right now, no one is depositing money so they have no liquidity to distribute the money. We deposited the money here 10 days ago, but no one has yet received their payment. Monday I must go to try to cancel the transfer and figure out how we can pay locally ourselves.

To provide health coverage for these same families, we have local authorized health centers. The family members go to be treated, they pay the bills and we reimburse them afterwards. The problem is that since they have not received the money transfers, they have no money to pay. So yesterday I found someone to go locally and negotiate for the centers to treat our people and run a tab for us that we will pay when we can get money to them.

With all this going on, we also have a problem of “migrating” staff. Some of our employees have fled the “hottest”sites – going to more secure areas like here in Goma. Of course, while they are here, we are putting them to work. Unfortunately, this drains the structures in the hot sites. We have been talking with these employees every day, trying to convince them to return, but we cannot force people to go back to an area which is not safe. The same morning as all the rest, I got a call from the team in Rutshuru. They were going nuts trying to keep up with all the activity in the hospital there, especially with the staff cut in half. Apparently, the rumour is that we pay them more here in Goma than in Rutshuru. We talked with the group here again and informed them that this is NOT the case. We now have at least 12 people returning to Rutshuru Monday morning.

In the middle of all this, the personnel delegates from Goma informed me that they wanted to have an impromptu meeting to discuss some issues (the same as usual – salary levels, working hours, the need for more staff, benefits, etc.). My response to their request was less than polite.

All of this before 10:00 am. I should have understood what type of day was in store for me when I was awaken at 5:30am by a telephone call from one of the staff asking if she could stop by the office to have a salary advance – another impolite response I’m afraid.

After a while, we got a call from the team going to Kampala. They had a good start, but when they arrived at the Congo/Uganda border, a truck broke down in the middle of the border crossing, blocking the route. They finished their paperwork and were ready to look for a taxi on the other side to continue their journey, but just at that moment, the truck was removed and they were able to continue in our car.

But at the end of the day, they arrived about an hour late for their flight. All is not lost – they are at least in Kampala, at an MSF site. Our doctor has his return flight reservation to Angola, and our nurse has her ticket for Tuesday’s flight. They should be able to get back to France fairly quickly. And today I can to the thousands of things I wanted to do yesterday.

Back in Town

I am back in Goma - Anne, a logistician, and I arrived yesterday, leaving two other people on the other side of the border. The town is pretty quiet - not as much circulation as usual and most of the commerces are still closed. We will keep the staff at a minimum for a while.

With the displacement of the population, there is a lot of work to do, but we are bringing people back slowly and cautiously because the conflict is far from over. There will be a lot of movement of people between projects, and some people will be returning home early because their profiles no longer fit the program. We had a two-hour meeting yesterday evening to plan the movement of the expats and the relocated staff - that's about 56 people.

We have started a new project, trucking water to the 20,000 displaced above Goma at Kibati, because this is the biggest need there. We are also doing mobile medical clinics for these people who have no access to medical care. Other actors are involved in distribution of non-food items, distribution of food, etc. It is important to coordinate between all the Non-Governmental Organization (NGO's) to maximize the aid provided to these people and to avoid wasted or duplicated efforts.

I am a lot more involved in the strategy for covering this crisis than I was in 2006 when we had a mini-version of the same type of conflict. It's a very interesting experience.

Hot time in Congo

Things have heated up here in Congo. The fighting between the government troops and the CNDP (the major rebel group here) have intensified, and even the UN Monuc troops (who are usually only in an observer role) has gotten involved.

The combat arrived at the doors of Goma, where I am, Wednesday. We wanted to do a partial evacuation then but we were caught a little too late. We closed down the office early and all the expats and relocated staff went together to our first house. With the police gone, and the military having fled, it was a night of looting, vendettas, and general mayhem everywhere. We heard shooting all evening, starting around 6:00pm. Around 9:00pm when a round of machinegun fire was heard VERY close, all 10 of us at the house fled to the “safe room”, one of the bedrooms with no windows exposed to the outside, metal doors which bolt from the inside, a stock of food and a ham radio. Since the room is about 10 ft x 10 ft, let’s say that the night for the 10 of us together was very intimate!

Thursday morning, we did a partial evacuation of 5 of us (yes, I am in the group). We didn’t go far – just across the border into Rwanda – about 7 miles. But the border crossing (exit stamp, entrance visa, payment of an exit visa for the car and customs of a lot of baggage – including a case of sensitive documents we brought with us) took about 1 ½ hours. We are pretty worried about our colleagues still in Goma because apparently there was heavy artillery fire there this afternoon. We’re not sure how long we will be here, but we can still work and communicate with the other sites, some of which are also in evacuation, now that we have found an internet café close to our guest house.
We are not sure how this will end. The CNDP said Wednesday evening that they wouldn’t attack Goma. Then Thursday evening Laurent Nkunda, head of the CNDP announced that no one would keep him from taking Goma. No one knows if they have the capacity to hold onto the positions they have already taken. No one knows either if the Congolese government has the power to retake those position. At any rate, whatever happens, MSF will have a lot of work waiting for us as soon as we can put all our people back into place.

26 October 2008

Happy DSD reunion for the Californians!

I sent off my quarterly budget review Wednesday, asking for a 7% increase to finish the year. This is always a traumatic exercise – it took me about 3 weeks to put the whole thing together, while dealing with the usual stuff (already a 12 hour a day job) plus an outbreak of cholera.

