Duotiayee clinic

Earlier this week I made my first trip out to one of the four clinics for which I will be "responsible".
This clinic is located in the village of Duotiayee. A note to those interested in pronuciation in Liberia - pretty much, you pronounce everything. So, Duotiayee is pronounced "due-oh-tea-eye-ee".
Duotiayee serves as a Primary Health Center for the village and catchment population of approximately 10,000. Note, though, catchment population essentially means "how many people could walk to the clinic in a day", so the figure is quite large. The region itself is sparsely populated.
The trip to the clinic takes approximately one hour by TLC (Toyota Land Cruiser). The road is pretty much nonexistant for much of this trip. However, it suffices, at least during the dry season. When the wet season comes in April it may be a different story.
MSF-H supplies the clinic with materials and drugs that the MoH (Ministry of Health) has no money for. In this case, that's everything. We also have one doctor and one nurse who make weekly trips to the clinics (there are four total) to do consults. The clinic serves as an outpatient service only. There are a few beds (three) in the clinic just in case of emergency, but as there are really no staff on shift in the evenings they truly are "emergency" beds.
So, what does Taj do with all this? Quite a bit, and not much at all, as it turns out.
I'm responsible for making sure the clinic runs properly and has what it needs to be a functional clinic. So far, this week and the coming one, this will include: building a kitchen attached to the clinic, tearing off the mudded walls and plastering them properly, whitewashing said walls, laying new concrete floor for much of the clinic, arranging for new shelves for the pharmacy, installing a new incinerator for medical waste, building a proper bamboo fence around the clinic, cleaning the well, installing proper well containment, and installing a hand pump. Oh, and building latrines in the village itself.
Yep.
Now, in point of fact, obviously that's a tremendous amount of work. Truthfully, my job on this clinic will mostly consist of being a bit of a 'foreman' for the whole thing. It's unlikely that I'll actually do any of the above list myself. I'll negotiate the contracts (with the help of my local assistant, David), agree on payments, designs, and plans, and be in charge of the project being successfully completed.
I _hope_ that at some point my job will be a bit more than that, if for no other reason than I'd really like to pick up some of these things myself and help out - if only to learn. But for now, I'm going with the system in place. I think its good, really, in that I'll be able to do much more this way, but I don't want to do it like this forever.
Honestly, however, I've only been in the project for a week and don't have a solid idea of how this is really going to work. I likely won't have such a picture until the end of March.

This picture I took as we were passing through a village on the way to Duotiayee. This village is representative of the small-ish villages in the area. It's not tiny, but it's big enough to have actual houses of mud-brick and plastering.
The nationals seem quite fond of MSF. I had a wrong story before, and should correct it: MSF did NOT pull out in 2000/2001. MSF-Holland left the country because all the needs MSF could fill were filled - there simply was nothing to do. Four other MSF sections stayed in Liberia during the ensuing years and conflict. In 2003, MSF-H went back in to address some particular critical care issues, such as medical access here in Nimba county.
As a result of this, MSF has quite the reputation in Liberia - it's the ONLY NGO that did NOT leave during the war. This gives us quite a bit of credibility, both domestically and with other iNGOs in the country and the UN. MSF is well enough liked that when I entered the country, carrying my two bags plus two full duffel bags of gear and parcels for the project teams, a customs official came to make sure I didn't have any trouble getting my bags, clearing customs or immigration, and finding my driver. So where the rest of the passengers on the aircraft spent some time waiting for the stuff and in lines to enter the country, I pretty much just breezed through.
But anyway, the road to Duotiayee is long, twisty, and bumpy. It's actually only about 12 kilometers to the clinic, but it takes an hour to get there. On the way you pass through many small villages where the people are of course very excited to see you, especially if you're in an MSF truck. The picture is just one I took from the back of the TLC at one of many hoardes of children that ran from their huts/houses to wave at us going by and shouting "quigloo, quigloo!" which means "white person, white person!" in Manu (one of the tribal languages in the region). The proper response would be "meetee! meetee!" which means "african, african!".

