Category Archives: MSF Work

Rope and Boreholes

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In Lankien, life is very very busy. Being TechLog means that one can rarely leave the confines of the Clinic Compound, as generators, water pumps, and everything else depends on constant attention. None of us ex-pats get out more than once a week, except to go to the airstrip and receive a plane, or for the morning jog up and down the runway. This is quite different from the kinds of project work I am used to, where I tend to explore and liaise under my own steam, research and co-ordinate within the community itself. We probably walk miles and miles every day within a radius of about two hundred metres, but because of the various security issues, and the fact that we are ‘in the community’ every minute in the workplace, the inclination is to withdraw from it in downtime, and seek peace and solitude.

We have to hold back the kids as they pelt onto the runway to dance in the slipstream of the plane when it takes off.

I’m sure medics will tell you the same story of ‘voluntary incarceration’ in hospitals the world-over, but it was a great treat when WatSan advisor Matt came from Amsterdam HQ, to walk around the outside of Lankien ‘Payam’ (district), touring the twelve water boreholes. It’s amazing how much you can know a place from within a compound, and vicariously through the hundreds of people coming to the Clinic.

Part of me was reluctant to take the time to go with Matt. I was so caught-up running supply and Admin as well as Technical Logistics for this project and our two Outreach Projects, but I’m so glad I did. Matt and I got on like a house on fire, and I really enjoyed having somebody to bounce technical ideas around with, and also a fellow British person to have a beer with. The provision of Water and Sanitation to a population is at the very heart of all services provided by MSF. Although the technical intricacies of the methods of this provision, i.e., how to fix a generator which powers a pump, which provides water to a plumbing system, which supplies water to an Operating Room might seem ‘Logistical’, it says a lot that WatSan has recently been handed over entirely to be managed by the medical side of MSF in each project. Functionally, of course, it relies on TechLogs on the ground, as most doctors don’t do mechanics, but Medical Service without Sanitation is like a bath without a plug. And a great deal of preventative care in our mission countries is simply the provision of Hygiene. It is a strange situation in many ways, and a field in which, like no other, Logistics and medicine are completely interdependent.

Walking around the different boreholes in each different hamlet around Lankien gave a great demographic overview. There was a borehole by the huge abandoned WFP tents, one in the area used as barracks, one called ‘Church’, lying next to the catholic church, one in the market, a few in rural farm, or as they say ‘garden’ locations.

Duba Tropic, MkII handpump and borehole. The village municipal capital!

Duba Tropic, MkII handpump and borehole. The village municipal capital!

At each place, a gaggle of girls and children were crowded round the ailing pumps, squeezing-out the cup-fulls of ground water from (way-too) deep in the ground, frenetically pumping, the water trickling into stained, faded and battered vegetable oil drums and jerry-cans. It is sparse bruchland here, and the dry season can be seen physically advancing every day.

The mechanics of boreholes and the pumps used as standard were, until recently, pure theory to me. Sure, I have built a sewage treatment system in my house where there was none, and the same goes for the very effective plumbing system, but I have never taken apart a deep borehole handpump. This week just gone, I have ended up following on from Matt’s work, supervising the strip-down and rebuild of one of these pumps, and getting the submersible electric pump in the Market Borehole, fitted by some long-departed NGO, working again. It was a classic bit of cobbling-together for the test-run. A very rough-looking Chinese generator, coupled to a very dodgy control panel which emitted electric shocks, which was then connected to an unknown electric borehole pump, positioned about 180 feet underground, and intent on pumping shovelfuls of the earth’s core up with every load of water. But it worked, after I had figure-out why the panel kept tripping. The ropey old borrowed generator, with its bare wires, was knocking-out about 330 volts, way more than the 230 volts it was designed for. A few words with the alcohol-soaked owner to ‘turn down the volume’, and we had it ticking-over nicely.

Shame, of course, that it was only a test which revealed several issues. I have had it before, where a whole load of people think that you have solved their problems when really the solution is a long way-off, so I tried to slope-off quietly after pumping a few gallons of water, amidst excited congratulations from villagers. But one day soon it will really be working, and then the ‘Water Messiah’ attitude of these friendly folk will not leave such a bad taste in my mouth…

These people come from a culture steeped in herding. Everything from the songs sung by moonlight to the large staffs carried makes one think ‘Cowboy’. Many times I have gone away, leaving instructions for something to be built, and come back to inactivity, confusion, or something completely wrong. But it is simply the concept of permanence which is alien, not only because of recent years of unrest, but deep in the culture of the nomad. There is a lovely expression used by Riek a few times when he beams as he at last understands something I have asked him to build. ‘You have a big mind’, the first times, and then: ‘I understand you; my mind is joined with yours. Our minds are joined in these (shelves, latrine design, etc.)’.

