Approaching Christmas

My workload has been pretty intense the last 10 days. We have several recruitments going on simultaneously. For example, we are recruiting a pool of people whom we can call for manual labor and to replace guards who call in sick. We received 148 candidatures. We narrowed this down to 68, by selecting the people who have already worked for MSF in this capacity, or those who live in the neighbourhood of our office and our pharmacy warehouse (so that they can come quickly if needed). We had a short interview with each of these people. From that, we selected 14 people for the guard pool and 20 people for the manual labor pool. The final step will be to select 1 person from the guard pool to be hired full time to replace another guardian who has moved up the ladder to be a radio operator. This process takes a lot of time. At the same time we are recruiting a pharmacy supervisor, a country-wide supervisor of our sexual violence program, and a maintenance man. We have just completed recruitment for a mechanic, 2 psychologists, and 2 pharmacy managers.

We also had to fire our pharmacy supervisor and 1 of our pharmacy managers. This was tough. They have been with us for several years, but they still make the same mistakes that they have been making all of those years. That is a real handicap for our programs, so we decided that they had to go. The labor law here is based on French laws, and it is not as easy to fire someone as it is in the States. It took me a lot of time to build the file for each guy justifying our action. In the end, they accepted the decision much more quickly and easily than I expected. We had not even received the responses to a couple of legal questions when they told me that they accepted the decision and were ready to sign the termination letters and leave.

We are also restructuring one of our programs. The human resources aspect of this restructuring is fairly complicated. I have been working with the team there by telephone and email. At the end of next week, I will be going up there to continue the work.

Also, the outgoing members of our team have been working overtime to put their pet projects in place before finishing their missions. That has kept us all busy.

Finally, we have had an abundance of disciplinary problems in the last few weeks; some minor incidents and some very serious and complicated situations.

All this plus the normal workload has kept me very, very busy.

Our head of mission left this past week, and his replacement arrived today. Over the next month our deputy head of mission, medical coordinator and logistics coordinator will change also. That will probably create a change in policy and direction. MSF expatriates tend to have pretty strong characters and a will to get things done. We will see. Here’s a photo of a big part of our staff in Goma. It was taken last week just after the weekly staff meeting and just before the departure of our head of mission.


Bad news: my computer disappeared 10 days ago. It is usually in the living room at the house so that everyone can listen to music, work on photos, and watch movies. I have never worried about the security before, seeing that we have guards on duty on permanance. But at the time that it disappeared, we had a temporary housecleaner and 2 electricians working in the house. We never found out which person left with the computer and 2 portable speakers, and we never will. Fortunately, I had the major part of my files stored on an external hard disc. I was thinking of buying a new computer when I return in August, and I was going to give this computer to a local charity organisation for their use. Now that won’t be possible.

We are approaching Christmas, and I am looking forward to it. I love Christmas on mission. When you work with people a while in emergency situations, you really become a temporary family. It is great to spend some downtime together. In August, I bought quite a few small items so that everyone in the 2 houses will have a gift. And as usual, we will prepare a holiday feast with the local means.

I will be taking my next break the 6th of January through the 13th of January. This time I will be going to the south Kenyan coast, just south of Mombasa, to a place called Diani Beach. For 2-3 days during that week, I will visit the Tsavo game park. It will have been 4 months since I returned from France, and I need this break. Fortunately, there will be someone to replace me this time, so the workload upon my return shouldn’t be so bad.

An MSF measles vaccination program used for military purposes in North Kivu

Press release Kinshasa, 6 November 2009: Seven sites of a vaccination campaign by Médecins Sans Frontières (Doctors Without Borders) in North Kivu, Democratic Republic of Congo, recently found themselves under fire in attacks by the Congolese army against one of the major rebel groups, the Forces Démocratiques de Libération du Rwanda (FDLR) .

Assisting the national health service, MSF began a mass vaccination campaign Saturday, the 17th of October 2009 in the territory of Masisi in response to a measles epidemic. The medical teams of MSF were vaccinating thousands of children in Ngomashi and Kimua, areas controlled by the FDLR. Although they had received guarantees of security by all the parties involved in this conflict for the vaccination in these areas and at this time, the Congolese army launched the attacks at each of the seven sites of vaccination. All of the people who had come to have their children vaccinated fled the intense battles and are now under safety. The MSF teams had to stop their activities in these areas and have been repatriated to the city of Goma.

“We feel that we were used as bait.” explained Christopher Stokes, General Director of MSF. “The attacks coincided with the beginning of the vaccination campaign and the MSF teams, as well as thousands of civilians, found themselves trapped under fire. These attacks represent an extreme risk to the lives of civilians, and an unacceptable utilisation of humanitarian actions to serve military objectives. How will the population consider MSF from now on? Will our patients still feel that they are under security with us? We have chosen to strongly denounce this situation, because our neutrality has been compromised.”

MSF is an independent medical humanitarian organization which provides medical services without discrimination and in strict respect to the principle of neutrality. This neutrality permits MSF teams to vaccinate in areas controlled by the FDLR, which are inaccessible to personnel of the national health system.

