Category Archives: Asia

Three familiar sounds

A little after 19:00 on 19 October 2015, a man named Nawaf, neatly dressed in a white ankle-length robe and smart suit jacket, arrived at our office in Taiz, Yemen, bearing a flimsy brown cardboard box. Around his waist he wore a large, finely crafted and highly stylised leather belt, which held in place the sheath of his traditional dagger. Nawaf had left the dagger itself outside on his car seat, because he knew the rules: Médecins Sans Frontières (MSF, aka Doctors Without Borders) facilities have a strict no-weapons policy. He handed me the box which contained 62 jagged pieces of metal, not one of which was clearly labelled, while I struggled to contain my excitement. These were the long-awaited keys to the hotel/shopping-centre building we were to convert into a Mother and Child Hospital, where all services would be provided free of charge.

Keys to the MSF Taiz Mother and Child Hospital

The very next day, we commenced the logistical works required for establishing the hospital: erecting internal walls to create rooms, installing electrical and diesel generator system, setting up a huge medical warehouse and receiving more than 40 tonnes of medical supplies and equipment, installing fencing for access control, assembling hospital furniture, and much more.

MSF Mother and Child Hospital, Taiz, Yemen. Opening day: 7 November 2015.

Less than three weeks later, on 7 November, we opened the front doors of the hospital to accept our first outpatients. Even though we hadn’t announced the opening, so many patients arrived on that first morning that we had to close at midday! The following week, we opened the nutrition programme. Two weeks after that, we opened the emergency department and had our first baby born, a beautiful baby girl.

One of the most common complaints of people coming to the hospital was scabies. Our medical team determined that a large community of people in Taiz, displaced by the war and thus forced to live in cramped and often unhygienic conditions, was in the midst of a scabies outbreak. Rather than treat these people in our hospital, the team suggested it would be better to address the problem at its source, in the community. So the MSF Taiz team planned a special tented clinic, met with representatives of the community, organised supplies of benzyl benzoate, set up a large white MSF tent near where many of the displaced people were living, and began treating them on 1 December.

The following day – Wednesday, 2 December – I arrived at the MSF Mother and Child Hospital to check the work of various contractors who were, respectively: installing workbenches and a filtered water system for the new laboratory to be opened the next day, welding an intermediate steel burner for waste incineration, installing doors for the staff’s rooftop sleeping quarters, and finishing the masonry for the hospital waste-zone pits.

Making progress on the hospital waste zone

I had also planned to spend an hour with the medical storekeeper, with whom I’d been working closely, to complete a full physical stock count of our enormous 315m2 central medical warehouse.

Medical warehouse

We arrived at the hospital around 14:00, and I was still standing outside behind the building, speaking with my colleague when, at 14:08, we heard a jet come in low overhead. It’s an all-too familiar sound, one usually followed by two other familiar sounds. I stretched my arm up toward the sky and pointed at the plane with my index finger, tracking its path as it moved northwest of our location. Within fractions of a second, we heard the second familiar sound: a bomb screaming downward from the sky, toward its target. With my index finger, I continued following the sound of the bomb, which I couldn’t see, until my arm was horizontal and my finger was pointing straight toward the horizon, at which moment we heard the last of the three familiar sounds: the airstrike hitting its target. There was a loud bang, followed by a pressure wave that shook us as it flexed the glass window panes of our five-storey hospital building. A column of brown smoke rose up from the spot I’d been pointing at, just a few hundred metres away from us.

Cloud of smoke after an airstrike in Taiz, Yemen on 02 December 2015

After chatting briefly with nearby staff about the airstrike and how close this one had been, I returned to my work, comfortable in my certain knowledge that the airstrike couldn’t have affected our nearby tented clinic. After all, the Saudi-led coalition, which was responsible for these airstrikes, knew the exact GPS coordinates of our tent, just as they know the coordinates of our Mother and Child Hospital. I had been talking for just a few minutes with an engineer about the next steps for our hospital waste zone, when I received a phone call from our Project Coordinator. He wanted us to return to the office promptly. Our tented clinic had been hit, he said, and several people had been injured, two of them critically.

Sadly, the following day, one of these two people succumbed to his injuries. As our Head of Mission in Yemen says, “The health structure’s GPS coordinates were regularly shared with the Saudi-led coalition, most recently on 29 November, when we informed them about this specific activity in Al Houban. There is no way that the Saudi-led coalition could have been unaware of the presence of MSF activities in this location.”