But generally it seems a Nuer from Lankien would as soon understand the idea of a tradition of construction standards, or a fixed workshop, complete with tools which are permanently there, as a Londoner might understand washing-up after eating in MacDonalds. But when it comes to halters, harnesses, goods for herding, there is a magical door opened into the Nuer world.

One of our old Kapirs, tirelessly friendly, and determined to teach me Nuer through sign language and his not one word of English, can be seen all day at his post, with his big toes through a carefully splices loop in a polythene rope he weaves from ruined woven food aid sacks. His work is beautiful and intricate, and when he has finished weaving, he has made a noose-tether for a goat. The other day, as I have decided to sure-up our fences around the compound ready for any ‘events’ that might occur in the near future, I paid-out several hundred Sudanese Pounds to my Log Assistant, Moses Makuach. Moses is one of those super-lean local Nuer, who, to fit with his current position in the MSF team, will often turn-up for work in a three-piece suit. He knows everyone, and is known around the area, and seems to foster many a waif and stray in his down-time out of hours. I trust him, and he brings in supplies for building, and helps me to run the jobs in-hand.

So I was closing-up the workshop for Christmas, and last thing before closing the door, my eye was caught by what looked like a figure, huddled in the corner. A flash of the torch revealed not a person leaning into the wall, but the most gigantic hank of rope I have ever seen. Makuach would have purchased it with the construction money I gave him. But it was not so much the size of the hank, but the fact that it had been custom made, woven from Savannah Grass. A six –foot bale, beautifully wrapped around itself, like some kind of exquisite exhibit, or an improbably crafted part of a classic yacht.

Beautiful handmade cowboy rope Beautiful handmade cowboy rope against a wall

It put me in mind of that D.H. Lawrence quote about ‘Things Men Have Made’, which I love so much:

“Things men have made with wakened hands, and put soft life into ?are awake through years with transferred touch, and go on glowing ?for long years. ?And for this reason, some old things are lovely ?warm still with the life of forgotten men who made them.”

Today is Referendum Day

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Southern Sudan has fought on-and-off for the last century both amongst its own tribes and over issues of North and South division. Today is a very quiet day both in the Hospital, and in Lankien in general. There has been no drumming, singing, or dancing, none of the usual Sunday parades. It is a bit eery, thinking about it. Today, history of some sort is being made. Last night, we had our annual staff party, and the staff themselves organised it. It was complete with wonderful dancing and singing, and a cow was killed, but there were certain organisational elements which left me wondering, with so little ‘organisational culture’ embedded in the national identity, how will the new South Sudan be run? Certain basic things were overlooked, or ‘expected’ from the outside world (i.e. MSF), and one wonders how ready this country is for catch-all centralised self-governance.

‘As ready as any of the other African countries were at Independence’ – is, of course, the answer. And it is true.

Meanwhile, in the Hospital, we await the new world order, ready, and with open arms, and hope we are prepared enough to deal with the demands of this new era. We have stocks of medicines, and space for overflow. Our staff each have a day-off this week to vote, and I have tried my best to prime the staff which I supervise how to deal with changes and difference in workload and work-type.

Lankien_19

There has been a change in the air, of course, for some time, and perhaps this is best expressed through changes in our working environment. Our print-server laptop ate one too many gusts of dry-season dust, and had to be put on a rotation back to Loki. To be overhauled. All of a sudden, my laptop became the print-server of sorts, as an independent machine upon which I was allowed to lodge a downloaded driver . So everybody was coming to my laptop by the printer and putting files on there to be printed. Everything office-wise is by hook or by crook, but the MSF protocol is that we must not interfere with MSF standards. So I am looking through my desktop, and it gives me some kind of a demographic. Files called things like ‘Dehydration’, ‘Guard Schedule’, ‘Outreach Worker Interview – A.N.C.’, and ‘Interview Announcement’ documents appear. But most prevalent of documents of topical concern right now are ‘Returnees’, and Returnees 2’.

I am already slightly relieved that there are often one or two more people every couple of weeks in my Monday-morning worker-pool who speak some English, or know how to mix cement, or how to impress a work-boss. Many people have now returned from the North. Every day has some kind of tale about some family member stranded halfway home. People are making their way back often generations later, to the homes (read: ‘Territories’ – they are herders) of their forefathers.