The last few months have seen an augmentation of attacks against humanitarian organizations by different armed groups in North and South Kivu.

“MSF asks all parties in this conflict to respect the work of humanitarian organizations”, adds Meinie Nicolai, MSF director of operations. “It is the population who pay the consequences. Already exhausted by the extreme violence and incessant displacements, today they risk being cut off from humanitarian aid.

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165 000 children between the ages of 6 months to 15 years have been vaccinated against measles as of today. In the territory of Masisi, MSF aids a hospital and a health center, and provides mobile health clinics and vaccination campaigns. MSF also provides health services in the territories of Walikale, Rutshuru and Lubero, as well as in the province of South Kivu. MSF has been working in North Kivu since 1992.

October / November posting

One big project down: we closed the site of Kabizo last week. Although the closing of a site is not the most pleasant of events, it went well. My changes to the payroll software for the final payment worked like a charm! And the team on site did a great job of communicating with the staff, helping them put together their résumés and to apply for jobs available in our other sites. Even the government made some concessions, making it easier for the staff to apply for government-run training to help them with reinsertion. We also paid a big portion of the final payments here and the other sites, so that the staff didn’t have to travel with a lot of money on them – road robberies are a common thing here.

But with the closing of Kabizo, and the down-sizing of the Kayna project, I should have some more time to concentrate on the long-term projects. At least, until we open up a few more sites.

Here in Goma, we are doing a lot of recruiting. We just hired a psychologist (to work with patients, victims of sexual violence, and even with the staff) and a radio operator for the weekends (we stay in contact with the cars by HF and VHF radio). We are in the final stages of recruiting a maintenance person and a mechanic. We have just started the process for a guard (148 candidates for 1 post!) and for a pharmacy manager. And tomorrow, we start the process for someone to coordinate all our activities concerning violence (sexual violence, armed aggression, etc.). Recruiting is managed directly by me, to protect our national staff. Unemployment here is very high, and friends, family members, and others in the community would put enormous pressure (physical, monetary or both) on a national staff member to be hired. And it is also unfair to put national staff members in a position where they could be tempted to take bribes in exchange for influence in the hiring process.

Our head of mission just returned from the semi-annual meeting in Paris, concerning our directions for the coming year. No big changes. We will continue to work in the hospital in Rutshuru, where we send all the surgical patients in this area. We have 3 surgical teams, and will be adding a 4th team to cut down on the hours these people put in. And we continue with Nyanzale, a health center in a zone which changes hands between the different factions of conflict very often. Up north around Kayna, the programme changes every week, with sporadic fighting breaking out here, then there. So we are modifying the program to give us more flexibility in getting to the areas where we are needed, when we are needed. Other than that, we will continue to follow the situation, opening where we have to. We are sending a team to south of here tomorrow to help with an outbreak of cholera. Already this year, we have had 13 temporary programs of this type, and that will continue.

That puts quite a bit of pressure on the staff, so from time to time, we try to lighten up. It had been a long time since we have had a staff party, so we had one this past weekend. A lot of the staffs who had just been let go from Kabizo were there! No one got drunk enough to be really obnoxious (not always the case). And, seeing how the party was on the day of Halloween, I just had to play the idiot. Some of the staff really thought that I had been attacked when I showed up. I swear that someday, I will grow up. But don’t hold your breath.

September

I’ve now been back in Congo for a month, and I just finished reading and filing away the 1500 emails that arrived while I was gone, while keeping up with the new ones arriving even faster. That is really a relief!

We are in the process of closing down two of our programs. This is actually good news. It means that those areas are relatively more secure than before. But it also means that 170 people will be losing their jobs. I’m becoming quite an expert on the legal aspects of firing people in Congo. Call me terminator. Fortunately, we have a very good lawyer who is keeping me on the straight and narrow path.

At least these are total closures, not like in Niger where we reduced our activity and therefore had to decide which 350 people out of 770 had to go. That is a lot trickier. We will be able to place a handful of our key people in other programs, but not too many.

To get ready for the first program closure at the end of October, I am working on our pay-slip generation software, to correct some errors and make the final pay-slip easier to understand. We realised that we needed to do this in May, but the closures have made it a priority. It’s a pretty complicated task, but very interesting.

Once the two programs are shut down (probably by the end of the year) we will remain with two big programs plus our coordination here in Goma. And since the conflict in the Kivu region of Congo continues, we will probably need to open new programs in other areas. But getting back to a normal size should allow me more time to work on the big projects such as restructuring the salary scales, refining our policy for working with employees of the national health care system, changing our job function scale to fit an international MSF standard, developing model work contracts for new projects which allow us to change the orientation of the program as the context changes, and a few other projects.

I have also been working on some tools to help our transit person to make sure things don’t slip through the cracks for arrivals, departures, travel for breaks, and all other travel. We have at least 15 nationalities represented here, all with different visa requirements for Congo and Rwanda (all our flights are to Kigali, Rwanda and afterwards there is a 3 ½ hour car trip to the Congolese border, thus doubling the visa nightmare). And Congolese staff going to Europe for training courses or for expatriation to other countries must go (again from Kigali) to the French embassy in Kampala, Uganda to obtain a visa before leaving. It can get pretty complicated.

