Hello Mom and Dad, number 4

18-02-05


Okay, this letter is getting long, and I’ll send it soon. I have been reading over my last letters, and wondering if I’m drifting on issues. Most people ask me, “how are things here,” and, “what are my daily tasks,” but I have been most focused on what is happening in Somalia, than my daily routine. That is what consumes my thoughts, and this is just a recording of my thoughts, so I continue.

February 9th, as I said above, a journalist was shot in Mogadishu. Well, she died in the hospital from her injuries. All journalists have left Mogadishu afterwards.

Again, I point out that we are in Puntland, not the south of Somalia. Here things are much better, no public opposition to the Federal Government and no opposition to the foreign peacekeepers.


Yesterday, we received confirmed reports of another protest in Mogadishu, protesting the foreign peacekeepers. Also there was a bombing there, targeting an assessment group, for the upcoming African Union peacekeeping mission. We are concerned about what will happen to the Federal Government coming to Somalia, and the struggle that comes with it.


Right now, we are watching the events in Mogadishu very closely, as they may deteriorate, and influence us and the programs here.


As for the TB program: Things are going well, but I feel I am loosing a little focus in the priorities. It is becoming very obvious that there are many unmet needs for TB treatment in this part of Somalia. Everyday there are more and more reports of hard conditions patients overcome to participate in the treatment; and it is obvious that many of them will not be able to overcome those obstacles for the duration of their 6 month treatment. “We are getting many patients from _____ area. We must go there to assess the needs.” Came a fully agreeable comment from our MD. “Yes, we should go there, but it is inaccessible.” I would reply. “But if that is where the patients are, we must go!” “Sorry, we can’t” I feel like I am bringing down the wishes of the team, by voicing my thoughts on feasibility. There is an obvious trend that medical people don’t want to hear the problems, “we must address the needs!” and I’m bringing in the problems to why we can’t do this or that. So far I have met with agreement on most issues, but it is difficult. I think it is good to have the two sides of the argument, to keep the debate alive on treating patients, but it is difficult. “We must bring food to feed the patients. Treatment without food, is half-assed and not acceptable. Steve don’t tell me you are not willing to feed the patients!” “I see nothing more important. It is only a logistical issue. In the last shipment the hospital project had, 500 50kg bags were looted. It presents some logistical demands that I don’t think we can take on right now.” “But we try?” “We try.” It is a balancing act with more than two components. Medical needs vs access to patients vs staff capacity vs cultural considerations vs etc. I can see why other NGOs aren’t here. It is a difficult place to be.


Well, I should leave this off on a good note. A recent thing I’ve taken on. Jocelyne the PC in the Galcayo North hospital and the south Galcayo hospital projects is out for R&R now. I have taken over as the Security In-Charge of the projects in Galcayo. Looking around, I see that I’m comfortable in this role. I was wondering how I would like to be a Project Coordinator, and living with the hospital team, I have been under Jocelyne’s responsibility, security wise, so it hasn’t been an objective view. But, now that she is out, I find I am comfortable in this role, comfortable in the security analysis going on, and lastly and most importantly, comfortable that others have trust in my abilities. (Funny thing, with my birthday just passing, my age has finally come up. It turns out that I am the second youngest of 30 people in the MSF Holland Somalia mission, yet right now in charge of 13 of them. I think that really took the piss out of some people, but only by my age, we hope.)


Well, I still don’t know if I like it here. It is a difficult place to work, and I have questioned more here than elsewhere, why are we here? The medical needs are blindingly obvious, but it is only the ability to meet those needs that I find unquestionably inadequate.


We have an interm Head of Mission, as Colin (the regular one) is out on paternity leave. Tim (the interm HoM) asked if I would extend my contract. I have signed on for a 5.5 month contract (ending in June). I said no. I’m not ready right now to do that, for this place, for this project. I’m torn between those big medical needs, and my personal needs. This debate of inadequate meeting of medical needs doesn’t help resolve that issue. I think, unless things change a lot, I will come home in June, for another time between missions.


Okay, well maybe that isn’t the “good note” to leave off on, but this is a record of my thoughts, and that’s where they are.


