High Risk Zone: Diary of an aid worker in Sierra Leone

This story was originally published as the feature article in the February 2015 issue of Trek Magazine.


December 22, 2014

As I disembark from Lufthansa flight 492 at Vancouver International Airport, two young men in dark blue uniforms deliberately block the economy class exit; another pair blocks business class. Painful-looking telescoping batons hang from their hips as they check the passport of every travel-weary passenger. I saw this routine many times during my UBC Arts Co-op days when I worked with the Canada Border Services Agency, and I know exactly who they’re looking for: me.

I show my passport. The leader of the quartet tilts his head to his shoulder, radios to someone that I’ve been found, and leads me away. As we pass the airport’s mesmerising jellyfish aquarium, I ask if they really expected to find me in business class. “No, it was just in case you decided to wander.” They needn’t have worried; I wasn’t about to hide from the authorities: my carry-on is a big, fire-engine red duffel with “Médecins Sans Frontières” plastered on each end. “So,” he asks, “how was Sierra Leone, man?”


November 9, 2014

Following a two-day Ebola training course in Amsterdam, our MSF team flies to Freetown, the capital of Sierra Leone.

MSF Ebola training in Amsterdam

As we walk off the tarmac at Lungi International Airport, a man directs us to a water-filled bucket with a simple plastic tap, on a stand to the left of the airport terminal entrance. He instructs us to wash our hands. During training we’ve been warned that, while hand-washing stations are omnipresent in West Africa, many are either empty or hold unchlorinated water. Curious, I raise my dripping-wet hands to my nose and inhale deeply. My head spins as not-so-fond memories of childhood swim lessons slap me in the face. I won’t repeat that mistake.

The immigration officer stamps my passport with a half-page visitor stamp reading “occupation in Sierra Leone prohibited” despite my multiple-entry work visa. As I watch his left hand pick his nose then return my passport, I’m already lifting a bottle of hand sanitiser from my pocket. Obsessive hygiene habits will regulate my every move in this Ebola-stricken country if I want to sleep soundly at night.


November 11, 2014

The Ebola management centre where I work in Kailahun, eastern Sierra Leone, is big. At peak occupancy, its 12 tents held over 100 patients. Ambulances carrying suspected Ebola cases show up several times a day.

An ambulance arrives carrying suspected Ebola patients in Kailahun, Sierra Leone

The Low Risk zone holds the on-site medical office, water and sanitation team area, laundry service, dispensary, change room, and dressing and undressing tents. The Public Health Agency of Canada’s mobile laboratory operates out of two canvas tents, also in Low Risk, testing samples every morning for Ebola RNA.

Patryk, from the Public Health Agency of Canada lab, tests blood samples for Ebola in Kailahun, Sierra Leone

The patients’ area – the High Risk zone – is straightforward: two tents for people suspected of having Ebola; two tents for people showing more symptoms than the suspect cases but not yet confirmed by the Canadian lab; and eight tents for patients testing positive.

As logistics manager for the MSF Kailahun Ebola management centre, I’m responsible for keeping the centre running smoothly. This involves construction and rehabilitation, infrastructure maintenance and repairs, site security, maintaining diesel generators, electrical systems and lighting, plus odd tasks such as setting up an outdoor projector screen and sound system to entertain patients with movies and dance music.


December 1, 2014

I’ve been called back to the centre – the lighting has failed in two of the patient tents. Without light, the medics are not allowed to work. Anna, a Dutch medical doctor specialising in infectious diseases, accompanies me. We enter the change room, swap regular clothes and footwear for hospital scrubs and rubber boots, and exit through another door into Low Risk. While I will be in High Risk, Anna will remain in Low Risk ready to manage any unforeseen situations.

I can only enter High Risk with a buddy, so a hygienist named Foday comes too. If either of us leaves for any reason, the other will need to go too. In the dressing tent, we don our now-ubiquitous and colourful personal protective equipment (PPE), covering our faded turquoise hospital scrubs and white gumboots with a yellow spacesuit, white apron, blue nitrile gloves, pink facemask, white hood, anti-fog ski goggles, and green rubber gloves. My mirror-writing-on-forehead skills improve quickly in Kailahun.

Writing my name on my forehead, so colleagues and patients know who's hiding under the spacesuit

Donning PPE in Kailahun Ebola centre, Sierra Leone

Foday and I check each other for dressing mistakes – we’re responsible for each other’s safety, especially any PPE “accidents” such as snagging and tearing the suit on an exposed nail or splinter, or exposing skin because of a goggles slip. Something as simple as fogged-up eyewear, or a facemask soaked with condensation, will trigger an immediate departure from High Risk. A fashion faux pas in an Ebola centre could be fatal.