It has been pretty quiet for a couple of weeks, but fighting broke out again early this morning about 40 kilometers from here – the objective is a government military camp, which was taken by a rebel group this afternoon. It is on the road between Goma, the district capital where I am, and Rutshuru where our biggest project is. This is also the route we use to supply all our projects in terms of medical supplies, logistics supplies, money, etc. So we hope that the situation is the same as a month ago – the rebels took the camp, stole all the arms and left quickly.

If all goes well, I should go to Kabizo on Tuesday for a couple of nights. This is a site which we evacuated at the end of September. The objective of the visit is to see if we can return the expats and non-local national staff. Apparently, even 90% of the local population left the area, leaving only the refugee camp full - they have no where else to go. We have been back a couple of times for day trips, but this time we had hoped that the logistician, Anne, and I could spend a couple of nights there to evaluate the security situation, see what the needs are to put the program back into regular running order, and pay the few local staff who are still there. With the fighting, which is much closer to Kabizo (which is a rebel enclave) than here, our trip is very uncertain

Never a dull moment.

Explanations of North Kivu Facts Sheet & Press Release

The two preceding postings concern a press release sent to the world press by MSF yesterday. The first explains the involvement of MSF - all operational sections (France, Belgium, Holland, Spain, Switzerland) - in this region of Congo. The preceding one is the press release explaining the current events here and our concerns.

Anne Taylor, mentioned in the article is my boss.

North Kivu Facts Sheet - MSF

MSF ACTIVITIES IN NORTH KIVU - FACTSHEET

MSF provides primary and secondary healthcare in North Kivu in and around Rutshuru, Masisi, and Lubero districts. MSF supports hospitals in Rutshuru, Mweso, Masisi and Kitchanga as well as surrounding health centres, and runs a network of mobile clinics. MSF teams also provide medical care to victims of violent trauma and of sexual violence and treats children for malnutrition. In some areas MSF has opened new health posts to provide care for the increasing number of people fleeing the violence. Mobile teams are doing assessments and providing medical assistance in new areas, including Ngungu in North Kivu and Minova, in South Kivu. MSF teams are also monitoring the situation in the camps to prevent outbreaks. MSF teams respond to potential cholera epidemics and carry out vaccination campaigns against measles. MSF has been continuously present in the North Kivu since 1981.

RUTSHURU DISTRICT

Rutshuru town area

MSF has been working in the Rutshuru reference hospital since August 2005 providing secondary health care, including surgical, medical, paediatric care and specialised care to victims of sexual violence. The hospital capacity has been increased to 220 beds. The number of surgical interventions per day during the first nine months of the year has increased in comparison with previous years to an average of 12 per day (3 in 2006). Between January and September, MSF teams have performed 2,777 surgical interventions and 7,359 emergency room consultations. In June, 832 patients have been admitted to hospital. Between January and June, an average of 87 victims of sexual violence have been treated each month. Between January and September, MSF has treated 158 war wounded at the Rutshuru hospital; 36 in September alone. Between January and September, MSF has also treated 1,469 people for cholera.

In Nyanzale, MSF conducted 2,320 consultations in June. From January until June, MSF treated more than 1,300 malnourished children (776 treated in ambulatories and 585 hospitalised). Between January and June, an average of 450 victims of sexual violence have been treated each month.

In Kabizo, MSF is normally conducting medical consultations (1,590 in June), and hospitalises IDPs and residents in a 16-bed centre. MSF teams also treat victims of sexual violence and malnourished children.

LUBERO DISTRICT

In Kayna and Kanyabayonga, MSF is providing assistance to thousands of people fleeing the conflict since the 20th of September. During the first ten days of activity, MSF teams already treated 140 victims of sexual violence and 15 war wounded.

With thousands of displaced persons constantly on the move, from all these sites, MSF also supports a network of health centres, has set up a system of mobile clinics and has regularly conducted measles vaccination.



MASISI DISTRICT

Masisi town area

Since August last year, MSF has been supporting the hospital in Masisi, whose capacity has been increased from 70 to 120 beds. MSF medical teams provide secondary healthcare in the hospital, including life-saving surgery, and support a health centre in town, where they provide primary healthcare. MSF has also set up a 25-bed structure that welcomes pregnant women before they give birth.

To respond to the needs of the displaced population in the area, MSF has set up a system of four mobile clinics with an adequate referral system. MSF raises awareness about the need to provide medical and psychological care to victims of sexual violence in seven locations.

During the month of September, 55 victims of sexual violence have been treated. During the same month, MSF also treated 25 people for violent trauma.

Mweso and Kitchanga area

MSF supports the St. Benoit hospital in Kitchanga since 2007, and the hospital in Mweso since April 2008.

MSF also supports a network of health centres and, since January of this year, has significantly extended the programme to provide assistance to people affected by the conflict in the Masisi districts. MSF supports health centres in Kirolirwe, Bukama, Kachuga and Kalembe since 2007. Since January 2008, MSF supports the health centre in Pinga and Mpeti and, since April, Kanyatsi. Mobile clinics go weekly to Malemo and Busihe.

During the first eight months of the year, 2,703 people have been hospitalised, 2,069 women have given birth and 11,698 women have received antenatal care. MSF medical teams have conducted 94,094 external consultations (30,239 for children under 5 years), and have treated 18,103 cases of malaria. MSF surgical teams have conducted 384 operations, 306 of them urgent. MSF has also treated 2,354 malnourished children, and 377 have been hospitalized.