Take care everyone. Lots of Love,


Steve

Hello Mom and Dad, number 3

10-2-05


Continued


I think our TB office (and clinic) is near the market. So far in one hour this morning, three guns have been “tested.” That is the term for describing one, or two shots, with no return fire. I don’t like it. There is some anticipation after the shot, to hear if there is return shooting. Bangggggg, there is another. Those last two are very loud, and low sounding. They sounded bigger than an AK. Blaahhh, there is a goat just outside our office blaahhhing away. There have been more guns tested lately. People are saying that some people in the south are buying more guns, or servicing their guns, getting ready for the next fight in the south. (In the south there are two sub-clans that fight a lot. It is 4-5 hours drive south of our project in South Galcayo, but still, we get involved in the clash response. Anyway, for today, no in-depth analysis, just noting more gun testing than usual.


I’m reading about the occasional fighting in Mogadishu these days. The transitional government is trying to go there, and there are heated debates about how, and who supports whom. There is debating about what peacekeeping forces can come, and how many. Some people don’t want outside peacekeepers to come. (In fact, there are many stakeholders in the equation of power transfer, or sharing. Some risk loosing power they have already, and they will resist African Union (AU) or United Nations (UN) peacekeepers to come with forces to neutralize their interests in a no government state.)


Recent politics in summary (Note, this is my understanding of the issue, know that I believe it is much more complicated than this): Somalia Government recently formed in Nairobi, after 2 years of peace talks, and selecting members of parliament. To incorporate all powers-that-be, there are approximately 250 members of parliament. Additionally, there are approximately 50 Cabinet ministers, a Prime Minister and a President. Roughly, this represents Somalia. The thing is, they are staying in Kenya, until the situation back in Mogadishu is stable enough to return to Somalia, and Mogadishu, as it is the capital.

It is a little more complicated though. The President and many other ministers aren’t liked in Mogadishu. As such, he has called for the help from foreign peacekeepers to intervene. Some governments have agreed to send troops, namely Ethiopia, Kenya, Djibouti, Yemen, Sudan and Uganda. Sounds fair enough, if things aren’t stable in the capital, send troops. But… it is a little more complicated than that.


The French, Italian and British divided Somalia up when they colonized it. The French had Djibouti, and allowed it to be its own country when the French pulled out. The British had three colonies of Somalia, and they separated them, giving one to Somalia, (in the north, called Somaliland). Another to the south, called the Ogadan, they gave to Ethiopia. And the one further south, they gave to Kenya. As for the Italians, they had the east coast portions, and left them to the Somalis. Looking how this influences today, well, Somalia has wanted its portion back from Ethiopia, for quite some time. Ethiopia has backed some militias in Somalia, in return for keeping it’s portion of Somalia (that is bridging many links together and summarizing it, but many people believe that is the link). It is more complicated than that, but that may be enough to know that with Ethiopian troops coming to Somalia to back their buddy the current President, (as they backed him when he was a struggling militia leader) there are very biased interests, (for example Ethiopia keeping its portion of Ethiopia) and there is very strong opposition to this foreign involvement.


If that isn’t complicated enough, let’s continue. There are memories of other international peacekeeping forces “helping out”. The last, and most famous, was in Mogadishu in 1992-3, where the UN and USA got involved, and left after sparking off a battle in the streets of the capital city, leaving more than a thousand Somalis dead, (also hundreds of UN dead, and a little more than a dozen US soldiers dead.) So, people are opposed to having Western peacekeepers here, but it goes deeper.


Somalia is a Muslim society, and the majority of the other surrounding states, are not. There are large populations of Muslims in all these countries, but the Governments sometimes are Christian based. The religious leaders don’t want non-Muslim troops helping out here. There is more.


There are many people making substantial amounts of money in this society. There are no formal taxes, port authorities, radio licenses, etc. As such, some smart businessmen are making a lot of money. Some strong people with the help of militias are making a lot of money. Some smart people with medical degrees, working in areas without regulations, are making a lot of money. And the Government may change all that. (You may ask what is all this wealth doing in Somalia? Well, the not-so-smart, or not-so-strong, or not-so-businesslike-minded, live quietly, and die quietly, as objections to the wealthy aren’t tolerated.) For the Government to come to power, it needs the support of all these powers-that-be, but to get support from the powers, the Government needs to show it is a worthwhile thing to have; tricky position to be in.


People opposed to the Government. Other people opposed to peacekeeping troops from Ethiopia. Other people opposed to any foreign peacekeeping troops. The Government has much work to do.

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Yesterday, Feb 9th, we had a rumour of a journalist being injured (unsuccessfully targeted) in Mogadishu. It is thought this is related to the opposition to foreign troops coming in.


