Life begins and ends with a meeting


BOOK: The Dierctor by David Ignatius. This is just a perfect spy CIA read that transports me to a world so completely apart from my reality. It needs nothing from me…it is a story.

THOUGHT FOR THE DAY: Sometimes, what you have is not enough.

SONG: Ordinary Love by U2…because it is the root of everything

I was sitting at the desk in my room the other night, trying to get some last little things into the computer and I was grumbling about how the lamps in the room look really cool and all, but the are not helping me much from where they are. In these rooms everything is either riveted to the walls (artwork) or to the floor. Nothing will be stolen. I tried moving my desk but it is big and heavy and not riveted down but it would splinter in a heartbeat if it was torqued the wrong way…in that Walmart sort of construction way. I am not sure what prompted me, but I jostled the lamp at the end of the desk and realized it was NOT bolted down. Aha! I moved the damned thing and shifted my world view and the light in my world. Who knew? How very simple. Only took 4 weeks to get to it. I wish I could impress myself once with finding the simple solution within that first window of distress. But I guess that would have made my life so completely different I would not even know myself!

It is Saturday morning and we had to be at the base by 8am this morning to meet with all of our national staff to tell them that the project would be making big cuts and these would mean cutting significant numbers – more than 50% in fact. They have realized the inevitability of this but have hustled mightily to look busy to keep themselves from losing their jobs. This aspect of the MSF initial intervention was the emergency response to ebola in the critical need period. The goal was to set up of the Ebola Treatment Center to assist the government that had no capacity to manage. While Sierra Leone is reducing its numbers, it has not arrived at “0” cases but the ability to manage is in place in huge number of other NGO’s who have arrived on the scene with dollars and flags and declarations of full support and investment in Sierra Leone. In actuality, at this point NGO $$$ is the newest industry. I think it beats diamond mining at the moment.

In this period since the first week in March when our ETC was closed and the last patient discharged, several other ETCs were set up and have been function more or less well. We needed to begin then with heading thing over. We had asked the world for help and it was here and working. The government was regaining ground, and renewing itself and wanted to move back to center stage. They still needed some assistance and wanted MSF to help. So we did. Gradually our hospital turned back into the playing field for the high school that had agreed to let us use their setting for our work. No school was permitted and we did not use the student facilities for anything other than admin. We built the hospital and all its components on the grounds and in the tear down, disinfected everything with standard chlorine care and fire…we burned a lot of shit.

Transition has become the mandate for MSF. It is not, however, as simple as it should be (of course.) First we linger over the questions like “Have we put enough in place?” “Are they ready to do it right?” “Should we do just one more thing?” My first image was the nest and the baby birds…we are so fearful that even though they have wings and the softest of feathers, are they really ready to fly? The government wants only the moneyed folks on the team and MSF is not a money proposition, but a medical service provider…and only under emergency need. We are now at the point where the Government has told us, by never returning or initiating calls for “next step” activities and other very not-subtle messaging that they don’t want us any more. There is a touch of MSF hurt feelings, but just a touch. We are trying (some more than others) to recognize that this “partner” wants to break up with us. We are verging on denial and maybe a bit of stalking. It is not so good.

Meetingnbefornthe meeting to tell people the meeting for the cuts will be in 2 days

At a 50% reduction of my staff, that will happen Monday morning, I have proposed a survey /evaluation HP activity that I wrote up 3 weeks ago. It somehow stalled in Geneva because someone was on vacation. I am doing it anyway and have figured out how I will apologize and come up clean in the end. I purposefully designed it for completing the work and finally getting the written data evaluated and prepared for distribution to other social mobilization actors who will probably use it as a jumping in point. They are floundering and duplicating many needs and leaving other needs completely unaddressed. To describe it as low-ebb chaos is probably the best. The best effort to coordinate services started back around the 20th of Mar and they are still trying to develop the terms or reference that will describe the actions for the 5 governing actors. They will then have to develop common evaluation tools and reporting formats. Then the will have to train the teams. That latter would be after they figured which sections of the Freetown sectors the other ngo’s want to work in. Then, the rainy season comes along soon and all this other stuff will be made much more complicated. And they will certainly not be ready before I am in flight back to TX. So we will work on our own bull and we have him by the horns for moment. My half team will critique my tools and projections and rework the whole thing into reality this coming week. We will see. Even if I am not here to finish it and wrap it up, my local staff will be in the perfect place to do it.