GOMA DISTRICT

Tens of thousands of people are thought to be living in camps outside Goma, with several thousand more finding accommodation with host families. MSF is working with the Ministry of Health to treat and contain cholera. Cholera is endemic in DRC and MSF teams will normally see a number of cases in North Kivu every year. MSF has treated 1,480 cases of cholera from January until September.

MSF has 62 international staff and 716 national staff currently working in North Kivu.
MSF has been working in the Democratic Republic of Congo since 1981.

MSF press release

War in North Kivu (DRC)
The international community is failing to provide adequate assistance and protection to the population

Goma, 6 October 2008 – In the most volatile parts of DRC’s North Kivu province, violence has reached its highest levels in years, while assistance is hardly reaching those most in need, the international medical organisation Médecins Sans Frontières (MSF) said on Monday. Hundreds of thousands of people have been forced to flee their homes since full-scale war resumed at the end of August and are living in fear, without the means to meet their most basic needs.

The international community has failed to address the on-going conflict in the region as a priority. Even though one of the largest peacekeeping forces in the world is currently deployed in DRC, the United Nations peacekeeping force (MONUC) is clearly failing to fulfil its mandate to protect the civilian population in North Kivu.

Most UN agencies and NGOs are also failing to provide an adequate humanitarian response whereas the already disastrous humanitarian situation is dramatically deteriorating. Despite the presence of a large number of humanitarian organisations in Goma, the province’s capital, few are active in the areas most affected by the war.

Many people who now need assistance have been forced to flee several times. They have repeatedly lost their homes and belongings – often as a result of looting – and are losing their capacity to cope. In addition to the extensive needs of the population – food, shelter, access to water, medical care and protection – the risk of epidemics is high, and many health clinics have been looted.

Some of the people who flee reach relatively established camps, while others gather in isolated pockets of calm or with host families. Still others have become ‘invisible’ – hiding in the bush, trapped between armed groups. "We were assisting over 100,000 displaced persons in Nyanzale and Kabizo. We have no idea where they have fled in the past few weeks”, says Anne Taylor, MSF Head of Mission in Goma. “Only 25,000 people arrived in Kayna and Kanyabayonga. Where are the others? We are extremely worried about their fate."

In other areas, MSF found groups of newly displaced people. In Ngungu, thousands are living in terrible conditions, without any health care. Thousands of people also arrived in Kitchanga during the last weeks. “Reaching these people is extremely difficult because of the volatile security context and because they are constantly on the move,” says Anne Taylor. “But it is not impossible. We just keep trying and trying until we can find them and provide some vital assistance. But we are aware that we are only dealing with a small part of this humanitarian catastrophe: hundreds of thousands are out of reach.”

In North Kivu, MSF teams are currently working in and around Rutshuru, Nyanzale, Kayna, Kanyabayonga, Kitchanga, Mweso and Masisi. Mobile teams are doing assessments and providing medical assistance in new areas, including Ngungu in North Kivu and Minova, in South Kivu. MSF has 62 international staff and 716 national staff working in North Kivu.


For further information, please contact:
Andrea Pontiroli, MSF communication officer in North Kivu
+243 817100003 / +88216 50360889

October Posting

Since my last message, we had to evacuate all our expatriates and non-local staff from 2 of our 4 projects in North Kivu. But they haven’t been idle – they are following the status of the population fleeing the combat. We have set up mobile clinics in 4 new sites to treat these people medically. Three of these clinics are in the same sites in which we set up under the same circumstances when I was here in 2006!

In fact, last Friday I was on my way to our Nyanzalé project, but during the 4 hour car trip Nyanzalé evacuated. Instead of returning to Goma, we decided that I should continue to Kayna, where we have set up a base to follow the population movements and treat the displaced people just south of there. Kayna is where I spent my first mission of 8 months in 2005-2006. It felt like going home! I did a lot of set-up work for the project, but I also had the opportunity to renew friendships with people I hadn’t seen in 2 ½ years.

The fighting has calmed down temporarily in most spots, but the situation is far from stable. In Rutshuru the full team is back in place since last Monday, the team from Nyanzalé returned to that site yesterday, but the Kabizo team (in accordance with our neutrality policy, this project is in the heart of one of the rebel zones) is split between Kayna and a new mobile clinic for the displaced not far from us here in Goma.
We just finished a measles vaccination campaign in the southeast of the country (vaccinating around 25000 children before the beginning of the rainy season) this past week, which has freed up some resources (personnel, cars). This is fortunate because they were sorely needed to help with the activities listed above.

It's Hot!

It’s been a busy week here in North Kivu. On Monday, fighting broke out between the government forces and one of the principle rebel groups fairly close to our biggest project, Rutshuru. So we reduced the expatriate and relocated national staff by half, bringing 14 people south here to Goma. This makes it easier to perform a total evacuation if necessary, but allows to keep the project going – we treated about 20 wounded there (both military and civil) since the fighting broke out. Later in the week, the conflict zone enlarged and we had to evacuate all the expatriates and relocated staff in the other 2 projects to a more secure area up north. (FYI: Following our policy of total neutrality, one of those projects is in a government-controlled area and the other is in a rebel-controlled area.) That makes 30 more people evacuated.