A lot of our coordination team have extended their contracts here: me (2 years), the financial coordinator (1 ½ years), the logistics coordinator (10 months) and the pharmacy manager (10 months). The head of mission, his deputy, the medical coordinator, and the psychologist have also extended their stays by 1-2 months. That is really good for the continuity of the mission. But the top 3 posts (head of mission, deputy head of mission and medical coordinator) will all be changing between the end of October and the middle of December. We will see what management style comes about with the change. The atmosphere is pretty intense for the moment, partially because we have some pretty strong personalities in the group, partially because the short-timers are trying to get all their objectives in place before leaving. And the objectives of some are in conflict with the objectives others!

I’ve been thinking a lot about my sexuality since returning from vacation. I am gay. (For those you who didn’t know, now you do.) And that is not something that we talk about in a big portion of Africa. The expatriates here know (and don’t care). But I don’t announce my sexuality to the national staff. Even if some have suspicions, I think they are more comfortable not really knowing. And I do not go looking for partners here. That could be dangerous, especially with my position as human resources coordinator (conflict of interest, abuse of power, etc). I don’t really have a huge sexual urge (breaks and time back in France give me sufficient opportunities), but it is kind of frustrating not having some “colleagues” around. Some evenings after work and before going home, I take advantage of the internet to connect with other gays, and it helps. I have “met” some really interesting and refreshing people, both gay and gay-friendly. Thanks to Mihai, Marcus, Alan, Ion, André, Masoud, Msingi, Josh, Pasha and Yannick. You have helped to keep me relatively sane.

Big news of the week: We now have city power in our house! Before, we were dependent on the generator which operated a couple of hours in the morning and from sunset at 6:00pm until 11:00pm. An electrician has arrived in our coordination team, and before heading off to the field, he is putting some things in place here. He found a way to connect us into the city power grid (legally, of course!). It’s not perfect. The power grid goes off for a while almost every evening, some of the lights and outlets are not on the same circuit and thus do not work, and I did get a pretty good shock in the bathroom the other day, but it is really an improvement. Nicolas is slowly getting the kinks out of the system, and we still have the generator when the grid goes out.

It’s Sunday, and I am not working as much as I usually do. It is nice to be in the office, though, when there are less people around. I can get a lot more done, especially on the long-term projects which require more concentration.

End of my vacation - sigh!

I am at the end of my break.

I spent 3 days in Paris for meetings at MSF headquarters, then I went to Indiana for a bit more than a week with my brothers and their families. I missed on of my nephews, who is working in Boston this summer – that was a problem with my timing. But everyone is doing really well, and it was a good trip. We had some great meals together, Mike and I moved my niece to Ball State University for her second year there, and I met her boyfriend. Byron's youngest daughter was amazed that I had never heard of Wii - she thinks that I live on another planet (yes, Congo is sort of another planet). But the thing is really fun! I explored Louisville a bit - it is becoming more and more interesting.

Finally, we had a "flash flood", if natural disasters are your thing. We had 15 inches of rain in some places (38cm) in 75 minutes. And since they already had a very wet season, the ground couldn't hold any more. In the parking of University of Louisville, there were cars hidden in the water! It was incredible to see. But no damage in my brother's houses.

I returned to Lyon on a Tuesday, and flew off Friday to Bucharest, Romania, to see a friend there. He introduced me to some other people, and we had a great day at the Black Sea, near Constanta. I was really impressed with the country – it is more developed that I thought, and the Black Sea is great. Bucharest is a huge, beautiful city, although I had very little time to explore it. This is Ceausescu's parlimentary palace, the second largest building in the world after the Pentagon! I did visit a "village museum" - a collection of houses from everywhere in Romania, reconstructed in a beautiful park, demonstrating the diversity of old housing styles. Many thanks to my friends In Bucuresti for a great weekend.

Then back to Lyon for about 12 days. That also has been nice. I saw some old friends, I met some new ones, and I missed out on a couple of people. I did nothing constructive! But I had a lot of aperitifs and ate some really good meals. I even went out dancing a few times. I bought a lot of books, electronics, and gifts for Congo. I also stocked up on deodorant, razor blades and Chapstick for the next year. And I spent a lot of time on the internet, since our connection in Congo is so bad. I caught up on a lot of things, and spent some time on some naughty sites, too. Bad boy!

So now back to Congo. I leave Lyon with the fast train tomorrow at 7:46am. I will be at MSF again tomorrow for last minute meetings. Then, I take the plane Thursday morning for Kigali, in Rwandan, arriving at 10:40pm. So the MSF driver will pick me up, we go to the hotel, and then we leave for Congo the next morning. I should be in Goma hopefully around noon Friday.

It will be really great to see everyone there again. The month has gone quickly, but I would start to get bored if I stayed with work any longer. Mind you, it was VERY nice to do nothing, but now I am ready to attack our big projects in human resources which are waiting for me. Plus my 1000+ backlog of emails, I imagine.