Several airstrikes in the morning, only 2km from our tented clinic, had shaken our staff, so MSF had called the coalition to remind them again of our tented clinic activity, just to be on the safe side. The tent sported a huge MSF flag spread flat on its roof, with the bright red MSF logo easily visible from the sky. The coalition was told multiple times about the tented clinic and its location and yet, because of this Saudi-led coalition airstrike, several people in the clinic were injured and one is now dead. This is the second MSF facility in Yemen to be hit by airstrikes from the Saudi-led coalition. The other, an MSF-supported hospital in Haydan, was turned into a pile of rubble in late October by a series of airstrikes.

One after-effect of this airstrike was a temporary reduction of staff in Taiz. I, among others, was relocated to the capital, Sana’a until things calmed down. As I had nearly completed the term of my contract, there was too little time for me to return to Taiz before I was due to leave Yemen, so I returned home to Canada a few days early. It’s unfortunate, as I’d hoped to complete some of the remaining works at the hospital, into which I had put so much thought and energy. Still, in the few weeks since the keys were handed over to us, we worked full-tilt to get the MSF Taiz Mother and Child Hospital up-and-running, and I’m confident this hospital will continue to grow and serve the community for a long time to come.

In case you’re wondering what an airstrike sounds like, I recorded several during my stay in Yemen. Below is a short audio clip recorded on my phone in the middle of the night at 03:36 on 03 October 2015, as I heard it from my bedroom:

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

7th Annual Update: Tenth Anniversary Edition!

Caution: this blog post has my favourite rainbow photo in it. Just in case you don’t like rainbows.

I started this blog ten years ago, but I didn’t start writing long-winded, chart-riddled, tiresome annual updates until Christmas Day in 2008. So, only 21 days later than planned, here’s my seventh annual annual update: tenth anniversary edition. Here’s what I did in 2014, illustrated with 112 photos. Protip: you can now click on any photo in my new blog posts, which will open up the high-resolution version of that photo in a new tab or window (unless your pop-up blocker dislikes me).

Key facts and figures:

Afghanistan, Sri Lanka, Afghanistan, Netherlands, Belgium, Netherlands, Belgium, Netherlands, Luxembourg, Belgium, Netherlands, Canada, Netherlands, Central African Republic, Germany, Canada, Netherlands, Sierra Leone, Netherlands, Canada.

38 flights, 9 countries, 1 rose arbour

Chart - number of flights per year
Pie chart - percentage of 2014 spent in each country

January

On New Year’s Day 2014, I woke up in my cosy room with vaulted ceiling and whitewashed mud-brick walls as thick as my arm is long, to a frigid winter day in Lashkar Gah, provincial capital of Helmand, Afghanistan, where I was working with MSF (Médecins Sans Frontières aka Doctors Without Borders) as the Technical Services Manager at Bost Provincial Hospital.

We spent the month replacing the broken submersible pump in the primary hospital water well…

Replacing a broken submersible pump at Bost Provincial Hospital

…repairing and repainting room B-17, which had been badly damaged in a gas heater fire in late December…

Repainting room B-17

…building a structure to protect the big diesel incinerator we’d installed in December…

Incinerator cage

…removing unsafe heating appliances such as this one, to prevent further fires…

Bare wire resistive heater

…and sending our 250 kVA generator to have its engine replaced.

FG Wilson P250HE2 diesel generator

February

We had snow in Lashkar Gah in February, for the first time in more than a decade / more than fourteen years / more than twenty years (depending on who you ask).

Chris Anderson in the 2014 Lashkar Gah blizzard

The snow lasted several days, which caused some problems. Our medical office roof, being flat, held the snow beautifully. However, once the team arrived for work in the morning and the heaters were all cranked up inside, the ceiling warmed up and the white rooftop carpet liquefied, leaving a heavy pool of standing water which began dripping through any small fissure it could find in the concrete roof. My team and I climbed onto the roof to shovel snow, push water, drill more drainage holes at the edges, and cover the area with plastic sheeting to divert the water to the drains. While we were up there, of course, we started an epic half hour air-to-surface snowball fight with staff on the ground below. The human resources assistant took this photo as I threw a snowball right at him:

Air-to-surface snowball after launch

With our new 30,000-litre water backup system built and running smoothly, in February we closed off the 45,000-litre metal tank perched atop a 12-metre steel tower and began the process of rehabilitating the tank, starting with a thorough cleaning. Before:

Sediment on floor of 45 cubic metre water reservoir

After:

Cleaned floor of 45 cubic metre water reservoir

On 13 February, I flew aboard the International Committee of the Red Cross (ICRC) plane from Lashkar Gah to Kabul.

