That Kindamba Kid

This may look like an ordinary, harmless clothesline draped with drying laundry. In fact it’s a breeding ground.

The female tumbu fly loves nothing more than laying her eggs in wet laundry. It’s the tumbu fly equivalent of a safe suburban neighborhood with good schools for the kids.

The children in question are tumbu fly larvae, and they like to spend their formative days nestled cozily in your towels, trousers and underpants.

Drying laundry.

These little fly kids are very sensitive to heat and vibration. When you slip on your sun-dried drawers, they get to work right away, burrowing painlessly under your skin in less than a minute.

This soon produces a prickly, itchy boil, inside of which the developing tumbu fly incubates for up to 12 days. The fly breathes through its tiny rear end, which you can see at the head of the boil, if you look very closely.

If you’re patient, your foster fly child will eventually grow up and want to get a place of its own. One day it will fall out of the boil and get on with its brief, annoying life.

But if you’re impatient, as most people with fly larvae living inside them would naturally be, you can turf the little freeloader out right away.

Simply spread vaseline on the boil, which cuts off the fly’s oxygen supply. Small indignant bubbles will appear, and then the suffocating larva will start to work its way out. You can speed its departure with some helpful squeezing. (Though if you don’t squeeze properly, you can develop a big abscess and end up under the knife of Dr. Ahmed or Dr. Sam).

An ounce of prevention is worth a pound of cure, and the good news is that you can prevent this whole nasty business by vigorously ironing both sides of every piece of cloth that comes near your body. Socks, sarongs, skivvies, the works. The hot iron cooks the little fellas where they lie.

Here in Kindamba, we have Mama Thérèse and her well-toned ironing arm to thank for the fact that we are not covered in itchy, prickly pustules. Matondo!

(Written with help from the 21st terrifying edition of Manson’s Tropical Diseases — 2000 pages of raw horror that will send you bolting for the next flight to some polar ice cube where you can’t get whatever that is on page 519)

Anybody interested in helping to run a 93-bed general hospital in south-central Republic of Congo? Inpatient, outpatient and maternity wards, surgery, laboratory, great water and sanitation facilities, everything you could want.

Martin (mobile clinic coordinator), Jean-Christophe (guard) and
Leonie
(Kindamba PC) at Kindamba hospital.

I should also mention the charming, professional local staff; welcoming townsfolk; peaceful, picturesque surroundings; and great climate. Though it does rain quite a bit.

Protestant church, Kindamba.

Until now I’ve said very little about why it is we’re all here in Kindamba. MSF runs a general hospital here, as well as conducting mobile clinics that support health posts in six small surrounding villages. These are virtually the only health services available to the people of this region.

MSF has been in Congo-B since the civil war. But now that the war is over, it’s time for MSF to leave.

Remnants of the civil war at the market in Kindamba.

Our worldwide mission is to provide healthcare to people caught in the middle of violent conflict and extreme natural disasters, where others are unable or unwilling to assist. That’s what MSF does well. One of the reasons that MSF is successful is because it sticks to what it does well and doesn’t try to be all things to all people.

So it’s time for MSF to leave Congo-B. That doesn’t mean that everything is fine here. It isn’t. What it means is that it’s time for other organizations to step up and pitch in. The Congolese Ministry of Health is ultimately responsible for health care in the country. As long as MSF remains, the Ministry of Health will not take up this responsibility. And in any event, it won’t be able to operate Kindamba Hospital at nearly the same level as MSF. The resources just aren’t there.

The Ministry needs a partner to help provide vital healthcare services to people in this relatively isolated region, people who are struggling to get back on their feet after years of war.

One way or another, MSF will leave Congo-B at the end of May 2008, reallocating the resources it now uses here to the overwhelming needs it faces all over the world.

The clock is ticking. Who will step up to help?

Inside a destroyed building in Kindamba.

By 9am I may be struggling to hold about 15 different things in my head at the same time. It’s a little like plate-spinning or cooking a 10-course dinner – run over there, check on that thing. Then go talk to that guy. Then send an email about something else. Update next week’s travel plan. Then do a little of another thing. Then run back to the first thing and see if it’s gotten worse or better or has exploded in flames while I was away.

The generator at the hospital isn’t giving power? Do we know why? No. Emergency surgery in 15 minutes? OK, someone take the backup generator from the base over to the hospital. Talk to Richard about why the hospital generator has broken down again. Call Brazzaville to get a new backup generator.

They don’t have a generator they can spare. We have to get it from the other MSF project in Mindouli. When are we scheduled to connect with Mindouli? Next week is too late. Call Mindouli; reschedule it to this week. But if it’s moved to this week then we need to reschedule this driver, and that vehicle’s alternator just died.