Billboards advertise Ebola messages and Top up cards for cell phone networks...not connected in any way


There are pigs in this picture if you can find them

Today I took advantage of being able to come back and work from home. The morning meeting was to tell the staff that cuts would be done on Monday. Sort of mean really, since now everyone has to wait through the weekend to see which side of the list they will be on. I meet with my full 40 person team and will keep 20.

I also got my driver to stop at the supermarket in Krootown, which is not too far from our hotel. It was just before the markets all opened…once that happens, there is no hope for getting through the traffic jams. I got the staples that support what makes the day belong a bit more to me. The 3 meal deal is great, but there are no cookies and my real coffee store is running low. I got a bottle of wine, but usually go for the beer at the end of the sweaty day and someone else manages to make that appear at the hotel. The wine becomes the treat at the end of a particularly crappy or wonderful day. Beer is the average day item. And I got some Mentos…the food group that became basic for me in Sumatra.

My personal happy stock

This particular project wrap up was something I consciously accepted when MSF called. Just as when they called for Liberia, I had no idea what they needed, but I wanted a part of it. And I got that. The incredible nature of starting Foya made me greedy for what I hoped was going to be the completion of the MSF circle. I have been surprised and amazed at how diametrically opposed two activities can be. I mean I do recognize that opening and closing are opposites. But the the work here is like whittling a Sequoia into a single toothpick without your glasses when you are pretty close to being blind. And it is done with such a confusion of who thinks it is right and how it needs to be done. At least when we started inLiberia it was simple. The disease needed action and it was clear what the action was. We moved through it. Here we are not quite in that mode!

I am stunned to look at my calendar and realize that I am about 3.5 weeks from coming back home. I will still have my 21 days of isolation but I will be in TX and will be counting the days to going east to see my grandaughter and grandog and their handlers, in July.

I am still working on the needlepoint from Cambodia. Most centering thing I do in the middle of the crazies. Daily Yoga stretches keep me in motion…meditation for a dedicated time each day brings me back to earth and keeps me grounded. The Malarone I have to take daily for malaria prevention is my countdown marker. It is effective. I take it every day and will do it for a week after I get home and I have just that amount in my stock. The staff personalities are interestingly mixed and I am able to move in and out with some level of control. BUT every day does include a meeting at the start, a couple in the middle and one between arrival home and supper at 8:30 pm…too late!!!!! Sometimes, I have to drive to meetings that are outside MSF but I have knocked most of them out by them not wanting my opinion or me not really being able to play with them any more. Sad? Actually not sad at all.

We did have 3 new cases this week in the poorest and most crowded zone. It might change a few things, but hopefully the controls that are in place will just kick in. On the plus side, the kids started school again. Everyone is very watchful and hopefully that NOTHING will mar this most normalizing of events to come up in the past year. The safety structures are in place and the parental caution comes from knowledge and awareness.

Beginning to get the market stalls in place Saturday mornings

I love you all.



Digging in

Mc Cann's Transatlantic, is like SEEING his imagery so beautifully in his words that it is really a HD read. I look forward to reading at least a little bit before bed every night.

Thought for the Day: Practice Gratitude even when it seems impossible to find it. Just practice, practice, practice until it floods you and flows out in your smile!

Song: Because my own momma guides me in so many things without my asking, and it really gives me strength, I choose Bobby McFerrin's rendition/adaptation of the 23d Psalm. With thanks to my mom…

Over the long weekend, there has been much time to work through the incredible details of what has been and needs to be done. There are several piles of papers all over my room that attest to that. I plug away at it and sometimes the piles decrease and then I get caught by one of the expats who stops me for a “quick” concern or point and either a new pile emerges or one of them shifts or just gets bigger.

Fortunately, I took a day off on Saturday to go off the compound and relax. It was a great energizer and fortunately we do get to take one day like that every week. Leaving the compound gives you a much better chance at not getting caught in a passing meeting.

All that being said, seeing the monumental difference between this mission and Foya just rises in me at every turn. I was showing the DVD we made from the pics in Foya to some of the expats here and I realized that those of us who actually worked in the early field are very few and far between in this stage and setting. The team that is here is to create the disengagement. They are focused on weeding out activity that is no longer necessary and targeting a responsible closure of activities. They are administrative folks. I think there are 3 field folks and since I have the super-sized staff, I am in everyone's line of sight. Little teensy bit of pressure. Talking through the void from paper to people and maintaining the MSF standard for delivering care is delicate. If we were talking about me walking on eggs, I would have to say that there would be a lot of scrambled egg meals.