Flying over Afghanistan

The following day, I flew to Dubai for a connection to Sri Lanka, where I spent twelve days on holiday. I had an incredibly warm welcome in Colombo from Oxana and her son Nikita, who I’d met three months earlier in Nepal. Oxana took me south to visit the old city of Galle on the coast, to kickstart my Sri Lankan adventure:

Galle Lighthouse, Sri Lanka

I also took some trains

Train ride from Galle to Colombo, Sri Lanka

…visited loads of ancient ruins in Anuradhapura, Mihintale, Sigiriya, Aluvihara, and Polonnaruwa

Kaludiya Pokuna

…and drove a rental scooter all over the teardrop island, admiring the beautiful scenery, wildlife, people, and mouth-watering cuisine.

Beach off the coastal road to the north of Trincomalee, Sri Lanka

I flew back to Kabul on 27 February, and arrived back to my workplace in Lashkar Gah on 3 March.

March

The winter cold soon turned to beautiful spring weather. I spent the month admiring colourful auto-rickshaws

Auto rickshaw

…scaring other expat staff by handling a completely harmless snake (Coluber rhodorachis aka Jan’s Cliff Racer)…

Coluber rhodorachis in Lashkar Gah, Helmand, Afghanistan

…getting up close to the beautiful poppies that seemed to grow overnight everywhere we looked…

Poppy close-up

…watching lightning storms for hours at a time…

Lightning in Lashkar Gah, Afghanistan

…discovering four kittens that hadn’t yet opened their eyes, born in the room next to mine…

Newborn kittens

…and going to Kim’s room after hearing her scream from across the compound, to catch and then release a swallow that didn’t understand the concept of a glass window being solid.

A swallow I caught in a bedroom and released outdoors

April

I left Afghanistan in mid-April, but before my departure we spent several days working to unblock the Bost Hospital sewage system several metres underground which, after years of having large and non-biodegradable items flushed down the toilets, had become completely clogged in multiple locations…

Hussein working in the underground hospital sewage system

…finished condemning the former waste zone and converting that area into a materials storage area for bricks, sand, gravel, etc…

Materials storage area

…and completed the new fuel delivery system with carbon steel pipes and rehabilitation of the two fuel reservoirs:

7000 and 7700 litre diesel reservoirs with gauge and carbon steel pipe system

April was not only a month in which the opium poppies were in full bloom in Helmand…

Papaver somniferum (opium poppy) in Lashkar Gah, Helmand, Afghanistan

…but also the first round of the 2014 Afghanistan Presidential Elections:

Ink marks the finger of a voter to ensure he does not vote a second time, Afghanistan April 2014

I flew out of Lashkar Gah for the last time on 17 April after nearly 9 months on the ground:

Outskirts of Lashkar Gah viewed from the air

Very late the next day, I landed in Amsterdam, where Cathy met me at the airport. She drove me three hours through the night to Ghent, Belgium, where I spent most of the next four weeks, exploring the old town…

Ghent city centre, Belgium

…eating tinned apricots with tuna and mayonnaise for Easter…

Tinned apricots, tuna, mayonnaise. Must be Flemish.

…and appreciating the spring flowers and their guests:

Dragonfly perched on a Clematis bloom

May

In May, in addition to seeing more of Ghent…

Ghent city centre, Belgium

…I stopped briefly in Antwerp…

Antwerp train station, Belgium

…spent a half day walking around a sunny but wind-chilly Rotterdam…

Rotterdam riverscape, Netherlands

…and visited my old friend Pieter-Henk in the Hague, where he works as an artist at Suitup Studio in an underground nuclear bunker:

Suitup Studio, the Hague, Netherlands

I also made an impromptu decision to visit Luxembourg, where I stared at pointy buildings from caves carved out of steep cliff sides

View from the Bock, Luxembourg City

…and visited a rainbow-girdled castle in Vianden:

Rainbow over Vianden castle, Luxembourg

On 15 May I flew back to Vancouver for some summer fun, and ended up spending most of the next two months on Bowen Island, including removing moss from the roof of Glencairn…

Removing moss from the roof of Glencairn

…and planting dozens of herbs and flowers, like these columbines:

Columbines planted at Bowen Island

June

I spent most of June on Bowen Island, where I began building a rose arbour to replace the one that had existed decades before, one side of which remained to inspire the design:

First pillar of the the new rose arbour at Bowen Island

I also spent a few more days on rooftops, this time with a climbing harness and ascender, carefully removing several years’ worth of roof moss from Marycroft and Star of the Sea:

Rooftop moss work at Bowen Island, BC

Before:

Before removing moss from Marycroft

After:

After removing moss from Marycroft

July

In July, my brother Matt oversaw the big project of removing several hundred square feet of Hypericum aka St John’s wort, an invasive plant that was taking over the lawn on Bowen. Mom helped too!

