Packing for dummies

Right.

I get to bring 20KG with me. MSF provides no list to work off of. I'm now in the (probably) unenviable position of having decide what to pack for a 9 month trip to someplace I've never been, in a climate I've never lived in. I want to keep it to minimum needed...but I also want to make sure I've got what I need.

Help!

I've alread been informed that:

• I shouldn't bring too many clothes
• The laundry person does laundry almost every day
• The culture tends to 'dress up' more often than not...
  
• It's usually between 30-40C for the next few months
• After that it rains. A lot. In stunning amounts.
  
• MSF provide bug dope and sunscreen. And soap. And a towel. And sheets. And lots of other 'sundries'.
• MSF also provides T-shirts and vests (!) for wearing when you're working or leaving the compound (you always want to be wearing your MSF shirt when you venture out. Unless, as we discussed - a lot- in the training in Holland, you're going out to visit (a) a bar, (b) your secret native lover, or (c) a prostitute).
  

Anybody have any ideas for me? Especially anyone who's been to Africa, the equator, etc.
My biggest question thus far is: what do I bring for my feet? I've got hiking boots, work boots, flip flops, business-casual work shoes, tennis shoes, etc. What am I going to want? Shoes could easily be the most bulky thing I bring.
I need something for kicking around day-to-day, but also something for when I'm out tromping in the bush on 'explos', and something, too, for when I have to attend 'events' in-country (weddings, funerals, meetings with high muckity-mucks, etc.).

Any input would be appreciated!

It's official!

I received notice yesterday that I have a ticket.

That definitely gives the whole thing a greater sense of reality than it had before. Yikes.

I'll be leaving Seattle on the 9th of February, arriving in New York for briefing, leaving New York on the 11th, arriving in Amsterdam the 12th for briefing, leaving A'dam on the 15th for AFRICA (and more briefing...)!

For those of you who like numbers.

On statistics, the following are some reasons I'm going to Liberia, and MSF is already there:

• Infant mortality rate is 134/1000 live births
• Child Under-Five mortality rate is _235_/1000 live births (think about that...almost 25% of children die before 5 years old...In the united states, this number is 8/1k )

Those two put Liberia at number 5 in the WORLD for death rates of infants/u-5s.

• Less than 10% of the population has access to health care
• Maternal mortality is estimated at 580/100,000 births (US: 8.9/100k)
• Less than 20% of the country has access to safe drinking water
• Less than 30% have access to latrines (!)
• HIV/AIDS is currently estimated to be at 12-15%

All of this in a country of 3 Million people, where there are only THIRTY Liberian doctors.

...I'm glad I'm going. I'm elated that I can contribute changing something to this. I'm excited, terrified, anxious, happy all at once.
It's really starting to sink in that this is going to be unlike anything I've ever done before...I knew that, intellectually, when I signed up, but...hrmmm...yep. And not just because of the mongooses. (mongeese?)

A veritable menagerie!

Pictured Above: Not my mongoose.

Got some more details of my living situation the other day. Sounds like I'm practically living in a farm!
As of the email I received, the 'compound' in Sanniquellie has 3 goats and 1 teenage goat, 1 adult sheep named "Cybal" who is apparently an MSF mascot of some sort, as well as her lamb, 1 guard dog, 2 'guard' cats (yeah, right!), a whole run of chickens, and a mongoose who owns the place but doesn't even have a name.

Thank goodness - I was worried I might not have a mongoose!

Taj's medical insurance...

Since I've received a few questions about 'what happens if...', I thought I'd share a brief description of my medical coverage.
First off, I think I'll have one of the best medical insurance packages in the world. So, hypothetically speaking, let's say I manage to break my leg in 5 places. First off, I'm out there with a bunch of the best physicians from around the world who have high quality training and, having worked with MSF, an acute sense of emergency medicine. But, for purposes of example, lets say they decide they can't handle my compound fracture in the field.
MSF has medical coverage that includes a company called (I think) International-SOS. Here's how it works: I break my leg. Doctors with me decide they can't handle the fracture. They presumably give me pain drugs, but immediately sat-phone I-SOS.
SOS immediately sends an air-ambulance (a big, fancy jet plane filled with equipment and highly trained medical staff) JUST FOR ME to the closest capable landing strip. If they can't land near where I am, they simultaneously dispatch a medical chopper to where I am. The chopper will take me to where the jet is waiting. The jet takes me to whever they decide is the best hospital for treating whatever it is to high-level first-world standards. So, from Liberia, it may be to South Africa, it may be to Madrid, it may be to London, it may even be to New York or Delhi. It all depends on what they decide is the best route for the highest quality treatment, cost unconsidered. From there, they're responsible for everything involved in my treatment until I'm better.
We actually had a 'session' on this in the training, and they cited an example that had just happened with an expat in Nepal. He had not notified MSF that he had a pre-existing heart condition, and, surprise surprise, whilst hiking around at 7000ft, he had 'an incident'. They satphoned I-SOS, who dispatched a plane that was there in I think ~2 hours, while sending a chopper to the remote part of Nepal where he was. He was airlifted to the waiting jet, which then took him to maybe Delhi? which was waiting for him on arrival.
All told, this is what I-SOS specializes in. Veteren logisticians, who've been in the field many times and are ALL ABOUT effectiveness and timeliness, speak of I-SOS in hushed tones when referring to how well they get the job done.
So, hopefully that will alleviate some of folks' concerns about the matter. I'm in good hands :)
taj

