Tag Archives: Bost Hospital

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].

Free cake in Lashkar Gah, Helmand (May 2014)

[This post is being published out of order; it was written in May 2014]

There is free cake in this story, though you may not believe me at first. But trust me, there really is free cake, so read on…

The MSF mechanic testing our moody incinerator burner:

Flamethrower in Afghanistan

A couple of months ago, my mechanic in Lashkar Gah (provincial capital of Helmand, Afghanistan) requested a few days of annual leave to visit his relatives living in Pakistan, including two of his sons sent there for studies. Sadly, he wasn’t able to make the trip as planned; instead of spending father-son time with his young boys, he helped with funeral arrangements in Kandahar for his sister-in-law and her husband. Driving down a dirt road in one of the districts, their tractor hit a roadside bomb. When my mechanic arrived back to Lashkar Gah, he brought his phone to show me photos of the little that remained of the tractor – a few oversized shards of metal contorted into oversized barbed wire, sitting in the tall grass by the side of the road, serving no purpose to anyone.

He’s a tremendously funny guy, though – check out his beard:

Snowbeard in Lashkar Gah, Helmand, Afghanistan

In April, about a week before I left Lashkar Gah, my mechanic had a baby daughter born in the maternity at Bost Hospital. One evening several days later, he called me for help – his wife was unwell and he worried her condition was quickly becoming serious. He brought her to the hospital, where the maternity staff took care of her, and it all turned out quite well.

The following morning, I could see on his face that my mechanic hadn’t slept very well – a logical outcome after the stress of the previous night. As a general rule in Afghanistan, there is a separation between men and women. Owing to this cultural norm, men are not allowed inside maternities, with limited exceptions in some facilities for male hospital staff. He therefore had to return home after his wife was admitted, driving two female relatives to the hospital to act as his wife’s caretakers during her stay.

It came as no surprise to me that he was so tired, but as I spoke with him near the huge hospital generators, he appeared not to understand much of what I was saying. With faint signs of pain on his face, I asked if he had a headache and needed to see the staff doctor. His smile – a smile I knew very well after nearly nine months working together – told me that I was on the wrong track but that he would happily help clear my silly foreigner confusion (I was fortunate to manage a team of guys who were not shy to point out and correct my frequent incomprehension, but were also skilled at doing so without offending me at all).

Adjusting the fuel flow rate on an FG Wilson diesel generator

Letting loose a little laugh, he pointed to one ear and said “Sorry, my heering… no good – no workeen. Paroon (yesterday) nighte, my wipe go haspital. After, I bring anadder, stay haspital por my wipe. I am dribe near Kandaharadda (station for buses going to Kandahar), in prant ob maykanic shope. My car, here – fipty meeter derr – blast. My ear apter, no good. Yesterday, two ear, no good. Today, one ear ok, one ear steel no good. Bat, no problem.”

If you didn’t quite understand, allow me to translate: “Sorry, I’m not able to hear well. Yesterday night, I took my wife to the hospital, then I made a second trip to bring female relatives to stay with her. I was driving near the Kandahar bus station, past the mechanic shops, when there was an explosion fifty metres from my car. I couldn’t hear properly afterwards. Yesterday, my hearing was bad in both ears; today, I hear well in one ear but not the other. It’s no big deal, though – I’m fine.”

Later that day, as I drank sweet afternoon tea with my technical team in the workshop, the mechanic arrived with something to share: cake to celebrate not being dead. I joked that I was happy he was alive, because we got free cake as a result. While he understood my English better than he let on, he replied in Pashto, as he often did. I understood his words before my assistant could translate: “I’m not happy. If I were dead I wouldn’t need to spend money on this cake!” We all laughed with him, enjoyed a few minutes of cake and tea, then returned to our job of keeping Bost Provincial Hospital running.