The local population is moving to get out of the fighting zone as well. Apparently they have also fled north, but not as far as our staff. So today and tomorrow, we have sent out a small exploration team from the evacuated group to evaluate the situation of this displaced population. If they find a need for health care or water supply or distribution of basic non-food items, we will probably set up an emergency project, using the team that just evacuated. Our plans change hourly.

But today is calm – not much we can do until the explo team has evaluated the situation. We should know more tomorrow. I worked a hard yesterday so that I could take this Sunday off. For the first time since I arrived here, I took a discovery tour of the town by foot. Goma is a secure place, but still, our security rules only allow us to walk along the 2 biggest streets. I visited Kivu Market, a grocery store which caters to the white humanitarian organization clientele. I was amazed at the selection – you can find a lot of French and American products (Pillsbury cake mixes?) Tonight, Claudia (our medical coordinator) and I are making dinner for the 11 people in the house – beef barbeque, vegetables, rice and apple pie.

And tomorrow the work starts again. We will know more about the situation of the displaced people tomorrow evening. Then we can decide whether to put the evacuated team on standby in a really secure area (like Uganda) until things calm down or, if there is the need, to put them to work. I will be going to Rutshuru (where we did the team reduction last Monday) tomorrow for a week. I will be replacing the administrator who was evacuated and is now on break and working on some big human resources problems that we have there. Between that work, following the situation of the evacuated group and the situation of the displaced population, it risks to be a busy week again.

That’s what we do! And I am as happy as a pig in shit! Yes, it is a pretty intense situation, but right now, I have to start making my apple pie!

Posting end of August

I arrived Goma three weeks ago. After being in the desert for 2 years, the green of North Kivu in the Democratic Republic of Congo (formerly Zaire) is beautiful. Our house is right on Lake Kivu, which is enormous. On a clear day, we can see the volcano Nyragongo, which is still active (it destroyed the town about 12 years ago).

A week after arriving, I did a tour of our 3 projects. It took 10 days. I think that I know about 1/3 of the staff already from my first stay in the region (2005-2006). It is wonderful to see them again. Since the project in which I worked has closed, they have found jobs in the other sites and here in Goma. Some are working with other organizations, and some are unemployed. It is a bit disconcerting for a few of the other expats when we are in the middle of nowhere and someone calls out my name and then hugs me!

There has been quite a turnover of administrators here the last year, and it shows. I have a lot of work to do to get things back into order. Fortunately, I have a great staff here, in Goma and in the field. And our expat coordination team is great. It is going to be good to work here.

I am already overwhelmed with work. My head of mission has already told me that I work too much. (For those of you who know me, this probably comes as no surprise.) But at the same time, she added to the list of critical things to work on! Right now, the big items are
· a complete overhaul of the payroll supplement we pay the state health system employees who work with us (around 90 people)
· a revision of the job function scale for the local staff (around 400 people)
· a study of the “fundamental needs basket” on which the salaries are based
· implementation of analytical axes in the accounting, so that we can track expenses by activity
· implementation of a more complete budget follow-up system

The day-to-day human resources problems also take up a huge amount of time, as it did also in my last 2 missions. Keeping track of all the expats coming and going and the reference visits from Paris is also a nightmare. Part of my grunt work is to assign rooms to all the expats and délocalized (I can’t remember the English word for this – yes, this is a French-language mission again) staff here in Goma, as well as the visitors. For the moment, we are 6 expats (+ the daughter of one), 5 délocalized staff, plus transit and visitors. This weekend, for example, we are 13 and next weekend we are 15. There are 9 bedrooms in the house! Fortunately, we are renting a second house starting in September.

Ahh! We don’t get paid a lot, but we sure have a lot of fun! At least there is beer and wine in Congo, which already beats Sudan!

Leaving soon

Yes. I will be leaving Lyon for my briefings in Paris on Sunday the 27th of July. Then I leave for Goma in the North Kivu region of Democratic Republic of Congo (also known as Congo - Kinshasa) on the 29th. My flight arrives in Kigali, Rwanda and then it is a short drive across the border to Goma.


The good news is that my apartment is finished and I should finish moving my stuff from Savoie tomorrow.

I am very happy with the place, although it took me longer to finish the plaster and painting than I had anticipated. Anyway, it will be ready for me when I return in a year.

I have enjoyed my time back in France going to concerts, other spectacles, bars and restaurants. I have gained back some weight and am ready to attack my time in Congo. Actually, I am thrilled to be going back there.

Apparently, there is a lot of work to do on the "big" topics: staff follow-up, salary scale, budget follow-up and analysis. Fortunately, my Paris contacts for human resources and finance are the same ones I had for Darfur. So we are used to working together.

We are about 30 international staff and 700 national staff, bigger than Darfur. Our programs in 3 sites include war injuries (including surgery), cooperation with a district hospital, victims of sexual violence, malnutrition, and mobile clinics. There should be enough to do!

July Posting

The admin training course went really well. There are some really good people in the class. Most of them will be leaving very soon on mission, or they have already left. It was a pleasure to help out with the course, and I learned a few new things too.

And the party in Italy the 21^st of June was great! Emanuela has some interesting friends. Apparently, most of them were in the communist movement in the 70’s. Some had prison terms to serve because of this, including a doctor and a researcher for the Pasteur Institute. They were all interesting people, and I was able to communicate with quite a few of them in English or French. Emanuela has about 40 people living on her property (her great-grandfather both the village at the end of the 18^th century). It’s not a commune, but almost. The big party was the 21^st, but I stayed 3 days and was not the last to leave!