Removing Hypericum at Bowen Island

Once the Hypericum was removed from the lawn, Matt did a grass dance to seed the lawn:

Grass seed dance

I found a snakeskin two and a half feet long in perfect condition – even the skin over the eyes remained intact!

Garter snake skin

While we worked, the deer chewed happily on all sorts of greenery:

Doe and fawn at Bowen Island, BC

It was nice spending so much time with all my siblings on Bowen; we even took a photo together down at the beach for our parents:

Sibling photo by the water

Matt also decided to build an arbour down near the boathouse, where there had been one many years before:

Matt building an arbour

I hauled several logs from the beach up into the forest, where we worked with our cousins to shore up the path to their cottage:

Path repair work

In mid-July I left Vancouver for my next field placement with MSF in the Central African Republic (CAR). When I arrived on the ground in CAR, I helped out in the warehouses in Bangui for a while…

Looking out from a warehouse by the river in Bangui, Central African Republic

…ogled bizarre plants…

Funny plants in the garden, Bangui, CAR

…watched the watchmen cook up a big pot of caterpillars…

Caterpillars for lunch

…and then sat down to eat caterpillars with them:

Eating caterpillars with baguette in Bangui, CAR

At the end of the month, we drove up to Bossangoa and then on to Boguila. We had an MSF plane land during our visit, and I was hugely impressed by the team’s preparedness: not only did they cordon off the airstrip to keep the hundreds of villagers clear of the landing area, but they had fire extinguishers pre-positioned and a huge signboard angled up toward the sky with the airstrip name and coordinates:

Boguila Airstrip, Central African Republic

August

In August, we were blocked on multiple occasions as French Foreign Legion convoys got stuck in the mud on narrow rural roads and made it difficult or impossible for us to pass:

French Foreign Legion Operation Sangaris stuck in the mud, again, Central African Republic

I spent some more time in Bangui, during which time I got to do one of my favourite things: teach the warehouse team the basics of cardboard box masonry! Look at how beautifully they stacked the gloves and anti-malarial drugs:

Coartem towers

I then flew east to Bambari, in Ouaka Prefecture, where I tried my hand at real stone masonry…

Stonework in Bambari, CAR

…then drove to Grimari, where I would spend the next two months. In Grimari, we got to eat the biggest mushrooms I’ve ever seen…

Giant mushroom in Grimari, CAR

…and I made a huge effort to improve the working and living conditions of the office and guesthouse compound, such as building an additional shower and latrine, and working on the poor drainage as it was rainy season:

Drainage work in front of new latrine and shower, Grimari

From Grimari, we supported several rural malaria treatment posts with training, supplies, and follow-up visits:

Malaria post supervision visit

But first, we had to get to them, which often involved cutting through trees blocking the roads:

Removing trees from the road, Ouaka, CAR

The conflict that brought us to the region had left thousands of homes burned like these:

Burned homes, Ouaka, CAR

We also ran mobile clinics, in which even the drivers and I participated by managing the setup and performing the rapid diagnostic tests for malaria:

Testing children for malaria, Ouaka, CAR

September

In September, we crossed dozens of bridges, many of which we had to reinforce with planks we carried on the Land Cruiser roof racks…

Crossing bridge in Ouaka, CAR after reinforcing with wooden boards

…MSF medics dressed wounds at the Grimari health centre almost daily…

War wounded dressings in Grimari

…ate raw coffee, straight off the tree…

Coffee beans fresh off the tree

…visited villages small and large, many of which had been decimated by the conflict…

Central Market of Lakandja, Ouaka, CAR

…helped organise and setup more mobile clinics…

Setting up a mobile clinic in Lakandja

…did heaps of pull-ups and chin-ups after Mark taught me the different techniques…

Chin-ups in Grimari

…and tested hundreds of people for malaria with Yvon, one of our legendary drivers. He tested me a few minutes after this photo was taken, and it turned out positive! My first time catching malaria since 2010!

