Wednesday, September 10, 2008
Nearly everyone in Banda Aceh lost family members in this horrific disaster. 40% of the population was killed.
People divide history into two categories: Before Tsunami and After Tsunami.
Before tsunami, Banda Aceh was in the midst of a long-running civil war. The province wanted independence from the central government of Indonesia. Aceh province was a very dangerous area, with battles going on everywhere, including Banda Aceh city. The few people I've talked to about it said that it was very risky to even leave their homes most of the time.
A peace agreement between GAM and the government was signed a few weeks after the Tsunami. This agreement still holds, but there are pockets of GAM strongholds in more rural areas that still want independence. There is a national election next year and it is anticipated that GAM representatives will win throughout Aceh province.
So the population of the province was already traumatized when the tsunami hit. The 9-meter (30 foot) wall of water wiped out a large portion of the city almost instantly. The portions that were not flooded were without water, electricity, and food for a long time before aid arrived. People searched desperately for loved ones. Livelihoods, homes, businesses, and possessions were destroyed in a few minutes.
People talk about what happened quite frankly, and the topic pops up frequently in coversations. I'm a bit reluctant to ask people about it because I know everyone lost loved ones.
Here are some pictures from the first few days after the tsunami from MSF (Medicins Sans Frontieres), who were one of the first groups on the ground. I have not posted the most horrific ones as they are far too disturbing.
Its almost as if a giant scrub brush came along and scraped the beach areas completely clean and dumped everything inland. You can see the strength of the water in the below pictures showing massive boats that were carried several kilometers inland. What is remarkable is the fact that you would hardly know that the tsunami ever happened now. The ruins have been cleared away and most of the city rebuilt. The only giveaway is the row upon row of identical freshly constructed homes lining the flats near the beach. The hundreds of millions of dollars of aid money that poured into Banda Aceh helped to reconstruct many of the homes that were demolished.
Sunday, September 7, 2008
much cuter than american possums!!
Monday, September 1, 2008
Ramadan (Arabic: رمضان, Ramaḍān) is a Muslim religious observance that takes place during the ninth month of the Islamic calendar, believed to be the month in which the Qur'an was revealed to Angel Gabriel which later was revealed to Prophet Muhammad. It is the Islamic month of fasting, in which Muslims don't eat or drink anything from dawn until sunset. Fasting is meant to teach the person patience and humility. Ramadan is a time to fast for the sake of God, and to offer even more prayer than usual. Also, asking forgiveness for the sins of the past, asking for guidance in the future, and asking for help with refraining from every day evils and try to purify oneself through self-restraint and good deeds is involved in Ramadan.
Muslims pray five times a day, and there is a call to prayer at each of these times, broadcast from mosques with varying loudness and intensity. Its actually a beautiful sound, the Imam (holy man/priest) calling the faithful to prayer. Click here to listen:
During Ramadan, people read and recite the entire Koran. I didn't realize, however, that some mosques broadcast this recital over the loudspeaker and it lasts all night long! We have a mosque near our house and the reading (in much the same musical voice as the call to prayer) started at sundown and went on till sunup. Despite ear plugs It was so loud that I couldn't sleep. Not to be disrespectful, but this is going to be a long month!
Sunday, August 31, 2008
I am living in a fairly nice (way too big, cavernous actually for 2 people to be rattling around in) house with my colleague Geraldine, a lovely girl who has worked at HQ and in Chad. She is French. She looks after the finance and administration here, which is great as I don't have to deal with it (my least favorite part of the job). We have a housekeeper who does all of the washing and cleaning and shopping for us. Food is incredibly cheap (a big relief after Liberia). You can buy fruits and vegetables for a week for under $10. And the variety is huge, every fruit and vegetable you could imagine is available (including the notorious durian fruit, or stinkfruit, which is supposed to be tasty but reeks so bad that some hotels ban people from bringing them in). So I've been eating really well!
Every street is packed with little kiosks selling cooked food - mostly the ubiquitous nasi goreng (fried rice). Literally every street corner has a couple of little "restaurants", which are little boxes often attached to a motorcycle. You sometimes see them driving slowly down the street, with the driver/chef dinging a spoon on a bowl....like the ice cream man. THere is fresh fish and seafood galore, but obviously no pork as this is a muslim area. I stopped one night and bought about 2 pounds of satay - pieces of meat marinaded in spicy sauce, threaded on skewers and grilled then coated in a spicy peanut sauce - for like $2. There is KFC, pizza hut and A&W here as well. The only thing missing is a Starbucks.
This programme has been running since 10 days after the tsunami in 2004. We've trained over 4000 health care workers in malaria and dengue case management, provided drugs and diagnostic tools to all of the health facilities in the province and done spraying in a large number of communities. Immediately after the tsunami we distributed insecticide-treated plastic sheeting, which is used to create shelters and is very effective at keeping mosquitoes away.
Indonesia has a double-whammy of malaria and dengue. Malaria isn't such a huge problem but dengue is quite bad. And there is not a lot you can do about dengue, as it is transmitted by Aedes mosquitoes that bite during the day. There is no treatment as it is a viral disease and no vaccine. In most people it is a mild illness but in some cases it turns into its deadly form, dengue hemorrhagic fever, which is very serious and can be fatal.
It is hot as blazes and very humid. A bit like North Carolina in August except hotter. I break into a sweat as soon as I step outside the air conditioning. Unfortunately for me, this is a muslim province under Sharia law, so I have to wear long sleeves and long pants everywhere! At least I don’t have to cover my head like the women here do. They all wear hijabi (I think this is how it is spelled) and I don’t know how they stand it.
Ramadan is about to start next week and it causes a drastic slowdown everywhere. Everyone fasts from sunup to sundown, no water, food, cigarettes, or anything. As you can imagine by the end of the day everyone is dragging. At sundown some sort of signal goes off and everyone eats, drinks and smokes like crazy (I have not met a single man who does not smoke here, everywhere you go there is a cloud of stinky cigarette smoke, which is disgusting). Everyone takes time off to go visit their families the last part of September/beginning of October so that slows down work as well.