A Day in the Life of an MSF Technical Logistician in Afghanistan

From the start of August 2013 to mid-April 2014, I managed the technical services team for Bost Provincial Hospital in Helmand, Afghanistan. It was a fantastic, if at times somewhat exhausting, job. There were days when I spent most of my time in the office, but much of the time I was lucky enough to spend the day running all over the place with my team. For my family and friends (or anyone else who’s interested) who’d like to know just what it is I was doing over there, I figured I’d tell you about a day on the ground. It’s a bit detailed, so you may want to skim through and just look at the photos! This post was written in December 2013, but I’m publishing it with a delay:

Saturday, which is the first weekday in Afghanistan:

06:15 – Wake up, get ready for the day. This involves trying to remember who I am, where I am, and what I need to do. I face tough questions each morning: which sock should I put on first – the right or left one? Which one of my six identical MSF shirts should I wear today? Precisely what day is it today? Once I’ve had a coffee, the world becomes a bit less confusing, and I realise that I only have a few minutes left to eat and rush to the car.

Afghan coffee mugs

07:20 – Enjoy the drive to work. I usually wave to some of our neighbours who are standing outside their homes or their shops, as well as children walking to school, drivers who stop to let our car cross an intersection, traffic cops who make cars stop to let us cross said intersection, and generally anyone who stares and looks like they could use a smile and a wave to start the day. We certainly get loads of smiles and waves back.

Heading to work in Lashkar Gah, Afghanistan

07:45 – Morning meeting.

08:00 – Check every room of the entire hospital with one of my staff, looking for windows cracked or shattered by a nearby explosion the previous night. Note down locations and dimensions to plan repairs, arrange help from the supply team, with our carpenter, to buy glass cut to size in the bazaar.

Hospital pharmacy window shattered by a nearby explosion, Bost Hospital, Helmand

09:15 – Zip over to the paediatric intensive care unit (PICU) to solve an urgent problem. In an ICU, hypothermia is a serious risk for patients – especially as the weather begins to cool, and particularly for the small bodies of children in NICU and PICU (neonatal and paediatric ICU). Newborns may be placed in incubators, but a toddler is usually kept warm on a bed fitted with a heat lamp. We didn’t have a suitably-sized bed with heat lamp for one of the little ones this morning, so I MacGyvered a fairly simple solution which satisfied the nurse in charge until we can order more medical heat lamps: First, I grabbed four wooden blocks, an extension cord, and two 1500 Watt electric space heaters from my stock. Next, a medic lifted a bed while I crawled around on the floor to place the wooden blocks under each of the bedposts, raising the underside of the mattress from 40cm to 60cm above the floor. Then I simply put the two space heaters under the bed; I placed one heater directly beneath where I expected the child’s chest/head to be, and the other heater under his legs/feet. I then plugged the heaters into the extension cord, put it under the bed, turned everything on, and the heat rose nicely up from the heaters to give a fairly uniform temperature on the mattress. Not perfect, but certainly better than nothing!

09:40 – Send a member of my team to the bazaar to buy a steel I-beam and get it cut into three pieces.

09:45 – Set up a work site in the Female Ward Burns Unit. We recently rehabilitated the female burns unit to accommodate half a dozen bedridden burns patients, but the number of people showing up has been higher than predicted, so we needed to create more space. Just as with energy, in this hospital space cannot be created; instead, it had to be converted from another type of space. Accordingly, we expropriated the nurses’ locker room next door, emptied it out, and used a blue marker to draw a lintel and doorway on the wall. On the other side of the same wall, the female burns unit was still in use, so we taped plastic sheeting up with the aim of stopping any dust coming in when we smash through the wall. We also used a lot of plastic sheeting to set up a work area on this side – as soon as the hole is opened, our guys will need a bit of space on each side to work, but we don’t want masonry dust entering the room. My staff members all wear industry-certified face masks to avoid breathing dust in, and protective glasses (when smashing things) to prevent irritation or injury from dust or masonry fragments.