Call Brazzaville HQ to find out when we can get a new alternator shipped. Call Mindouli back and reschedule for Thursday. They can’t do it on Thursday, they don’t have enough drivers that day. How about Friday?

Fine. It’s 9:30am. Deep breath, cup of coffee. Who’s next?

And so on. It can be tiring and frustrating, but also fun and exciting. Definitely beats sitting at a desk all day.

No weapons! — entering the MSF base in Kindamba.

Don’t get the wrong idea. I don’t actually dig latrines, fix fences or drive cars. Sometimes I like to help move a generator or something, both for the exercise and so people won’t think I’m a helpless city boy.

Latrines under construction at Kindamba hospital.

No, I have a staff of about 30 professional, experienced Congolese national staff who do all the actual logistics work. Yet despite that I somehow manage to keep busy about 12 hours a day, six days a week. On Sundays I only work half a day, unless there’s an emergency.

There are probably veteran MSF logisticians out there mocking me right now. “What? When I was in Sudan in ‘87 we worked 26 hours a day with only cold sand to eat, and we’d fight each other over who would get to lick the condensation off the tent flaps in the morning.

The Malaria Special — water, tomato soup, cheese bun,
and a strong dose of artemether/lumefantrine.

“In the afternoon I’d get shot and fall off a mountain, then walk 20 miles across the desert carrying a hundred pound bag of bricks on my head.”

Actually I’ve never met anybody who talks like that.

So what exactly do I do all day? Mainly try to keep all the different pieces working together harmoniously.

On days that our vehicles are travelling to Brazzaville or going on mobile clinics, the workday starts at around 6:30am, as I run around making sure that the vehicles, drivers and cargo are all in order, and arguing with passengers who want to take more than their one-bag luggage allowance.

At around 7:30am I meet with my storekeeper, Marcus, who can tell me off the top of his head just how many 400mg tablets of Pyrazinamide we have in stock; this brilliant guy named Freddy who recently arrived from Brazzaville to sort out our bizarre electronic supply system; my head mechanic, Richard; Gotron, the head of the guards, and my logistics assistant Eric (my right hand man, the guy who actually knows what’s going on).

Logistics Assistant, Eric.

At the morning meeting we go over everything that everybody is going to do that day. This is where startling facts like “we will run out of diesel on Tuesday” are first revealed and initial panic reactions suppressed.

Then we disperse and I begin to tackle one of the 38 urgent priorities that must absolutely be finished before lunch. But before those urgent priorities can be addressed several critical tasks are brought to light, and then a couple of people will run in with pressing emergencies that take precedence over both the critical tasks and the urgent priorities.

Also Rose wants to reschedule her trip to Brazzaville, Leonie has lost her pen, and somebody needs the keys to the store.

MSF Head of Mission for Congo-B, Lai-Ling Lee
works by lamplight in Kindamba.

A couple of Sundays ago I got a staticky call on the radio from Gotron; my head of security. Something about a woman and a knife, somebody getting attacked. That didn’t sound good, so I grabbed Dr. Ahmed and hustled over to the hospital.

Kindamba hospital.

It turned out that a local woman had gone after one of our nurses with a mean looking 12-inch kitchen knife. Fortunately a guard tackled her before she could reach her target. He proudly presented the confiscated weapon. Apparently it all had to do with some alleged infidelity.

Normally you’d call in the police to deal with a knife attack, but there aren’t any police in Kindamba yet. So we set about interviewing all the witnesses and making sure that our staff wasn’t at further risk.

In the end the local government representative, who seems to wear a lot of different hats, called the attacker and her family into his office to talk it over. She pledged in front of everyone not to attack MSF staff with knives anymore, and the matter was peacefully resolved.

I’m a logistician. What is MSF logistics exactly? When people asked me that before I came to Kindamba, I had a hard time explaining it.

Basically MSF’s fieldwork is divided into two parts – medical activities, and everything else. The “everything else” is logistics.

In a country like Congo-B, which is slowly recovering from a decade of civil war, a lot of things that you would normally take for granted just aren’t there. Let me give you some examples.

If you want water (and we certainly do), you have to dig a well or trap rainwater. When the dry season comes, you have to put a 5000 litre bladder into a truck, drive to the river, fill it with a pump, drive it back, filter it, and store it.

If you want lights and computers at the base, microscopes and centrifuges in the lab, and an oxygen concentrator in surgery, you need to assemble and maintain your own system of generators and battery backups.

This involves a rat’s nest of cabling, charger-inverters, circuit breakers, solar panels and car batteries. The word in French is ‘bricolage’. As you might expect, this system is not faultless and requires a bit of maintenance now and then. Several times a day, in fact.