I had to go to Singapore last week to renew my visa (yes, after being here only a week, a long story involving the massive and complicated government beauracracy here). It is a beautiful city. Incredibly clean, landscaped with lush tropical plants everywhere, totally modern and one big shopping mall!! I've never been anywhere that seemed so obsessed with shopping! Every subway station is a shopping mall. Not that I could afford to buy anything...it was all Gucci Prada Cartier super high end shops. I bought some starbucks coffee (the stuff here is too strong for me! burns a hole in my stomach!) and some books, and got my hair done.
After Singapore I flew to Jakarta for meetings with our donors. We sat in a taxi for 4 hours to get to 2 meetings. The traffic is totally insane. Did a bit more shopping, I found the running shoes that I pay over $100 in the US for less than $70 here. Bought my colleague Geraldine an 80G Ipod for $200. Stuff is cheap here, i guess cause they make it in Asia.
Geraldine and some of the team at going away party for Panos, outgoing Programme Director
Preparing the barbeque for fish - burning coconut husks to add extra flavor
Rathmat, our data manager, and his daughter
Riza, my assistant (can you believe I have an assistant?) and his adorable boys
Hindu temple in Singapore
Jakarta traffic jam
Yes, that is a real Krispy Kreme - in Jakarta!
Thursday, August 21, 2008
Wednesday, August 13, 2008
Tuesday, August 12, 2008
Arranging the itinerary through to Jakarta was a nightmare, and now it's out the window and will have to be rebooked, along with hotels in Brussels and Jakarta and the flight from Jakarta to Banda Aceh.
I am all packed and am SO ready to leave here, and am very bummed that I will be stuck here for longer than I was supposed to be!!
Sunday, August 10, 2008
There is a lot of humanitarian and development money coming in to Liberia, and everyone, especially the government, is trying to get their fingers in the pie. Unfortunately when the money goes to the government, it is more likely to disappear into someone’s pockets than go to benefit the people it was intended for. Everyone here talks the talk about “building local capacity” and says nice things at meetings when the government is in attendance like “partnerships” and “joint implementation strategy” but underneath the façade of a desire to involve locals in improving the country and behind closed doors, many NGOs express extreme frustration with working with government. Everyone is competing for development dollars including the government and local NGOs. The competition can get ugly. We NGOs are accountable to our donors and demonstrating that we spent their money responsibly. We are also required to work with the government. Unfortunately having two bosses can lead to problems, particularly when one of them is more interested in lining their pockets than helping their people.
I’ve spent a great deal of time since I’ve been here working on sorting out a fiasco with a mosquito net distribution. Few people understand the problems involved in distributing these items, which at $5 each are a valuable commodity. Unless a distribution is done correctly (including physically removing the net from the package and hanging it in the recipient’s house), the nets will be on the market within 5 minutes of being given out. I can understand why, $5 will buy a lot of food, and if people don’t see the benefit of the net (perhaps because they don’t know that mosquitoes transmit malaria) then they are likely to sell it, use it for a fishing net or a wedding dress (we’ve seen all sorts of original uses for mosquito nets). A bigger problem is large-scale theft of thousands of nets during the distribution. Unless properly supervised there is a huge risk of large quantities of nets disappearing. The problem is, who do you trust to do the supervision? How do you get enough trustworthy people to carry out such a massive operation in remote areas with little access?
The methods of theft are very creative, and can happen at all levels. Forged documents, faked signatures, lying government officials and stealing staff all play a part. I can’t get into the specifics because of the political implications, but a large quantity of nets from a recent distribution of nets purchased by a European government have turned up on markets in neighboring countries. There will be huge political fallout from this and there were several local and international NGOs involved. The Ministry of Health insisted that the NGOs use local people including local Ministry staff for the distributions. Guess what, nobody can account for all of the nets they were given! The Ministry is doing its best to discredit the international NGOs while not criticizing the local NGOs involved in the process (and a key figure at the Ministry has his own local NGO that was awarded a contract to do the distributions – can you say conflict of interest?) so that they can get the contracts for future distributions. The Minister of Health and the ambassador for this country is involved.
Every time I go to a meeting the government people tell us international NGOs that we are here working for them. However, as I said, we are accountable to our donors, not to the government. The government is trying to convince donors to give money directly to them instead of to NGOs. They want to be in charge of money and programming but they are so utterly incompetent that donors will never fund them directly.
I went to a meeting on Friday at the National Disaster Management Commission. There has been huge flooding in Monrovia and the NDMC wants to do an assessment of the scope of the problem. We have the capacity to do indoor spraying to help prevent malaria so I went to the meeting to see what they planned to do for this “assessment”.
They spent the first hour arguing about how to conduct the meeting and who was going to be in charge of what. I thought I was going to lose my mind. I brought up the point of what exactly are we going to assess? Nobody could answer that. Do we want to count the population affected? How do we do this? Do we want to do a survey of how many people are sick? How do we do this? They had absolutely no clue as to what to do. They have no vehicles, no camera, no fuel, and clearly no technical skills to carry out any type of meaningful assessment. Every time I tried to bring up a point I was shut down by the Ministry of Health representative, who clearly did not want to hear any criticism or suggestions for how to carry out the work. So I decided to keep quiet and never attend another meeting. There is little point being involved in such a useless activity, especially if they don’t want to listen to and learn how to do it right. The guy listened to all of the input from the Liberians, but would hear nothing from me.
I was warned about the hostility towards international organizations and staff, and every time I go to a meeting I see it. The Liberians certainly don’t want anyone telling them how to run their affairs, even if they are totally incompetent. Fair enough, but then in the next breath they are asking us for money and support. You can’t have your cake and eat it too!
Here’s another example. We have been trying to set up a sentinel surveillance system for malaria in the country. This is a simple reporting mechanism where a few facilities are chosen and people trained to report on malaria incidence to monitor trends and watch out for epidemics. Obviously we have to work with the Ministry of Health on this. However, they have made ridiculous demands like we need to buy them vehicles, provide fuel, computers, and per diems (oh my god the omnipresent demand for per diems to do anything, I’m so sick of it!!), none of which are necessary to develop this system. There is no money in the budget for any of this. They have ground the discussions to a halt over these demands. Greedy, greedy, greedy. Who cares about helping people? I want a new Landcruiser!