So, I would say that tensions have risen a little. Maybe just the impression of tensions has risen, but all the indicators of tension rising are just normal things, coincidentally happening at the same time. Regardless, we keep an eye out, an ear out, and heads down. The National Staff say there is no problem at the security meeting this morning. Maybe I’ll talk individually with some people today about things to get a more in depth opinion.


Fortunately though, we are in the stable province of Puntland. Puntland is the province on the top Northeast Corner of Somalia, extending down to Galcayo. Puntland, under the leadership of (current Somalia President) Yusuf (and the support of the Ethiopian Government) has been very stable, sporting its own government, and police force. Also, since the population in Puntland is all from the same tribe, it enjoys more security than other divided sections of Somalia. There is limited influence from more extremist Islamic groups as well. The tensions in the south, in Mogadishu, are not here in Galcayo. People in Puntland, mostly, embrace the Federal Government, as they have embraced the Puntland Authorities.


Enough for now, goodnight,

Lots of Love,

Steve

Hello Mom & Dad 2

Well, it is almost a month now that I have been in Somalia. That was pretty quick. I don’t feel the chill of January in Canada in my bones, skin, or in fact anywhere. I guess it has been a month then.


I’ll get into the specifics of what I’m doing here later. For now, some comments about Galcayo. I still don’t know if I like it here. There is one thing that keeps happening to me that I’m not too happy about. Kids, (little boys around 6-10 years old) keep putting on angry faces and generally show off that they don’t like you. Driving to the airport one day, a group of kids were playing, then one yelled something in our general direction (probably, “hey, here come some white folks”) and the group divided, some cheering and waving, some yelling and putting their fists in the air. One kid ran up to the car and tried spitting on it as it passed. Funny little kid; really makes me wonder though.


To be fair, I remember being a kid and up to no good around the neighborhood; occasionally throwing something at a moving train, road sign, or whatever I wanted to, regardless of right and wrong. No malice in my actions to the train or signs, but maybe just finding an outlet for my rebellious youth. I wonder if this is the same with these kids.


Today, a kid (probably no more than 8) came to the door of a store I was in, and was holding a knife. This wasn’t a butter knife, but something you bring hunting small game with. Anyway, he held it there and started saying some things and waving it around, then he put on that same angry face and started pointing at people with the knife. As many times before, I looked around at others to see if their faces would let me know how I should react to this. And there, around the store, a couple people watched this kid, like it was a 3 o’clock in the morning infomercial, no emotion on their stare. My assistant turned back to the storekeeper to conclude our business, and there I was, just looking at this kid, confused. I didn’t feel threatened at all, as this kid was about the size of my five-year-old nephew, but this is leading to a trend. What is going on here? Not with this kid, but many of the kids. This kid was the most vocal and active of the ones I’ve seen, but his face was similar to the others. I believe this kid hates me, my skin colour, and/or finds me as an outlet for his rebellious youth; a focus for some frustration he holds.


There is a wonderful word I have learned recently, “Bufis.” Bufis defined: Descriptive to a 3rd person, (“that man is Bufis!”) Descriptive to an object built by a person: (“See how they build that wall, kind of on an angle?” “Yeah.” “Bufis.” “Yup.”) Descriptive to a person, based on something they did, ie: non-logic thinking, (“I thought I would try to improve the system. The building didn’t work out so well because not everyone knew the new system.” “What was wrong with ‘the metric system’?” “There is always room for improvement, no?” “You are Bufis.”) A person, a building, a system, a discontinuity in the logic, all constitutes “Bufis”. Now that I have learned this word, I hear it all the time. “Blah blah blah, bufis.” “Haa (Somali for ‘yes’)” I think my Somali speaking skills have doubled since I learned that one word.


I don’t know yet whether I can use “Bufis” to describe my observation of these kids. I think not. I think Bufis is a good word to describe a situation like, “wouldn’t it be funny if that was the last gas station for the next 200kms.” But 150kms into the road without a station, it isn’t funny anymore, it has stopped being a Bufis situation; it is serious. I’m curious to learn more about Somalis and why the kids wear angry faces so young. What at first looked Bufis, now isn’t funny any more.


