Ready for a vacation

November 2nd, 2009

Let me tell you about my day. Woke up at 5am. Lay in bed thinking about everything I had to do. Got out of bed at 5.30am, took a shower in our horrid bathroom that leaves me feeling dirtier after I’ve showered than before.

By 6am am sat at the desk on the porch outside the office calculating bed occupancy rates for the hospital for the month of May. The hospital – the only hospital around for miles and the only place offering free health care, is bursting at the seams. There are sometimes two kids on every bed in the paediatric ward and since the mums spend the night with them on the same bed, that’s a crowded bed. However, due to a problem with how bed occupancy rates have been calculated, the figures show the hospital at only 60% full, which means asking for more resources raises questions at headquarters. So this month we’re determined to get it right, and I sit on the porch, coffee in hand, doing some maths.

7.30am, daily MSF morning meeting in the front garden of the compound, chance to discuss any security incidents that have happened in the area. The Chief of Surgery comes to me straight after with an issue with two of the anaesthetic nurses; have to negotiate a change in the holiday program of our Congolese Nurse Manager, but by 8am I’m at the hospital morning meeting.

ITU ward round, find 2 kids who have been admitted into hospital for over 24 hours without any blood tests, one doesn’t even have a Paracheck (rapid test for malaria) done yet. Have subsequent meeting with Chief of Service of Paediatrics who blames the lab techs. Have an impromptu meeting with the lab techs. Realise that people like being listened to.

Lunch with Pierre, the Admin Coordinator on a visit from Goma (where MSF has a coordination team), discuss how to respond to a problem with two of our staff. Spend afternoon writing formal written warning. In French. Which Pierre then corrects. (Rewrites).

Meet with first member of staff. Give out written warning. Meet with other member of staff. Tell her that given her excellent service until now she will not be receiving a written warning, this time. Feel touched for a moment, she is crying happy tears and telling me how grateful she is for all my support.

This mission with MSF is definitely the most challenging thing I have ever had to do. To manage 30 nurses, 6 doctors, a hospital a pharmacy a laboratory would be challenging enough but then to do this in French where you lose all the subtleties of language, when you can’t soften a blow or not be directly affrontive because all your vocabulary is basic – you can, you should, you must, etc.

Evening finds me sat back out on the porch checking through the estimated consumption figures that we have given to the logistics team to enable them to put in the next international order for the project. We have used the consumption figures for every drug / paper form / fluid bag / syringe / cannula / catheter in the hospital for the last four months, averaged them, taken into account the growth in our patient numbers and come up with figures for how much of what should be ordered.

Have a moment of reality check, where I realise I’m sitting at a desk outdoors in Congo drinking tea and spending thousands of pounds of donor money on much needed medications. Using a drug list written in French. Makes me giggle initially. Then makes me very nervous.

Have dinner. Try to avoid stepping on a rat as I put my plate away in the kitchen. Go back into the office to start writing up the mortality narrative for the hospital – basically a short summary of each patient that died in the month of May and whether anything has been highlighted by it or whether unavoidable. Had nine paediatric deaths this month, feel a little like the grim reaper. Finish working at half past midnight, not because I’m finished but because I’m not writing anything useful any more.

Am leaving on holiday tomorrow morning 7am. Sit in bed, know I should pack, but am exhausted. Fall asleep instead.

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