This picture is from the back of the truck on the same trip, only here we're back in Sanniquellie town, heading back to the compound. The townies are much less excited about our presence, but we still receive a friendly greeting. I'll have much more to write on Sanniquellie town when I get a chance - hopefully tomorrow.

I still have so much to write on, about my first week here, my team, my living conditions, the work I've done so far, challenges I see coming, etc. It seems clear at this point that I'll likely only get a real chance to update this blog on the weekends - we're too busy and the internet is occupied during the week with real work. However, I'm going to do my best to get more photos, maybe a movie, and definitley more of what I'm thinking/feeling/doing up for everyone to read.

So, I'll try to write more tomorrow. For now, I'm off to a football match between national staff and expats. I don't yet know if I'm going to play - I'm not well acclimated to the weather (35C in the shade during the day) and fear that playing soccer may well kill me. But, we'll see.

Ciao for now - all my best from Liberia.

Liberia: country of optimism!

I'm in Sanniquellie, Liberia. For those that may not know, Sanniquellie is in north-east Liberia, close to the border between Cote D'Ivoire and Guinea. It's a town of approximately 10,000 people (of course, by western standards, you wouldn't think that many people live here) in Nimba county.

Sanniquellieis at about 1000 meters...giving it a bit of elevation. This helps, actually, although I've yet to see it, I've heard that the heat isn't so bad up here and that Sanniquellie can get tropical 'breezes'which help to mitigate the extreme temperature.

Certainly, the temperature has been hot. I don't think it's been under 30C since I've arrived. What I can say for sure is: it's bloody hot!

I've got heaps of stuff I want to share, but I find only a limited time to do so. I thought I'd make my first real post about the project here more of an overview of what I've observed in the last week.

 

Liberia is a ruin. 15 plus years of civil and uncivil wars have left the country in a state that's unimaginable. The native Liberians actually refer to three different phases of the war - different struggles for different power groups happened at different times - they refer to the phases as World War I, WWII, and WWIII. They use this information to help you know what happened when. For example, when I asked one of the drivers when it was he started living in Sanniquellie town, he said that he moved here between WWII and WWIII. This, for him, perfectly encapsulated the information - sometime between the conflict between LURD & the government and the conflict between MODEL and the government, he and his family were forced to leave the coast and headed for the Guinean border.

 

I should preface the rest of my story with the knowledge that I've never been to the developing world to speak of. All of my impressions I think should be taken with a grain of salt. However, at the same time I have already discussed much of this with the team here in Sanniquellei (SA) and I feel like I have some authority to say what I'm about to say.

 

Liberia is exceptional among developing countries (shares with only a few right now) in that quite literally the last two decades have been spent destroying everything that was in place. Before the war, by African standards, the country was quite rich. It has a remarkable amount of natural resources at its disposal in the form of rubber trees, iron ore, diamonds, bannanas, etc. and as a result (before the war) had quite an infrastructure built all around the country. The bombed out remnants of this infrastructure is frequently still visible. 

 

Monrovia looks like...well...a bomb went off in it. Everywhere you go, you cannot help but notice the fact that the walls are full of bullet holes and burned out shells of buildings stand filled, frequently, with squatters who have no place to live. Like many developing cities, in every available space people who are trying to eke out their lives have put together whatever they can to provide themselves with some sort of shelter or housing. They've piled into partially destroyed apartment complexes with half of the building lying in rubble around it, simply because at least it provides cover from the rain.  

 

I can go more into that in the future. I have not yet been here long enough that I have a good feel for the place. The one thing that I can say for sure is just what the title of this post refers to: it is a country of optimism.

 

Everywhere you go, you see evidence of people thinking that now things are different. The new president, with the backing of much of the western world, is beginning to rebuild the once influencial nation many of the residents were raised in. Everyone has tremendously high hopes for what this governement will accomplish; indeed, some of them even recognize that it's possible she won't do everything herself but will lay important groundwork for years to come.

But the optimism is quite spectacular. Especially in the face of the destruction they face every day and the remarkably extreme poverty they endure, the optimism frequently shows on their faces. Talking with anyone you meet - anyone at all - reveals their confidence that: now things are going to change. Now things are going to get better. Now the electricity will start to run. Now the water will work again, the sewage system will be restored, people will have jobs, industry and investment will return. In short, these people who have suffered through so much war and death, ensconsing an entire generation of the country, have something to look forward to.

