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.

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.