So many of you are probably asking why I continue with this work with this level of frustration. Believe me there are days when I ask the same question of myself. However there are other days when things go well with my own staff, when I get to teach someone something new, or I learn something new that make it worthwhile. Of course the ultimate goal is to reduce human misery and suffering, but on a day to day basis you never get to see this happen. You have to take your victories when they come, because they are few and far between!
I’m sure that it is much the same in Indonesia, but at least I’ll be in a much nicer setting, with beautiful beaches, good food and plenty of things to do outside of work! Unfortunately it is going to take me 3 days to get there!! I overnight from here to Brussels, 12 hour wait in Brussels, go to Amsterdam, then 15 hours to Jakarta, overnight in Jakarta, then on to Aceh. What a nightmare!
Wednesday, July 30, 2008
I’m getting better at understanding it but it is still a struggle with some people. To my ear it sounds like Elmer Fudd speaking Chinese, with a Jamaican accent. It’s the strangest thing I’ve ever heard. The words in a sentence seem to blend together, and there doesn’t seem to be any hard consonants like r or t in the dialect.
Here are some samples:
Where’s Oscar = whe-o-sa
How are you today = ha-u-deh
Close the door = clo-do
You want to go to the supermarket? = yu-a-go-sua-maka?
So every day I struggle with trying to understand what people are saying. In the worst cases I’ve given up, and just smile and nod. One of the drivers, Cassel, a dear young guy who drives in the evenings and usually is the one who delivers me to the gym and home after work, has become very friendly and very chatty with me. Honest to god I have not the faintest idea what he is saying. I usually have some clues because the conversations usually revolve around something we’ve seen on the streets as we move through Monvrovia, but the details of what he says escape me completely.
The worst part is, which I found out a couple of days ago, is that the Liberians have trouble understanding me!!! I was absolutely astonished. Here I thought I was speaking so clearly, when I’m in Africa I’m careful to enunciate every word clearly and slow down the cadence of my speech, which has always worked in other countries. Unfortunately it seems that this approach is ineffective here. Apparently I need to start slurring my words and drop the rs and ts. As always in Africa, people are too polite to tell me that they don’t understand what I’m saying. This results in things not getting done that I’ve asked for. It seems people would rather risk not doing their job correctly than tell me they don’t understand what I’m saying.
There’s a whole lot of nodding and smiling going on in Liberia!
Sunday, July 27, 2008
Working with the Ministry of Health (MoH) and the national malaria control programme is an art in itself. While the government wants the Aid Brigade and its accompanying funding here to do the work that they don’t have the capacity to do, there is tension between the government and the “implementing partners” doing the work that the donors pay for like MENTOR. The government would rather have all that money going directly into their coffers so they can control it, and the fact that it doesn’t creates some resentment.
I feel bad for the MoH, they really do have no money. I was at a meeting this week for disease surveillance and the big news was a spike in cholera in Monrovia because of flooding. The guy handed out a list of the things they need to control it: chlorine for disinfecting wells, buckets, jerry cans, soap for distribution so people can wash their hands, etc. The only thing on the list they actually had was the chlorine, that had been donated by some agency. They don’t have any way to move around Monrovia – the MoH has no vehicles and no fuel. So they appealed to all of the various NGOs at the meeting but all of us have strict programme requirements that we must use our own funding for so are not in a position to donate to this effort.
The problem is that if they do get money it is often misused. Inevitably money is sucked into someone’s pockets. Shell NGOs are formed on paper and programmes never implemented once the money is received and the money can’t be accounted for. Mosquito nets and drugs meant for distribution never make it to the people who need them and are sold on the market. This is not only an MoH problem, but can happen with the staff of any NGO. Items like drugs and nets are valuable, and I’ve seen some of the most clever plots to steal things. Every NGO that deals with items of value has strict inventory and delivery procedures in place but the best planned distribution system can still be breached…signatures can be forged, fakes substituted, and pockets are lined. If people put half as much energy into doing their job as they did into how to steal and make a few bucks on the side we’d have malaria under control by now.
It’s a perennial problem and one that is unlikely to go away while people are so poor. A $5 mosquito net (never mind a truckload of them) is a lot of money to someone who works for the government and gets paid $100 a month.
Davies and I went to the “beach” yesterday. I have to say I was rather disappointed….it was a 50-yard stretch of sand about 6 feet wide (I don’t know if it was high tide or not) with a few plastic tables and chairs and a small restaurant Walking beyond this area is considered unsafe so that is the extent of the beach. The waves were big and I’m too scared to go in the ocean so I sat and read. I guess it beats sitting in the apartment and reading. Then it clouded up and looked like rain so we left.
Someone who worked at the restaurant and lives nearby has a baby chimp. I was shocked. I guess coming from East Africa that has such strong conservation laws that are actually enforced I was floored to see a baby chimp in a cage when I walked in. She was adorable though!! The woman who owns it took her out of her cage and I got to hold her. Very cute now but in about 10 years when she’s the size of a large man she won’t be so cute anymore. Like I mentioned earlier they eat chimps here. That’s totally disturbing especially seeing how humanlike this one was. I think this country has a long ways to go in terms of protecting wildlife or their habitats. From what I understand they are cutting down the rainforest at a record pace. The bushmeat at the market last weekend tells me they are clearing the animals out of whatever forest is left as well.
The beach was my big excitement for the week, otherwise I went to the gym every day after work, came home, ate supper and went to bed. Today I’m reading and doing a bit of work. Very boring. However, I’m feeling more rested than I have in a long time..strange to have to come to Liberia to feel rested, but the last few weeks before I left home were so busy and stressful, and now that I’m here and have nothing to do I’m forced to relax. It’s weird to not have a million things to be done! I have no idea if the pace of work in Indonesia (where I’ll be in 3 weeks) is anything like this 9-to-5 gig here, but that would be nice!
