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.

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