Foday and I walk through the Suspect and Probable areas, and into Confirmed. Flashlights hang from strings tied to the tent frame; others rest against the faces of patients sleeping on canvas cots. Between two tents, we find two light garlands have been disconnected from each other. I reconnect them and the lights come on. Happy to have solved the problem, we begin telling Anna, still standing a safe distance away in Low Risk, when a light turns off behind her. A second later, the lights above us go out. I hit the nearby switch to turn the lights back on and hear a loud pop. Not a good sound. Then, I hear a much worse sound: the generator rumbling to a painful stop a hundred metres away. The remaining lights flicker out as the entire Ebola centre loses power.

“Oh no,” I think to myself. “What am I going to do now?” Still wearing full PPE, there’s no efficient way for me to get to the generator. I take two long, deep breaths, then send Anna with basic instructions for restarting the generator. This way, I can stay in full PPE a little longer and keep trying to get the lights back on in the two tents. However, five minutes later Anna returns, unsuccessful. For safety’s sake, I need to get the generator going, so Foday and I make our way cautiously through the dark to the undressing tent, sidestepping furniture and trash scattered by patients. Tripping in the dark could expose us to Ebola, and neither of us is keen to be the next patient in Kailahun. In the undressing tent, the undressers shine flashlights so we can see to remove our gear. Unencumbered by my spacesuit, I race across the street to the generator room and succeed in restarting the generator, restoring power to most of the site. Other staff will enter High Risk to relocate patients from the unlit tents so medics can care for them.


December 12, 2014

Another hot, sunny day and I return to High Risk with my handyman for routine maintenance. As we hammer nails into an overhead beam, Andy – a British nurse with a thick northern accent – comes over and speaks through his spacesuit: “Hey mate, have you got a lot of this work to do?”

“No, just a few more nails and we should be done. If the noise is making any trouble for the medical work, we can stop.”

“No, no,” Andy says. “It’s just that we’ve got this little girl dying and we’re trying to give her a bit of peace in her last moments, but it’s fine if you’ve just got a few more nails to finish.”

Looking over his shoulder, I see the girl lying on a bed outside a tent, her head tilted to one side, her little body unable to cope with the disease. Three medics in yellow spacesuits sit on the edges of her bed, stroking her head softly as if she were their own daughter. Adult fingers in a white surgical glove gently hold her small brown hand. It’s all they can do for her as she drifts away. Later, in the medical tent, I see the grave-stick prepared for her: Augusta*, age 2, patient number 1166. Andy has drawn a little flower on the grave-stick, next to her name. Five red petals on a simple stem, with two green leaves.


Late December 2014

Despite the tragedy, there’s good news at the centre almost every day: patients are discharged, families are reunited, and the number of patients steadily decreases. When I arrived in Kailahun, the centre was packed. Six weeks later, only two patients remain.

At the Vancouver airport, a quarantine officer takes less than an hour to check me over, while a border services officer stands guard. I’m given a thermometer, instructed to report daily to the government by phone, then I collect my luggage and step out into the chilly winter air. Looking right and left of the door, there isn’t a bucket of chlorinated water in sight.



*Name changed to protect patient confidentiality

Two trips to Portugal

During my current contract with the International Federation of Red Cross and Red Crescent Societies in Guinea, according to the policy for delegates working in the stressful context of the Ebola epidemic, I had to take two short R&R breaks.

For the first one, I chose to visit Portugal because the flight price and length were both low, and because I’d never been to Portugal before. As a bonus, it just so happens that Portugal starts with the letter P: I’d never been to any country starting with the letters O, P, Q or X, Y, Z. Now, only five remain (X is going to be a tough one…).

Before I’d even left Guinea, my Singaporean friend Angela (check out her design portfolio at Behance: Angela Soh) told me about her plans to travel Europe, and we agreed to meet up wherever she’d be during my second R&R. As it turned out, Angela planned to arrive in Portugal at the end of May, at the same time I would be starting my holiday, so I booked a second trip to Portugal two months after the first. Here are a few photos from the two trips:

Trip 1: Sintra and Lisbon

I landed at Lisbon Portela Airport in Portugal on 24 March, caught a bus into town and then a train west to the small town of Sintra. As soon as I’d dropped my bags in my rented apartment, I hit the cobblestone streets to explore. This is the town hall:

Sintra Town Hall, Portugal

On my ramble home through the side streets of Sintra, I stumbled upon this old Piaggio three-wheeler and wished I could take it for a joyride:

Old Piaggio three-wheeler in Sintra, Portugal

The next morning I visited Quinta da Regaleira, a fantastical estate built by a set designer for a very wealthy man. Looking out from a cave:

Looking out from a cave at Quinta da Regaleira, Sintra

Walking through an underground tunnel:

Tunnel at Quinta da Regaleira, Sintra

There are also two initiation wells on the estate: towers that make you feel like you’re descending underground as you enter through a secret revolving stone door at the top and spiral downwards.