Sunday, July 20, 2008
I was going to go to the beach yesterday but Davies said not to go by myself, and it turns out that the "safe" ie expat beaches are quite a ways away so I didn't bother. I went to the local market to see what I could find, I was hoping to get some tomatoes and other veggies. Oh my god it was like being in a horror movie. It was nasty. It's a big, dirty indoor market full of stalls, pretty typically African except everyone was selling the same few items...hot peppers, onions, potatoes, and tiny little plastic bags full of what I presume to be spices...maybe a teaspoon in each bag. Then they had plastic bottles full of some sort of red liquid, maybe hot pepper sauce (they like their food hot here). That was on the bottom floor. I went upstairs, and the smell hit me about halfway up - fish. Gross. But the worst was what I saw at the top of the stairs...piles of bushmeat on the first table. Cut up monkeys and little antelopes. People eat monkeys here!!! I actually knew this but thought the trade was a bit more illicit than in the open market. Little humanlike hands piled up on the table. Tiny little antelope hooves and fur. I almost heaved. The driver told me they eat chimpanzees in some parts of the country. People prefer bushmeat to beef etc even though its more expensive than farmed meat! I'm just sick. I understand why and am trying to be culturally sensitive, but I would have preferred to not have seen it. I'm still disturbed.
After that, I went to the supermarket for another horror- the expense of buying food here. I went to a different shop this time, and this one had about 10 times the stuff in it, but it was even more expensive than the first one. A container of Folger's coffee just like what I get at home for 5 bucks was 25 dollars!!! Ham is $15 a pound, turkey $17. a box of Rice Krispies is $7. Premium Plus crackers - $5 a box. Kraft parmesan cheese - $8. I ended up buying milk, some pasta, 4 cans of diet pepsi, a jar of peanut butter, two tins of green beans, and two tins of tuna, for $25. My In Country Living Allowance is not going to go far. In Kenya I lived for 2 weeks on $25! There is no food production to speak of locally so everything is imported - and it must be flown in. Of course the local businessmen are totally exploiting the expats, many of whom do get paid enough that $10 cheese slices are not a big deal, but many of us do not get paid that well! I thik I'll be eating a lot of pasta. I had pasta mixed with a tin of tuna and a tin of green beans for supper on Friday and lunch on Saturday. Pasta with Ragu last night. No idea what I'll do tonight but I suspect pasta with Ragu.
I also went and checked out a nice new hotel that expats frequent. I had a look at the menu - same as the other restaurant I've been to - $27 for a steak, $10 for a salad, $10 for a hamburger. Eating out is going to be infrequent if it happens at all.
So today (Sunday) I’m sitting in the apartment doing some work and killing time. Maybe I’ll watch another bootleg DVD. I watched the new Raiders of the Lost Ark last night, complete with the silhouettes of people getting up out of their seats at the movie theatre where it was videotaped off the screen. It seemed good, but I couldn’t see half of it because the quality was so poor. I guess I’ve learned to wait until the movie is actually out on DVD “for real” before I buy a bootleg copy. For 5 bucks I got Raiders plus seven or eight other movies, nothing special but will kill time.
This job seems to be pretty much 9 to 5 Monday to Friday. Definitely not what I was expecting after working in Kenya, which was 12 hour days 7 days a week. I don’t quite know what to do with myself with all this time, especially given that I don’t know a single soul in the country besides Davies, and he is in his room when he’s at home. I don’t have to go to the field, and I don’t have to do any finance, or HR, or any other administrative stuff. There are staff that do all of that. I feel like a bit of a warm body waiting in case someone has a question about malaria. At least I found a gym and I can kill a couple of hours a day there, and when there is power and internet I can waste time like no one’s business.
I went to a meeting at the UN this week, a mind-boggling hour of acronyms meant to help NGOs coordinate with each other (mostly on security issues). There were a couple of presentations about the food crisis and its impact on Liberia. It was depressing.
- the GDP is 40% of what it was before the war
- Liberia imports 50% of its food
- 92% of exports are a single commodity - rubber - making the country extremely vulnerable to price fluctuations
- 2/3 of its rice (the staple food) are imported (in urban areas 90%) and the price has more than doubled in the past year
- to make rice more affordable (and under pressure from the World Trade Organization) the government dropped its $2 per sack import tax. This was great for consumers, but a disaster for the government...it lost $6M in revenues, which is HALF of the health budget for the year (which is also depressing because for only $12M some rich person could pay for health for all Liberians instead of buying a new mansion)
- 56% of the rural and 29% of the urban population live in "extreme poverty" (less than $1 a day income
- 40% of children under 5 are chronically malnourished
So, here we are trying to do our best to help what seems a hopeless situation...I guess I shouldn't complain too much about the price of coffee and ham when most families can't afford a cup of rice.
Here are a few more pictures of lovely Monrovia:
abandoned construction site
Wednesday, July 16, 2008
As the plane flew in, I saw the signs of the Aid Brigade in full force – huge UN compound with the standard white “UN” marked goods: 15-20 helicopters, transport planes, and dozens of new landcruisers lined up neatly. Clearly they have a huge presence here, as evidenced by the large blue and white UNMIL (UN Mission in Liberia) building in Monrovia and every other car on the road being UN. Soldiers of all nationalities everywhere – incuding Americans, apparently they have the contract to retrain and reintegrate the Liberian. Blue berets in equal numbers. Everyone is working hard to maintain the peace that this country has finally found after 20 horrific years. And getting their hands in the huge pot of development money that’s flowing in to this country. Not that I’m cynical or anything.
The landscape is heavily forested, the only difference between here and, say, western Uganda is the palm trees everywhere. And water. Everywhere. It is rainy season here and they’re not kidding – it has been raining about 80% of the time I’ve been here so far. It rained all day yesterday and today. Nonstop.
The place is in a shambles, but to be honest not quite as bad as I expected so recently after the war. The usual African story – potholed roads, streets lined with little ramshackle huts selling various bits and pieces, total chaos. Not so different from anywhere else I’ve been in Africa. There are several large buildings whose construction was obviously abandoned during the war in downtown (see pictures). Monrovia is, however, one of the ugliest cities I’ve ever been in. And that’s not just because of the war, it had to be ugly before (again, see pictures).