Since then – WORK! I have just finished painting and varnishing. Yesterday, I installed some of the bathroom fixtures (one drill bit for each 2 holes) and the blinds for my one window. I moved a few items yesterday, including a huge painting I bought 3 years ago that has been in storage since – the place already looks more lived in. I cleaned the place today because there was dust and other crado (is this French slang?) stuff on all the surfaces. And I washed the chandelier today – something exploded just afterwards. I changed all the bulbs and verified the wiring inside and the circuit breaker didn’t even shut off. I have no idea what the problem is, but I have an idea that I will have to change the dimmer switch. We’ll see that tomorrow. I would like to make a couple of shelves for the bar, and I have to move my stuff from Savoie. But we are getting there. I won’t have too much time to enjoy the place before leaving, but I will be finished, I hope.

I am also trying to get reacquainted with Lyon the evenings. There are a lot of really nice restaurants and bars near my place. That’s one of the reasons that I chose this location. It is, however, difficult to meet people here. I’m not great at starting conversations, or even keeping them up, but I’m starting to break the ice with a few people.

And I am still psyched about going back to Congo. I have been studying the hand-painted map they gave me of the region before leaving in 2006 – trying to get re-acquainted with the area. I’ve also been studying their plan for the next 6 months. Apparently, all the capital admins they have had this year have been for a very short time, for one reason or another. So it is good that I am staying for a year. I should be leaving before the end of July (around the 28^th?) because I would like to have a last briefing with the lady who is in charge of all the field admins (and who is also a very dear friend) – she leaves on vacation with her new daughter the 3^rd of August. I will leave Paris, for Bruxelles, then Kigali in Rwanda and then going by car to Goma in North Kivu in the Democratic Republic of Congo (formerly Zaire, also known as Congo - Kinshasa to differentiate it from Congo – Brazzaville).

Tonight I am going to Jazz a Vienne Blues Night with a new acquaintance. I will also be going Thursday evening for “A Tribute to Frank Zappa”, an evening with Jean-Luc Ponty, a jazz violinist whom I adore.

So life is fine. All is well with the world

Paris in June

I am writing from Paris again. We have been preparing the course for the future group of 17 admins this past week, and the course starts tomorrow. I hope they are all good, because we need all of them in the field as soon as possible.

The general assembly for MSF-France was last weekend. The election of the president and administrative council was pretty important this year – there were a lot of absences. Most people, including me, are very pleased with the outcome. For the first time, we have a woman president – Marie-Pierre Allie, who is excellent. And I now have two very good friends on the administrative council.

I’ve crossed paths with a lot of old colleagues this past week in headquarters, including some old national staff members who have become expatriates. It’s great that MSF is improving here: the people who started as local staff have great experience and motivation to bring to our programs in the other countries where we work.

My next assignment is now official. I will be leaving at the beginning of August for a year in the Democratic Republic of Congo, also known as Congo Kinshasa to different it from Congo Brazzaville. I will be the coordination admin in Goma, on the eastern border next to Rwanda.

I’m really excited to be returning to the same area where I did my first mission in 2005-2006. The site where I worked, Kayna, has closed, but apparently quite a few of the people from that program are still in the area working with our other programs. The assistant admins in Goma are the same ones that were there when I was in Kayna, and they are great!

The programs are also interesting. There’s still a lot of conflict in the area, so response to displaced populations is often an issue. We are also working in a hospital which receives a lot of combat wounds, and there is a big nutritional program. An agreement has been signed recently to incorporate the old Rwandese rebels into the Congolese army or repatriate them to Rwanda, but the implementation of these plan will be tricky and will probably incite some more fighting.

I will have a lot of work to do. On one hand, the assistants are in place and well trained. On the other hand, there is a lot of work to do on the salary scale and the internal regulations for the staff. The program is expanding. And the field teams still have to evacuate from their sites from time to time. It won’t be busier that Darfur was, but it will be pretty close to the same level.

I wasn’t planning to work in Paris for three weeks, and the work on my condo is going a bit slower than expected, so I don’t think that I will be getting back to the States this time. I will try to finish the apartment by the end of June so that I can relax a bit during July, so that I can concentrate my full energy on Congo for a year.

I'm back

I arrived in Paris on Monday afternoon and started my debriefings immediately. I still don't understand it, but everyone is really happy with my work. It doesn't seem to me that I have done better than an average job. Anyway, I just finished my debriefings on Wednesday. I have already met up with several of my collegues from previous missions who are passing through Paris to or from missions, or who are working in headquarters.

I will be leaving Paris for the Savoie on Friday afternoon. I have already begun eating and drinking like a wildman. Tuesday evening, I had already drunk enough, when the owner of the restaurant where I was announced that it was his birthday and brought out the champagne and cognac. The walk home was difficult!

The weather in Paris is gorgeous! Today is a public holiday - celebrating the signing of the peace treaty for one of the wars - so everyone is out, sitting on the terrasse of cafés watching the world go by, which is one of the favorite passtimes of the French.

I will be returning to Paris at the beginning of June. The financial director and her deputy, both of whom are good friends of mine, offered me a 3 week job to teach the course for future admins here. I'm really looking forward to it. The course ends on the 20th of June - just in time for me to catch an overnight train to the Lac du Gard in Italy for a party on the 21st of June at the home of our Medical Coordinator from Darfur, who will be finishing her mission shortly.. And the head of our "desk" (management of a cluster of countries) has put me down on the list of candidates for the context and environment training (training course for future field coordinators) in September in New York. I'm pretty excited about that, too.

