The journey to Farchana is moving along at the pleasant pace of a water-logged pinball. I was expecting a one-day turn-around time in Abéché, but the logistics just worked out such that the scheduled departure is on Friday, so it’ll be a four-day wait here. Our Abéché-departing Land-cruiser met the one sent from Farchana at a half-way point to transfer passengers in both directions. This operation, done twice a week, is uniformly and rather endearingly called “the kiss.” As much as I’m psyched to finally get to my project, I’m finding these extended layovers a great way to get a feel for how MSF operates. Today’s briefings were on security and the regional politics in eastern Chad, and it was no gloss. Lots of details, but I won’t write reflections or a description on this. (When I did, in a previous post, it was edited out by someone in Germany. And just for the record, while it chafes to be censored in any sense, I am not upset, nor particularly surprised. My writing was noted to be too political and, at times, variably factually uncertain or too accurate. C’est la vie. It is the mark of expertise to speak broadly on a complex subject while still maintaining accuracy; needless to say, I’m not there for the most part, and when something may be an accurate comment on the facts in the ground, that statement itself may not appropriate for blog treatment).  Learning.

So I’ve got time to dither, and when I’m not playing scrabble on my laptop (about eight games today… it’s coming out my ears, and I dream of anagramming words at night) I’ve been musing on the set-up here, and getting to know some of the in-country management team better. I’m having a hard time understanding the French spoken by the Chadians, mostly because of my poor ear for these things, and in part because of the dialect. It’s going to be a slog to function in French with the team in Farchana.

Abéché: the most pervasive environmentally trenchant fact about this desert town, which is the largest in eastern Chad, and it’s second largest city, is dust.  No paved roads, no grass, just dry earth. It feels like how I imagine Marrakech would have been in the early-mid1900s, but with cell-phones and white Land Cruisers. We’re in the heart of winter now, and it’s actually pretty chilly at night (about 15˚C), while the days get up to 27 or so. I awake to the sounds of birds chirping, and from the tin door of my small room at the compound, I can see streams of them lined up on the coils of barbed wire. While walking from the sleeping compound to the office, there is a chorus of chirping while they flit from barbed metal to spaces between shards of broken glass embedded on the tops of the walls. It’s a rather cheerful sound, if but a heady image, and if you add their stochastic hum to that of the generator and the occasional yelping of the new puppy (named Tonto), you have the deep soundtrack to morning life here.

I’m trying to figure out who the other people are who are on the airplane.  It is a 100-person flight from Paris to Chad’s capital, N’Djamena.  The fellow sitting beside me works for Exxon, and at the airport he and many others are greeted by people holding Exxon placards with various names on them.  As well, people in military fatigues are greeting other passengers.  Military, oil interests, humanitarians, missionaries.

A young fellow with a bright smile that shows all his teeth wanders calls out my name and looks relieved to have found me. “Papi” introduces himself and takes me directly to the bar, where I meet the administrative coordinator (AdminCo) who seems a bit fatigued, but offers me a beer almost before saying hello.  This is a good thing.  We chat briefly before heading back to the MSF compound, and I’m shuffled into the back of a 4X4 and we zip off.  Very quickly, however, we’re off paved roads and traveling slowly on bumpy ground in what looks like a sprawling shanty-town.  There is nothing that would betray that this is the capital city of a country.  Nothing.  You know you’re off the beaten path when you’re in the capital city of a country and there’s no Starbucks.  I’m not being anti-corporate, because if there were a Starbucks I would probably be there right now, and it wouldn’t be for the coffee.  As it stands, there is one (count it: ONE!) internet café in the city that the staff here know of, and it ain’t wireless. (The UN people may have wireless…)

Fast-forward a day.

I’m now on the patio under the thatched-roof gazebo.  High white walls topped with barbed wire surround the compound, and there are guards 24/7, without guns, of course (this is MSF… more commentary to come on that). Most neighbourhoods that I’ve seen so far have this look, with the lucky ones having paved roads in front (ours does not). Muslim garb adorns people in the street, with goats and chickens running free amidst the ubiquitous vendors of gasoline (in old 2L drink bottles) and cigarettes. Also common are “recharging stations” for your cell phone. Toyota land-cruisers are the call-sign of humanitarian aid workers, and are surprisingly common, emblazoned with large identifying logos.

As it turns out, rather than scooting through N’Djamena in a day, I’ll likely not get my in-country “circulation” certificate for a week.  This is due to an unfortunate incident about a month ago wherein a group of French aid workers (working with the group “Zoe’s Ark”) tried to leave the country with 103 Chadian children.  Well intentioned at best.  Woefully stupid, irrespective.

At the training session for this mission, we were give talks by a number of people, but that by David Trevino stands out, probably because he is diva-like in his dramatics, brief, and has one of the best jobs of anyone I know (logistical consultant). He said that there were only three things we had to take from this week: 1) If you want to leave, just say so, and you’ll be on the next flight out, 2) If you are told to leave (ie. you’re being evacuated), don’t argue the point, just go where you’re told and argue later, and 3) never forget that your actions affect other MSF and NGO staff, even long after you’re gone.

It’s this third point that’s the most interesting. I’ve made comments to friends about the “brand management” that is done by MSF. They’re a $400 million-dollar outfit and collect most of it in donations from grandmothers to bake-sales (I’m told this, but it must be more complicated; at any rate, there is a push to deemphasize funding streams from private/governmental sources) . At any given moment, there are about 3000 expats, and many more inpats, in the field, all with the MSF logo on their sleeves, hats, car doors, etc. In this world of viral information transmission, a story or picture can be seen by thousands of people, and have greatly unintended consequences. To this end, in my briefing today, I was reminded that drug use leads to direct repatriation; sexual liaisons with local staff and Chadian nationals are forbidden; that I have to radio my whereabouts at all times; and even that my blog postings must be read and approved before being posted. Usually my big-brother hackles get raised pretty quickly with these things, but not this time. It just strikes me as uber-prudent and well thought-out so far

Non-sequitur: this arabic keyboard is bloody hard to navigate…   damned punctuation.