There is no electricity grid in the entire country. Yes I’ll say that again, there is no electricity in the entire country. There was hydro power before the war but it all got blown up and the wires were stripped and sold. If you have power you are on a generator. That is the constant background noise in the city, generators. The generator for my building is right outside my window and runs from 7am to 9am then 5pm till midnight during the week, and apparently it is on Saturday afternoons and all day Sunday. There is also no running water in the country. Can you imagine? A city the size of Monrovia, 1.2 million people, and no running water. I imagine cholera etc are rampant.
There are many beggars on the streets missing limbs, presumably from the war. These guys are very aggressive and they congregate at the shops where expats shop.
Roads are nonexistent in most of the country as well. Programmes that work upcountry basically have to shut down in the rainy season because the “roads” (dirt tracks) become impassable. Delivering health care services to these areas is a major challenge. How do you keep vaccines cold? How do you keep records? It’s a nightmare. Large parts of the country are basically in the stone age.
The MENTOR staff house is a nice apartment that I share with Davies, a Kenyan guy who’s been with MENTOR for quite a while, he is a good guy, in his late ‘40s. We went out for a beer last night and had a nice chat, he’s been working for NGOs all over Africa for a long time so has lots of stories. I have a big room and a bathroom to myself, with HOT WATER – I know, it’s too much luxury – and there is a cook/cleaner who cooks lunch/dinner and does the washing and ironing. We come home for lunch every day (another luxury – in Kenya I didn’t have time and it was logistically impossible to eat lunches). He keeps to himself a lot at home, which is a bit disconcerting but better than being annoying I guess. We have a TV, unfortunately there is only 1 channel, Liberian National TV, and it seems to mostly play poorly made local music videos. Although I did manage to catch an episode of “Touched By An Angel” the other night. We do have a DVD player and I’ve already checked out the assortment of bootlegs available on the street, I believe I’ll buy the new Indiana Jones movie (and I mean the one still in theatres) for the $5 asking price and watch that this weekend.
I went and checked out a gym after work today and I think I’ll pay the extortionate fee to join, there are 12 treadmills and lots of equipment so it will be worth it (and for what I'm paying I'll have incentive to haul my ass to the gym every night). I think I’ll have time and energy to work out here so that will be a bonus. In fact I brought home some work tonight and Davies told me not to! Don’t bring work home, he said, home is home and work is work. I have a hard time with that concept, work was 24/7 in Kenya! I won’t complain though, it will be nice to finish a mission with my health, hair and sanity intact!
The programme here is huge, the office is enormous and they have 8 or 10 vehicles (haven’t had a chance to count them all). Very well equipped and since it’s been running since 2004 everything is well organized and I don’t need to worry about admin or logistics stuff or going to the bank. Basically, this is an office gig with lots of meetings. The pace seems to be MUCH less intense than Kenya was, we work 8 to 5:30 with an hour lunch break (they turn the generator off at the office between 1 and 2 so we have to go for lunch!)
IT IS INCREDIBLY EXPENSIVE HERE!!! I was warned about this but I’m still shocked. The businessmen (apparently mostly Lebanese) are taking full advantage of the Aid Brigade and their per diems, particularly the UN people who make absurd amounts of money, so $10 for a bottle of salad dressing is no big deal for them. That’s right, $10. I bought some cheese slices, cereal, bread, crackers, 5 tins of tuna, and some coffee, and it was $54!!! I looked at the menu at the restaurant Davies and I went to last night, $10 for a salad, $27 for a steak, $15 for pasta and pizza. We had three beers between us and it was $14. I guess I’ll be eating at home every night, that suits me just fine. We get a $17 per diem, which was great in Kenya as I probably only spent $2 a day on food!
I spent the first two days here at a conference, discussion of Liberia’s health system – progress and future directions. It was depressing. 80% unemployment. Maternal and child mortality among the highest in the world. Average male life expectancy 43 years. 40% literacy rate (lower for females). 70% of the population live on less than $1 per day. They are doing their best to try and improve, but of the estimated 154 million dollars needed to provide the Basic Package of Health Services (and it is very basic – immunizations, antibiotics, maternal care, malaria treatment) the Liberian government only has the revenue to contribute $10 million. Per capita annual spending on health care is less than $5. They are relying on donor financing to fill the gap, but the country is now in transition from humanitarian emergency to development and these are really two completely different ballgames with two sets of funding critera, different donors, different NGOs, etc.
Lovely view from the apartment balcony - that's the ocean in the background, too bad about the foreground!
Internet not behaving tonight to put up more pictures so will try again tomorrow!
Monday, March 31, 2008
I thought I'd try to post some pictures if the internet cooperates....
Welcome to rainy season...don't ask me how this happened, but we spent a good hour watching them try to get out by rocking forwards and backwards one inch at a time...
of course this was blocking our route home so we had to take a different way and this is what happened....thank goodness for winches....
we had an audience......
The internet is not working well so no more pictures for tonight...
My new colleague Esther is from Germany, 54, and has worked all over East and Central Africa for many years as a nurse, administrator, and educator. She was in Rwanda during the genocide and has absolutely horrific stories about it. She worked for many years in Congo, trying to improve health systems (a very difficult challenge in a country where doctors are paid $5 a month). She is VERY German, Ya, ve vant to vork now! She is a bit stubborn and not nearly as much fun as Isabelle and Fanette but we get along fine and she works very hard (a bit obsessed with organization, Ya, ve MUST be ORGANIZE-D"!!). She and I are sharing the coordination of the IRS campaign and she is taking over Isabelle's position as the Clinical Coordinator.
I'll try to put up more photos tomorrow or later this week!
Sunday, March 16, 2008
Training teachers on malaria prevention - we trained 100 teachers from all 22 primary schools north of the river on Saturday. It was a logistical nightmare, but I think they enjoyed it (especially getting the sodas and "allowance"). It's amazing how little people know about malaria, even teachers. Hopefully they will pass on correct information to their students.
Saturday, March 15, 2008
Our big treat today: hot dogs. I found wieners in Kisumu this week. I think I'll eat a dozen.