Anyway, my next break will be in January! (I hope I don’t spend as much money as I did this time – my account is EMPTY – but it was worth it. That is what the money is for anyway – to enjoy. And I did.)

First 6 months of 2009 for MSF- France Congo

I often communicate what is happening in my life and job, but here is a summary of what MSF-France really does in the North Kivu, Democratic Republic of Congo:

There is a bit less violence this year, but still quite a bit. The variation is feeble, even though the political context has improved. Our approach and positioning in the region seems to be good, although we question the pertinence of one of our programs - questions which will be analysed for a decision by the end of July.

Good news: fewer epidemics this year. MSF and the other non-governmental organizations are much more reactive in following outbreaks than in the past, and we have developed a strategy of lobbying so that the central authorities and humanitarian groups are notified as soon as a medical situation is noticed among the displaced populations. Another factor is that we performed a large vaccination program in 2008 against measles. Also, in 2008 there were many spontaneously created camps in the regions where no humanitarian actors were present to assist in developing sanitation systems. These camps are perfect breeding grounds for epidemics. These camps no longer exist.

To summarize our activities for the first 6 months of 2009:
1936 cases of sexual violence treated
233 injuries due to conflicts received in out-patient clinics and emergency rooms
572 surgical acts for wounds due to conflicts
320 cases of cholera treated
14 cases of measles treated
38 cases of meningitis treated.

And our biggest activity consists of 110,254 medical consultations in our mobile clinics (setting up where needed) and out-patient facilities.

Success!

Hooray ! I finally got authorization Friday evening, the 19th of June, for the salary and job function scale changes. Then it was a race against the clock to implement these changes. We had an all-day meeting Saturday with the project coordinators, so I couldn’t do anything that day. Sunday I worked from 10:00am until 8:00pm implementing the changes into various tables and data bases, and prepared my presentation for the staff. Monday, I cleaned up all the essential work necessary before going on an announcement tour. Tuesday the 23rd, I left for Rutshuru (3 hour drive), where we made the announcement the same day. Wednesday, I went to Kabizo (2 ½ hours), where we again made the announcement the same day. Same thing Thursday for Nyanzale (3 hours). I had to leave Nyanzale rather late on Friday, arriving in Kayna at 5:00pm after a 2 ½ hour drive. That was too late for the meeting (the staff needs to be home before nightfall at 6:00pm for security reasons), so we made the announcements Saturday morning, the 27th at 7:45am. I left directly afterwards at 8:30am and arrived here at 5:00pm. My last presentation was to the staff here in Goma at 8:30 Monday morning. It was a whirlwind trip, but I had to put the changes in place at each site and announce the actions before paying the staff on Monday the 29th.

Overall, the acceptance of the changes was good. Essentially, we made an operational change in the job function scale to allow us more flexibility in moving nurses between different services. And we augmented the lowest salaries to maintain an acceptable living standard for our employees. Of course, the people who didn’t receive an augmentation would have preferred to have one. We explained that they are already fairly well paid next to other organizations like ours, and that we would continue to monitor the situation for future salary evolutions.

Since Sunday, I have been catching up on the work that arrived while I was gone.

Today (the 30th of June) is the Congolese national holiday, the 49th celebration of independence from Belgium. President Kabila is here in Goma for the celebrations. They finished the road work just last night on the street on which the parade took place! Kabila flipped the switch on the new streetlights last night as part of the festivities. Today a few of us expats went downtown to watch part of the parade. I think about half of the town was in the parade, with the other half watching.

Most of the other non-governmental organizations went across the border into Rwanda, in case any of the rebel groups took advantage of the festivities to make a “statement”. But with all the military troups in place, I have never seen the town so secure. Unfortunately, the troups tend to be less disciplined after dark, so we will not be moving from the compound after 6:00pm until their departure.

June in Congo

A month has gone by, and still no decision on our salary and job function scales! The team in Paris who should validate these has been decimated lately by illness and family problems. Hopefully, the team will be complete next week so that we can get some decisions. I need to put the changes into our human resources management system, and then I have to make a tour of the projects to explain the changes, all before the end of June.

And it is going to be difficult to find the time. My finance collegue just returned from her break in France, and she must go out to the field all of this week to finalize the budget revision - she is also under time pressure. So I am covering for her. And my own two assistants are at the MSF-France general assembly for the moment, so I am covering for them too. It’s pretty hectic. But it is the same for all of us. When I leave on vacation for the month of August, my finance collegue is going to suffer!

For the moment, security here in Goma is changing for the worst. There have been a couple of attacks on some of the other big Non-Governmental Organizations (NGO’s) here in the las couple of months, and these robberies were very violent. About 80 homes were burned and looted this past week in one part of town. And at 8:00pm last night as I was preparing to leave the office for the house, there were a few gunshots just behind the office. The guards actually saw the bullet traces go over our compound.

But this is still very calm next to the towns where we have our programs. The people living in the compound in Rutshuru spent part of last night in the security room due to shooting. In Kayna, this happens fairly regularly (as it did when I was there in 2005-2006). The attacks are usually attributed to one armed faction or another. The soldiers are paid sporadically and they have guns, so the take what they need. For various reasons, the unemployment here is very high, and MSF is known to pay our staff rather well. This makes our people good targets for bandits, and aggressions against them are rather common.