Yvon during a quiet moment at a mobile clinic
My first positive malaria result since 2010

We also rehabilitated one bridge 6km south of Grimari and built this one from scratch 50km south of Grimari:

The brand new bridge we built - Pont Pende

In September we also benefited from all the base improvements, as the heavy rain finally began draining properly:

Heavy rain in Grimari, CAR

October

I left Grimari on 5 October then spent the next two days assessing a new base and planning the rehabilitation and construction needed to make it useable, before flying to Bangui on 8 October for my planned departure back to Europe. On landing in Bangui, however, I got stuck at the airport. Violence had broken out in the city centre while our plane was still in the sky, so I spent a couple of hours hanging out at the airport with Joe, the MSF Flight Coordinator, before we received permission to drive to our house. For the next five days a group of us were stuck enjoying each other’s company and the sunsets at Château, the MSF house overlooking Bangui:

Sunset over Bangui, CAR
Château house, Bangui

By 14 October, the security situation had stabilised sufficiently for me to fly out on a 19-seat United Nations Humanitarian Air Service (UNHAS) plane to Cameroon…

Snaking river seen from the UN flight to Douala, Cameroon

…from which I was able to fly via Paris to Berlin for meetings and aimless street wandering.

Checkpoint Charlie, Berlin, Germany
Brandenburg Gate, Berlin, Germany

Two days later, following some interesting flight juggling, I arrived in Vancouver for a short break. Back in Canada, I spent time on Bowen Island admiring the autumn mushrooms…

Mushrooms at Bowen Island, BC
Mushrooms at Bowen Island, BC

…admiring Vancouver’s new stop sign template…

Stop Harper sign, Vancouver, BC

…and finally getting a taste of the Colin Jack Antidisestablishmentarianism Amber Ale – a beer created in memory of a great man who died unexpectedly in 2011.

Colin Jack memorial Antidisestablishmentarianism Amber Ale

Just after arriving in Vancouver, we got the sad news that our grandmother, Margaret Anderson (née Monk) had died back East in Nova Scotia. I boarded a plane in time to spend about 30 hours in Nova Scotia, though I forgot my suit on the plane when I disembarked in Toronto before my connecting flight, so for the funeral I had to borrow trousers from Matt and a belt from Josephine to pair with the shirt and tie I had in my carry-on. Dan and I stayed behind to help the funeral home close the grave and throw the first handfuls of soil in:

Closing the grave

In scooping the soil with our bare hands, we found this friendly little Eastern red-backed salamander:

Eastern red-backed salamander, East Ship Harbour, Nova Scotia

This was the first time ever in the history of the world that my entire immediate family was in Nova Scotia together, because my youngest sister was born after the six of us moved out West. Seeing as how it would also most likely be the last time, we took a team photo in Grandma’s backyard overlooking the Atlantic Ocean:

The entire Anderson family in Nova Scotia for the first time ever

Back in BC, I returned to Bowen Island and worked some more on the summer’s unfinished arbour project, preparing the beams and rafters for the arch and cutting lots of notches in them:

Notching rafters for the rose arbour, Bowen Island

I also got to celebrate Halloween for the first time since 2006! Every one of the intervening years had found me in countries where Halloween is hardly or not at all celebrated, so I was pretty excited! My sisters dressed up as dead My Little Ponies:

Dead My Little Ponies

November

On 3 November, with a lot of help from my oldest brother in the cold rain (and food prepared by my mom inside), I got the top of the arbour installed at Bowen Island:

Rose arbour with top installed, Bowen Island, BC

That same day we caught the ferry back to Vancouver just in time for me to pack my bags and get a ride to the airport that afternoon. When I brought my check-in luggage to the bag drop counter 2 minutes after the cut-off, the electronic boarding pass in my phone said I had seat 43A, which I’d chosen as the only window seat left online the night before. By the time I arrived at the gate, however, my phone was showing 13A! Sure enough, I’d been bumped to World Traveller (business class) on the long British Airways flight to London – dinner was Alberta tenderloin steak with a red wine gooseberry sauce and other fancily named foodstuffs.

After arriving in Amsterdam on 4 November, a large group of us attended a two-day MSF Ebola training course in a rented warehouse space, where we learned the basics we’d need to work in Ebola projects in West Africa. The training was well organised and included a mock-up of the layout of a large Ebola centre, complete with mannequins and fake body fluid spills to be disinfected and cleaned up!