Music is everywhere, in multi-register singings undertaken by workmen, to sweet tunes of washerwomen at work, scrubbing fists together under the tree, and the dramatic voices of church singing through the compound fence. It isn’t a performance, though; it is a consciousness. ‘Rupert, did you hear the song of the Car?’ (when the first car turned-up in the village since last dry season, or ‘I think the machine (electric saw) is Kalas (broken), it’s song has changed’….

The first ‘stereo’appeared in the village some three weeks ago. I heard it, playing some old soft-rock and modern R ‘n’ B, and caught myself mildly appreciating that change from tribal tunes and drums, when the owner switched to some Jamaican soft Reggae mix. But this evening caught me wondering about the ‘Returnees’, who are bringing back this music, especially hearing a stereo go past tonight playing some more Eastern, almost Bollywood music.

I have been here for only two months, but that is long enough to take some solace in the mono-culture of the simple old herding drumming-tunes, the church songs blended from ‘bible musicals’ and tribal spirit songs, the words to which everybody – bar none – seems to know the words. The night entertainment here has, until very recently, been wholly organic.

I have noticed my Log Team’s diligence of late in taking the free English Language classes we offer in the compound at lunch. This has stepped up very noticeably. At the same time, soldiers and politically engaged people in the village will confront a Kuwai with their clear dislike of all things ‘Arab’. It must be mildly terrifying to start hearing these influences eclipsing the more usual sounds, with no real reason to feel afraid of them – a bit like growing up, as I did, with a background fear of Japanese or Russian product because of the cold war propaganda.

But to hear it here is more than just media study. Electrically-produced sound is happening in Lankien, is coming to this village, for the first time in history, ‘on my watch’. A strange acceleration of evolution, amongst many others. I can’t help worrying whether the days of strange tribal leaping-dances en-masse on the airstrip are somehow numbered. There is a strange loss of innocence in the air. And I know I am sounding ‘colonial’, but it is the only way I can find of describing it. And it is a very demonstrative transition.

New Years Eve saw us all gathered around the table here in the compound, waiting with a bottle of champagne which had been flown in as a gift from OCA (Operations Centre, Amsterdam). As we compared notes on different ways of wishing Happy New Year (Russian, Welsh, Italian, English, Dutch, German), Sheila the midwife was called away. Two minutes to midnight, saw us all heading towards ANC (Delivery Room) with the Moet under our arm, mugs in hand. When the shooting started, we all expected it, of course, as a celebration, but sometimes it was so close, through the frail grass perimeter fences of the compound, that we couldn’t help wondering about the odd stray bullet, with so many shots, and basic laws of probability, as well as Newton’s Law, that ‘What goes up – must come down’. Reluctantly, we snuck sheepishly through the dark back to the safe-room, and waited for Sheila to finish.

Men here are mainly named after their father, using the prefix ‘Gat’. My name, then, is ‘GatKuwai’ – Son of a the Kuwai (white man). All women here have a name prefixed with ‘Nya’. So NyaKuong would be the daughter of Kuong, and one of our National Staff has the beautiful name NyaKuoth – Daughter of God. All a bit ‘Handmaids Tale’ and patriarchal, but children here – like in many developing countries are often named topically, not just after their menfolk. Gatkuoor, my driver, has named his new baby boy ‘Reuben (easier to say than Rupert) Demarcation’, as he was born the day after Referendum, and came out right-hand first, as if voting! One of our expats has even met a child called ‘MSFCompound’.

To get back to the story, when Sheila came back from having delivered the New Year Baby amidst the torrent of gunfire, we all speculated that the little girl may well end-up being named ‘NyaPangPang’, after these particular birth conditions. It wouldn’t surprise me in the least, except for the fact that most little girls less than one year old and born in MSF Lankien are called ‘Sheila’!

The Nuer language is something which I am being forced to pick up by the multitude of requests and communications which are lost in translation, resulting in no water for delivering babies, shelves being built in wrong places, etc. It has many charms, and the idioms already fascinate me. ‘Maleh’ (‘How is it?’ is the standard greeting here, but it can be augmented, in response, to ‘Maleh Ma Gwah’(It is Good’), Maleh Ma Chum-Chum’(It is Tasty’), ‘Maleh Ma Lim-Lim’(‘delicious’) etc. ‘Gwah-Lun’ is ‘Very Good’. A lot of fun can be had with these additions. There is a lot of Arabic used, too; ‘Shukurum’ being reminiscent of the Turkish ‘Teshukur’ – no word in Nuer for ‘Thank You’, and I believe the word ‘Kapir’(‘Guard’) is Arabic, too. ‘Kawai’, as I mentioned, means white/foreign person – said of other black Africans as well as Europeans, equivalent to the Swahili ‘Mzungu’ across the rest of this part of Africa.