Our head of mission and medical coordinator get back this week from strategy meetings and the general assembly in Paris. We will have all the project coordinators here in Goma next weekend with us, to hear the results of these meetings and to plan the process of achieving the strategies. We are all looking forward to hearing which of our proposals were accepted and which were not.

Here to stay......longer

The visit of our interdepartmental team from Paris was very useful. The big topics included our salary scheme, the job function scale, and our relationship with the employees of the Ministry of Health with whom we work in some structures. One of the outcomes of these meetings is that we have a lot of work to do - some of it short term, and some of it medium to long term.

After talking with our human resources referent from Paris (who is also a good friend), I have decided to extend my stay here as human resources coordinator for the Congo for another year, up through July or August 2010. The projects will be really interesting for me, and will allow me to learn a great deal about human resource management. It will also allow us to have some continuity in the development of the systems. My decision also puts me on a path of little or no return – I will be out of the running for a purely operational post, such as project coordinator. But I have thought it over and I prefer to continue in HR, where we have a real shortage of expertise in MSF (as do a lot of the other non-governmental organisations).

And I will need a break. So I will be returning to France at the very end of July. After a day of debriefings in Paris, I will go to Indiana to see the family. I am booked to arrive on the 1st of August and to leave on the 10th of August. I will then have 3 weeks in my own place in Lyon before returning to Congo for another year.

After that, who knows?

By the way, here is a photo taken by an Australian photographer, Kate Geraghty. It is taken in Kabizo, where we operate a health center serving the local and displaced population in the area. In the foreground are some of the patients, who were fascinated by the camera Kate had. In the middle ground is our medical coordinator, Manal Shams Eldin, a Sudanese doctor. In the background is me, doing the traditional head-bump greeting with one of our staff who I had not seen in a long time.

Back from Break

I returned from my break one week ago – it already seems like two months ago! This time I went to Lamu, an archipelago off the northeast coast of Kenya, not very far from Somalia.

I flew in via Nairobi, and visited the animal orphanage (animals abandoned by their parents) in the Nairobi National Game Park. The monkey in this picture is named Barak Obama. Later, I walked to a modern shopping center to buy some “muzungu” (white person) products (toiletries, french cheeses, chocolate, books) that we can’t find in Congo. I even ate a burrito and had some gelato! The next morning I was off again by plane to Lamu.

Lamu Town is the oldest living village in Kenya. It is Swahili and Muslim, as is most of the coast of Kenya. It has escaped the modernisation of many of the coastal tourist towns – there are no high-rise hotels, and there are no cars on the whole island, except one car for the governor and one ambulance for the hospital! Transportation of people and goods is by foot, by bicycle, by donkey or by boat. The donkeys are everywhere,and so are their feces. One must be careful of this while navigating the medina-like maze of small streets. There is even a donkey sanctuary for mistreated or sick donkeys which is run by an order of Catholic sisters. The streets are between 3 feet and 6 feet wide. There is one big pedestrian square dominated by a huge almond tree in front of the old fort. The lifestyle is slow and easy.

I stayed in Shela, a smaller town about a 45 minute walk from Lamu Town. Lamu Town is livelier, and Shela is more upscale – Caroline de Monaco and her husband Ernst of Hanover have a house there. A pristine white sand beach starts at Shela, running 12 miles along the east coast of the island. I was in a small hotel, and since I was the only customer (it’s not right on the coast, and a bit difficult to find in the maze of narrow alleyways), the owner gave me the penthouse. I have never stayed in a hotel room so large, on the top two floors of the hotel with beautiful Swalihi furnishings. The top floor is an open roofed terrace and this is where I slept. The hotel restaurant, the Barakuda, is heavenly – everything is bought fresh each day and I took advantage of the incredibly good fish and seafood.

Lamu Town has a small museum explaining the history of the island, a Swahili house museum showing the typical layout of an old wealthy Swahili family home, and the old arab fort. All three of these can easily be visited in the same morning. I ran into a deaf/dumb guy for whom I bought a Coke, and he was so happy that he gave me a tour of Lamu Town, the village west of Lamu and his own home where I met his equally handicapped wife. His explications were a bit difficult to follow, but it was really pleasant to see how the poor (the vast majority of the population) live – not unlike here in Congo. Although Kenya is a much more prosperous country than Congo with a certain infrastructure missing here, the wealth and amenities reach a very small percentage of the people.

I also also rented a kayak to cross the channel to Manda island to visit the Takwa Ruins. This is an old Swahili town which was abandoned at the end of the 19th century, due to a change in the water table which turned all the wells to salt water, and due to fighting with a tribe from another island. The ruins are well preserved. From my kayak, I also saw where they mine the coral blocks used to build the houses of Lamu. Once the blocks are sculpted, they are transported across the channel by dhow, loaded and unloaded by hand, and transported to the building site by donkey. The 1 ½ hours of paddling each way on this trip did me a great deal of good.