A list...Shots Taj has received in the last two months

Whew! I'm glad I'm not afraid of needles. My arms have definitely been sore.
To date, I've received:
Hepatitis A
Hepatitis B
Typhoid
Polio
Yellow Fever
Rabies
Meningitis (ACYW)
Hepatitis B (again)
Influenza
Rabies (again)

I still need a Hep B (in June), a Hep A (in June) and one more rabies (soon).
I'm quite happy the drug companies continue to research these things...If it hadn't been for GlaxoSmithKline or someone, I'd have had to get a big old Immune Globulin shot...that's the one with the BIG needle, and a whole lot (10ccs?) of liquid, and wouldn't have been able to sit for a couple days. Since Glaxo has developed an effective Hep A vaccine, they no longer need to do that one.

so, about that training

My 'team' , from L-to-R: Susie (medical - doctor), Paddy (medical - nurse), Santosh (medical - doctor), and Me (non-medical - log). We're happy because, well, we're the best! (we were the only team to get 8-of-8 on one of the quizzes)

The first few days we worked in kind of 'ad hoc' groups. They'd split us up whenever they wanted us to tackle something in teams, but mostly the first few days were plenary sessions.

The last few days, however, they split us into 'operational' teams, each with meds and n-meds, to tackle what they call the 'case days'. These days they'd use real MSF scenarios (that actually happened) and have us work through to solutions. This was everything from assessment on initial setups for landing on the ground and having 100,000 refugees in front of us in Afghanistan, to building a medical 'caravan' to deliver medical aid to remote Columbia (with appropriate security concerns). We had to become familiar with what sort of resources we'd have in the field, what sort of conditions were/are present, our local staff, etc. Then, we'd present our solutions in plenary, to be discussed/analyzed/torn apart by the other groups and the facilitators.
For many of these modules, they'd split our ops groups out, and pull us n-meds (non-medicals) into a separate room to discuss specific concerns, while the meds dealt with theirs. Then, we'd all get back together in our teams and come up with solutions that were appropriate given both aspects of the team's concerns.

All told, the training was intense - lots of learning, lots of discussion, lots of thinking and working. We spent a lot of time focused intently on the problems or issues at hand. Burning up the braincells. I was very impressed at the whole group - very rarely did folks slack off when it came to the training contents. It was hard, sometimes, especially when you considered how little sleep most of us were getting, but the whole team really buckled down and kept at it, for all 13 hours of every day. Very inspiring.

Of course, with such intense work comes intense play. But, i think that i've already touched on some of that. ciao for now.

Training, part 2

Ok, so apparently i've ranted enough about the food in holland. To summarize - it wasn't the greatest.

The rest of the training, however, was fantastic. Sure, we couldn't ever leave the hostel to speak of. Sure, we were all crammed together for 10 days straight. It was excellent!

The hostel waas about 30 minutes by train outside of Amsterdam (about 30kms, I think). It was in very un-urbanized area, actually near one of the last forests in holland, as well as close to the Dunes national park and the North Sea (as you could maybe see from the map in the previous post). The dunes is a 2km wide, long (don't know how long, maybe 20km?) stretch of protected land that runs along the beach. The dunes are protected because if they were torn down, north holland would flood whenever there was a big storm. For those that don't know, most of holland is below sea level...So the big sand dunes (and they _are_ big, they get up to a couple hundred feet high) help protect the whole country. Must make them feel important...