Week 4

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Anybody who remembers the first Star Wars movie will recall the monster in the sewage-crusher that our heroes got trapped-in. I went to check up on a latrine which we were decommissioning in our ‘TB village’. This is a compound of some twenty tukuls, mainly residential, where patients suspected of having tuberculosis live, whilst being monitored for developing symptoms. I spent a few seconds looking down into the slurry before it was filled-in, and felt that ‘vertigo’ compulsion to look down from a great height. As I was taking my eye away from the effluence, it was caught by a big yellow eye looking back at me. A huge fat lizard-like creature had made its home there, living off the flies. It was at least a foot and a half long, and I wondered if it was a monitor-lizard, or just one of the many four-inch lizards around, which had become massive, gorging itself on the thousands of flies which live down the warm, disgusting hole.

But the other things living off flies here are the chorus of amazingly colourful birds. I do not know any of the species names apart from the African Bee-Eater, but they are a constant blaze of incandescent light at the corner of the eye. It may be that they have found a particular haven in our compound, safe from children I have seen toying with small birds before eating them around Africa. They capture them and keep them by a string around the foot, and it can seem cruel to the western eye. It is hard to imagine that happening here, though; people seem so gentle and dignified. No doubt, all will become clear, but Felix, the compound cat, flea-ridden as he is, does not seem remotely interested in these little birds either, although I did find the wing of what must have been a juvenile African Kite lying around in the dirt the other day.

This week has seen me take over responsibility for all the supply to the clinic. This is done through our HQ in Loki, where half of our stock for the project is stored – along with stock for the other projects in South Sudan. Weight limits for flights, and monthly consumption rates have to be juggled with each 10-day plane flight (‘rotation’). If we get it wrong, anything can happen, from having no UHT milk for tea (local milk risk of brucellosis) to no second booster for a course of vaccinations. ‘Don’t overthink it’ was the best advice I’ve had from Laraine, the LogAdmin going on leave and handing her job over to me. Yesterday we were working til 10.30pm compiling our medical ‘buffer’ order for the next month, when we may have our supply interrupted for reasons to do with the Referendum. Every medicine has an MSF code which must be found, and a weight, and expiry date, all of which has to be taken into account. Confused? I was. All I know is that last night, for a 700kg load restriction, we clocked up a 1250Kg demand. So now I have to request a new flight, or slot it into a cargo flight which I hope will come the day before New Years Eve.

At 3.30am I was awoken by Daniel, Medical Team Leader, saying that the generator, which had been running because a patient was on the Oxygen Generator had ‘passed away’. I have been in increasing contact with death this week, more babies dying, and reports of someone dying from a gunshot wound in our outreach project. When people die, family members waste no time in their burial. At 5.30am, I was again awoken by Bo Gatluak, one of my Logistics team, who needed to bury his brother. It was he who had been on oxygen, and Bo needed a pick/hoe to dig his grave. My heart went out to him, as I imagined the lone soul digging in the gloaming of dawn. I asked if he needed help, and as I spoke I realised that he would have plenty of help from his family and friends.

So many things have happened this week which merit reporting, and which I was saving for the blog, but my memory has been distracted by the panic of the new handover from Larraine, and I seem to have forgotten so much in the daily panic. I will remember, in time, but the helter-skelter at the moment, jumping from one situation into another, without even time to think to myself ‘This is Mental!’ renders me wholly preoccupied with surviving in the job in hand.

As I browse through past postings, I notice some typing errors. This will be due to all the keyboards here being full of dust. In fact, everyday I am filthy with it. People spit in it, and one of my responsibilities, for Water and Sanitation (WatSan), is to supervise the prohibition of open defecation around the clinics. What with the ‘sputum’ from TB positive patients (everybody spits in the dust here as a habit), and the other fluids that end-up on the ground, drying to dust, and then getting blown up by the gusts of wind, and breathed-in, it’s a constant battle against infection. My nose now doesn’t smell the smells it did when I first arrived – the ‘normal’ smells of the In-Patient’s Department, the Kala-Azar Clinic – but I can still smell the carefully constructed pit-latrines, from down-wind. The other day, I tried to have an English-Nuer conversation with Majok, whose job it is to try and enforce sanitation in the Hospital compound. During a ‘translation lull’, I watched absently as one of the lady patients walked over to a newly-built corrugated iron pit-latrine building. These are simple, but with custom-made foot-pads, and well-constructed ergonomics, they are highly effective and familiar to the Nuer people. We put a new one together at least every week, to keep up with them filling.