Being Muslim, nightlife is fairly limited. About the only places to buy a beer are Petley’s Inn on the waterfront in Lamu Town, and Peponi’s Hotel in Shela. Obviously, these two places are where to meet the tourists, and the locals who are not strict Muslims. And there is a floating bar in the middle of the channel. There is also a shop in the police canteen where I bought a bottle of white wine to take back to my hotel, to accompany the delicious seafood. At Peponi’s I met a really nice couple - Chende is from Lamu and his girlfriend Ilona is half Indonesian and half Dutch. My last night in Lamu, which was a full moon, they took me across the channel in their boat for a night on the beach: music, Kingfish cooked over a bonfire, LOTS of beer, others coming across to join us, and sleeping tents on the beach before returning to their place in Shela for coffee the next morning. It was wonderful.

In all, it was a peaceful and relaxing week.

Now I’m back at work, and things are hectic. We have a lot of journalists documenting the situation here on the east side of Congo (MSF is a strong advocate of bringing the attention of the public to ignored or forgotten conflicts which continue to endanger local populations). There are also technical visits from headquarters medical specialists, and our new department head getting to know the mission of Congo. I also have a small team from Paris here for three weeks to help advance the work (and hopefully get a decision from Paris) concerning our salary and job function grill, the policy concerning our remuneration of employees of the state health system working with us, and some other human resource issues. I’m really happy that they are here to work on these things. But I must admit that I am struggling to keep up with my daily work and the work required on these issues. I knew that this would be the case – that’s why I took my break BEFORE they arrived.

And after the departure of the team from Paris, my colleague taking care of finances will be leaving on break. I will be covering for her. A mission of 1 year in a war situation is not the easiest way of earning a living. I knew this already and I wouldn’t change what I do for anything, but I will really appreciate a 2 month pause starting in August before returning to work somewhere else.

Back from the field

I left as planned three weeks ago to help set up the program to provide primary and secondary health care for the displaced families in the area of Lubero. We set up in an existing health center, working with their staff and recruiting others to accommodate the 50,000 displaced people, along with their local population.

Our small team stayed at the catholic mission in Lubero, where I had stayed 3 years ago for a weekend. It was great to see Father Robert again, and some of the brothers who are still there. Catholic missions in Africa often provide the services of a guest house for travellers, since hotels in the bush are inexistent. We rented 5 bedrooms, plus another one to use as an office.

The start-up went surprisingly well. We were able to negotiate with the Ministry of Public Health (with a bit of difficulty), our entry into the health center. Handicap International loaned us a small warehouse for our material. And the staff of the Kasalala health center welcomed us with open arms. We defined our staff needs to complement the 18 people already working there the first day, and developed the recruiting flyers. There were 2 days of collecting candidatures and the pre-selection. Recruiting interviews to hire 4 nurses, 1 hygienist, 2 drivers, 3 guards, 1 logistician and 1 administrator were done in a single day. And we started working in the health center the next day. As always here in Congo, we were able to find really good people.

During my stay in Lubero, it came to our attention that a cholera outbreak had begun farther north on the Congo/Uganda border at Kasindi. Cholera is a disease which propagates very rapidly, and it is deadly if not treated quickly. Basically, the cholera bacterium causes the body to eliminate all its water via constant defecation and vomiting – one dies from extreme dehydration. Treatment of cholera consists of pumping liquid back into the body as quickly as it is eliminated, until the bacterium dies on its own. At the same time, the patients must be isolated from the rest of the population, because the body wastes are extremely contaminating – they must be treated before disposal to avoid infection of others.

So once I had helped to get the Lubero operation going, I headed northeast to Kasindi to help set up the cholera treatment center. At Kasindi, a doctor, a logistician and a driver had arrived 2 days before me. The treatment center was already taking shape. I went to a larger town 2 hours away with the driver to rent 2 cars (1 with a driver) for the program, as well as to pay the guards at a warehouse we have there (prepositioning emergency stock, including the product we use to treat cholera!). Once we had the cars, we loaded up as much of the cholera drugs that we could hold and returned to Kasindi. Once again we defined our needs and started the recruiting process, this time even quicker than the last, due to the nature of the beast we were fighting. I spent a couple of days, finding a base (we basically took over a tiny hotel), making purchases for the treatment center, speaking with Ugandan health officials (who were VERY happy to see us there so that the epidemy would not spill over into their country), finding a place for the staff to eat, and posting recruiting flyers. Once again, we were able to find great people.

My trip was supposed to be 4 days when I left. It turned out to be 2 weeks - my jeans weighed about twice what they do when they are clean. I returned on Wednesday evening the 18th of March, to find an astounding number of mail messages to respond to. And Friday and Saturday were wholly dedicated to the MSF field associative debates, where we bring in employees from each of the sites for the 4 sections of MSF in the region (France, Holland, Spain and Belgium), to discuss issues pertinent to our operations. Needless to say, the trip didn’t help to alleviate my work overload – I have just caught up with the backlog of mails. But I was really happy to help start up these programs. In Lubero, we are working well in the health center, and have started up some mobile clinics, treating displaced people in other villages. And in Kasindi, the cholera outbreak has been contained, and we will soon finish our intervention there.