 

So, I suppose, here I sit in Sanniquellie, hoping to be part of what they expect to see happen.

 

For now, anyway, I have a tremendous load of responsibilities to cope with. First and foremost, I am being called to dinner.

 

I'll try to write again soon.

ciao-

taj

Alive and sweating in Monrovia

Made it to Liberia just fine and am now hanging out in the Country Management Team Base in Monrovia. I'll be here for another day or two before heading out to the project in Sanniquellie. It's hot...not middle-of-death-valley hot, but definitely hot, and i'm trying to make sure I stay properly hydrated. I've got heaps of thoughts and impressions to pass on, but I actually don't have time right now to type too much. I've been in briefings since I arrived on all kinds of things, and have more to do. Tomorrow, I get to do a full medical stock count of the CMT Store...a good introduction to my work here.

So, just thought I'd post a quick one so everyone knows I've officially started my wild and crazy adventure!

 

Lots to talk about

I had been hoping to write quite a bit here in the airport in Brussels but seem to have been stymied by a remarkable keyboard where nothing is in the right place. Ive got quite a lot of interesting stuff from the last few days...but, judging by how long its taken me to get this far on the post, Im going to wait until later to post the infomation. My apologies for the bad punctuation but I cannot for the life of me find the apostrophe.

Talk to you all fro, Liberia...
taj

And so I go...

Well, my flight leaves tomorrow morning at 0615. I fly to Brussels, then switch carriers and fly straight from Brussels to Monrovia where (supposedly!) there will be an MSF driver there to pick me up.
Stress level is pretty high but quite acceptable.
It's been quite remarkable for me the last few days that even though I haven't received much information on what/where/who/why/how my stress level has been much more manageable. I credit this to being in the MSF office where I've been surrounded by folks with similar mind-sets and moral values. In addition, they've all been through what I'm going through - at some point, everyone (with very few exceptions) in the MSF office in A'dam has been a first missioner. So, it can't be that bad, right?
I've got an awful lot to write about, but not so much time and I have to be up at 0400 tomorrow. As such I'll probably try to wait and see if I can get to it when I get some down-time in the field.
Ciao, all, see you in nine months!

Travel, briefing (pt. II), and more

Here I am in Amsterdam again - it sure seems like I was just here! Everything felt strangely familiar when I arrived...it was much more comfortable arriving in Schippol this time than it was last time. The jet lag, the strangeness of the airport, the customs process: the impact of everything was much less taxing than it was the last time I came through. I guess at this point it seems almost familiar - at least international arrivals does.