It baffles me to know what went through her head as she spotted this building, for which everybody knows the use, and how she clearly thought: ’what a great thing to defecate BEHIND’! I realized at the same time as Majok spotting her, and the cry went up to take a crap INSIDE, but with language and culture being so impenetrable, it does sometimes seem two steps forward and one step back…

A Ruby in the Dust: I hope to post more photos than I have on Facebook, but sat-link is very difficult. Then I could show a picture of our clinical laboratory. Sammy, our Kenyan former acting project coordinator, is in charge of the lab. Here he meticulously investigates sputum, blood, and stool, looking for evidence of Malaria, Kala-Azar, Tuberculosis, HIV, and loads of other tropical diseases. It is incredible to see the place where this all happens; a low Tukul (mud-hut), beset by dusty gusts of wind, with stick and rope poking through the mud walls and a bilingual sign saying ‘Laboratory’. It just struck me last week at the team meeting, when Sammy was reading-off his statistics, what an amazing feat it is to achieve reliable laboratory conditions in this environment.

I went looking for a list of data, so that I could go through the long-winded job of ordering new supplies for the lab. I have been in there before, but not when it is in full swing. It was a bit like going into the Tardis. Suddenly, ultra-violet light on desks, lighting-up microscope slides on a squeaky-clean surface. A high-tech microscope glowing with its micro-image, and a technician diligently logging and rechecking his findings. For a moment, it felt like Boots The Chemists, until a glance at the wall above, with thatch sticking through the mud, and a big flat spider scuttling after a termite, reminded me I was where I was. The lab is the closest I come to home.

One of the many areas of my work which I am trying to strengthen is supervision of the guards. Since arriving here, I had, until recently, had no time whatsoever to get to know the names and faces of my Nuer guards. There is little, if any, English spoken amongst them, and they work shifts through night and day. They guard the flow of village people wanting water, and I try to balance the needs of the clinics with the needs of the community for our limited supply of borehole-pumped water. Discipline is something which I am trying to foster, across the spectrum, as it will be our reference-point in the midst of any panic. This has to be done by example, of course, and through a friendly appreciation of mutual professionalism. The other day we took-in a gunshot wound through the leg, but not a critical one, and as I received the soldier at the gate, our guards were very good with making sure that the incoming recognized the ‘No Guns’ sticker which adorns all of our gates, and left their weapons outside.

Of course, certain colleagues wanted to make sure their friend was all right, and so I let them look through the mosquito net gauze and communicate with the sedated man. There is much suspicion of our medical techniques (particularly in childbirth), so it is important to be transparent, but also to be firm that our doctors are doing a professional job, and must not be disturbed from their work.. This seemed to go quite well, and I hoped I was able to enforce a calm and clear respect reciprocation across the language barrier.
It was great to see Doctor Hanna in action. She is a tough first mission medical doctor from Holland, who sends my logistics boys away when they go to her with work injuries, healthily dismissing them as ‘big babies’. Like all the team, she is thoughtful and caring, but takes no prisoners when it matters. Together with Daniel and the other doctors, they are a formidable force, and the man was treated quickly and discharged. We are in safe hands, and our protection is in our impartiality.

‘Temoignage’ is an interesting key part of the ethos of MSF. It goes hand in hand with the medical agenda, and it is interesting for me to be in a position, for the first time in my adult life, perhaps, where I think it important and justified to express my opinion. This is why I dare to write this blog, and what lets me forgive myself for what might seem like ‘talking all about me’. Here is what MSF has to say about Temoignage and Independence:

Witnessing (témoignage) consists of:

  • The presence of volunteers among people in danger, motivated by concern for the fate of fellow human beings and a willingness to be at their side and to listen to them, as well as to carry out medical work among them, and
  • Reporting on the situation and on the fate of these people, which is seen as a duty. Where MSF is present as a witness to large-scale human rights violations, such as forced population displacements, sending refugees back from their country of refuge (refoulement), genocide, crimes against humanity and war crimes, then MSF may ultimately be forced to make public denunciations.