Speaking of learning Somali. I’ve been confused lately about all the greetings, so today I compiled the ones I know:

• Quora wanaagsan – Good Breakfast
• Malin wanaagsan – Good Day
• Subaah wanaagsan – Good Morning
• Duhur wanaagsan – Good Mid-day
• Qado wanaagsan – Good Lunch
• Galap wanaagsan – Good Afternoon
• Fe-ed wanaagsan – Good Evening
• Asho wanaagsan – Good Dinner

Haben wanaagsan – Good Night


The funny thing is, I still don’t know how to say hello in Somali. Usually I revert to Salaam, (Arabic), but everything else here is a “good (quick think hard. Is it morning, or evening? Is the person going to a meal? Hurry, pick one!) afternoon.” It seems hard, but for every phrase I have learned (except for Bufis), an English one or two can be thought of. Just a note: I’m still enjoying learning the language, turtip, turtip, (slowly slowly.)


So, this is the 6th day of the TB program we are starting up. Unfortunately, Irene (our Doctor) is stuck in Nairobi right now. She went to Ethiopia to visit a similar TB program there, but just a couple days before she was to fly in, the organization that provides us with most of our flights, had some problems, and all flights are cancelled. So, she comes in a week when we charter our own flights.


But, we have started 6 days ago. Starting a TB program sounds big, and it is, just we are doing those little steps at the beginning of a big hike. The first few steps are almost effortless.


The project will do the following activities.

• Take over the responsibility of two existing, but not-supported, clinics (treating approximately 200 patients now.)
• Evaluate the existing clinics, clinic staff and facilities.
• Train staff as needed.
• Prepare for large increases in patients.
• Once those two clinics are running smoothly, then spread out a little to the 120km stretch of land between the two clinics by setting up TB referral systems and rough diagnostics in more remote areas. Still with most treatment in the two centres.
• Further along the timeline, we would offer diagnotsitcs and treatment to nomadic rural patients who do not have access to the current health facilities, yet suffer from TB all the same.

The last parts of this will be done in 4-6 months from now. Right now, we’re just taking baby steps. We have been given a room in the clinic, set up an office, had a local carpenter build us some tables, bought some chairs, cell phones, books, paper, etc. We have met with the staff and have heard 20 ways how the salary is not enough and not acceptable. As well, there is a bunch of administration that is now part of my job description as Project Coordinator. Security guidelines have to be changed to incorporate our program running outside of town. Job descriptions need to be finalized. Orders still need to be going out and coming in. Etc, etc.


The issue regarding staff salaries is a funny one. In many aspects I believe it is a wonderful textbook example of a two-sided negotiation; Directors vs. Shareholders, Labour vs. Management, or maybe even Israel vs. Palestine. There are parts that are unfair all around, and it is a matter of sorting out which ones can and cannot be agreed on. Today was a good day in this negotiation, but let me give you a little background.


During my briefings, I heard many times, “those Somalis are difficult people to deal with. They will ask, ask, ask, and it will take a lot of effort not to loose your shirt in the meetings. Taking over the clinics is tricky too, Steve. They haven’t been paid for the last year since that other NGO left, and now they want MSF to pay last year’s salary as well as hire all their staff and pay more than our regular salary scale. Bon chance!” Gulp, “Er, thanks.”


At my first meeting with the staff, within two minutes, after a couple pleasantries came the comments, “What do you plan to pay us?” and before I could answer, “That is hardly enough.”


As I said, this negotiation has been a rewarding challenge. Rewarding, because I am applying some formal negotiating ideas I’ve been learning, and to date, the staff are satisfied, and we have built a relationship, solving this problem together. I think it really helped explaining how MSF wasn’t like other NGOs, paying salaries and leaving, but rather working with staff, ensuring quality care, living in the communities we work in, etc. Also, as if by cue, a couple of staff members said things like, “I was in a refugee camp in Kenya, and MSF was there before others arrived, and they didn’t get involved in the politics, just like you said Steve.” Good luck working with me here in Galcayo, so far.


Anyway, things with the program are going well. We have some big challenges ahead of us, mostly focusing our program to something achievable. Right now, it is plainly obvious, there is absolutely so much TB in Somalia, and to treat it all, is not a reasonable goal at the moment. Now, we must build on what is here, (skills and clinics) and take it from there. Note: Back in July, MSF built a feeding centre to take over control of malnourished children treatment. Mortality rates in the hospital were approximately 45%, very unacceptable. Anyway, within some months, numbers rose from 30 to 50 to 80 to 120, very quickly. Most people say that once the population knows there is treatment somewhere, everyone travels there to get treatment. We think similar things will happen with us starting to take over the TB clinic. Right now there are 200 people in the two clinics we are taking over, I’m concerned that number will grow quickly.


That isn’t my biggest concern with the program though. More on that below. Have to go now.


Lots of Love,


Steve