Thursday, March 13, 2008
Things are fine here security wise. No incidents have happened here since January and work has been going on pretty much as usual. To be honest I haven't even had time to read a newspaper or check websites for news about Kenya for the past 3 weeks so totally missed the big deal on the power sharing agreement, all I know is that something has been worked out and Kofi Annan went home. I hear the odd thing about disagreements on the actual deal and stories about secret negotiations and rumors about secret pacts being signed but I haven't the time or energy to follow it, as long as I'm able to work and go to Busia when I need money it doesn't really matter as far as I'm concerned.
In the past three weeks I also had to write a proposal for an extension of this programme for another two months, as well as contribute to a proposal for working to provide emergency malaria control services in the Rift Valley in areas where people have been displaced or are returning to their ancestral homes to get away from the ethnic violence. It's a huge proposal, over 2 million dollars, for a 9-month programme. The concern is that a huge number of people who fled the violence left non malaria-endemic areas and the Rift is a very high transmission area so these returnees will have no immunity and a huge malaria epidemic will happen. Also the health care system in these areas has collapsed because of health care workers fleeing the area. Anyways, we'll see what happens. It takes forever for grant proposals to get reviewed and funding to be put in place.
Work here is going on but we have shifted our base to a new location and it has been a logistical nightmare. We finished spraying south of the river (over 10,000 houses sprayed in 3 months, good for us!) where our office is and we used it for a base. Now we are working in a whole new area and we have had to shift operations to a new area, find a new base, move the teams and equipment, find water sources, etc etc and it has been very challenging. However, the acceptance rate has been very high so far which is good.
I found out some interesting things about the communities on the south side. We met a lot of resistance in some villages, people refusing to have their houses sprayed even after we explain the benefits to them thoroughly. These communities are used to flooding, every year, sometimes twice a year. They WANT the floods to happen because then the Aid Brigade comes in with donations of food, blankets, pots and pans, mosquito nets, etc etc. In fact there is an entire culture of aid in this area (and in many parts of Africa that experience natural disasters I suspect). People refused spraying because this jeopardizes their chances of getting another mosquito net in the next flood, which they promptly sell for a few dollars. They line up for food distributions even if their gardens are full and their houses did not flood. It makes sense when you think about it. The West has created this culture, unfortunately. I don't know what the answer is.
The people on the North side of the river, which does not flood, never get any of this aid so have been much more receptive to the spraying.
Most interestingly, I found out that the people in the South may have actually sabotaged the dyke that broke and caused this year's flooding. Apparently they dug out the base of it so that it would collapse and their aid would come. They are absolutely not interesting in rebuilding it so that it doesn't flood next year.
It's very frustrating to know that we have created a culture that expects a handout. We experience the same thing every time we try to run an educational programme for people. Everyone expects a handout for turning up at a workshop. If you don't give them their "per diem" they won't come. I don't know who started this idea but it makes getting anything done very difficult and expensive. We invite the elders of villages to an educational session on how to prevent malaria, and they refuse to participate unless we give them sodas and a couple of dollars. The same thing has been happening with the staff in the hospitals. We provide drugs, training and support, and in some places they have absolutely refused to follow the procedures that we (on behalf of the Ministry of Health, their boss) have trained them in because we are not giving them "motivation". They ask us for MENTOR t-shirts EVERY TIME we show up at the Health Center. They are charging people for doing the diagnostic tests that we have provided to them for free, and pocket the money. Rumor has it that they are selling the drugs that we have provided as well.
It's all extremely frustrating, and I must say my tolerance level has gone down significantly in the last few weeks.
At least I have a Logistician now! we hired a guy to help me with cars and administrivia that have occupied 95% of my time for the past few months. I've handed everything over to him and all I ask now is what car am I using today. He's a very bright Kenyan guy who worked for 4 years in South Sudan with GOAL, an Irish medical NGO. I'm so happy!!!!
OK, that's all for now, sorry if I sound negative, I'm just VERY tired. Things will get better once I get my assignments finished!
Sunday, February 17, 2008
On Wednesday we organized to have it towed the 15 km to the house. A big dump truck came and we hitched up the car with the winch. We made it to 1/4 mile from the house where there is a steep hill full of loose stones and the truck just couldn't go any further. They tried and tried and the truck was spitting big stones out from under the wheels and I was afraid it would smash the windscreen. Of course by this time I was already completely fed up with the whole thing and just wanted to be able to do some work other than deal with cars. I walked the rest of the way home after instructing the driver to get another truck that had enough power to pull the car up the hill.
I assumed everything was going fine until the driver called an hour later. The usual story: "There is a problem". My blood pressure was already sky high by this time and I was absolutely furious, so I marched down the hill to see what was the matter. The whole front end of the landcruiser was bashed in; the story I got was that the brakes in the truck "failed" and it rolled backwards and smashed into the car. Thank god we have bull bars on all our cars or it would have been even worse. I went absolutely ballistic. Why did the driver get a truck with bad brakes??? The truck driver tried to tell me that the brakes had been functioning just fine until this very moment. Right. Then the owner of the truck turned up and he changed his story to he had not been in the truck, that he engaged the handbrake and put stones behind the wheels and the handbrake failed and the stones broke. The whole story was extremely convoluted and totally dodgy and I'll never know what really happened. In any case, I thought I was going to have a heart attack and I yelled and screamed at everyone, including the crowd of bystanders that gathered to watch the whole scene.
I called the police to make a report. they turned up on their bicycles, wearing raggedy clothes (they very seldom wear their uniforms) and smoking cigarettes. They stood around for a half an hour (of course everyone is speaking swahili so I have absolutely no idea what anyone is saying) and asked me for a piece of paper to draw "the scene". The driver of the truck disappeared as soon as I called the police, but this is such a small area everyone knows everyone so they said "we will find him". We all piled into the pickup and drove to the police station, a few ramshackle buildings and round huts made of iron sheets. The other policemen at the station were sleeping on the ground outside when we arrived. We sat around for another hour while they filled in a couple of notebooks and sat around going "hmm", "ah", and nodding their heads. The owner of the truck offered to pay for the repairs, but only if his mechanic did the work. I replied thanks, but no thanks, I want my mechanic to do the work. This turned into another series of "hmmm" and "ah", myself involved, as we discussed whose mechanic should do the work. after 30 minutes I finally said we would figure it out the next day as I was exhausted, hungy and thirsty and thought I was going to lose my mind if I had to sit there for one more minute. In the end I decided we would file an insurance claim and let the insurance companies figure it out. I'm sure this will take at least six months.