The initiation well at Quinta da Regaleira, Sintra

Some flowers floating on water with little green somethings:

Flower petal on green aquatic plants at Quinta da Regaleira, Sintra

There are loads of fancy stonemasonry creations at Quinta da Regaleira. Here’s an example:

Tower at Quinta da Regaleira, Sintra

That afternoon, Ricardo picked me up and drove me down to the coast to see some of the natural beauty of the area. Looking toward Cabo da Roca, the westernmost point of continental Europe:

Cabo da Roca, the westernmost point of continental Europe

Views in Sintra-Cascais Natural Park:

Waves crashing on the rocks near Cabo da Roca, Portugal

Yellow building in Sintra-Cascais Natural Park

The next day, I walked through the fog and some rain to the Capuchos Convent (which was a monastery). Luckily I had a map in my phone, as I walked along forest paths through the hills not on any tourist maps.

Low clouds in the forest walking from Sintra town to the Capuchos Convent

Cross on a cairn at the Capuchos Convent:

Cross on a cairn at the Capuchos Convent

The monks used cork to protect against moisture, tacking it around windows, doorways, even entire ceilings.

Cork-insulated window at the Capuchos Convent

On this visit to Portugal, I finally got to see real Cork oak, the tree species from which we get genuine cork material. This is what it looks like when it hasn’t been harvested:

A Cork oak tree

On the walk home, I stopped in at the Park and Palace of Monserrate, formerly owned by Sir Francis Cook. The botanical gardens are amazing, but I didn’t take too many photos so you’ll have to visit to see for yourself. Tree roots overgrowing a mock ruin:

Tree roots overgrowing a mock ruin at the Park and Palace of Monserrate, Sintra

Young Aloe vera leaves growing out of an old plant:

Aloe vera growing at the Park and Palace of Monserrate, Sintra

Monserrate Palace:

Monserrate Palace, former estate of Sir Francis Cook

Parts of the palace were under renovation, as water had damaged the ornate alabaster designs. It was interesting to see what’s behind all the fancy moulding:

Alabaster restoration inside Monserrate Palace, Sintra in March 2015

On 27 March I walked up the steep path to visit the Castle of the Moors, a fortress overlooking Sintra:

Castelo dos Mouros, seen from below

The Castle of the Moors (Castelo dos Mouros), Sintra

For a brief moment while I was at the Castle of the Moors, the sun shone through the clouds and directed a spotlight right onto the National Palace of Sintra in the town below:

National Palace of Sintra, seen from the Castle of the Moors

After rambling over the ramparts, I headed over to Pena Palace, which appears to have come straight out of a fantasy fairytale:

Pena Palace, Sintra

Grandiose vaulted carriageway into Pena Palace

Poseidon at Pena Palace

Pena Palace, Sintra

Pena Palace, Sintra

The view from Pena Palace to the Atlantic Ocean:

View to the Atlantic from Pena Palace

I was highly impressed by this wood and velvet shelf inside the palace:

Ornate woodwork and velvet shelf at Pena Palace

Mandatory flag photo:

Flag of Portugal

Pena Palace from a nearby vantage point, with Sintra in the background:

Pena Palace, Sintra

On the grounds of Pena Palace are a number of other things to see, including the Chalet da Condessa d’Edla, a whimsical home with ornate cork woodwork framing the entire thing:

Chalet da Condessa d'Edla, Sintra

On 28 March, I caught the train to Lisbon. The 25 April bridge bears a striking resemblance to the Golden Gate Bridge, no?

25 de Abril Bridge, Lisbon, Portugal

On 29 March I wandered the streets of Lisbon, wrote postcards while a daytime drunk blasted tunes on his phone nearby, and wandered the streets some more. This is Rua Augusta Arch, built to commemorate Lisbon’s reconstruction after the 1755 earthquake:

Rua Augusta Arch in Lisbon, Portugal

If you’re familiar with the Brussels street art scene, you’re used to seeing pencil crayons all over town. If not, you can see a collection of over 600 photos of the pencil crayon street art here: flickr ancatphil. Well, one of the artists seems to have made a visit to Lisbon, where he or she got to a hard-to-reach spot to paint this pencil crayon figure, who appears to be sitting on a toilet taking a dump:

Pencil crayon street art in Lisbon

There are many old street trams in Lisbon, mostly packed full of tourists:

Electric tram in Lisbon, Portugal

Sunset over Lisbon:

Sunset in Lisbon, Portugal

My flight out of Lisbon was on 30 March, but before I went to the airport I caught a train to Cascais to take a walk by the sea. Cascais is too beach-touristy for me, but it was nice for a stroll.

Cascais lighthouse

While standing near the underwhelming Boca do Inferno, I spotted a school of catfish having some sort of feeding frenzy at the surface of the water:

Catfish feeding frenzy at Boca do Inferno, Cascais

Walking farther along the coast, ice plants (an invasive species initially brought in from Africa on purpose) colour the shoreline:

Ice plant in the foreground, lighthouse in the background, at Cascais

That evening I flew back to Guinea, landing at 04:00 only to find no vehicle waiting for me. A fitting start to two very challenging months of work.

