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.

Humanitarian Logistics in a Nutshell – Part 5b: More Construction and Rehabilitation

While I was in Lubutu as interim logistician from May 19 to June 11, I had the lucky chance to oversee a number of improvement projects being carried out on the office base. While the main focus of any humanitarian is on the community in which he/she is working, it’s important to remember that the national and international staff managing the program need to have a functional and safe working space.

One project involved hiring a subcontractor to rebuild the paillote (thatched-roof hut) that protects the 13kVA generator. Without a good, rainproof shelter, a very expensive generator could be badly damaged or destroyed by one of Lubutu’s unbelievably heavy mid-afternoon downpours, leaving the base with no source of electricity.


The finished product, tested several times in the weeks that followed:


We got another subcontractor to build a new hut for the guards, because it’s not very fun to work a 12 hour shift after being soaked to the bone:


Another project during my stay was increasing the security of the base by building a new brick wall at the front to replace the bamboo fence and increasing the height of the brick walls on the sides of the base. These are four photos of the same section of wall; the first two were taken from inside, the last two from outside:


A leaking building can be problematic if you’re using computers for most of your work, keeping binders of archived documents for donors on your shelves, and vital medicines in your storage rooms. Since there were many leaks in the office roof, the landlord agreed to replace it and Merlin (Medical Emergency Relief International) agreed to supervise the work. It was ridiculously loud but it was important work.


Back to the walls – after the bricklaying was done, the walls were plastered with cement as you could see in two of the photos above. Following this, a tyrolienne was used to give the walls texture (I don’t know if this has any practical application, but it sure looks nice!). That metal machine – the tyrolienne – shoots out thousands of tiny drops of cement onto the wall as the worker winds a handle on the side of the box.


Paint comes next, white and green to suit Merlin’s organisational image:


An ultra-smooth area was created on which to paint an organisation logo and spraypainted before the logo was added:


A shiny new roof and a bright new wall:


Final touches – adding a hand-painted Merlin logo for visibility:


It was really neat watching as the different improvements on the base were carried out and it was a good learning experience as I was able to ask lots of questions to our rehabilitation logistician and the different workers pictured in this post.

Well, that’s the last of my “Humanitarian Logistics in a Nutshell” posts. If you want to read some stuff written by someone who knows a lot more about what he’s talking about, check out Michael Keizer’s well-written blog on humanitarian logistics and other aid-related stuff: A Humourless Lot. He offers good insight in a writing style that’s very accessible.

Humanitarian Logistics in a Nutshell – Part 5a: Construction and Rehabilitation

Depending on the organisations by which they’re employed, and the projects to which they’re assigned, humanitarian logisticians may become involved in construction or rehabilitation projects. People with civil engineering backgrounds and some management experience often make very good humanitarian logisticians for this reason. I studied international relations, politics, and French for my bachelor’s degree, and humanitarian work for my master’s degree, but I used to party with civil engineers (and all the other kinds of engineers) at UBC so I can pretend that I know a bit about all this stuff.

This is a typical centre de santé (health centre) supported by Merlin (Medical Emergency Relief International) in Obosango which is in the Lubutu health zone of Maniema Province in the DR Congo:


This is a maternity which is in the final stages of being rehabilitated by Merlin in Osso, which is also in Lubutu health zone. The funding for the rehabilitation came from JOAC (Jersey Overseas Aid Commission), while funding for the medical support (drugs and medical equipment, trainings, staff incentives, etc) for almost all of Merlin’s activities in Maniema comes from DFID (the UK Department for International Development).


The facilities in Osso, as you can see from the previous two photos, are a notch above those in Obasango. If there was money to rehabilitate the more than two dozen structures in the Lubutu and Obokote health zones, it would probably be done, but with the funding available two structures were chosen for rehabilitation and two for construction from scratch. These buildings are built using fairly simple construction methods.

Sand and gravel are donated by local communities and transported by Merlin to the construction sites, where cement powder provided by Merlin is mixed with the sand, gravel, and water to make cement for the foundations. Sand:


For the walls of the buildings, clay soil is donated by local communities and turned into bricks using brick presses, then baked in brick ovens like this one:


Once the bricks are ready, the walls start going up along the contours of the foundation as in this maternity being built from scratch in Omoyaki, in Obokote health zone of Maniema:


The brickwork for the Kabakaba maternity starting to go up:


This is the maternity in Mukwanyama, which is nearly finished being rehabilitated:


Once the building is finished, the brick walls are covered with cement-based plaster, then painted. The second photo in this post shows what the plastered and painted walls look like at the end.


At each structure supported by Merlin, a signboard is erected to let people know what the building is for, and who is helping support it:


Of course, there are many, many problems that come up with building or rehabilitating buildings in places like the DR Congo. For example, the community usually needs to help with a certain amount of free labour. Sand, gravel, and clay are needed and if these were not donated by local villages the work would be far more difficult. Communities don’t always understand the usefulness of a health centre, and may even oppose the disruption that construction or rehabilitation can cause to their villages. Various levels of local government may try to impose harsh restrictions that prevent NGOs from working efficiently. If construction workers, masons, and roofers are brought in to do some of the work, the local community may become upset that local villagers are not being given the opportunity for paid employment to work on the project. When community members are responsible for part of the project, such a making and baking the bricks, they may simply not do it because they feel they need to spend their days tending their crops.

For all of these reasons, and many more, construction and rehabilitation projects can easily stumble or even fail completely. The two foundation photos of Omoyaki and Kabakaba (above), for instance, show halted works – the villagers had stopped working several weeks before for a number of reasons. In the photo below, the foundation of the Lubao centre de santé in Kailo health zone is barely visible. All that greenery you see is growing where the floor should be. This foundation has lain untouched for two years.


In order to avoid problems like this, and to keep construction and rehabilitation projects moving along, a lot of community sensitisation is necessary. Staff members are needed to explain the importance of health for the local populace. These community sensitisers spend time in villages, often staying several nights at a time, motivating the community. With good sensitisers, the work tends to go relatively smoothly, and the sensitisation continues even after the buildings are completed so that the population actually uses them too.