Ebola mannequin

We learned how to don and doff our personal protective equipment – the spacesuits and accessories you often see in the news media – and had MSF staff role playing as patients to be transferred from a modified Toyota Land Cruiser ambulance into the centre.

MSF Ebola training course, Amsterdam

The modified Land Cruisers have a separation wall to protect the driver from exposure to Ebola if the patients in the back turn out to be positive cases. These vehicles also have a latch system (metal bits on the floor on the right-hand side of the photo) to secure a standard patient stretcher for transport. Very cool.

Modified Land Cruiser ambulance for Ebola

Five of us flew together through Casablanca to Freetown, while five others flew together through Brussels and Dakar to Freetown. By the morning of the 10th, we were on the road to our field projects. Some stayed in Bo, while most of us continued past Bo to a town called Kailahun, close to the border with Guinea and Liberia. On the outskirts of Kailahun was a 100+ bed MSF Ebola management centre. My role for the next five and a half weeks was to manage the logistics for the Ebola centre, more details about which I’ll post later on.

Ambulance arriving to Kailahun Ebola Management Centre with patients on board

Getting my first pair of gloves on:

Dressing up in full personal protective equipment (PPE) in Kailahun, Sierra Leone

Working with Kalla, our handyman, to repair some fencing:

Working with Kalla to repair fencing in Kailahun Ebola Management Centre, Sierra Leone

Stepping out of my spacesuit during the slow and careful undressing procedure:

Undressing in Kailahun Ebola Management Centre, Sierra Leone

We also had a visit from the President of Sierra Leone, Ernest Bai Koroma (pictured, wearing a white baseball cap) who toured the site rapidly and spoke to some of the staff before leaving:

Sierra Leone President Ernest Bai Koroma visiting Kailahun Ebola Management Centre

One Sunday in November, I found this baby kingfisher near my room. He was by far the most beautiful and multi-coloured bird I’ve ever seen in my life. I spent about half an hour hanging out with him, during which time he even let me pet him!

The most colourful kingfisher, Kailahun, Sierra Leone

December

In November, my team of carpenters built a new burning pit shade structure. In the first week of December, my team of daily labourers finished digging an enormous fire pit under the new structure, and we began burning scrap wood from the carpentry workshop in order to bake the walls of the pit before handing it over to the water and sanitation team for burning medical waste.

Piling up scraps of wood in the new burning pit at Kailahun Ebola Management Centre, Sierra Leone
New burning pit at Kailahun Ebola Management Centre, Sierra Leone

While we were working on that side of the Ebola centre, I found this cute little white tree frog (technically, I believe it’s called a shrub frog), in some orange net fencing that I was about to remove. He ended up spending the next seven hours hanging out on my neck before I found him a suitable tree.

I found a tree frog in Kailahun

One day I accompanied two medics to the local children’s orphanage, where MSF referred children who’d lost their parents because of Ebola. The friendly folks from the Public Health Agency of Canada lab, who lived and worked with us, had brought over loads of children’s items donated by their colleagues in Winnipeg, specifically for this orphanage, and we were the lucky people who got to distribute the stuff.

Playing with toys donated by staff at the Public Health Agency of Canada labs in Winnipeg

As the dry season took hold, the nights were cooler and we began waking up to foggy mornings more frequently. Driving through the fog to start each day, the leaves of the tall roadside trees played tricks with my mind, changing shape and shade as we moved closer.

Trees in the fog

As the rainy season had ended, the evening sunsets in December were magnificent. Huge groups of pied crows appeared as the rains subsided, and in the evenings would converge on certain large trees, like this one at the central mosque in Kailahun:

Sunset over the mosque in Kailahun, Sierra Leone

December was also the beginning of pineapple season in Kailahun, and I soon found myself receiving 1-2 pineapples on an almost daily basis as gifts. Each one had to be carefully and very thoroughly sprayed with a strong 0.5% chlorine solution, the same as we use for the bottom of our boots, before I would take them home to wash again and share with the others.

Spraying a pineapple with 0.5% chlorine solution

I spent a lot of time in December overseeing the manufacturing of hundreds of pieces of furniture and signage for a new Ebola centre in a place called Magburaka. As we already had a large carpentry workshop with 12 full time carpenters and a head carpenter on contract, plus a list of skilled labourers I could hire on a daily basis to be carpenters, the team in Magburaka asked me to sort their furniture needs while they got local carpenters to build the infrastructure for a 100-bed centre on the ground. We made most of the furniture in pieces that could be transported more easily and assembled by local carpenters in Magburaka.