Trip 2: Porto and Lisbon

On 28 May I once again flew from Conakry to Casablanca, and then onwards to Lisbon. This time, I jogged a bit and mostly walked as fast as I could through the airport, caught the metro to the train station, bought a ticket, and boarded the train to Porto with 2 minutes to spare. The next one would have been an hour and a half later. I arrived in Porto in the late afternoon and met up with my friend Angela, who’d arrived a few hours before. The next morning we had breakfast with Callum and his girlfriend, who happened to be in town for a wedding.

Callum Benson and me in Porto, Portugal

Angela and I walked up and down the steep streets of Porto, got confused a few times, drank lots of coffee, and took photos. Looking across the River Douro to some ruins and the Mosteiro da Serra do Pilar:

Mosteiro da Serra do Pilar, Porto

There are only two tram lines remaining in Porto:

Electric tram in Porto, Portugal

We stopped in to look at all manner of old camera at the Portuguese Centre of Photography:

Old camera at the Portuguese Centre of Photography, Porto

Every day we passed by the Church of Saint Ildefonso as we walked to or from our rented apartment:

Church of Saint Ildefonso, Porto

The Lello & Irmão bookshop is said to have been the inspiration for the library at Hogwarts, in the Harry Potter series, although the best part of the bookshop – this fantastic staircase – isn’t found at Hogwarts:

Livraria Lello & Irmão, Porto

On 30 May, we caught the tram to Foz do Douro. The old trams still have the cable to ring for the next stop; the cable causes a little striker to hit the bell mounted on the ceiling of the driver’s cab: full analog.

1920s tram in Porto, Portugal

Felgueiras Lighthouse:

Felgueiras Lighthouse at Foz do Douro, Porto

Queijo Castle:

Queijo Castle, Porto

On 31 May, we caught the train to Guimarães for a day visit. After a couple of coffees each, we visited the Palace of the Dukes of Braganza, which has an interesting roof construction:

Roof structure at the Palace of the Dukes of Braganza, Guimarães, Portugal

Two of the rooms in the palace have ornate paintings on the ceilings, causing much neck strain:

Ceiling detail, Palace of the Dukes of Braganza, Guimarães

Ceiling detail, Palace of the Dukes of Braganza, Guimarães

After the palace, we bought some chips then caught the cable car up to Pena Mountain:

Angela and me in the teleférico (cable car) de Guimarães

Teleférico de Guimarães

Pena Mountain has some neat paths through, over, and under boulders although on this quiet Sunday in Guimarães, the mountain was a gong-show of families and groups who’d driven up with gear for Sunday picnics and merriment.

Steps through stones on Penha Mountain, Guimarães

There was a Cork oak up on Mount Pena which was missing most of its cork bark. So, here you can see the before/after of cork harvesting:

Cork oak, with the cork bark partially stripped

Back down in Guimarães town, the Church of São Guálter is a neat sight:

Church of São Guálter, Guimarães, Portugal

On our last day in Porto, we walked across the bridge to Gaia and took a short tour of the Taylor’s port wine cellars. They age different types of port in different sized barrels, such as these enormous 24,000+ litre wooden barrels…

Enormous barrels of Taylor's port ageing in the cellars at Porto

…and these 600+ litre barrels:

Hundreds of barrels of Taylor's port ageing in the cellars at Porto

After the tour, we were given small taster glasses and encouraged to sit in the sun and enjoy. Here, Angela and I are enjoying port wine in the sun:

Enjoying a tasting sample of Taylor's port with Angela

Back in the day, port wine was transported down the river on boats like these:

Dom Luís I bridge, Porto

On 2 June, Angela and I caught the train down the coast to Lisbon, where we drank coffee then wandered the streets, eventually stopping in to see the Design and Fashion Museum right before they closed. This colourful chair caught my eye:

Colourful chair at the Design and Fashion Museum, Lisbon, Portugal

That evening, my last in Portugal, we went to a small bar to enjoy some fado,a traditional form of Portuguese singing accompanied by two guitars. We had a great time listening to music and making friends with strangers from Italy and Germany at our table during the breaks.

Twelve-string Portuguese guitar during a fado performance in Lisbon, Portugal

It just so happened that Mike and his brother Sebastian were in town as well, so they came down to watch fado and then dragged me around town for late night adventures. Here, we each make a serious face:

Post-fado adventures with Mike and Sebastian in Lisbon

Although I was five minutes late to the airport, the check-in lady was kind enough to sit back down and print my boarding pass. Not long after, I found myself in Casablanca, on an airport shuttle to a nearby hotel to have a nap and dinner, before flying onward to Conakry. I landed at 04:00 and, once again, they had forgotten to send a car to pick me up. Hopefully not a sign of things to come, this time.

Domiz Refugee Camp and the Blustery Day (March 2013)

[This post is being published out of order: the story is from March 2013]

From September to November 2012 and again for two weeks in March 2013, I worked in Domiz Refugee Camp, a few kilometres outside Duhok, in the Kurdistan Autonomous Region of northern Iraq.