So...the last few days have certainly flown by. I had two nights in New York which were nice. Thursday night was a bit of a blur, with emotions from having left Seattle hitting me quite strongly. Found my hotel (after a 3 hour shuttle ride), rustled up some dinner at a local Irish place, and pretty much crashed. Friday was the infamous briefing in New York, which in retrospect I appreciate more than I let on previously. The information was certainly useful/helpful, just not for the next nine months. If I had attended Welcome Days in New York instead of the PPD course in Holland, I wouldn't have had to stop by on Friday. Since I went to Holland (and I'm glad I did...the Welcome Days is much less comprehensive) I was required to get a little bit of face-time in NYC.
Friday night I met up with my good friend Sarosh, who lives in DC. When he heard that I was going to be in New York for an evening, he decided that would be a good time to visit his sister who lives in Manhattan. It was really nice - I hadn't seen him for nigh on 9 months, if not longer. And it was particularly nice to finally get to meet some of his extended network - including his sister Zu, some folks I'd first heard about from Tania waaaay back at BU (Fowzi), and Noam and others...These are all folks I've heard all kinds of wild tales about for almost 10 years...which is quite a hoot, really. The whole idea that someone I met in college (Tania) happened to know someone I met 5 years later in Seattle (Sarosh) and they all knew the same people...well, that still blows my mind even now.
Saturday morning bright and early I went to meet my brother Z, sister-in-law Amy, and their two absolutely stunning little ones Willow and Elliot. We met for dim sum in Chinatown where we probably spent almost two hours noshing and talking (and, for me, playing "I Spy" with Willow). Elliot was the hit of the retaurant - all of the staff wanted to play with him and hold him and get him to smile, which he did with aplomb! Once we finally decided we were stuffed (and we were definitely stuffed), we headed out to walk a bit to get to some bakeries that Z had identified through his multitude of baking books as 'places I need to go'. The first one was closed as it was a jewish bakery and of course it was saturday. The second one was a fairly hopping, trendy kind of place, but the pastries were quite good. From there, we went back to Chinatown, picked up the car, and Z & Amy took me to Newark (ahead of the storm) to fly to Heathrow.
It was very, very nice to see them. Both the kids are growing up so fast it's incredible, and I don't see Z and Amy often enough. While it would have been nice to get to go out to Allentown and finally see their house and relax a bit, I'm glad I stayed in NYC - I think the added stress of leaving the city and having to come back in would have gotten to me.
Second to when I departed from Seattle (and Sky), I was probably hit hardest emotionally when Z & Amy left me at the airport. Having mulled it over a bit, I can definitely say that I recognized, when they left that it was the last time I would see a friendly familiar face for the next nine months. That was a hard one for me...took me a bit of time to go ahead and work through it; to recognize, accept, and transform the emotions. I'm feeling a lot better now :) Fortunately, I feel I'm someone who makes friends easily and is generally pretty amicable, so I'm quite excited to get opportunities to get new friendly, familiar faces to add to my list.
From NYC I flew to Heathrow in an airplane that I think contained every Indian family that had a small (read: infant) child and its grandmother. Lots and LOTS of infants and fussy grandma's on the flight - made for quite a ride. Got to Heathrow, had _another_ 5 hour wait for my flight, during which time I strongly believe I could have walked to A'dam if it weren't for the bloody channel. The flight from London to A'dam takes about 45 minutes. Got in last night, caught a shuttle to the Hotel Arena (where I stayed last time), scrounged up some excellent green pea soup with rye bread and bacon (note to self and others: the dutch serve their "bacon" cured only - not fried or cooked), had a heinekin or two while thinking that I should stay up until at least 10PM...and then I literally woke up, having fallen asleep right there at the table in the cafe. Not for more than a few seconds, but it was certainly a bit unexpected! Went to bed about 8:30PM and woke up this morning at 8AM. Excellent night's sleep, and not feeling too jet-lagged!

So here I sit in the library at the MSF (Artsen zonder Grenzen) in A'dam, waiting for my briefing to begin. It turns out I didn't need to be here until 11AM, not the 9AM I was originally told. i think I'll go have some of that good Dutch coffee, maybe read a country report on Liberia or something.
Take care all - I'll write as often and much as I can (when there are things worth writing about)...

Briefing

Started briefing today in NYC...Surprisingly little to cover, really. They don't have a lot of specifics. I get an office tour, a bit of meet-and-greet, some overview of MSF-NY policies and procedures (which by and large won't have anything to do with me as I'll be in the field). So far, so good. The tension and anxiety I was feeling yesterday (during the flight especially) seems to have subsided pretty much entirely, leaving me just sort of...anxiously excited!

The word from my HRM is that as I get closer to the project, I'll get more and more actual details about what I'll be doing and the context of the situation. For now, it's pretty broad-strokes and not actually anything about the mission itself. Which is OK.

Offices in New York are nice, right on 7th (Fashion) Ave, big offices, lots of staff (more than I expected...probably 60 people work here). They're close to the hotel which is not nearly as nice and a bit dingy.

New York is absolutely frigid right now and they're expecting snow this weekend (the news says "Severe Nor'Easter"), which makes me a bit nervous about the flight I'm supposed to be on tomorrow, but, hey! que sera, sera, right?

And so it begins...

Arrived this afternoon in NYC. I go to the MSF-NY offices tomorrow to start my briefings and on Saturday I fly to Amsterdam.
Leaving today was hard. Saying goodbye to Sky was really hard. But I know I'll be back soon.