Making shelves in Kailahun for Magburaka Ebola Management Centre, Sierra Leone
Furniture piling up for the first truck shipment to Magburaka

On my final day in Kailahun, I took a walk with my assistant past the cemetery and a little village, arriving at a small clearing by the river. Only 10 minutes on foot north of the Ebola centre, we found ourselves looking across the river to Guinea:

Standing in Sierra Leone, looking across the river to Guinea

I also spent a good chunk of that last morning hanging out with the Canadian lab staff, who allowed me to observe as they went through each of the stages of testing blood samples for Ebola RNA. The final step involves running a PCR (polymerase chain reaction) device for nearly an hour, as the results popped up in the form of a graph on their laptop screen. That day, several patients tested negative for a second time, which means we considered them cured and eligible for discharge – great news! When I left Kailahun on 18 December, there were only two patients remaining in the centre, which had been packed just a month before.

PCR results in progress, testing for Ebola RNA in blood samples, Kailahun, Sierra Leone

I landed in Amsterdam on 19 December, had debriefings on the 20th, spent the weekend wandering around town and hanging out with MSF friends, plus an intellectually stimulating coffee with my old friend Martin, then flew out on 22 December to Vancouver.

Amsterdam at night

Landing in Vancouver, I spent some time speaking with the quarantine officer in her “office” which had been prepared the night before in a disused janitor’s closet at Vancouver International Airport. The only evidence it had been repurposed was the writing on this whiteboard:

A disused closet converted into the receiving room for the Public Health Agency of Canada quarantine officer, YVR

After missing Christmas 2012 and 2013, it was nice to be home with family this year. We had our traditional Boxing Day party with the extended family over, including lots of food and good conversation.

Boxing Day family party

I also learned that putting multiple people on the same smartphone video call and pointing two of the phones at each other creates a neat sort of melodic feedback loop with intriguing echoes. This particular group call ended up netting us fresh bagels hand-imported from New York a few days later:

Feedback loops with Google Hangouts video calling

On 29 December I went out to Bowen Island to enjoy the fresh ocean air and the next day, in the forest, we spotted two bald eagles circling directly overhead. Perhaps they were thinking I might make for a nice lunch?

Two bald eagles circling overhead in December at Bowen Island, BC

The next day, I went to a huge eatART party to ring in the new year, and then… [2015 annual update coming in approximately 11.3 months].

Refugee hospitality in Domiz camp, Iraq (November 2012)

[This post is being published out of order; the photos and experiences are from September-November 2012]

I arrived in Iraq in early September 2012, expecting to be sent to Kirkuk after some initial briefings at our coordination office. I had been hired to spend six months living in Kirkuk, working semi-remotely to support our project in Hawija, where MSF is supporting some activities of the local hospital. Unfortunately, there were a series of bombings in Kirkuk just before I landed in Iraq, so the team was temporarily relocated. Rather than have me sit twiddling my thumbs in the coordination office, waiting for the dust to settle in Kirkuk, we agreed that I would lend a hand up north in Domiz Refugee Camp for a week or two, as the young MSF project there had never had an expatriate logistician. The team would drive down to Erbil each weekend for some rest, so I would only need a few days’ worth of clothing. I packed my bag appropriately, leaving most of my stuff at the guesthouse in Erbil, and hit the road. Little did I know, those two weeks would stretch into three months.

Domiz Refugee Camp, Duhok, Iraq

In April 2012, as fighting in neighbouring Syria intensified and spread, Domiz Refugee Camp was set up to receive some of the people who’d begun fleeing across the border the month before. The camp is located in the Kurdistan Autonomous Region in northern Iraq, about 10km southwest of the city of Duhok as the crow flies, or 15km as the tarmac lies (for unknown reasons, various websites and Google Earth say that the camp is northeast of town, but this is definitely incorrect).

Initially planned to hold about 5000 people, the camp rapidly surpassed that figure, straining the limited resources available to the mostly-Kurdish Syrian refugees living there. MSF was warmly welcomed into the camp in the spring of 2012 to help manage the healthcare needs of the growing refugee population.