In Foya, we who have stayed in touch from that Foya experience, we have all agreed that the level of perfect balance between activity and outcomes gave us an experience that is peak in anyone's dream world. In Freetown, it is the business of the business. It is a clean up with the goal of not throwing the baby out with the bath. Some are more aggressive than others so our discussions become heated and justification is the critical standard, without the tools. So I am making some. It seems to diminish the chaos.

I have offered a plan of assessment throughout the zones in Freetown. It was accepted and the detail devil needs to get going to make it bring about the change and conclusions that everyone wants. It is a great global plan, but the development of it is critical. Fitting it all together to grow it up and move it into application will hopefully be done and ready to start by April 13.

There is just no work in the world that does not demand administration and the work of management. Harmonizing that is the challenge. There are no sick and dying patients and that is good. But the absence of the compassionate recollection of what this work has meant to all the people who work with us – national and expat – often clouds the activities we wre part of now. There are remnants of failed public health messaging, but discovering it is an elusive process. Personally I like a nice chunky visible set of problems…never was much at sorting out things in the smoke and mirrors world. That is where I am however, so I will get going.

No photos. The president of SL had forbidden public gathering as is usual for Easter and Easter Monday. None of the NGO's got the memo however and they were photographed at the beach and apparently the newspaper will show the lack of responsibility on our parts. Fortunately the MSF car in the photo was from another center…but it still was us among all the others. They want to show how we do not abide by the safety standard that might keep the country safe…arghhhhh!

I am off to work for a bit at the office. More next week. I love you all.

Just a few thoughts

If you are living your life in search of misery you should not take a position in managing people. They are not likely to follow you with much enthusiasm.

When living with a house full of more than 5 different native language speakers and the common language selected is English: (and English is the only language you speak)

1. You need to try to think with an accent.

2. You need to find a way to fake a bad phone connection and jumble your words so it sounds like you have a poor network connection. Regardless of the number of times the message for you is repeated, you will not get it clear or correct (and the same goes for the person to whom you are speaking – you will be doing them a favor.)

3. Learn from a native person what the socially acceptable gestures and body language innuendos mean. “Tall man” is a universal and Lucy can explain what it means if you need it in English.

4. Even if public urination is one of the acceptable behaviors in society, it is not so for us, ever!

5. Fine red dust in Africa or Asia is equally invasive. Your mucosal lining will be a rust color and it can clog the tear ducts. You will, however, not be as contagious if you get Ebola and this condition is present since the virus is present in tears and you will be unable to produce any. I will make this point to the dept of Public Health before I return home.

6. “I do not need a shower” is NEVER a true statement.

7. If your vehicle has air conditioning but your supervisor has mandated that, to “save donor dollars” you cannot run it ever, you need to Google the facts on fuel consumption and running the air. Then make a copy, save it to your desktop and soft copy it to as many people as you can with your supervisor's name in the middle. If you can send this from someone else's computer it will save your job. If you are fired, you can go on home and run the air all you want.

In Sierra Leone the vehicle windows can only be left slightly lowered since the street vendors reach into the car to try and convince you that you need a Rolex watch or some cashews – surprisingly close to the same price. At 90 degrees in a traffic jam the heat kills small animals. I will summon PETA if I ever faint in the car…donor dollars be damned.

Tonight is Good Friday night and the local house is having a Werewolf party. I have no costume and no silver crosses. I am sol.

I love you all!

Every day a new day.

BOOK: Transatlantic by Colum McCann. Every author has his/her style and some of us like one much more than another, but this man just takes my heart into his story from the first page. He is a WOW writer for me and I love this book!

THOUGHT FOR THE DAY: A day off is not a day off unless you really do NOT work the whole day. So I will write a bit for fun. And then Imwill work because there are thoughts and proposals that will get written better in the quiet

SONG: This was a big variety music week and I will set some of it out in the text where it came floating into my head. There were also intermittent fairy tales. Alice In Wonderland and Humpty Dumpty were at the top of this latter group.

This has been a week where sun shone thru the clouds in my mind for brief periods. That is always a good sign. Like it was in Liberia, the Health Promotion Coordinator has a really diverse role. In Liberia we were creating something and MSF was the only player and our skills on the full team blended so well, knowing the immensity of our task. Here in Sierra Leone, the scene is very different. I arrived just as the hospital was being taken down at the MSF base. There are a number of other Ebola Treatment Centers still operating, but they will progressively close as ebola cases do the same. Unfortunately there continues to be a gap in understanding in the communities throughout Freetown that is being handled even more clumsily by a glut of NGOs. While a lot of money and interest is a big deal, when it is not well integrated and collaboratively applied, stalemate occurs and the problem drifts into a muted nether world. Sort of like US politics, I guess.