A view of the city of Duhok, Duhok Governorate, Kurdistan Autonomous Region, Iraq:

A view of the city of Duhok, Duhok Governorate, Kurdistan Autonomous Region, Iraq

At the time, the camp was expanding like a child who outgrows her clothes faster than her parents can buy new ones. The local government institutions and local and foreign humanitarian organisations were struggling to keep up with the needs of the ever-increasing numbers of refugees crossing the border from Syria. They made a serious effort, though. There was even a garbage service in place, though the truck sometimes encountered difficulties getting around the camp:

Garbage truck stuck in the mud in Domiz Refugee Camp, November 2012

Some areas of the camp had sprung up haphazardly during one of several sudden surprise influxes of refugees. Having not been planned out ahead of time, these areas had worse conditions than most of the camp, like these makeshift latrines installed in an area that flooded as soon as the first rains fell:

Ill-placed latrines in Domiz Refugee Camp, November 2012

In the final weeks of my first stay in Duhok, I had the great fortune of being invited by the Directorate of Health (DoH) to offer my input on the design for a new health centre to be built by the Kurdish government and jointly managed with MSF (Médecins Sans Frontières aka Doctors Without Borders) in Domiz Refugee Camp. I met with their engineer, and over the next two weeks we passed designs back and forth by email until we had a final version that satisfied everybody.

The construction process was managed entirely by the DoH. The Yazidi contractors they hired were soon breaking ground and setting the foundation for a new health centre in a spacious area on a hill overlooking the camp, a significant improvement on the cramped, makeshift health centre housed in prefabricated containers right across from the UNHCR refugee registration offices in one of the busiest and most crowded parts of the camp:

Crowds fill the area between the MSF primary health centre and UNHCR refugee registration area, November 2012

The cramped pharmacy in the old health centre:

Cramped pharmacy in the undersized MSF primary health centre in Domiz Refugee Camp, November 2012

Starting the new health centre:

Beginnings of the foundation of the new primary health centre in Domiz Refugee Camp

A member of the Yazidi construction team takes a smoke break from building the foundation of the new health centre in Domiz Refugee Camp

Two MSF drivers admiring the new health centre foundation

By the time I left Domiz Camp on 28 November 2012 the foundation work was just about done but, sadly, I wouldn’t be there to see the rest of the centre built. I spent the next six months splitting my time between Kirkuk and Hawija. These two cities were a world apart from peaceful Duhok. Suicide bombers, exploding vehicles, roadside bombs, and armed attacks were commonplace in these two cities, though they were never aimed at us. However, in March 2013 our entire team was relocated from Kirkuk to Erbil (the incredibly safe capital of Iraqi Kurdistan) for security reasons for about three weeks. Rather than twiddle my thumbs at a desk in Erbil, I returned to Duhok to lend a hand for two weeks. Arriving back to the camp after a three and a half month absence, the first thing I wanted to see was the new health centre, now in use:

March 2013: the new primary health centre is up and running in Domiz Refugee Camp

The new health centre was a tremendous improvement, but the camp population hadn’t stopped growing, so the building was already a size too small by the time it opened. Part of my job during my short stay would be to order prefabricated sandwich-panel portable buildings and install them on the health centre grounds to house some of the health services such as a planned child malnutrition ward. I made the simple floorplans with advice from the medical team, ordered the buildings, and soon afterwards we began receiving them:

Lowering the prefabricated malnutrition building into place

Just a few metres from the health centre, there were a series of modular tents left behind by a German medical organisation. MSF was using these tents as temporary medical facilities while we planned to build something more permanent:

Tents helped MSF handle the overflow of patients at the new health centre in Domiz Refugee Camp

On 16 March I was at the camp, as usual. It was a breezy morning, and as the hours went by the breeze became a strong wind. As the wind increased in power, the tents began swaying. I would learn later that day, on closer inspection, that the German medical organisation had not installed the anchors correctly for the guy lines. Not knowing this, in the early afternoon I and a couple of helpers set about weighting down the tents with cement breezeblocks and checking that the guy lines were taut.

Placing cement breezeblocks to weigh down the tents during a building wind storm

Well, the wind kept howling and pretty soon it was a full-blown blustery day in Domiz Refugee Camp. I noticed a slack guy line at the corner where the larger consultation tent met the stabilisation tent, so I bent down to tighten it. As I was doing this, I caught a sudden rush of movement in my peripheral vision to the left of me, and instinctively dropped to the ground. My body naturally rolled without any conscious decision to do so; I watched canvas flying over me, metal poles passing just inches from my body, as the enormous consultation tent lifted, flipped, and twisted. It carried the smaller consultation tent, stabilisation tent, and central hall with it through the air, along with dozens of cement blocks we’d added for weight, and the medical examination tables, desks, and chairs that were inside. I was relieved to be unhurt: just a little dirty from the fall, my shirt torn, and my phone no longer in my pocket – an acceptable outcome, considering the circumstances. I took a photo of my torn shirt when I got home:

My shirt, torn as I rolled on the ground while the consultation tent flew over me

One of the health centre cleaners was deeply saddened by the destruction and needed a moment to settle her emotions:

Cleaner fights back tears as she ponders the destruction of the medical tents

I made a sketch of the tent setup for my incident report at the time. In the photo below, I’ve marked a small circle where I was working on the rope when the 6 x 10 metre consultation tent flew over me. The tents labelled 1 through 4 ended up in the area marked “4 tents mangled”:

Sketch of the medical tents in their original and post-storm positions

By late afternoon we’d given up hope of getting anything productive done with the tents that day, so we readied ourselves to leave. We climbed into the vehicle but, as we began to drive away, I spotted a man walking among the tents so I got out and spoke with him. I could tell he was hiding something, so I asked him to open his jacket. He did so, revealing the electrical cabling he was trying to steal. He returned it and left, and as I walked back to the vehicle a loud noise took over the skies, and out of nowhere grains of sand began hitting my face. I rushed to the car and within seconds we were in the middle of a sandstorm. We opened the vehicle doors to let in some refugees caught in the storm nearby, then watched as the 6 x 10 metre triage/waiting tent stood up on end for a moment before flying across the yard and catching on a streetlight. In the sketch above, it’s tent number 5 that flew to the top left corner of the sketch – over 50 metres.

In this photo, the tent doesn’t appear very large, but have a look at the people to the left and note that it’s caught on a full-sized streetlight:

A 6x10 metre tent blown straddles a streetlamp in Domiz Refugee Camp, 16 March 2013

At the end of the blustery day, only two tents remained standing, one of which was damaged and later repaired with poles salvaged from the wreckage. Here, between the two remaining standing tents, you can see the large footprint of the consultation tent that flew over me:

Between the two remaining standing tents, you can see the large footprint of the consultation tent that flew over me

Removing cement breezeblocks from inside the destroyed tents:

Removing cement breezeblocks from inside the destroyed tents

Cleaning up after the storm:

Cleaning up after the storm at the primary health centre, Domiz Refugee Camp, March 2013

Tent poles and posts sheared off:

Tent poles and posts sheared off

Tent poles and posts sheared off

As we cleared the rubble, we found my phone wrapped up inside the remains of the consultation tent a far distance from where I’d been standing. The phone, which I’d bought in 2011 in Côte d’Ivoire, still works to this day (2015).

Nokia 1280 found amongst the rubble

We took down the isolation tent (which, though still standing, was damaged), found replacement poles among the wreckage, and put it back up next to its last surviving relative:

Two surviving tents at the MSF-supported primary health centre, Domiz Refugee Camp, March 2013

The tents weren’t the only things to be tossed around like children’s playthings. The prefab malnutrition building pictured earlier had tried to escape during the storm:

The prefab malnutrition building tried to escape during the storm

I measured the distance from point to point and made the sketch below, showing that one corner of the malnutrition building shifted 8 metres (~26 feet), while the other corner shifted 11 metres (~36 feet) as the building slid and rotated. respectively.

Sketch of the malnutrition building in its original and post-storm positions

Immediately following the sandstorm, dozens of people were rushed to the health centre, mostly suffering from breathing problems caused by inhaling sand, and a small number of injuries from flying objects. The refugee homes were mostly untouched, as they were lower to the ground and securely fastened.

By noon the following day, it was perfect spring weather in Domiz Refugee Camp:

Perfect spring weather in Domiz Refugee Camp, 17 March 2013

Like the ill-fated tents, this kid flipped head over heels to get over the fence, showing me his parkour skills:

A Syrian refugee boy performs a gate vault, a move frequently used by traceurs in Parkour

Lastly, here are two random happy photos. A father with his children taking a break from setting up his new tent on a cement base, and a pair of siblings I bumped into a number of times in the camp:

A father with his children taking a break from setting up his new tent on a cement base in Domiz Refugee Camp, November 2012

Refugee children I frequently saw in Domiz Refugee Camp, November 2012

Building bridges with the community – Part II: from bamblooprint to reality (September 2014)

[This post is being published out of order; the story is from September 2014]

Disclaimer: This post does not contain any technical information or advice for constructing or repairing bridges that are safe and structurally sound. Do not use anything written below as a guide for bridge construction or repair.


On the second Thursday of September, we arrived at the Pont (bridge) Pende, 40km south of Grimari on the Kuango road in Ouaka Préfecture, Central African Republic, and found ourselves unable to make the crossing in our Land Cruisers. Turning back northward, we stopped in Lakandja to speak with the mayor and some of the villagers. With Yvon, one of our superstar drivers, I explored the central section of the conglomeration of seven villages, creatively named Kandjia 1 through Kandjia 7, on foot.

In addition to a number of dirty wells, we were taken one kilometre down a path to a natural spring from which many villagers draw their water. The natural spring water flowing out of a rock face looked and smelled clean enough, but without testing it there’s no way to know whether it’s really safe.