Independence

  • MSFs independence is, above all, an independence of spirit that has its roots in an independent judgement and a critical attitude towards the way in which humanitarian interventions are both made use of and abused.
  • An independent spirit is a prerequisite for independent action, ensuring a free choice in regard to where and how to intervene, when to start an operation and when to end it.
  • This operational independence implies an independent organisation. MSF refuses to intervene under pressure from any authority, whether ‘de jure’ or ‘de facto’, or to be manipulated into seeming either to support any such body or to act as an alibi for any of them. MSF therefore maintains the strictest independence from any organisation or de facto authority (be it political, religious, economic, financial or other). However, the search for independent financing must respect certain ethical safeguards and the values held by the MSF movement.
  • This overall independence must be respected by each member of MSF, who must at all times refrain from linking the organisation with their own political and other affiliations.

(Chantilly Document, MSF Guiding Principles)

Remaining a voluntary organisation is an important factor in maintaining and renewing an uncompromising spirit, refusing to be bound by routine and the risk of institutionalisation.

These are the words that made me decide to work for MSF.

Christmas

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Crikey, this is an inhospitable and unlikely place for people to have a settlement. The only water here has to be pumped up from boreholes nearly 500 feet deep in the earth’s crust. Holes used to get dug by hand, apparently, desperate nomadic cattle-herders frienziedly chasing the receeding river-flood, grubbing for dampness in the blinding dust. Indeed, Christmas this year in Lankien, South Sudan, will be a dusty affair. One of the great bonuses of the build-up for me here though, is the complete unawareness of its immanence. Religion here is, officially Christian, but with the absence of a market goes the absence of marketing. Fantastic!

That is not to say that anybody here is remotely ‘Bah-Humbug’, and I am informed that New Year will be ‘off-the-chain’. Continuous drumming and singing thud into the walls of the Tukuls (Mud Huts) of the clinics, wards and accommodation of the MSF compound here all through the night, and over the weekend. Weekend dances continue regardless of any other longer-term agendae, and every Sunday the imposingly tall and thin males of the Nuer tribe do a circular dance, wielding their wooden staffs on our hard dusty airstrip. The staff, a sturdy, carved, worn, and sometimes battle-scarred stick is a part of the adult male’s self-presentation. Along with the six wrinkle-like scars across the forehead. The dancers take giant steps in a circle, bouncing up and down above the heads of the crowd, every other step being a giant leap into the air, their sticks brandished. Tall thin giants, leaping giant steps, and singing, like a rugby team, in unison. Energetic? I think so.

I’m sure that Christmas will be a monster helping of this, the church singing and drumming added, which is beautiful. The Nuer sing in everything they do, and it is normal for me to wander off into the dark to switch-off the generator, and locate the whereabouts of our unarmed guards in the compound by their soft but note-perfect solo singing. Most of them are respected warriors, and are not afraid of many things, including bullets or any insecurity we might feel here. They have seen it all before.

I caught one of my carpenters singing a Sudanese carol whilst cleaning the workshop yesterday. He has promised to teach it to me. Christmas, as I’m sure everyone back home is acutely aware, falls this year on a weekend. It will be characterised by both Saturday and Sunday off here in the hospital, instead of just Sunday, but of course we shall all be on-call. A goat was brought into the compound as a Christmas present for our midwife ‘Miss Sheila’. But that will probably get slaughtered tonight for the weekend, probably by me(!), as happened last weekend when we had a little leaving party for my predecessor.

I am determined to get the Frisbee out, and continue to teach the village boys what moves I know on the airstrip, but personally Christmas will be stressful for me, as I will be covering both Technical and Supply Logistics. Any mistakes will have a direct impact on hundreds of patients and all of our ‘in-pat’ and ‘ex-pat’ staff. Time here is measured-out in the long-term in flight-rotations. If there was not a flight on Christmas Eve, it seems quite possible that Christmas would get ignored in favour of that magical flight date. Everything arrives here by small plane, onto our hardened-mud runway, which I have to check at 6am/dawn on flight days, and report back via Sat-Phone or sometimes High-Frequency Radio, to Mission HQ five hundred miles away.

Cattle, goats, stray equipment from other emergency helicopter-drops, kids, rain(unlikely). All of these things could stop us from having the Christmas parcel on the 24th flight. It will mainly consist of treats, I have heard BACON, and some whiskey and wine. If I was asked what I most wanted for Christmas, it would be an elusive item; too heavy to be included on the plane-full of medicine, impossible to obtain here, in the middle of this dustbowl. A large; very large … cold … BEER.