The sea was a solid 45 minute walk from the hostel. You had to walk through the dunes to get there, which made for good exercise. The North Sea, I guess, in that area, never gets more than like 30-40m deep - at least, that's what my new Dutch friends told me. So the surf never gets too huge. The water is freezing. We briefly entertained the idea of going for a swim, however, the air temperature was about 2-C, and the water not much warmer, and we would have had to walk 45 minutes back to the hostel, so we decided to forego the requisite hypothermia in lieu of just looking at the nice water.

We made a brief trek one evening to the seaside town of Egmond En Zee - a resort town (in the summer) that pretty much shuts for the winter. However, diligent travellers that we were, we managed to find an open bar in the dead of winter and spend some hours drinking fine dutch beer (mostly heinekin) and strange 'traditional' dutch liquors that were an awful lot like jaegermeister, except, of course, that you were supposed to sip them. But, after an hour+ walk along the freezing beach, a warm fire and warming liquor sure felt nice.

The other place we went after hours was the town of Alkmaar, to the north. The last night of the training we got to have a party, so we went to a nightclub/bar in alkmaar. it was absolutely packed.

I have to mention now that I have never felt so _small_. I'm not huge, but i'm 6'2", and I'm used to being at least a little bit taller than most of the people i'm around, especially in a crowd. When I was at the nightclub, for the first time ever, i felt genuinely diminutive. The dutch people are TALL! Many of them easily 6'6, 6'8, and not just the guys! I have a new-found appreciation for being 'short' in a crowd - you can't see where you're going, or what's happening near you, or anything!
It was pretty wild. We had a lot of fun, although the dancing was a bit hard as there were so many people.

That's it for now.
taj

First training - Holland

From the 5th to the 15th of January, I attended a training session in Egmond, Holland. Now, I can't talk about it too much in public because, well, it's a secret, and if _I_ didn't get to know what it was about beforehand, than neither should anyone else.

Regardless, I can summarize by saying: it was intense. We all (I think) had a most amazing time, we all learned a lot, we all ate a lot of bread, and we all drank a lot. The days were long, usually 13 hours (in three blocks four-hour classes, plus breaks and intro's), followed by evenings in the bar at the hostel, drinking 2-euro, .75L Heinekens. Which are, by the way, the ONLY beer you'll find in hostels in Holland. (Well, that and 'Palm', which I understand is Belgian, and is in fact quite tasty. I'd never had it before - it's good!) Also to be found in all the hostels in holland - pool table. Internet computer. Talkative, friendly bartenders. Mediocre food.
The food, well, it seemed like they were trying, they just never quite 'got it'. Bread at breakfast (no toaster...) with cheese (not the good dutch stuff, but some bland-ish other stuff) and meats (pretty good, these), muesli and yogurt (except for the 5 days they ran out of yogurt), fruit (well, some days they had fruit). It sufficed, i guess, but I don't want to eat bread again for some time.
Lunch was the same thing, except no muesli, and they introduced a soup, which was usually cleverly created from last-nights dinner. mmm.
Dinner would switch to some sort of meat-in-sauce, accompanied by two types of starch (usually potato and potato), an overcooked vegetable, and salad. Then they'd have a dessert, usually some sort of ice-creamy thing.

All told, the food was passable, and it certainly got the job done.

Gotta go, i'll keep on this one later-
ciao
taj

My training cohort!

From L-to-R:
front row: Nic (ger), Maite (hol), Tania (uk), Paddy (uk), Simone (ger), Marilyn (oz), Susie (can), Magriet (hol).
back row: Astrid (ger), Maja (ger), Woody (s-kor), Maaike (hol), Phillip (ger), Santosh (ind), Rahul (ind), Jasper (hol), , Adam (uk)

Not shown: Raf (hol), and Anne-Josee (can)...Coordinators extraordinaire...

A good time had by all.

What is Taj going to do?

Right. A bit of background on the why and when having been established, I'd love to discuss a bit the 'what'.

I'm going to Liberia, Nimba County, for 9 months.
I'll be a logistician attached to a project, based out of Sanniquellie. I have some details, which I'll share, but I am still waiting for more information from my field HRM (human resources manager...MSF LOVES the acronyms!).

So...first up, "Logistician". What does that mean?
Fortunately, it's nicely encapsulated in the following statement pulled from the job description I received when deciding to take this posting:

"To provide technical and logistic support to all MSFH activities in the project through day-to-day execution of tasks, supervision and training as well as bearing witness to the fate of people facing humanitarian crisis. Main objectives are to maintain an office, expat housing, a warehouse and to provide logistic support to a hospital and four clinics, with explo’s in the Nimba district."

That does it nicely, eh? A nice abstract, I think.

