Logistics

Expertise in logistics is one of MSF´s greatest strengths. Efficient logisticians get supplies to disaster sites quickly after an emergency. They also are in charge of security, administration, and finances in the field. Most of all, they are problem solvers, the handy-types with common sense (Lola Evans, you were born for this job!). If the lights go out, go find the logistician. What?? There is no Fluconazole? Tell logistics I need it by tomorrow.

Logisticians come from diverse backgrounds, training, and education. Some of them are ex-military, some are engineers, some mechanics, and others are water or sanitation experts. Mary Ángeles (at left, in black sweater), our current logistician in Puerto Barrios, says that the most important quality in a logistician is curiosity and willingness to learn new skills. She also says it is the best job if you are a woman who happens to like men, as the male:female ratio is about 6:1.

These pics are from the logistics conference that Angles and Rafa attended in January. There were 25 men and four women. They had workshops on car fixin, water chlorination, antennas, and how to play tug-of-war with your vehicle. Note Rafa´s butt in pic below right, just in front of the rear wheel).

Fungal Pneumonia

Marvin, ELAM, and Cuban Doctors

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Marvin (pic at left) is the new doctor I am working with at the Hospital Nacional Puerto Barrios. He will take over as the Infectious Disease clinic doctor when MSF leaves Puerto Barrios. Over the next couple of months we will see patients together. I am teaching him everything I know about HIV.

Marvin was born in Coban Guatemala. He went to medical school in Cuba. He was in the first graduating class at the Latin America School of Medicine in Havana Cuba (also known as ELAM). After he graduated in 2005, he returned to Guatemala to work.

ELAM is a fascinating place. It is one of the largest medical schools in the world, and certainly the most diverse. There are currently about 10,000 matriculating medical students from more than 25 different countries (the majority are from Latin America). The school trains students from poor countries who do not have access to medical education. All students are given free tuition, room, and board for six years while they study medicine in Havana. They are encouraged to return to their home countries to practice medicine after they graduate.

There are currently about 100 ELAM students from the United States. The students are recruited and screened by the Interreligous Foundation for Community Organization (IFCO). Most of the North Americans at ELAM are from underrepresented minorities in US medicine.

There happens to be an article just this week in Slate about ELAM and Cuba´s system of medical education. It reports that Cuba has more doctors per capita than any other country in the world. Another recent article in the Economist discusses Cuba´s tradition of exporting doctors to sites that need medical help after natural disasters and emergencies. The article says that about 1 out of every 3 Cuban doctors practices outside the country at any one time.

How is it that Cuba can afford to train poor American minority students while the US can't manage to do so? How can Cuba manage to send thousands of doctors abroad to take care of the poor after International Emergencies and Humanitarian crisis, while almost all of the doctors in the US are too busy trying to pay off their medical school debt (average debt of graduating medical students in the US is currently somewhere around $100,000)?

Mancos, Tuertos, and My Weekend Strike

My Spanish is improving at an infinitesimally slow pace. The process of learning a language in my old age has made me appreciate the importance of words in a whole new light. I never realized how important it is to my well-being to have just the right word to express my idea or feeling at any particular time. The converse, of course, is the frustration of not having the right word, and having to choose the next best available choice, which is often does not convey anywhere near the idea I want to express. What´s the point of talking at all?

But, as I get better, I am starting to think that Spanish is a better language than English. I´m no linguist, obviously, but Spanish seems to be more organized, for one, with more rules and less randomness than English. You can make verbs from the nouns, and nouns from the verbs. You can increase and decrease the size of things simply by tacking on an ito or issimo to the end of your adjective. And there are many important words that have no English translation. For example:

Manco- A person with one arm
Tuerto-- A person with one eye
Cojo-- A person with one leg
Also, Madrugar (to get up at the crack of dawn), is a handy word for an unpleasant concept.

Despite the above advantages, it has been hard to live in a world where I don´t have the slang I need and I can´t throw around bad grammar just for fun, like I do in English. I tire of sounding stupid and being misunderstood. I am on strike this weekend, actually. No more Spanish for me until Monday. I need my rest, as I had to madrugar today to round at the hospital. There is a tuerto on my service who needed some attention.