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.)

Building bridges with the community – Part I: when DIY portable bridge deck kits are not enough (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.


We left Grimari in two MSF Land Cruisers in the early morning of the first of September’s four Thursdays, intending to drive 60km south to Lihoto. Our objective was simple enough: ask a few questions, have a look around the town, make some basic observations on people’s living conditions and, hopefully, draw some initial conclusions about possible unmet healthcare needs. This evaluation would inform our decision to do something or nothing in Lihoto.

It was thus that we trundled forward through the morning fog as it lifted gently off the tall grass that leaned out over the dirt road. The broad green blades slapped the windshield in front of me while my window – open just a crack – harvested leaves, twigs, and angry little black ants that only bit me once they’d found someplace difficult to reach. Pulling my trousers down while in a moving vehicle to crush the ants in my pants would have been technically challenging and a tad unprofessional, so I set to work pounding my thighs and shins with closed fists as if I were playing whack-a-mole at a funfair. I didn’t win any prizes, though.

With the ants defeated, the windows shut for self-defence, and the air conditioning moderating the greenhouse effect of all that glass, I set my mind to enjoying the surge of caffeinated optimism that often washes over me during early-morning trips to new and exciting places. This warm feeling didn’t last for long.

My wristwatch GPS unit showed a paltry 6.0km travelled when we stopped and climbed out to assess the first of several bridges to cross that day, the Pont (bridge) Boungou. I had sent a motorcycle driver the day before to check the road conditions all the way to Lihoto, and he had assured me that the Pont Boungou was easily crossed. We would only need to strap some wooden planks to the vehicle roofs and lay the planks down across the existing metal beams to create a bridge deck. We faced this situation frequently, and had planned accordingly.

Unfortunately, having arrived on the spot, we discovered the motorcyclist had judged the bridge structure rather poorly. Three of the original I-beams remained but they were each twelve metres in length, far longer than we could cover with our homemade sixteen-plank portable bridge deck kit. A deviation through the slow green water to the east of the bridge seemed to be the only plausible alternative, but recent rains had raised the river level to roughly a metre above the riverbed. We couldn’t risk destroying an engine, so we spun the Land Cruisers around and headed back toward Grimari. To avoid wasting the day, we quickly put together a backup plan: we returned to Grimari then headed north-northeast to explore the communities along the road to Bakala. We succeeded to reach a village called Takobanda, farther than we expected to reach, given the fact that we’d lost a full two hours on the aborted trip. All through that day, however, I couldn’t get the bridge out of my head. As we crossed multiple bridges, repeating our time-tested plank method, I kept imagining how we might use that experience to rehabilitate the Pont Boungou.

Before I continue, let me explain, with photos, how we cross bridges that are not otherwise passable. First, we buy wooden planks and cut them into 3-metre lengths. 3m is long enough to lie crosswise on the metal beams typical of the small bridges found throughout the area, and this length also allows us to safely strap the planks onto the Land Cruiser roof racks.

Preparing wooden planks in Grimari, for the portable bridge deck kit

Arriving at a bridge in disrepair, we assess the strength of the existing metal beams and any wooden decking that remains. We then offload the planks from the roof, arrange as many as needed crosswise to create a decent bridge deck and, lastly, we place a few planks as lengthwise runners for the vehicle wheels. This last step is very important, to distribute the load across a greater surface area on the bridge deck.

This is what it looks like for a short, 3.3-metre long bridge:

3.3 metre bridge with portable bridge deck kit in place

MSF Land Cruiser crossing 3.3 metre bridge

Right after the successful crossing, we reclaim our lumber and load it back onto the Land Cruisers:

Cyrille and Mark removing our portable bridge deck planks

Loading the planks back onto the roof of the MSF Land Cruiser

Loading the planks back onto the roof of the MSF Land Cruiser

As the day went on, I began hatching a plan to restore the Pont Boungou to working order so that we could reach Lihoto the following Thursday. Over the weekend I found people willing to work for about five dollars a day, and by Monday morning a dozen young men from the nearby village of Ngoulinga were clearing brush at both ends of the bridge. My assistant, Papa Zach, and I arrived on the spot at 06:42 that day. We were immediately impressed by the team’s early morning enthusiasm and the visible progress.

Tall grass cleared by daily workers at the north end of Pont Boungou, outside Grimari, Central African Republic

Backer makes notes at the north end of Pont Boungou

While standing with Papa Zach on the steel beams over the water, my thumb and index finger stroked the hair from the edges of my mouth down to my chin, over and over. It was during this period of pondering that something among the reeds on the other side of the riverbed deviation caught my drifting eyes: the tip of the fourth and until-now-missing steel I-beam was poking out at such an angle that it could only be seen from the middle of the bridge.