When you get right down to it, as far as MSF is concerned, an 'all-around logisitician' does the following: everything. Everything, that is, except the medical work in the field.
"Logs" are responsible for supplies. Security. Transport. Permits. Water systems. Waste management. Housing. Construction. Communication. IT. Bookkeeping. Etc.

Essentially, everything that the "Meds" need to do the work they do, the logistician is responsible for. Now, it's crucial to understand that I'm not so much to be _personally_ doing all those things, as making sure they get done the best way. Often, my job will be (...we'll see how this goes in the field) to find the best _local_ hire to get the job done and supervise their work. Certainly, I'll be doing a lot of things myself as well. But, by and large, I'm never going to be as good at all of the above items as someone else.

(I understand, after my training course in Holland, that the biggest mistake first-time Logs make in the field is to try to do everything onesself. Thinking about the context, and the circumstance, I can certainly understand how that might happen.)

I suppose, without going into to much further detail, that the description above will suffice, especially given that I've not yet been into the field. Once I've been there for, oh, a month, check in with me again. Hopefully, I'll have an even better idea then.

With that out of the way, on to the next part. As the abstract summarized, I'll be responsible for a warehouse, our housing compound, four clinics, and a hospital. The job description I was sent had a nice summary of information on what/where/why:

"The project currently consists of support to G.W. Harley hospital, in Sanniquellie as well as static support to four clinics in northern Nimba. The hospital has become very busy with the introduction of emergency surgery in late January 2004. G.W. Harley has become the main referral facility for all of Nimba County. In addition, in 2005, HIV/AIDS interventions will be designed and implemented to further enhance quality of services to our catchment populations and beneficiaries.

Only 2 of the original 4 hospitals in the County were functioning in a very limited way and there is still only one Liberian doctor who is a surgeon working at Yekepa hospital, north of Sanniquellie. MSFH is supporting the 31-bed G. W. Harley Hospital in Sanniquellie. The hospital is generally in good condition with new beds and mattresses and functional operating theatre. There is a small maternity area with two delivery beds and 3 pre/post delivery beds. The outpatient building is in good condition but currently rather small for the 100 + consultations we are seeing per day.

There is a small lab that is capable of providing essential tests including the necessary screening for blood transfusion. An expat lab technician is undertaking further training and support to the local lab staff. A waste management system is being implemented in the hospital and the necessary disposal facilities have been constructed. Minor repairs and provision of extra furniture, etc is ongoing.

MSFH supplie medicines and medical materials needed to support the hospital and outpatient department. In addition we are providing essential basic equipment to supplement what they have in the hospital to meet the ever-increasing demands for care. There are currently about 60 people working in the hospital/OPD of which very small percentages are qualified nurses, physicians’ assistants or midwives. Liberia in general suffers from a chronic shortage of qualified medical people that has been exacerbated by the long civil war.

As might be expected there is no formal functional referral system. Long distances, poor roads, lack of public transport and therefore no sure way for the patient to reach the hospital hamper the link between primary and secondary level health facilities. MSF is supporting 4 clinics in Northern Nimba County. The support has/will include some minor rehabilitation, provision of appropriate water and sanitation and waste management facilities, medicines and medical supplies."

I don't think I could summarize it better than that. In fact, I won't even try.

that's all for now. More, I'm sure, later.
taj

Here I am...There I go! (part 2)

So. Many of you are probably wondering "what the hell is Taj doing?" (OK, I'll confess, that's what I'd like to _hope_ you're wondering...)

Well, the short answer is this: In 3 weeks, I'm off to Liberia.

Yep, Liberia. Specifically, Nimba County. But I'll come back to that in a later post.

For those of you who haven't been kept in the loop (sorry!), I applied with Medecines Sans Frontieres/Doctors Without Borders back in, oh, September 2005. MSF is an international Non-Governmental Organization (NGO, or I-NGO) focusing on critical health care for populations in distress: refugees, war zones, IDPs (internally displaced persons), famines, etc. I've actually been interested in working with MSF for many years now. How they first appeared to me I don't remember, but I do know that I decided that MSF was an organization I wanted to work with for a number of reasons.
First, and most important to me, they provide help to anyone who needs it. They don't restrict access to their services based on who you are, what you've done, where you are. This goes directly in line with their two core tenets, neutrality & impartiality. This is important to me as I undertake this endeavor - again, maybe when I'm in the field and have some time on my hands, I'll discuss this a bit more, but for now, I'm going to try to keep it short.
Second, what they call "temiognage". For MSF, it's important not just to deliver the critical care to populations in need but also to be a witness to things that aren't being heard regionally or internationally. With witnessing comes advocacy - speaking for a population that can't speak for itself. This comes through at many heights - from regional rebel groups to the local governments in the countries they work all the way to the UN. Neutrality and Temionage are the two missions every MSF ex-pat takes to the field, under the auspices of health care for all.
Third, they don't do 'development'. Some people might want to work with development NGOs, but not me. At some point maybe I'll discuss the why's of that statement, but I don't have the time or the energy right now.
Fourth, they're not faith-based. While there are a number of absolutely excellent NGOs operating out in the world that are faith-based, at this point in my life I don't want to be part of them. Their goals are almost universally good, but I experience an amount of personal discomfort when I think about faith based NGOs and working with them. Maybe this will change, maybe it won't. Who knows? Regardless, MSF is _not_ faith based, and this is one of the reasons I wanted to work with them instead of a different NGO.