Well, I was told this afternoon that I may be off to Abeche, Chad (the largest city on the eastern border of the country, about 40km from Sudan’s Western border, the Darfur region.  If all goes well, in a couple of days I could be in the field! The next post will be from Farchana, in shala.

I awoke to the feeling of my thudding heart.  The rate was the same old 55 or so, but it was pounding. This may just be the unholy by-product of malaria prophylaxis and the alcohol from last night’s impromptu dinner party, but it likely has something to do with the fact that I’m off for my mission today.  Packed and stoked, I am! First to Berlin for a briefing, and then Amsterdam for another briefing, and then to Chad on the 17th, I think. Nobody’s given me tickets to anywhere except Berlin, so that’s where I’ll go. I feel like the humanitarian equivalent of a sure thing.

“How are you feeling?”

This is the question that I’ve been asked more than any other (yes, there may be a bias here in that lots of my friends are in the psy discplines…). Mostly, I’ve had a bland response. Other than some non-specific giddiness that could just be gas, my feelings haven’t betrayed (until maybe this morning) an imminent six-month trip to do cultural psychiatry in war-torn central Africa. And I have a guess as to why: I’ve got nothing to compare it to. I’ve never worked abroad, nor have I really travelled in Africa. I was born in South Africa, and immigrated to Toronto when I was 3 years old. And despite heading back every summer for about 7 or 8 years, I feel no more than a vague-yet-oddly-meaningful kinship with the place. A white privileged kid in an apartheid nation cannot validly empathise with the continent any more that a glass-bowl goldfish can with the open ocean. But more than that, I realise that I’m being careful with my assumptions.

“Are you always analyzing people?” / “Are you analyzing me?”

This is probably the most common question I get when I tell people that I’m a shrink. (The second most common is “Are you serious?” to which I like to answer “Hell, who lies about that?… If I was gonna make something up I’d tell you I was a surgeon.” This doesn’t make things less awkward, but somehow it does make it less weird.) The training for this job is 5 years. That’s 3-4 years of medical school, plus an extra five to specialize. It’s a bloody long haul, and a few ingrained habits are (hopefully) beaten out of you, the most entrenched being the idea that you can know something or someone quickly and surely. Yes, first impressions and intuition are invaluable tools, and you’d be a fool to discard them, but they’re just guesses that more often tell you about yourself than the other. As Anais Nin said: “We see the world not as it is, but as we are.” She was clever, amongst other things.  This quotation of hers is one of the very few things I could imagine Wittgenstein ever saying “I wish I’d said that.”

In my view, you gotta listen to a lot before assuming anything to be the case. How many jokes are there about the psychiatrist who just sits there, like some inert rock, for the first 6 months of therapy, repeating in some nauseating voice: “and how did this make you feel.” The kicker is that despite this being some mix of cliché and farce, it’s a stellar question. It’s the answer to this question that hints at who someone is in the world, and you’d often never know otherwise.

When a patient’s partner or parent dies and you say “I’m so sorry for your loss,” it’s more common than you’d think to get a “I’m glad he’s dead… he was an asshole!” in response. Or you congratulate someone for a promotion or accolade, and they only see it as a way for the higher-ups to substitute better pay for some empty title. They’re fuming inside. It simply pays to ask… and although some might consider the question intrusive at best, the short, open-ended question is often the most valuable and telling.  Any hack can jump to a conclusion and think they’re right without testing their assumptions, or grand to their personal choir, whatever form that takes.  It takes a boat-load of active, conscious effort not to do this.

Back to Chad. I’ve simply got no clue what it will be like… I have nothing to meaningfully compare it with; I’ve got no ability to empathise with my projections. Just some vague notion of something coming that’s gonna be big. My dreams have some danger, adventure and disorientation, though, so that’s a place to start guessing, for what it’s worth.  In some way, though, I do feel ready.

If you want to zoom around Chad from the bird’s-eye point-of-view, get Google Earth.  It’s a fantastic programme. (But, if it’s not possible, look at the pictures below.)

If you scroll about, you’ll see Breidjing Refugee camp, made up of approximately 30,000 Sudanese refugees, and Farchana refugee camp, with about 20,000 persons.

The top one is an image from Google Earth, which is the Farchana camp from about 2 km above, and the one below that same camp at ground level. From the UN-map below, you can get a sense as to where the refugee camps are located.

(NB: All of these maps, and frequent updates to the situation in Chad and other humanitarian projects can be found at 1) Reliefweb and 2) the MSF International site.

UN map chad 1

chad map actors on the ground

I don’t know about you, but I can’t think without a map. So, now that you have one, this is what I’m in for starting mid-January of 2008: The plan is that I’ll be stationed in Hadjer Hadid for about six months doing daily trips to nearby refugee camps (mostly Breidjing and Farchana, I think), and IDP (Internally Displaced People; Chadians who have fled violence in their own country) camps scattered around the area. Like most things in life however, and from what brief information I can gather, MSF is an on-the-fly fast-response medical relief organization, so even the best-laid plans can change dramatically and frequently.  The MSF contingent is 8-9 expats, and about 50 national staff.  Not sure about the size of the Mental Health Team contingent, or what the set-up will be.  My mind is racing with possibilities.