Moonrise on a muddy evening near the main entrance to Domiz Refugee Camp, Duhok, Iraq

The refugees living in Domiz camp were incredibly hospitable to me. Each day that I was there, I made an effort to take a walk and say hello to people in the different neighbourhoods within the camp, and on these walks my colleagues and I were almost invariably invited to sit down for a hot drink and some friendly banter. One day, we even got invited for a meal of epic proportions in the tent of one of the first families to arrive in the camp months before. This family became known in the camp for taking in new arrivals who had not yet been assigned a tent in which to sleep or given a food ration to feed their children, and hadn’t enough cash to get by in their first days.

Head of the family

It was a surreal experience for me, to sit alongside my assistant and the Field Coordinator assistant, the Directorate of Health ambulance driver, and two of our MSF drivers, in a yellow tent extended upwards with makeshift low cinderblock walls, eating a multi-course meal that would easily excite Anthony Bourdain, in the oldest sector of a rapidly expanding refugee camp for Syrians in Iraq. While the family had limited resources, they worked very hard to help themselves and others, and the meal was their way of welcoming us and thanking us for the work MSF was doing in the camp.

Sitting down to lunch in Domiz Refugee Camp, Duhok, Iraq
Sitting down to lunch in Domiz Refugee Camp, Duhok, Iraq

While such a grandiose meal was uncommon, we were offered hot drinks everywhere we went. Strong Arabic coffee – black and bitter, with a thick sludge of grounds to leave behind at the bottom of the little porcelain cup, and the initially unfamiliar cardamom pungency which took me by surprise the first time it rose to my nostrils – dealt a caffeine slap that would have spun my head through a full 360° turn if my neck were only capable of it.

Strong coffee and cheap cigarettes in Domiz Refugee Camp, Duhok, Iraq

The more frequently offered option – sweet tea, a deep orange river with brown swirling currents steamily streaming into tiny glasses already a quarter to a third with white sugar – had a gentler effect on my heart rate, though too many glasses in one day risked triggering a hyperglycaemic headache.

Sweet tea in Domiz Refugee Camp, Duhok, Iraq

I soon appointed myself unofficial camp tour guide for any new MSF staff and visitors arriving in the project, taking them on walking tours of the key sectors of the camp, highlighting the rapid evolution of the camp and our activities, and, most importantly, taking time to sit down with camp residents for tea or coffee, no matter whether the new MSF arrivals felt they had the time to spare or not. Most people were excited at the opportunity, but when the occasional person felt otherwise, a simple phrase solved the problem every time: “They’ve invited us in for tea; we don’t need to stay long, but it would be incredibly rude to refuse the offer altogether.”

Armando, a Mexican MSF doctor who organised triage training for the health centre staff, was particularly keen to visit with camp residents:

Armando with coffee

During the time that I was working in Domiz camp, it was through drinking tea that we learned about the challenges faced by its refugee inhabitants.

Spending time with refugees in Domiz Refugee Camp, Duhok, Iraq

We also heard interesting information and rumours that were going around, some of which could affect the refugees’ healthcare needs. Sitting in tents brought us closer to the community, and helped the community members feel more at ease seeking healthcare at the primary health centre that MSF operated in the camp.

Spending time with refugees in Domiz Refugee Camp, Duhok, Iraq

We put a human face on what appeared otherwise to be a strange company employing foreigners to do who knows what. We learned what people did and did not know about the nongovernmental, charitable nature of MSF, and shared information about the healthcare options available to them, free of charge, including referrals and free transport to the local government hospital for some treatment options that we didn’t offer in the camp.

A friendly face in Domiz Refugee Camp, Duhok, Iraq

With this information, we could adjust our strategy for community health workers and counsellors doing outreach work within the camp. We also increased our own security: the community respected us for the work we were doing in the health centre, but also for the way we interacted with them closer to their homes, always waving and smiling as we walked or drove around, joking with the children, listening during our tea drinking sessions, and advocating for their non-medical needs to the relevant organisations working in the camp.

Spending time with refugees in Domiz Refugee Camp, Duhok, Iraq

Although Domiz is far nicer than Dadaab (the world’s largest refugee camp), living in a refugee camp is not easy, and conditions are tough. It rains heavily and snows every winter in Duhok governorate. It’s incredibly hot (average high of 41-42°C in July-August) and dusty every summer there. With no end in sight for the war in Syria, Domiz Refugee Camp may remain home for a long time to come for the refugees who welcomed me so warmly during my short stay there.

Refugee tents at dusk in Domiz Refugee Camp, Duhok, Iraq