But for right now, I look forward to finishing my apartment in Lyon and living in it.

Khartoum

I arrived in Khartoum yesterday evening from Nyala. I got a lot of presents just before leaving - quite a few clothes. I think that they were telling me that I dress like a bum, which is true. Anyway, the pair of pants fits me like a glove! The local shoes also. The hat, too. I don't know how they did it!

The only problem with last minute gifts is that you have to enter them into your baggage! So I did some ruthless last-minute sorting again. I threw away some of my really old, torn T-shirts (the ones in which I dressed as a bum) and got rid of some of the papers that I no longer need. Everything fits in, and I have all my baggage from my 9 months, old and new, in a dufflebag and a small backpack at around 16 kg.

Speaking of kg, I scared myself today. I spent the night in the MSF transit apartment here in Khartoum last night. There is a scale in the house, so I got on it. I weigh 65 kg, or 142 pounds. I don't think I have weighed so little since I was 14 years old. It's true that I look like one of those skinny old men from a concentration camp - I don't have a muscle anywhere. But in fact, I feel fine - I have already started to recover some sleep-time. I hope working on the apartment in Lyon, eating everything that one does not find in Darfur, and drinking a few beers will get me back into shape.

I leave Khartoum this afternoon, arriving in Dubai a little after midnight. Then I leave Dubai around 8:20am. This is fine, because Dubai is one of the world's largest duty-free shopping centers in the world - I have a few electronics goodies I want to purchase. My credit card, which hasn't been used since my break in Zanzibar, is going to start smoking!

I will arrive in the Paris airport tomorrow at 1:30pm. I'll be there for 2-3 days for MSF debriefings, a trip to the embassy for an extension of visa space to my passport, etc. before going back to Savoie/Lyon.

It is just now registering in my little mind that I am leaving Sudan!

I'm going home

I leave Darfur tomorrow. It does not seem possible that it has been 9 months already. I have pretty much finished the handover to my replacement (who is another American), I have given away a few of my electronics goodies to some of the national staff, my bags are pretty much packed, and we had a small going away party at the house last night. So it is pretty much the end.

This was my first time in coordination, and I miss the direct contact with the beneficiaries of the programs in the field. But once again, I learned a lot.

My last month was probably the most interesting one. The highlight was going to Adila, where there was no set-up at all and creating a program in 10 days. The first day we made our purchases for the base in the biggest town in the area. The next day we took the 2 1/2 hour drive to Adila and found a place to rent as the base (office, two housing areas and the place for a warehouse). The next day we opened the recruiting process and began to take the applicant files. After that, the newly recruited medical staff from Khartoum (people who had already worked with MSF elsewhere) arrived and we filled them in on the project, They helped us to recruit the other 54 people the next day, Before leaving, I set up the accounting system, started the human resources data base, made all the work contracts and wrote the car and property rental contracts. All this under pretty primitive conditions. I have already had the experience of reducing programs, but this was the first time to be involved in a set-up starting from nothing,

I’m really happy to have been here. I think that I left the admin stuff in pretty good shape, although I left a list of pending issues of 4 pages - tt is never less than this! There’s quite a few things going on right now – receiving international drug orders for all the sites, the start up of the Adila program and the PlumpyDoz distribution program, a NEW water distribution program in a NEW site, some problems of dry wells in our existing water distribution program, a lot of hiring of medical staff, some personnel problems, and a few others.

I don’t think that I have ever worked so hard for so long as I have here over the last 9 months. And that is saying something! I am looking forward to 3 to 4 months of break. It will take about a month of work on the new apartment, but after that, I hope to relax, eat, drink (I'm dreaming of wine and beer - alcohol is forbidden here),travel a bit and sleep.

And I am looking to finally having a small place to myself in Lyon.

End-of-March Posting

I’m starting my last month. It doesn’t at all seem like 8 months have passed since I arrived. But I am getting tired more often.

This promises to be a very busy month. Our Head of Mission just came back from an exploration in the eastern portion of South Darfur. It is an area that was ravaged by rebel/government fighting in 2007, during what should have been the planting season. They have no food, little water, very little health care and few humanitarian actors to aid them. We have found around 45% of the kids under 5 to be in the “danger” levels of malnutrition. And the next harvest won’t be until October.

So we are planning to go into the local rural hospital in Adila to run the pediatric ward and a therapeutic feeding center. Along with this, we will have 2 or 3 outlying outpatient therapeutic feeding centers, to help those who can take their treatment at home and to find the ones who need to come to the hospital. We expect to treat about 10 000 children under 5 (the age group most likely to die from complications brought about by malnutrition). This will be a short-term project, starting mid-April up through the end of October. This is the kind of project that we do very well.

If all goes well (this is a very big “if”), we could have government approval Sunday or Monday. In that case, I will probably go to the area next week to start the recruiting process – we will need about 70 staff.

At the same time, we are starting a targeted supplemental feeding program in Zalingei, where we already work in the district hospital. This program is aimed at preventing severe malnutrition by distributing a therapeutic supplement to all the children between 6 months and 3 years in the area (15000) for 6 months. It is an experimental program, based on what we did in Niger last year, to prove to other humanitarian groups and governments that malnutrition can be prevented at a small cost which is later compensated by a healthier population (more productive with less health-care expenses).