But I can’t do everything. I felt so overwhelmed by the workload that I considered resigning from my post a couple of times lately, so that someone more capable could take over. I spoke this over with our medical coordinator, who told me that she had considered the same thing at about the same time. So we both decided to stick in out.

Our proposal for staff salary increases and job function scale revisions are still on hold in Paris. The staff are impatient, and Paris is blocking; due to the instability of the economy, they are rightly nervous about the amount of contributions we will receive during the coming year. A commission of 4 people will be coming in mid-April for 3 weeks to work with us on a final decision on these and some other pressing human resources issues. That’s a relief, but it will be an intense period for me.

So I am leaving Saturday the 4th of April for a week-long break BEFORE they arrive. I will be going to Lamu, an archipelago off the coast of Kenya, up near Somalia. It seems to be more expensive than Zanzibar, but it’s good to change destinations. And after 8 months of 12-13 hours a day 7 days a week, and 4 months after my last break, I really need a rest.

Life in Congo

Here is a recitation of one of my collegues which I just translated from French. Unfortunately it is an accurate description of what life here is like.

« The displaced »
between wandering and aberration

The armed forces which we won’t identify (even if here they are freely installed within the civil population, named and designated), include at least 6 different groups fighting between each other. They fight under title of alliance, certain groups in coalition against “one” other, decreed as the official enemy of the moment, of the regular national army. That’s been the principle… for more that 12 years. And during the last 10 years 5,700,000 Congolese have died, mainly civilians… and the majority in the Kivu region.

Whatever the military strategy, the scene is identical. The soldiers encircle a zone where life plays out between towns and villages, work in the fields, small businesses of selling fruit… The targeted zone which fills up little by little with soldiers is surrounded by scrub forest in which the ambivalence is completely between danger and protection.

Then starts the sound of bullets, the robberies, the burning of houses and all the rest. The soldiers, gifted with the magical power of arms, take possession of everything. The territory is now their new camp. The inhabitants flee, taking with them whatever they can. And they walk.

They walk in groups which will lose a member from time to time – men, women, and children of whatever age. They walk for days without end on rocky and washed-out paths made of red earth; the babies snuggled up to their mother’s bodies, the bundles of simple cloth holding a few pots, a bit of “manioc” for survival. They know that they have lost everything, even if they return in a few weeks.

They walk in files, small children of 5 or 6 years old often carrying three times their weight on their heads. They are all exhausted, after 30, 40 and sometimes 100 kilometres or more. So the groups break off into smaller groups more and more scattered.

They walk, and they are tempted by the scrub forest to sleep a bit. The forest - dense, very attractive, very green with large banana leaves - seems the perfect shelter… but perfect for everyone!, militias and other undesirable partners included.

They walk and sometimes get lost, wandering aimlessly.

At 35 years old, F.Muk’s husband was killed and their house occupied by soldiers. Obliged under threat, she took to the road one night towards what she considered a safe place. Her children are young….., she is intercepted on the path by a few soldiers with undisguised desires…, she begs her children to continue walking under the guidance of the oldest who is 13 years old…..

Afterwards, she searched a long time for her children, finding them two days later but with one missing! The despair is immense when I meet with her several times. Hazard and solidarity joined forces allowing her to find the last child 20 days later.

R. and L. are both nurses and have 4 children. Soldiers arrived at their house, firing haphazardly without aiming at anything. It was an expressive announcement of what was to come. After being beaten, R. resisted no longer – his brother had been shot a few months before. This couple also took to the road. The soldiers had taken their oldest child of 11 years old as hostage, to carry their plunder. R. and L. had to save the other children. They also walked the 150 kilometres that separated them from the rest of their family.

Stories like this can be told without end… the list is long and the recitals are extended. We’ll stop here. Just be aware the even those who “walk” know that one day they can also become one of the unimaginable number of 5,700,000 deaths in Congo.

Maryvonne,
Psychiatriste in Kivu
February 2009

It's me again. I should be leaving Goma for Lubero next Saturday to help set up a new operation in that area, to provide primary health care for a newly displaced population of around 50,000 people in the same situation as those who's tale is told above. Our resources are becoming pretty extended right now, mainaining our existing programs and at the same time trying to alleviate the suffering of the new victims of this chronic situation. Fortunately, we have very good people working with us who are dedicated to this work.

Our work has become more complicated recently by the fact that bandits are now targeting aid worker's cars, forcefully taking money, phones, and pharmaceutics. Having a Kalichnikov pointed at you, along with verbal threats that you can't understand, is not a pleasant experience. The number of roads available is limited already. This new development hinders us even more in where we can go and how we can react.

Trip to the field

I was in the field last week for 4 days. The main purpose of the trip was to explain our work on the job function scale to the personnel delegates. We are trying to approach the MSF Congo scale to the MSF International scale. Part of the process is to have the delegates sign that they understand the idea behind the changes and that we have explained the process for regularization with the people who will drop a grade. Not so easy, but our delegates are pretty reasonable. After that, we need to present the plan to the labor office.