I've officially started my adventure!
Happy birthday, Kats!

Wow...

My flight leaves tomorrow morning at 8AM. Even knowing that it's not actually taking me to Liberia it's still a bit surreal.
Not surreal that way most international travel has been for me (that sort of pre-departure lack of acknowledgement that something is going to happen, just going about my business and then, whoops! hello New Zealand!), but unearthly in much more of a "I can't believe I'm actually going to DO this."
So...yep. I can't believe I'm going to DO this!

Huh.

some rambling...

The first few days after I accepted the mission were pretty well fraught with all sorts of emotions...nervousness, anxiety, tension, fear...i had a fairly big lump in my gut as a result of all the unknowns and the fairly daunting nature of the news. That's not to say these weren't accompanied by a healthy dose of excitement as well...they most definitely were. Excitement, happiness, sense of an upcoming adventure, happy-surprise that I actually got a mission.Since that time, things have...gelled...a bit more for me. The nerves and fear are pretty much gone, for now. I expect to experience a resurgence of them as the departure date gets right in-my-face.

But at this point, I'm settled into being enthusiastic about this whole thing...what I'm getting in to, what I'll be experiencing, the work I'll be doing for MSF. I've come to grips, internally, with the fear I was feeling about my role (whether or not I am up to the task). I've accepted that I just don't know, that I'll do the best I can do, and that will be enough. I have to presume that MSF thinks I can do the job or they wouldn't send me. I'll get there, I'll learn, and I'll make it work.

Packing, for people who have decided what they want to pack

Well, for better or for worse, here's what I'm going with:
3 short sleeve button-down tshirts
2 pair shorts
1 pair trousers
1 pair super-high-tech, quick-dry, sun-proof, ultra-light, extra-gadget-holding, wacky-belt-looped, million-pocketed, zip-off things.
6 pair undergarments/socks (for those that must know, the answer is 'trunks'...)
A toiletry bag that's absolutely jam-packed with things I hope never to need, including all sorts of different stomach-trouble ailments (and shampoo)
flip-flops (or tevas, I still haven't decided...)
decent leather shoes
hat (aussie hat! yeah!)
a couple normal t-shirts (for when I get sick of the MSF ones)
Other stuff- head lamp, penlight, mp3 player, little tiny digital camera, assorted power & functional cables for said items, extra batteries...

I'll be wearing one pair of trousers, a long sleeve t-thing, a bulky flannel shirt, a goretex jacket, and hiking boots. I wish i could manage not to bring the bulky warm stuff, but it's freezing cold in Amsterdam and I'll have at least two days there...maybe I'll send it home before I leave.

Boy...I feel like perhaps I'm missing something. That can't be it. Ah well, if it isn't I'll add more later.

Suffice to say, it's been a fun challenge trying to figure out what the hell to put in my backpack, and while the input of others was appreciated, it didn't help clarify for me...For example, I asked the project team if I should bring more shorts or full-length trousers, and what for my feet. Two expats responded. One said "we almost never wear trousers, and are always in flip-flops", and the other said "we almost never wear shorts, and you should bring sandals and hiking boots".
Well, gee, thanks.

So, hopefully I've hit some sort of happy medium...If I'm horribly lacking in something or another, you'll for sure hear about it as soon as I can get to an internet connection. The post will be something to the effect of "for God's sake, send me some XXX!!! I'm dyin' here!"

Calm before the storm...

Well, that's not totally fair - I'm not expecting this to be a storm. However, it's a nice cliche, even if it's not entirely appropriate. After all, if the shoe mostly fits...

Last weekend (my last weekend before I start my travels), I made a trip home to see my Mom, Dad, sister and brother-in-law, brother and sister-in-law-to-be, and generally get a bit of face to face time before I go.
Flew out on Saturday, after much delay from the pesky wind-storm...Got in to MSP around 7:30, folks picked me up, went to a hotel, had some dinner, slept (poorly), got up, went to the Mall of America (wow!) did a little miscellaneous shopping, had some dinner, and left.
Whirlwind trip!
But, it was definitely nice, and really nice to see my family before I go (i'll see my other brother and sister-in-law in New York, outbound to A'dam). It was a bit strange, though, in part because of the duration (about 24 hours) and, in part, because of the circumstances.
After all, I'm only going to be gone for 9 months...That's not really too long in the grand scheme of things, and some years I'll go a full year or more between seeing the family. Sure, this time I'm going to Liberia in the meantime, but, all told, it's really not that much time.