We have also begun a 3-month vaccination program with 8 antigens in the Jebel Marra area (partially government controlled, partially rebel controlled).

All of this will be going on along with our normal programs (which are no less worthy – running 1 hospital and 3 outpatient clinics by ourselves, and working with the health ministry in the aforementioned Zalingei district hospital, all of which are treating internally displaced populations), while all my administrative staff is changing or taking vacation! And my replacement will be arriving mid-month. I will need to prepare my handover with him before he arrives, then start working on my end-of-mission reports and evaluations of my staff during the time that he is taking over.

As always, this is the time when I start asking myself if I accomplished anything during my stay here. Certainly, just keeping things running is an accomplishment, but there have been administrators before me (we are in Darfur since late 2003) and there will be others after. I would like to think that I put some systems into place which will be continue to be useful after I leave, but when one starts looking back, it’s not always easy to find the added value. This will be my theme of reflection while preparing my end-of-mission report.

March Posting

I just got word today that the work on my apartment is finished. I will have a place to live when I return to Lyon! The guy who did all the work sent pictures, and it looks great. It’s all oak, dark beige tile, light beige marble and stainless steel/chrome. I will still need to arrange the inside of the big closet, brush the old beamed ceiling, sand and finish the plaster, and paint, but I enjoy that. Besides, it is so small that it should go pretty rapidly. And the only ceilings to paint are in the bathroom and kitchen.

I will be leaving here at the beginning of May. My replacement has already been in contact. It’s another American, who has been with MSF about the same amount of time that I have. He arrives around mid-April, so we should have a couple of weeks of handover, then he can take a quick tour of the projects (about a week) before I go.

In the meantime, I will be busy. My financial assistant is moving to Khartoum to work with MSF there. He will be replaced by someone from one of our other sites, but I will need to do some training. My human resources assistant is finally moving here from our old coordination site in El Geneina (plus I loaned him to the Khartoum office for the last month) next week and we will have to get him installed. And my transit assistant will be taking some long-postponed vacation time after training his new short-term replacement.

I am trying to get some additional procedures in place before I go. The human resources side is getting into shape. I go to Bulbul Abu Jazou to recruit some staff on Monday. I have just put into place a system for financial analysis, which should help me keep better track of our expenses. It will also help me with the quarterly budget revision, which should be done before the end of March. Then I will need to do the personnel evaluations for my staff and prepare my handover reports and end-of-mission reports.

I hope to stay in France 3-4 months this time, to finish up the apartment, get back for a short visit to Indiana, and RELAX A BIT. But you never know with MSF – it’s better to stay flexible.

February Posting

I just returned from Khartoum. It’s really a capitol. We went out to eat every night: Italian, American, Thai. And I brought back some strawberries, one of the fruits we don’t see here (as if bananas, oranges, grapefruits lemons, apples, mangoes, and guavas didn’t suffice).

That was not, however, the objective of the trip – it was for work. I had two good days with my collaborators in finance and in human resources in the Sudan coordination office. We got a lot done, but as usual I came away with a huge list of things to do. Fortunately, I have already made a big dent in it.

I was pretty tired at the beginning of the year, but I’ve gotten my second wind. Getting out of Nyala to El Geneina, Niertiti and Khartoum helped. And we finally have a stable coordination team in Darfur - the changes here were also pretty tiring. Unfortunately, my human resources assistant will be going to Khartoum to replace someone who is leaving there, and my finance assistant will probably be hired for a position there. And my two closest collaborators in Paris have just moved from supporting our region to another. The only thing that is constant is change!

Politically, things keep changing, too. For the moment, the rebel activity in neighboring Chad is pretty heavy (their conflicts and those in Sudan intermingle). Today, the Chadian leader seems to have routed the rebels from the capitol of N’jamena. We thought that if all the rebels who are hiding here left for Chad to join the fight, that the Sudanese government would take the opportunity to go after their own rebel groups. For us in MSF, it means that we would need to get set up quickly on the rebel/government frontiers to treat the wounded. It’s something that we are looking at very seriously.

I just received a Christmas package from the MSF-Lyon office, which is the regional office where I applied to work for MSF. Of all the regional offices in France, they are the only one who sends out a Christmas package (coffee, tea, sausage, paté, and candy) to their affiliates, so I share with everyone in the house. Otherwise, they would kill me.

I also received news from Indiana, Savoie, Congo and Zanzibar. It’s always nice to hear from family and friends. That’s an unsubtle hint.

The work on my apartment is progressing. My builder sent me an email telling me that a lighting system I want will cost more than expected. I’m going for it anyway, it’s not THAT expensive. He should also put in the kitchen and some built-in furniture in February and March.
It’s hard to believe that I have already been here 6 months.

January Update

I was just in Niertiti, our eastern-most project in Western Darfur. It’s an interesting place, because of the politics. Niertiti is very near the border between West and South Darfur. It is also very near to the Jebel Marra, which is controlled by the Sudanese Liberation Army (SLA).

Niertiti itself was a tiny town of about 5000 people which became host to two camps of internally displaced populations of 30,000. There was just one small government outpatient clinic here before the camps. So we now work in that alongside the government health workers and we built a 50 bed hospital also, with a 40 bed feeding center for undernourished kids. This is a pretty unstable area, and gunshot wounds are a fairly frequent thing to treat in the hospital.