Starting work on a new doorway in Bost Provincial Hospital, Helmand, Afghanistan

Now, if only our blue marker line drawing could actually cut a doorway as in a cartoon… Instead, we got out masonry drill bits to start cutting holes into the wall, cracked tiles off the wall with a hand-held chisel, fitted a chisel-bit into a hammer-drill to chip away at half-century-old mortar, and hacked and smashed at the wall with a pick-axe to remove the bricks. When you’re attacking a wall sixty centimetres thick, it takes a LOT of patience, persistence, and precision to progress!

Using a pick-axe to break through a 60cm-thick wall in Bost Provincial Hospital, Helmand

11:55 – Run over to the area beside our backup generators, to meet the heavy-lift crane truck that had just arrived. Several old but perhaps fixable generators and an autoclave had been sitting around outside, and needed to be relocated to a more suitable (read: out of the way) location. The crane truck lifted the largest generator onto a flatbed truck, then both vehicles circumnavigated the hospital in order to place the generator for us.

A crane lifts an old generator onto a flatbed truck at Bost Hospital

Following that, the flatbed truck – equipped with a less powerful crane – relocated the hospital gardeners’ hut as it was also blocking access for large vehicles that we may need to bring in for unforeseen work in the future.

A crane moves the gardeners shack at Bost Hospital

With the hut moved, the trucks no longer had to drive all the way around the hospital to pick up the remaining equipment, including the second generator, which we lined up neatly near the first.

Moving another generator at Bost Hospital

Next came the fascinating old Soviet generator trailer which had been sitting inconveniently at the bottom of the hospital water tower for untold years.

Relocating a Soviet-made generator trailer at Bost Hospital

Finally, we moved the “little” autoclave (it may only be the size of a large washing machine, but you wouldn’t want to try and lift it yourself!).

A crane moves an old autoclave at Bost Provincial Hospital, Afghanistan

13:25 – Eat a very late lunch. Kebabs from a nearby restaurant for me and my assistant, because our staff kitchen lunch was at 12:30 and is all gone by 13:00 most days.

14:00 – Start one of our guys scraping and sanding two big diesel tanks to prep them for new protective coats of paint. Ask our painter to coat I-beams in anti-rust paint. Send our electrician to repair the boiler in the hospital laundry, then to check all the outdoor lights around the hospital, and repair or replace as needed.

Scraping old paint off a diesel fuel storage tank
Painting steel I-beams with anti-rust paint

14:30 – Discuss with mechanic about one generator having trouble starting in the cold weather: we’ll have to use some starting spray until we come up with a longer-term solution. Place bricks under a recently-installed fuel pipe to protect it from people accidentally stepping on it. Collect the carbon steel pipes left over from our recently completed fuel system, return them to our warehouse.

Carbon steel fuel system

15:30 – Advise our plumber on the placement and installation of a handwashing sink for the new entrance to the female burns unit.

Installing a new handwashing sink in the female burns unit of Bost Provincial Hospital, Lashkar Gah

15:40 – Place old bricks around a newly-poured concrete path to the hospital waste zone in order to keep people from stepping on it, even though I know some people will take a shortcut at any cost here. Check to see which windows broken in the blast were completely repaired, and which ones were only temporarily covered for later repair.

Newly-poured concrete path to the hospital waste zone, Bost Hospital

16:00 – Wedge one I-beam into place above the doorway-to-be, on the off-chance that something could happen in the night to collapse part of the wall. We planned to finish chiselling away at the area above the new doorway in the morning, allowing us to fix the three I-beams with concrete to form a lintel. This allows us to safely remove the part of the wall which we need to use as a doorway; otherwise, the wall could collapse someday.

I-beam lintel above new doorway in Bost Provincial Hospital, Helmand, Afghanistan

The workday ends at 16:00 in wintertime here, because of the shortened daylight hours, but many of my technical team members stayed past 16:00 to finish up their work without asking for overtime. For instance, our mason put the finishing touches on some concrete work and took the time to clear the work site nicely and clean our masonry tools properly before putting everything away and going home. Once again, these guys really brightened my day with their hard-working attitude and big smiles.

Although I was exhausted by the day’s end, I was nevertheless happy with the day’s achievements, and ready to tackle another one after some much-needed sleep.