Uncovering the missing bridge beam

Zach and I agreed before we’d even discussed – we would try and reinstall the old metal beam before building the wooden bridge deck.

We appointed a gentleman named Backer as the site supervisor to coordinate the work in our absence. Older than any member of the group by at least a decade if not two, Backer used to be the radio operator for the Grimari aerodrome, a laterite landing strip unvisited by aircraft in over twenty years. We agreed on the following steps to achieve our objective:

  1. Pull the metal beam from the mud and assess its usability;
  2. Cut 40 trees as straight as could be found, 4m long and approximately 20cm in diameter, and transport them to the worksite;
  3. Install the fourth metal beam, if possible;
  4. Attach wood to beams using vines, and strengthen by nailing joints together;
  5. Test drive, hopefully without falling in.

11 men heaving at an incredibly heavy bridge beam

The men discuss their strategy before continuing to move the bridge beam

By the end of the first day, the metal I-beam was up at road level, a few metres shy of the north end of the bridge. Severely bent and a bit twisted from the accident that destroyed the bridge, we found no signs of corrosion on the beam, and decided to use it as an additional support. Across the water, we had ten small, not particularly straight, tree trunks lying at the side of the road. We’d also succeeded to locate eight solid timbers at a nearby college, each 8cm x 23cm and 6m long, which had long ago been intended for rebuilding the bridge deck. Since political instability put those plans on hold, the timbers had been sitting patiently in the grass, accommodating all manner of ant, termite, and woodborer species, waiting to be put to good use.

On day two, the team chiselled and smashed and dug and clawed until a slot on each side was ready to receive the metal beam. While this work was beginning, two men were busy sawing the timbers into three-metre lengths, which we picked up in the Land Cruiser and drove to the worksite.

Sawing thick timbers for bridge supports

Timbers loaded into the Land Cruiser

The main group soon set off in search of additional small trees to place crosswise onto the beams, and strong jungle vines to lash everything together.

Two men carry a log for bridge repair near Grimari, Central African Republic

By the end of the second day we’d successfully moved the twisted metal beam to within a metre of its intended position.

11 men slide the bridge beam gradually into place

Two men carry a log for bridge repair near Grimari, Central African Republic

The third morning saw the guys place the twisted beam exactly where I wanted it.

During the final big heave, one of the daily workers let his attention slip for a fraction of a second and was rewarded with a deep gash halfway through the last segment of his ring finger. I immediately cleaned the wound, did a quick dressing with sterile compresses to stop the bleeding and wrapped it with a gauze bandage to hold the two flaps of finger flesh flush with each other. With the compresses securely held in place by the first half of the steadily unrolling bandage, I brought his pinkie finger up against his ring finger and wound the remainder of the bandage around the pair, thereby immobilising the injured digit. We then drove him directly to Grimari for proper medical care.

In the afternoon, we returned to the worksite and found a sturdy-looking bridge had appeared!

Timbers and logs lashed onto metal bridge beams at Pont Bongou, Central African Republic

Lashing the bridge deck onto the beams

Following a visual inspection, we tested the structure by driving the Land Cruiser across.

Seeing as how we arrived intact on the other side, we judged the job a success. A few improvements for long term durability, such as planks for the wheels to roll along, would be added later on.

Early the next morning, Thursday 11 September, we began our second abortive attempt to access Lihoto. This time we crossed the Pont Boungou without difficulty, but what we failed to foresee was the floodwater farther along the road, which, at the forty-kilometre mark, would ultimately force us to turn back.

The motorcycle driver who had earlier assured us that we could drive across the Pont Boungou, also promised that we could easily drive through the shallow water to the west of the Pont Pende. Pulling up to the crossing, however, our hope of reaching Lihoto quickly faded. We spoke with some locals hanging around the area, and one gentleman agreed to wade into the “shallow” water to give us an idea of the depth:

A man shows the depth of water at the location of the nonexistent Pont Pende

In the time it took us to decide that we could not safely make it to the other side with the Land Cruisers (the water was two metres deep!), I had a good look around and came to the conclusion that we could easily build a new log bridge with enough men from the local villages. And so it was that we hatched our second bridge building scheme in as many weeks.