From here, we run a mobile clinic (meaning that we go there in the morning and return with the team in the evening) twice a week in Thur, right on the border between West and South Darfur. This clinic gets a lot of patients from the South Darfur side, the local government controlled areas, and the rebel controlled areas. About 10 days ago, 3 trucks full of food from the UN’s World Food Program were stolen near here by the rebels and taken into the Jebel Marra. This was kind of embarassing for the local government. Afterwards, the town of Thur was sacked, and there was quite a bit of gender-based sexual violence. We aren’t able to go back to our clinic in Thur until we can assure the safety of our team. It should be fairly soon.

We also run a clinic in the Jebel Marra, the rebel controlled zone, in Kutrum. This is maybe one of the most peaceful regions of Darfur! The government can’t dislodge the SLA from this mountainous area, and the SLA is in control so it’s not moving. Therefore, no fighting (although we do treat some gunshot wounds from the border zones). We see about 200 outpatients a day and have a 10 bed hospital there. Three people (a doctor, a translator and a driver/logistician) leave from here on Saturday morning to work with the local staff during the week, returning to Niertiti every Thursday evening. I was there today, and got to meet 3 SLA commanders. They seemed like pretty nice guys.

In Bulbul, our water distribution project is starting up nicely. This is a village in which a nomad tribe has decided to settle, to avoid continued conflict between them and the farming communities in which they grazed before. Between 15,000 and 25,000 (real figures are hard to get) have arrived in the village since July, and the water supply was not up to the volume. We now have 4 wells installed and pumping, and we are now getting the distribution system in place. We will also be distributing non-food items (jerricans for carrying water, soap and blankets) to the families. If we end up working in the hospital in a larger village nearby (Kass, another possible new project), we could operate a mobile clinic here.

I still have way too much to do, but it’s better than at the end of the year. We have the layoff in El Geneina, hiring in Nyala, finalizing 2007 accounting, putting in place a system to track expenses by activity, getting everyone into our human resources data base, and a host of smaller items.

It rained here the last few evenings! This may not be surprising to you, but it's about the equivalent of snow in Indiana in August.

I am heading up to the big city, Khartoum, on Monday for a few days to work with our country-wide Human Resources coordinator on some issues. I didn't move at all for quite a while, but now I'm making up for lost time.

Happy NewYear

Things in Darfur are pretty tense for the start of 2008. A group of Arabic soldiers who were loyal to the government are now calling themselves “the neglected soldiers” and are siding with some of the rebel movements. El Geneina is pretty much surrounded by this group and the town itself is being defended by some fighters who recently fled Chad! Zalingei as well is circled by the neglected soldiers in conjunction with some other groups. Different and interesting alliances are springing up. Although there is no more fighting than usual, everyone seems to be preparing their positions. Right now, it doesn’t look like 2008 will be the year for peace here, unless this new positioning forces the government to make some concessions that they wouldn't otherwise.

I finished my 2008 budget preparation on the 30th of December. It was a long and laborious process. I always underestimate the amount of work involved. From what I have calculated, our projects in Darfur should run around 3.8 million euros this year.

I haven’t had a slow moment since I came back from my break in Zanzibar, and the tempo finally caught up with me. I went to bed at 9:00 pm on the 31st and was not feeling very well for around 36 hours. Now I feel better, and the pace should go back to normal, too. The budget is in, all the assistant admins should be coming back from annual leave soon, and the coordination team is becoming more stable.

Of course, a normal pace is not slow either. We are starting a new water distribution system and distributing non-food items in Bulbul, the layoff plan in El Geneina has to be put in place, we have to do permanent recruiting here in Nyala, I have to close the 2007 accounting, etc. Never a dull moment!

We celebrated the new year here in Nyala with the staff. There were about 25 people at the house. We had received a sheep from the community of Bulbul, and we bought another. The guards slaughtered the two in the morning and did the main butchering. A special cook came in to prepare the meat. The liver was prepared raw, marinated in lemon and hot peppers. The ribs and most of the meat was grilled. The most tender cuts were breaded in a special mix and then cooked over an open fire as well. It was all accompanied by green onions and pita-style bread. The meal was great and the company was good too.

Most of the guards, cooks and cleaners don’t speak French or English, only Arabic or Fur, so conversation is difficult. But it gave us an opportunity to get to know each other better than in a work situation. We ate, drank tea, danced, laughed, and communicated as well as we could. It was a very nice day (even though I was still sick).

As I mentioned, we are finally getting a stable coordination team together. We have a new Head of Mission coming in mid-February to stay for 9 months, and he will be preceded and accompanied by Fred Meylan who has already been here last year. This is really good. After 5 months here I am right now on my 4th Head of Mission, my 4th Log Coordinator, and 3nd Medical Coordinator. At the same time, Paris headquarters has been in turmoil. All these changes call for a lot of explanations, produce a lot of direction changes, and create a lot of fatigue. Maybe now we can move ahead in ONE direction and spend less time and effort CHANGING directions.

I recently received photos of my apartment made by the builder. It’s getting together. The sound-proofing and plasterboard are up, the tile and hardwood floors are down, the mezzanine is about done, the stairway up to it is installed, and the bathroom is pretty much finished.
He should come back in February and March to do the rest: kitchen installation, a built in desk and bookcase, and some finishing work. I will have a place to live when I return to Lyon at the beginning of May! But I will need to install the closet shelving, and do all the surface sanding, varnishing and painting when I arrive.

Have a very good 2008!