So it sits, with the bull bars bent back so that the wheels cannot be turned, halfway up the hill to the house. We are down to one vehicle, the pick up, which only carries two passengers and is useless in the rain. I don't know how I'm supposed to run a massive field program with one useless car!!! Thankfully, it looks like we are going to hire a Logistician to come out and deal with all of these things so that I can do other things.
At least security is fine now, and we can move around with no worries. I haven't even had time to check the news to see what is going on with the political negotiations. On top of all of this I have two assignments due at the end of March for my Master's courses, one of which is a statistical analysis of a dataset on leprosy and writing a paper with the results. It's ridiculously complicated and I spent close to 50 hours on the "practice" assignment for this course so I'm sure I'll spend at least this much time on this one which is worth 30% of my grade. In addition I'm starting a group assignment tomorrow that will last for six weeks investigating a cholera outbreak. THere are 10 of us in the group and we are to do the work together and write a report to submit at the end of the 6 weeks. It's going to be a very busy month!!!
So I'd better get to work now, Sunday is study day, I will spend the usual 10 hours straight working. At least it's not dealing with car breakdowns!!!
Saturday, February 9, 2008
There was surprisingly little evidence of the conflagration that occurred in Kisumu over the past month. Apart from the burnt out shells of several buildings (including a large supermarket that covered most of a city block) you would be hard-pressed to know that it was total chaos the week before. When Fanette and I left Kisumu on December 30 it looked like a bomb had gone off in the center of town, and I thought it would be months before the mess was cleaned up. On Tuesday, however, it seemed to be business as usual, with the street hawkers and small kiosks and traffic and the shops open and full of goods.
The remaining supermarket, however, was total chaos. I had to go in to buy “goodies” for us as well as stock up on essential items, and it was absolutely jam-packed, I could hardly push my cart up and down the aisles. The queues to pay were enormous, and the concept of orderly queuing is not something that hapens here, it’s every man, woman and child for themselves, pushing and shoving, elbows and shoulders, to get your spot in line and get to the front first. So, in I went with my cart and muscled my way to near the front of the queue, but the genius architect who designed the store did not leave any way to move the empty carts out of the way, so they started to accumulate at the front of the queue and made it even more of a mess. After it became impossible for anyone to move, someone finally came and they had to physically lift the carts over the checkout stands to remove them. Of course it was 95 degrees inside and I was starving, just to make the misery complete. It took almost an hour to get out of there. I will never complain about having to wait in line at the grocery store at home again!!!
It seems that rainy season is upon us, and the roads turn into a greasy mess when they are wet. Vincent, our Logistician, and I set off in the pickup yesterday morning to go to Busia, as Fanette and Isabelle were both doing fieldwork and needed the landcruisers. I took over driving because Vincent has little experience driving in mud, especially in a rear-wheel drive, lightweight vehicle. Not that I do either, but it’s almost identical to driving on snow and ice, and growing up in Canada you spend 6 months of the year slipping and sliding if you’re not careful.
Anyways, I managed to get a couple of km up the road (much to Vincent’s delight, he couldn’t believe a woman can drive like this!) by using the clutch, keeping our speed up without gunning the engine, taking my foot off the gas when we started to slide, and gingerly handling the steering every time we started to skid and spin. We almost made it through the worst part when we simply slid right off the side of the road into the ditch. Absolutely nothing we could do. The usual crowd of guys gathered around to help us and by inching backwards and forwards we got ourselves righted and carried on (after paying the requisite 5 bucks). By the time we came back 3 hours later it was dry. We are expecting another landcruiser from Nairobi next week, we will definitely need 3 4-wheel drives here during rainy season.
What else...another story from Isabelle about her experience working in Sudan, that really puts into perspective how fortunate we are living in the developed world. Don’t read if you are easily grossed out. She said a woman turned up at the hospital whose finger had been almost severed. She said that the bone was sticking out and it appeared that a dog or some other animal had ripped it off. She was very stoic and didn’t complain and was very matter of fact about the whole thing. Isabelle asked her what happened. She said that she and another woman got into a fight over a bucket of water and the other woman bit her finger off. Imagine. Having your finger bitten off over a bucket of water. That’s how harsh life is in some parts of the world. We really don’t appreciate how easy we have it and how much we take for granted. After running out of water here and having to bathe out of jerry cans I feel guilty for lingering in the (cold) shower. It is a precious resource.
Isabelle was working in one of the health centers this week and she called me to ask what the MENTOR policy is on transporting people in MENTOR vehicles. A woman had turned up at the health center who had suffered a miscarriage and she was bleeding heavily. Isabelle told me that unless she got to a proper hospital where she could have a blood transfusion she was likely to bleed to death. There are no ambulances, and no means to get people to hospital when they are in bad shape. It is a difficult position to be in because if we start providing transport to some people then it will be never ending. However, being that we are a humanitarian organization if someone is going to die without our intervention we are morally obligated to assist. Isabelle took her to the hospital, and she bled all over the car, but she got to a place where her life would be saved.