Mall of America - for those unfamiliar, it's a big freakin' mall. Actually, that was kind of neat, I hadn't been there since I was 18...but they didn't really have anything I needed.

Back to the point - I did want to make sure I got home before I left. The biggest reason was to make sure all of my family got the face-time to ask me questions they might have about my trip...expectations, fears, plans, activities, that sort of thing. I guess I must be writing a lot on this blog as they didn't really have too many of these. But I think the principle was important - or at least it was important for me. Some good ones came up, but I realized that I have, perhaps, been trying not to know TOO much about what/where/how/when to avoid building up expectations.

So, that was that. Since then I've been flying around Seattle trying desparately to get everything ready before I go...there're more bits and pieces to square away than I thought possible. Gah. I've got a big list and at this point only about 36 more hours before I leave.

More later!

Last day of work

Friday saw, for me, the end of an era. First, however, let me apologize for not posting in over a week - it's been really, really busy...I'll get back to what I was up to later.

For just shy of four years, I've been working for the Northwest Immigrant Rights Project. In many regards, I'm quite relieved to be done. In others, I'm sad to see it over.

Many of you know it hasn't been the easiest four years for me, with a tremendous number of ups and downs. Now, having had a chance to read through MSF's handy 'Stress In The Field' handbook, I recognice the following: I was officially burnt out.

It's a long a sordid story as to how I got that way, most of the details of which I won't share here, but anyone who wants the long version is free to write me and request it.

To summarize: About 6 months in to my work there, I was somehow caught in the crossfire in a showdown between the Staff and the Management. For the first six months at NWIRP, I was out there, in the middle of things, joined lunch club, hanging out with folks, going out after work, etc. Generally, doing those things that one does when you are enjoying your job and the people you work with. Then 'the crossfire' started, and I ended up feeling quite betrayed and hurt by a number of people who were on staff at the time, and I was unwilling, from that point on, to let myself be exposed to that risk again. Of course, the easiest way to not be betrayed by your 'friends' is not to have them in the first place...but that doesn't make for a great time.
I was again placed at odds with the staff when the interim Executive Director started, as I was suddenly being held to a standard that others in the agency were not (I was reporting directly to her, and few others were). As a result, I spent the last three years with my head down, doing my job and getting it done, but rarely fraternizing or enjoying my work from that point on. If it hadn't been for the belief I had in the work that the agency was doing, I would have left in a heart-beat. As it was, I identified with the tremendous impact that the work had on the community, and felt that I could continue to function in my role whether or not I was personally 'involved' with the staff day-to-day.
So, for the last 3 years, I've been plugging along, keeping the agency running in the best way I could (without any funding, of course. A note to any future budget controllers out there: if you want an infrastructure that works and systems that function, you have to FUND THEM! Otherwise, you end up with duct tape and superglue, and no one's happy). Over the course of my time, I actually got a lot done, and quite a few of the big projects I first identified at NWIRP were accomplished: moving, a new phone system, a server-side overhaul, new desktops and generally improving the overall quality of IT and systems. But, those goals aside, I was pretty isolated from the staff.

So it was a pleasant surprise for me positive going-away that I got from the staff. Especially considering how insular I and my activities tended to be, I was...well, not overwhelmed, but...surprised...that quite a few people on staff showed up for a bit of a going-away cake celebration, that folks had kicked down for a gift (much appreciated, BTW!), and particularly happy with the number of people who showed up for after work drinks on Friday evening. That was really nice, really. The whole thing honestly made me feel a bit bad about my interactions over the last three years, but I don't know, truly, whether I would have changed my behavior if I had known this or not...who can say? I'll mull that one over for a few years and get back to you.

I can certainly say that I still feel the impact of the results of the first six months, but I'm hoping that the closure of this chapter will help me get back to where and how I used to be at work.