So, I'll leave those at that. Certainly, there are more factors at play than just those four, but those are really the root, for me, of "why MSF."

Of course, the second question I think a lot of you want see answered is "why now?" (well, honestly, most of you probably had that as your first question)
This one, for me, is harder to explain. For one, this is the time I _can_ do it. I finally have the skills and tools I need to help. That, however important in the prospect of actually getting the work, is fairly secondary.

More, this is something I feel I _need_ to do. Whenever I think about this, I have a very hard time trying to verbalize what the 'need' is, or where the need comes from. All I can say is that I do feel it, as something I have to do. I am uncomfortable thinking about _not_ doing it. I'm uncomfortable thinking that I might never do it, knowing the need I feel when I do think about it. I don't think I could rationalize satisfactorily to myself five years down the road having felt this so strongly and turned away.

In many regards, I thank (and give tremendous credit to) my mom and dad for instilling me a strong sense of wanting to do what's right, of wanting to help, of not living in a 'small world' based on strictly my needs and wants. My mom, my dad, my grandparents, my siblings, and Sky, all have contributed to this over the years, but I have to give the most thanks to my mom and dad. Both for the ethical and moral upbringing that I feel they established at my core, but also in allowing me the freedom to find my way, even when it wasn't easy for them.

So, the need. Yes, whether or not I can verbalize what it is, it's there, and it's strong. Unfortunately, for now, that's really what I can come up with. I'll do a lot more thinking on this in the coming weeks and months, hopefully I'll come up with some more ability to communicate what I feel right now, but for now this will have to stand on its own.

The timing, well, the timing is complicated, but I really feel like it will always be complicated. I know I want to have kids, I know I want to own a house, have a 'real' job, etc. If I think about those, they are all very good reasons to do this _now_. Simply put, I may not have the option of doing it later. Once I buy a house, there's a mortgage. Once I have a kid, well, there's a kid. Once I have a real job...etc.
For the time being, Sky's in school, it's going very well, and she has a great support structure here in Seattle with her Mom recently moved out here, her sister & brother-in-law (and nephew!) across the lake, and her dad and step-mom just an hour away (and, perhaps, her younger brother moving out to Seattle as well). She's got an excellent group of friends that she's developed through school and socialising, and she's going to be _very_ busy in the next year with school, internships, clinicals, etc. Once she's done with school, we're going to want to really try to settle down. As such, if I want to do this thing, now is the time.

Unfortunately, this timing coincides unhappily with the planned marriage of my younger brother. I'm working on it, but there's a good likelihood that I'll miss the wedding. You never know, I may make it back in time, or get some R&R that week to be able to return for the wedding. Niall and I have talked about it a bit, and I'm unbelievably thankful to him that he & Liesa understand (or at least profess to) and want me to do this. Walking to the dentist's office this morning, thinking about possibly not being there for him, it made me teary, but at the same time, I was amazed at him, his depth and compassion, amazed that he could encourage me in undertaking this knowing I may be gone for his wedding. While the timing is not great, it's the best it can be, as far as I can tell.

I hope that, for most of you, this post answers more questions than it raises.
I'm going to leave this post at this, and hopefully post later today with some explanation of the where/what/how of what I'm actually going to do. After that, I'll hopefully post some on what my training in Holland over the last two weeks consisted of, what it was like.

take care-
taj

Nimba, Liberia

Here I am...There I go!

Hi to everyone-
This is my first blog, and my first of what I hope to be many posts. I'm going to try to use this to communicate with everyone over the next 9 months. Given the circumstances (which will be outlined in a later post) this may or may not work. We'll see, I guess.
ciao for now.
taj