My primary responsibility is to keep a team of promoters supported and effectively active in the communities in Freetown. Our purpose is to so clearly provide the wellness message and prevention/transmission points that the communities respond quickly and effectively with trust in the system in place to do what it can for all of the Ebola patients. At this point, we have separated the city into zones and send a small team out to each one. It is a sparse application of the energy at best. None of the contributing agencies are responding to needs of the community effectively and we have no authority to get them to play better. Instead, new organigrams get set up and more reports are developed and placed in the hands of the community workers. This is sort of adding insult to injury on the best of days.

Quarantines of families is a keystone of many of the NGO interventions and is also supported at all levels by the government which offers a strong military presence to keep it enforced. It is NOT supported by MSF in any form because the effective bad behaviors it creates by far exceed the value it may have theoretically. My favorite violation has been a 10 year old boy who refused to miss his pre exams for school because he was in quarantine. He just slipped out every day and went to the practice exams and then sat for the actual exam the day before his quarantine ended. Who could stop him? Apparently no one.

A community becomes quarantined when someone is diagnosed with Ebola. All houses and business places that s/he frequented in any way are included in the operation. A string goes up around the cluster of homes and they must stay inside that cordoned area for 21 days. They cannot leave to shop, work or do anything else they may need to do. In most cases neighbors will help but this is not as generous as it might be. Fear of giving water to the Q community might somehow lead to their contamination. There is a “system” among the NGOs that provides basic needs for these communities. It is a miserable failure, and that is a step up from the DISMAL rating it got last week. To consider the change an improvement is really not there!

Now, in this Q area you have taken out one patient. Each time another patient shows up with symptoms and goes to the hospital, the quarantine time is then extended another 21 days. Imagine the reluctance and pressure on sick people to “fuck it up” for the neighborhood. This latter part is improving a bit, but not fast enough. One community has been re Qd 3 times. They are continuing to see deaths of the cases take. Away, but do not necessarily get the link to the ebola message. Many still just feel that sending someone off in an ambulance is going to result in death and in most cases the ambulance drivers do not notify the families where their relative is being taken.

Surprisingly, there are still neighborhoods where no Ebola has actually come up. While they know the messaging, the possibility of a case coming up has a high probability of occurring because it is a rote message. It seems to me from what I have seen, that it is only in the presence of one REAL case emerging, that the community recognizes what it means at the ground level. Death is the reigning teacher and our job is to change that. A year later we are still not getting there in Freetown. But we try anew every day. To say it is frustrating is a weak representation of the reality. Add it to ineffective strategies by the smart, moneyed NGOs and it occasionally feels a little more “overwhelming” than it does “challenging”. Keep sending us energy for the strength of heart. I have a staff full of people who are so good and enthusiastic and creative and I would like them to keep feeling that way.

The national holidays celebrated for Good Friday and Easter Monday are prime family celebrations and we have given all the HP staff the 4 days off to be at home with the people they love and I know that will work wonders in making their wonderfulness even more so. It is what I continue to feel from all of you and there is not enough I can ever do to thank you for that.

As for the music in my head this week was a shuffle of Paul Simon’s Pigs, Sheep and Wolves which I mentioned before (it precedes each NGO meeting I go to); I Can See Clearly Now by Johnny Nash (this was in a Seattle sunshine break thru kind of way…intermittent and brief); Highway to Hell by Chris Rhea for each trip I have to make to get to a meeting at the British Consulate; With A Little Help From My Friends by Kenny Rankin; Code of Ethics by Manhattan Transfer as well as their version of This Independance. Last but never least, the end of the day anthem has to be, at least, a brief but patient listen to at least one phrase of the 17th Ave Allstars Yes You Can Can. Listen to those if you want the audio version of what I have written here. There is also a very old version of Alice In Wonderland (how did you get to Wonderland, over the hill and underland…) that is right before she falls into the hole. It just comes up at random times.

freetown route that tries to avoid traffic jams

I love you all. Here are some photos.These are actually the glamor shots. I need to get past my fear of traffic so that I can photograph the non-glam images

Dressed for success in the hp community

UpHill Freetown


The terrace that I don't usually see or sit on because of construction and generator noise or big church stuff. In wrote to you here early this morning.