I had a couple of interesting discussions this week about why people are so resistant to making simple behavior changes that might save their lives, like having their houses sprayed to protect against mosquitoes, or boiling their drinking water to prevent cholera. In the car on the way back from Kisumu, Jack, our driver, and Vincent and I were discussing why people don't take basic precautions with water, when they can boil it or use a drop of bleach to kill cholera bacteria. They said that around here, there is a belief that you must drink water from the river. Even if purified water is provided, there is some belief that river water is better for you (I'm not quite clear if this is some sort of spiritual belief or where it came from). Also discussed the same isue with a public health officer at the Ministry of Health. He said he worked on a cholera outbreak in Coastal Province some years ago, and no matter what they told people about boiling water the outbreak persisted. They finally sent people into the communities to discuss with people about what was going on. It turns out that they were boiling the water, but not drinking it...apparently to them, boiled water is "dead", and is harmful. Only "living" water should be drunk. Once they spent time educating people that this was a misconception, they began to drink the "dead" water and the cholera was eliminated. This might seem like complete craziness, but the influence of strongly held beliefs on health practices can't be underestimated when designing interventions. We have the same problem here, with people refusing to have their houses sprayed for various reasons, from thinking that the insecticide is poisonous and will harm them to not wanting to remove things from their houses to have them sprayed because they are afraid someone will steal them. It's a matter of education, and the more we can do to provide this the more successful our intervention will be.
Well, after those heavy stories, here are a couple more pictures of funny things I've seen...
Priorities.....someone bought this piece of land and the first thing they constructed (after the small temporary shack to the left) was a huge gate. I asked why this huge gate was sitting on the empty plot of land, with no fence and no house. By putting up the big gate it indicates big things to come as well as a sense of ownership of the land. Building a house can take years, as the materials are bought bit by bit as they can be afforded.
We went by this property last week and I saw a giant flat-screen tv being unloaded and put into the shack. Also a high priority!
Giant White Bubble
This is Ugali, a staple food in Kenya. It is boiled cornmeal, and is as ubiquitous as rice in Asia. It is bland, tasteless filler (as far as I am concerned anyways) with zero nutritional value. It is served with every meal. This was at our Christmas lunch, and we asked the cooks to prepare it along with beef stew and chapatis. There was at least 10 pounds of the stuff left over AFTER we fed 25 people. I tried to feed some to the dog but even he wouldn't eat it!
Things you don't need to worry about at home - goats on the verandah and in the flower garden- and cheeky as well - i went out to chase them away and they looked at me like, "what?"
Tuesday, January 29, 2008
Woke up this morning to the news that the one ODM party member that was appointed to Kibaki’s parliament had been murdered. An assassination is suspected. Gee, ya think? So much for peace and quiet. Been on the phone and email since 7am assessing security and revising emergency protocols. Things are getting ugly. I don’t think anyone cares about the election any more, it has deteriorated into what is simply tribal violence. We decided to try to make a run to Busia to get money and diesel in case we are socked in here but we got halfway there and the road was blocked by a massive burning log across the road. The police arrived 30 seconds before we did, jumping out of their truck waving kalashes and tear gas cannons. We simply turned around and went home. MENTOR is very clear in their guidelines for how to react to roadblocks; if it is not absolutely essential that you pass, you turn around. We do not pay bribes (this is the position of most NGOs, if you pay you encourage people to continue to practice this extortion). If we needed to get through we diplomatically and carefully negotiate with them, explaining that we are a humanitarian organization here helping people, etc etc.
Luckily we found diesel at a small local petrol station. We of course carefully checked the quality of the diesel (the station attendants thought we were crazy, staring at a bottle full of diesel for a half an hour) by watching it to see if anything separated out of solution. We bought 500L.
This has all been a very interesting learning experience. Things that I never would have thought of have to be carefully considered. Isabelle has worked for MSF, MDM, UN and many other humanitarian organizations and is extremely knowledgeable about security. She is very calm and patient and has been great at helping us get our plans in order. We park the cars in position ready to drive away. We carry copies of our passports with us at all times. We call each other before, during and after any travel. We have “evac packs” ready to grab in case we need to leave quickly. Don’t worry, all of these things are standard operating procedures for humanitarian organizations. Unfortunately nothing was put in place before I arrived and all indications were that the election would be a peaceful process. We are simply putting in place what should have been already done for any operation in Africa.
Isabelle was telling me about when she worked in Sudan, 10 years ago during the war. She is a nurse and worked in a refugee camp and feeding center literally in the middle of the war zone. She was dropped in by a UN flight and left there for 2 months. She had to evacuate as the rebels were approaching and bombing was getting closer. They had to divert a UN flight to come and get her. It’s interesting to meet people like Isabelle who have worked in this field for a long time. She speaks of her experiences in a matter-of-fact way, “yes, if the plane hadn’t been able to land on the airstrip if it had been raining we would have just run into the bush with our evac pack”. Organizations like MSF, MDM, Red Cross etc actually work closely with the various military factions in war zones and they negotiate agreements that ensure their safety. There is an unwritten “Geneva Convention” in bush wars that humanitarian organizations are supposed to be protected (again let me emphasize that this is not the situation here!!!) but sometimes aid workers are killed. The logistics and politics of aid during crises is very interesting.
Another funny story from Isabelle, her last posting was in North Korea for two years. She and her boyfriend were both posted there (he is also in the Aid Brigade, and works for the UN in Dubai) and she absolutely loved it. She said the people were lovely (although they spied on them and had to report to party officials weekly with a report on what she did and said all week) and that it is an absolutely beautiful country. People are not starving to death like the media wants us to believe. She said people are generally happy and very friendly but very mistrustful of the West (and indoctrination starts very young – pre school kids reciting anti-Western propaganda!). She said they went to a huge orchestrated and choreographed annual event in a gigantic stadium honoring “Dear Leader” and she caught a glimpse of him. She said she has never seen anything like it, with hundreds of thousands of people in the stands with little flashcards that they would raise and flip to create enormous dioramas of Dear Leader in various victorious poses while people marched and danced on the field, all after a huge military procession with tanks etc. She was not allowed to go anywhere without at least four Party officials accompanying her and her apartment was bugged but that was just a fact of life there that all expats accepted.
Anyways, that’s all for today, I have a feeling tomorrow is going to be another long day dealing with “the situation”. We are safe and sound here so please don’t worry!
Thursday, January 24, 2008
Interesting name for a town - an eating disorder:
Fanette in our "boardroom", where we carried out job interviews, with an interesting applicant:
Excellent African road repairs: they came with a load of boulders and dumped them in a pothole, making the road completely impassable. We had to get out of the car and move boulders to make a path that the pickup could get through. This was at the beginning of December. No one has come back to do anything else.