To be continued…

Rapid Malaria testing in Yamalé (August 2014)

[This post is being published out of order; the story is from mid-August 2014]

On August 13th, I accompanied three medical staff and a driver for a mobile clinic in Yamalé, a village on the road that leads from Bambari to Bakala in Ouaka préfecture, Central African Republic (CAR). Yamalé had, until very recently, been deserted; the population spent months living in the bush. We had already visited the village the previous day – August 12th – to resupply the “point palu”, which translates as “malaria point” – basically, MSF trains a small number of people in the local community and equips them to carry out rapid diagnostic tests for malaria, the leading cause of death in the region. We also supply medicine so they can hand out treatment to those who test positive, free of charge. In addition to resupplying the point palu, our visit would allow us to announce the mobile clinic we had planned for the following morning, asking the villagers to clean the school and cut the tall grass for us to use.

Only thirty-odd kilometres northwest of Bambari by road, you might expect the drive, in good weather and remarkably light traffic, to take about half an hour. The condition of the dirt road, however, lengthens the journey to nearly two hours, and that’s before accounting for the trees. While it’s beautiful driving through the dense green forests in CAR, the logs lying horizontally across the road are moderately annoying. Luckily we only encountered two such obstacles. The first tree took over twenty minutes to hack apart, while the second one was cleared within less than ten.

Guy and Eric bushwhacking in Ouaka, Central African Republic

Fallen trees block the road in Ouaka, Central African Republic

Clearing the road was a useful exercise, which would save a lot of time the next morning. Once we arrived in Yamalé, Eric and Gladys discussed medical stuff with the local point palu guys, restocked their metal trunk with malaria medicine, and then we turned around and headed back to Bambari.

Eric and Gladys speaking with Yamalé malaria point staff

We arrived shortly before 8am and over the next seven hours I drew droplets of blood from over two hundred people – mostly screaming children – to screen for malaria. Among the children, almost every single one tested positive for the mosquito-borne parasites, and a huge number of the adults tested positive as well.

One of hundreds of fingers I pricked to test for Malaria in Yamalé, Central African Republic

The other person striking fear into the hearts of the children of Yamalé was Brice, our driver. Together, we tested between four and five hundred people for malaria, most of whom continued on to the next rooms for consultations.

Brice testing locals for Malaria in Yamalé

As we sat in front of the village school stabbing people’s middle fingers, Anti-Balakas loitered around the centre of Yamalé, standing and sitting beside the main road less than a hundred metres in front of us. With long rifles slung over their shoulders, machetes in multi-coloured sheaths strapped to their backs or hanging from their hips, magical charms and amulets strung round their necks and taped to the foreheads of some, the Anti-Balakas are strikingly special in their outward appearance to those of us who doubt the protection offered by their magical machetes. Having been boiled in a very special herbal mixture, the machete’s flimsy steel blade is capable of stopping bullets. I wonder, however, if these boys took the time read the small print in the instruction manual: only stops bullets thrown by hand.

We considered the mobile clinic a great success. Each person was screened for malaria, and most of them also saw one of our medical staff for a consultation. Each person diagnosed with malaria received the appropriate medicine (a highly effective combination of artemether and lumefantrine) from an MSF medic. For these and other medicines prescribed, MSF staff supervised first doses on-site, explaining how much and how frequently to take them.

Our midwife held thirty consultations for expecting mothers, and the two nurses altogether consulted 375 patients. Among the more common health complaints compounding the impact of malaria, the nurses diagnosed many cases of worms, amoebic dysentery, various skin infections, upper respiratory tract infections, and bilharzia. While these conditions are all endemic in CAR, the rates seen in our mobile clinics are higher than we would expect if the people were not forced to live in the bush for months at a time, unable to protect themselves against the mosquitoes’ nightly feasts, forced to drink from murky waterways because they’re too afraid to return to their village wells, unable to reach a health post to access treatment because they feared being attacked en route. Those who aren’t afraid often cannot return home because their mud brick homes are roofless: armed groups routinely lighted the highly combustible archetypal thatched roofs on fire as a means of terrifying the population.

Roofs of homes burned by armed groups in Central African Republic

Large-scale arson seems to have stopped (to put it differently, the fire has ceased) in the area, though nobody can say with any certainty that it will not reignite again in the near future. Regardless, until the rains give way to the dry season toward the end of October, it’s too time-consuming to gather enough dry grass for new roofing, a circumstance motivating many villagers to remain in the bush for the time being.

At the end of the day, it was clear to me that the villagers urgently needed the medical care we were able to provide in the Yamalé mobile clinic, and they were demonstrably appreciative of our efforts, thanking us over and over for coming to help them. However, as I finished off a piece of stale bread and a handful of roasted peanuts on the three-hour drive back to Bambari, drifting in and jolting out of sleep, I wondered: will this kind of short-term medical activity have any lasting impact?

Before I could work out an answer, my eyelids dragged my chin down toward my chest, and my dirt track nap nodding began anew.