Logistics

One of the things that has struck me most here in the Democratic Republic of Congo is how vital infrastructure is to delivering medical and health services. Congo is a country essentially without an infrastructure. There's no postal service, no more rail services, few internal flights between cities and towns, the roads are nearly all unpaved and badly rutted, and anyway, there are only a handful of vehicles. Outside of the major cities and towns, there's no electricity. Many (most?) people don't have clean water for drinking and washing.

And so, in order to be able to provide, for example, maternity care, or pediatrics, or rape counseling and treatment, it's necessary to insert and support the doctors and nurses who will treat the patients. Medical staff require housing, transport, food and water. They need reasonable assurances about their personal security. They need medical facilities in which treatment can be delivered hygienically and safely, and in which patients can be assured of their personal safety during recovery. They need drugs, which have to be imported along with nearly all other medical supplies, e.g. rubber gloves, tongue depressors, surgical equipment, etc. [When I traveled from Kinshasa to Kisangani (a stop en route to Goma), I sat next to a Danish doctor who was en route to relieve colleagues in the midst of a campaign to vaccinate 780,000 children against measles. That's a lot of swabs and jabs, and a lot of measles vaccine and sterile delivery systems.]

During this trip I have met a handful of MSF logisticians, the people who make sure "the show can go on", and the job they do is impressive when you consider that nearly everything must be imported or bought or built. They buy Toyota Land Cruisers and ensure they're ready to run every day. They build hospital wards, and the beds to go in them. They build water sanitation facilities, not only for MSF operations but also for local communities (more on that in another post). They install generators and backup generators to ensure the availability of electricity (especially critical in hospitals and clinics). They built toilets and showers for MSF facilities and local communities. They need to source vegetables. And beer (pretty easy in the Congo, though I don't recommend an investment in a global distribution license for the main local brew, Primus).

These photographs are of Hayato Oguchi, the logistician for MSF's Kabizo operation, with whom we spent a couple of days and who is known as "Toto" to his colleagues. Toto and his team provide logistical support to not only the small MSF medical team in Kabizo but also the surrounding community, which has grown dramatically since MSF set up operations (in a country in which there is virtually nothing, reliable medical care is an attractive foundation on which to build a community). During my time in Kabizo I watched them plan, build and problem-solve (there was quite a lot of that), and best of all, enjoy one another's company and the respect of the community. As Ali G would say, "Respect."