An electrical bricolage.

And if you want roads, you have to build them, hundreds of kilometres of them by hand with just a shovel and a few bags of gravel.

No, I’m kidding, we don’t build roads. Apparently we built some bridges a while back, but that’s out of the ordinary.

On the road to Kindamba.

Many of the roads in Congo-B have not been maintained in a long time. In a lot of places the rain has washed them away completely. We’re about 140 km from the capital, Brazzaville, and the trip can take anywhere from 7 to 10 hours, depending on the weather.

For MSF, the camel caravan, horse-drawn carriage, and steam locomotive in all our operations is the Toyota Landcruiser. The Landcruiser is a bit like an SUV, but it can actually drive over mountains in real life, not just on TV.

Driving over mountains is not quite as straightforward as it looks in SUV commercials (and, after the first hour, a lot less fun as well). Even with vehicles that are designed with this kind of driving in mind, things tend to bend, break, puncture, overheat, and fall off. A lot of things. All the time.

MSF fleet of Landcruisers.

So keeping our Landcruiser fleet healthy and happy is a major preoccupation here in Kindamba. We depend on them to move staff, patients, spare parts, equipment, medication, food, and fuel.

All this driving over mountains also depends on highly skilled drivers, and ours could easily win the Paris-Dakar rally if they weren’t busy with MSF. (That doesn’t mean they speed, they just drive very skilfully).

These are a few of the things that keep us busy in logistics here at MSF Kindamba. There’s also sorting, storing, distributing and tracking hundreds of different drugs and medical supplies, digging pit latrines, changing light bulbs, tackling knife-wielding assailants, mending bamboo fences, fixing computers, and attending meetings. Lots of meetings. But let’s save some things for later.

Sometimes a dish will show up for lunch bearing a little handwritten note from the cooks: “viande de chasse.” This could be anything, but is usually some kind of gazelle. Or so I’m told. It’s very chewy.

According to Eric, the local boa constrictor is tasty, but it gave him a fever the first time he ate it.

Nurse Maartje (who is mostly vegetarian) says that if I go to the market I will stop eating meat. I have not been yet.

Dr. Daio and Nurse Maartje in Brazzaville.

Maartje also claimed that she saw an elephant on one of the mobile clinic trips. Big boss Leonie claims that Maartje is pulling my leg, but it could be that Leonie’s jealous at not having seen an elephant yet.

So far I have seen some extremely large spiders, a little green snake, and wide-bodied flying insects that seem to defy the laws of aerodynamics. Also some very burly cockroaches.

We go through several large bottles of local honey every month. Dr. Ahmed eats it on everything; he claims it’s good for your immune system. Sometimes you have to fish out dead bees, or bits of bees. The honey is that fresh.

I seem to recall a National Geographic special on honey harvesting in Africa. I think it involves climbing a very tall tree with a bundle of burning leaves in your mouth. If you get stung you have to focus on holding onto the tree. Falling a hundred feet would probably hurt a lot more.

Brazzaville Market.

Here is my head mechanic Richard, replacing the fuel filter on our base generator by filing down the leads on an old filter from a different generator, which he pulled out of the garbage. Better stay home MacGyver, there’s nothing for you to do here.

Mechanic, Richard, improvising a new diesel filter
at the MSF base in
Kindamba.

Since I’ve been in Kindamba, we have killed three generators. One went peacefully, another screamed in agony. Early this morning the Yanmar at the hospital failed, as Dr. Pascal was getting ready to perform an emergency caesarean section. Fortunately a back-up was waiting in the wings, so the baby wasn’t born in the dark.

Back at the base we have learned a valuable lesson – you can’t pour diesel fuel all over a generator and expect it to keep running. Gotta get all that juice in the tank, or it dribbles into the wiring and then you and ten other guys will have to load the monstrous thing onto a truck for Brazzaville, with a lot of grime, sweat and yelling in Lingala.

There’s something chewing through the ceiling above my bed. At night I can hear it gnawing away up there. When the crunching sounds wake me up, I shine a light to see if the invader has broken through yet. Rat, bat, cat – who knows?

Hopefully it isn’t big enough to break through the mosquito netting above my bed. One night I know it will land there like a furry little trapeze artist whose grip slipped, and I will see its small startled face looking down on me in the harsh glare of my headlamp. Whatever it is.

I told Eric to set some traps. Must remind kitchen staff not to cook it for lunch if it is caught.

Jake is currently an MSF logistician in Kindamba, Republic of Congo. He worked for human rights organizations in Nigeria, Israel and New York before hooking up with MSF in late 2006. After working a few contracts at MSF Canada’s Toronto HQ, followed by persistent and shameless begging, Jake finally got a field assignment early this year.