It is always good to get out of our coordination office to the field, to get back in touch with what we really do. I was at one site at the same time as two Australian journalists who are working with us to witness to the world the situation here. I made myself useful by doing some translations. We sat in on some consultations with women who had just been raped (This site sometimes receives 20 new sexual violence cases a day.). The consulting nurse would explain the reason for our presence, explain the consultation process, listen to the story of the girls, then proceed with the medical exam and whatever treatment was necessary afterwards (we would be gone before the exam). The nurse translated the stories from Swahili to French, and I translated from French to English. The stories were pretty dramatic, especially the 20 year old who has now been raped twice in one year. Most are attacked by armed men (often more than one) on their way to or from the fields where they cultivate the crops their families need to survive. Via radio campaigns, the women know to come to our health center quickly after the aggression so that we can start prophylaxic treatment to avoid sexually-transmitted diseases and other complications. They have very strong characters and I am in awe of their courage in dealing with such traumatic events.

Since I was here in 2005 and 2006, I know quite a few of the Congolese staff in the programs, so field trips also a time to catch up with good friends. We had the luck to pass through one more site than expected on the return trip, and for me it was like a homecoming.

Upon my arrival here in Goma, we had a big meeting with the head of one of the programs that I had just visited, which is doing some very interesting work in trying to bring up the quality of patient care in the public hospital in which we work in cooperation with the public health system. It was a really constructive meeting, and I think that we now have clear goals of what we can do, and what we can’t. It is a big, exciting program which will need a lot of attention and consistency in management to fulfil the goals we agreed to.

All in all, it was a great week.

Happy New Year

The holidays are over and Congo is still relatively peaceful.

We enjoyed a very nice Christmas at the house. A couple of new arrivals had brought some comté and beaufort cheeses, so we had a mega cheese fondu the evening of the 24th. It was delicious! I had expressly made some purchases in Zanzibar, so everyone had a gift – there were 13 of us. We even had a simulation Christmas tree (a branch of a local plant with a few Christmas ornaments on it. Alcohol is pretty easy to find here (as compared to my last posting in Sudan) so we were all pretty blasted by the end of the evening. Some of the faces the next morning were not very pretty.

The 27th we had our end of the year party with the staff – we are 79 employees in total here in Goma and some brought their families. The national staff did the organization of the party and it was a real success considering it rained most of the afternoon: good food, moderate drinking (this time), a lot of dancing to Congolese music and great conversation. It is really nice to talk with everyone outside of the work environment. We have hired some new staff lately and it gave me the opportunity to get to know them better.

On New Year ’s Eve, after a LONG aperitif, the expats split into 2 groups. One group went to a party organized by one of the other International Non-Governmental Organizations. The rest of us went out to an Indian restaurant – a big part of the UN forces is Indian, so there is one such restaurant here in Goma. The service was slow, the electricity cut out for quite a while (pretty typical here) and the food was great. It was nice to be out of the house.

I don’t want you to think that all we do is party! In fact the rest of the time during the holidays was the same as always. I start work around 7:15am and finish around 8:00pm.
Christmas eve, we were in a coordination meeting until around 7:00pm, so we were pretty rushed to prepare the fondu. The end of the year staff party started at 2:00pm, but I was working until 3:30pm. New Year’s Eve was the same thing again.

Working as we do, small comfort considerations sometimes become big issues. A couple of months ago, we rented a second expat house. With changes in the team and technical visits from Paris, we are between 8 and 18 expats at a time, and there was a moment when there were 4 of us (including me) sleeping on the floor in the living room. (This photo is from the front balcony of the second house – we are in a nice place. It’s a fishing boat on Lake Kivu, taken this morning) But we want long-term staff, relocated local staff and visitors in each of the houses. We also want to eat together – meals are the only time of the day that we are all together. We had been eating in the first house, but yesterday we moved the kitchen to the second house. The newer house is much closer to the office, which makes it easy to walk there for lunch - we have a limited car pool, and waiting for one to take you to lunch is often a problem. These kinds of changes can be fairly traumatic, but it worked pretty well. The cook, his helper and the logistics staff did a great job, and we had dinner in the new house last night, easily finishing early enough so that the people in the first house were able to go home by car well before the 11:00pm curfew.

As I said earlier, things are relatively calm for the moment. But there is some instability in the leadership of the major rebel group right now, which makes us a bit nervous. We have decided to keep a couple of short-term projects open, in case the conflict picks up again.

My biggest work for the moment is following the movements of the expats. We have a lot of expat resources available to us being under the emergency desk, but they are short-term postings. Each movement means working with Paris to see when the person will arrive or leave, scheduling the cars to pick them up or take them to the airport in Rwanda and the plane for Uganda, making sure that the have the visas they need for Rwanda, Uganda, Congo and France (for the African expats), getting them through the briefings here in Goma, and then getting them to their respective projects in the field. In November we had 65 expat movements (in and out). This week alone we have 12.

I am also finishing up my proposition for changes in the salary and job function scales. I have to finish up today, because it will be presented tomorrow in Paris.