Spring water flowing near Lakandja, Central African Republic

However, as I stood chatting with a local man named Samedi (Saturday) at the edge of the shallow pool of water beneath the spring, I watched a woman dip her yellow plastic jerry can into the murky puddle at her feet, swish the brackish liquid around for a few seconds in a misguided effort to clean the container, empty the contents back into the brown water, then set the jerry can on the stone pedestal and reposition it until the stream of spring water was falling through the opening. The other women and girls followed suit. Clean water is only as safe as the receptacle in which it is stored, so it came as no surprise to hear the mayor tell of many cases of diarrhoea in the village.

After two hours looking around Lakandja, Yvon and I reunited with the medical team and together we agreed to return the following week to run a mobile clinic there.

We left Grimari just after 06:00 on the third Thursday (Thirdsday?) in September, driving south along the road that leads to Kuango. The medical team was made up of Alex, our Swedish doctor; Jean-Claude, Éric, and Félix, our nurses; and Dimanche, a local sécouriste. They would hire extra help onsite in Lakandja for crowd control, registration, temperature taking, and so forth; our polyvalent driver, Yvon, would handle the malaria rapid diagnostic tests.

Eric and Dimanche setting up for the mobile clinic:

Eric and Dimanche unloading the Land Cruiser

The sign in the photo below says “Lakandja Central Market”. Destroyed by armed groups, the market was mostly just piles of mud bricks where shops had stood.

Marché central de Lakandja

On my bridge building team I had two daily workers: Backer and Max. Backer had overseen the team of daily workers rebuilding the Pont Boungou a week earlier. Max was a regular daily worker at our base, and had proven to be sharp, conscientious, and hardworking. I chose these two to jointly lead a team of twenty daily workers drawn from the five villages nearest to the bridge.

Once we finished setting up the mobile clinic tables, tarps, and crowd control fencing in Lakandja, I jumped back into one of the two Land Cruisers with Zach (driver and self-appointed logistics assistant), Backer, and Max, and we set off southwards for the problematic Pont Pende, ten kilometres down the road.

The bridge was actually much more than problematic – it was nearly nonexistent. Two of the four original steel I-beams protruded from the fast-flowing water at French-friesian angles. The other two beams, each flipped on its side, still straddled the gap. A handful of crooked little tree trunks, bound together and set parallel to the beams, allowed commuters to cross on foot while rolling overburdened bicycles and motorcycles beside them on the metal beam – riding across would be too risky.

The old Pont Pende, 10km south of Lakandja, Central African Republic

Eric stands on the old Pont Pende, 10km south of Lakandja, Central African Republic

The day before, I’d sent letters by motorcycle to the leaders of nearby villages, asking them to identify 20 strong, hardworking men to build the bridge. I did my best to write in a tone both polite and pressing, with a handful of bureaucratic buzzwords sprinkled into the mix. Then, I printed the letters on official-looking MSF letterhead, signed with important-looking long blue pen strokes, and endorsed each one with a red rubber stamp. The rubber stamp is vital; in so many countries once colonised by Europeans, the systematic use of cachets to assign authority to an otherwise mundane document has persisted. Pro-tip: your stamp and signature must overlap at least partly, otherwise your document will be considered by some to have not been officially endorsed. This actually happened to me on more than one occasion.

When we arrived at the bridge (or rather, lack thereof), there must have been over 80 people waiting for us! It took just shy of an hour for us to sort everything out. First, we had to discuss our intentions and proposed plan of action with the mayor of Goussiema and the chefs from a number of nearby villages and quartiers. With their approval, we then needed to confirm the selection of twenty daily workers from the nearby villages. The names had been chosen the day before in each village: 6 from Lakandja, 2 from Koussingou, 2 from Bimbo, 2 from Zouniyaka, and 8 from Goussiema.

It was at this point that we hit a slight obstacle: in the week that had passed between our first and second visits to the Pont Pende, a team of youth had made a very slight improvement to the existing bridge. They had sprinkled some spindly tree branches and a bunch of stones to increase the bridge deck surface area, which was a modest improvement for pedestrians, but served no purpose at all for anything heavier than a motorbike. They had not added any kind of structural supports, so the bridge remained unsafe for vehicles.

Max demonstrated, by standing in the middle of the bridge and jumping up and down – the whole thing flexed and wobbled and creaked under the strain of his 60kg body. A 1750kg Land Cruiser, with a driver and cargo, would not likely make it more than a metre onto the bridge before taking a steep nosedive directly into the water. A motorcycle could make it across, but only at great risk.

We thanked them for the effort and sentiment, but explained that it would not be possible to cross this bridge without rebuilding it properly. The boys understood, but they asked us to pay them for the work they had done. I explained that the bridge they built wasn’t correctly done, that we appreciated the gesture, but that we couldn’t pay for work that was supposed to be done for free, and which wasn’t even done properly. The boys accepted this, but they asked to be paid as part of the new team. I asked how many they were, and the leader brought me a written list of twenty-five names! I was taken aback: the work they’d done should have taken three to four hours for a tiny group of two or three people. The situation began to smell fishy, but looking around I could see nobody holding a rod at the water’s edge.

The mayor of Goussiema intervened and decreed that the first group had accepted to fix the bridge as a community service and should not now be asking for payment; they had not done a good enough job, and they were mostly quite young, so they could not be hired as daily workers in the new group. They reluctantly accepted, but only after we agreed for them to remove the work they had done. For some reason, they tried to remove the entire bridge, old metal beams included, which led to an acute increase in volume as people converged to stop them from moving the beams – we had no plans to incorporate these beams into our new bridge, but no locals would be able to cross during the works if the beams were removed!

As this situation was heating and cooling like the oscillating fever typical of malaria, a half dozen daytime drunks lounged in deckchairs at the north end of the bridge, asking for work, stumbling into each other and the bushes, and taking turns expressing their ill will toward the group of daily workers whose names figured on the official list. Eventually, the drunks variously dispersed or fell asleep.

The team divided into two groups of ten, hacked away a hundred metres of roadside jungle-shrubbery in half an hour, then returned for further instruction. A boy brought a narrow bamboo chute on Zach’s instructions, held it to the ground and chopped it into 20cm segments with a few sharp wrist snaps of his machete. My knees creaked and cracked like the bamboo chute seconds before, as I crouched down to begin the demonstration at ground level. The bamboo pieces represented logs. First, I formed a rectangle out of a handful of logs set parallel to one another, then I positioned a second handful above that one, but rotated ninety degrees to run perpendicular to the first layer. As the layers built up, a little platform took shape: this was the bamblooprint for the footings on either side of the water. With the footings solidly installed, the team would then need to drag five sizable tree trunks to the site and rest the two ends of each trunk on the two footings, bridging the gap. After that, the bridge deck could be made using smaller trees laid crosswise and nailed onto the large tree trunks.

With the team already digging out the areas for installing the footings, Zach and I said our goodbyes and wished them all luck. Max and Backer remained with the twenty daily workers to manage the job on our behalf. Three days later – Sunday – I sent a motorbike with a digital camera to take photos and bring Backer back to Grimari for an update. We gave him further instructions, extra supplies, and tools, then sent him back out to work. He also took the equivalent of twenty dollars to split between the two coffee planters from whose land we had cut the five large trees, and another twenty dollars to pay for two nice cowhides. The leather would be softened in the water at the worksite, cut into strips, and used for lashing everything together.

On Wednesday I sent two motorbikes to bring Max and Backer back to Grimari, hoping the work was finished. With no phone network, the only way to communicate was to send motorbikes! In the afternoon, they returned, exhausted from the gruelling week’s work. Photos from the digital camera indicated success. We chatted for a while before sending them home to sleep.

The next day, we were up at 05:00 for a 06:00 departure to Pouko, about 40km northwest of Grimari on the road leading toward Dekoa, for a mobile clinic. Yvon and I masterfully managed the 107 malaria rapid tests. By early afternoon, we had finished testing patients, so I asked Yvon to test me for fun. I’d been feeling unbelievably tired the day before, and had lower back pain that I attributed to my poor quality mattress and the rough roads we’d been travelling of late – both of these are common symptoms of malaria. A few minutes later, my test result came back positive, for the first time since April 2010.

My first positive result for Plasmodium falciparum, aka Malaria, since April 2010

The following morning, we were up again at 05:00 to hit the road at 06:00 with Zach, Yvon, and Alex. We picked up Max and Backer and headed to the Pont Pende to check the work. We hoped we could drive our Land Cruisers across!

We arrived to a waiting crowd – the daily workers were excited to be paid, but also eager to see if their efforts would satisfy our expectations. The bridge was indeed very well built; I was highly impressed, though I likely looked otherwise, owing to my malarial light-headedness and lethargy-betraying eyelids. Both Land Cruisers drove over the brand new Pont Pende, crossing from Grimari Sous-Préfecture southward into Kuango Sous-Préfecture, with neither anxiety nor accident.

Bridge deck of the new Pont Pende

New Pont Pende, bridging Grimari and Kuango sub-prefectures in Ouaka, Central African Republic

The first ever crossing of the new Pont Pende, by an MSF Land Cruiser

I paid each daily worker for the week’s work with a colourful wad of cash rolled up, squashed flat, and sealed tightly into a six-by-eight centimetre pill bag, then we shook hands with the two mayors present for the bridge inauguration, pulled tight three point turns, and drove three hours back to Grimari.

Photo by Dr Alex Nyman: Zach, me, Max, the mayors of Goussiema and Lakandja, and Yvon (sitting) after the inauguration of the new Pont Pende

I went to bed early that Saturday night, exhausted and feverish; by morning my pyjamas and bedding had trebled in mass, and my bodyweight had decreased by as much, from a night of plasmodial perspiration.

(Luckily, on Sunday I was able to relax by sleeping in until 07:00, spending the first half of the day on the road, and the other half manning the radio station and satcomms while two of our Land Cruisers and our DAF truck tried in vain to drive to Bambari before eventually leaving the truck with a village chief and returning in the Land Cruisers to Grimari. It was such a relaxing Sunday… once again, the only official non-working day of my week.)