Budgeting For Our Projects

My predecessor has flown home. I have my computer and keys to the office and safe. I guess it is time to get working as that is what I have come here for. Essentially my job is to manage the finance teams in the field, ensuring that they have enough cash to do what they need to do and that for every rupee spent there is reasonable justification and a correct accounting record. My days are punctuated with cheque signing and authorising payments and a large part of my work is relationship management down at the local bank. Nothing new there then. Except that things do not quite work in the same way here in Pakistan as in Europe. It is quite a wonder to work mostly in cash. I have to deal with large physical transfers of money that literally burst out of my backpack there are so many bundles and wads.

In order to draw up the budget, it is crucial that I understand the project and our operations. We have eight different cost centres that fund several activites:

MSF France returned to Pakistan after a previous evacuation to act following the earthquake in 2008. Since then we currently have a project in the Masehra district, where we are treating patients for Cutaneous Leshmaniasis, a skin infection transmitted by sandflies. Due to increasing security risks, we have evacuated all expatriates from the town and are running this project by remote control from a large city several hours away called Abbottabad.

We have another activity in the North Western Frontier Province (NWFP). Here we are running a cholera treatment centre and have a presence in the in patient department and emergency room of a local hospital. We are very successful in this region as people are are travelling for miles passing public hospitals just to attend our basic clinics for accurate diagnosis and referral.

Coordinated from Peshawar we are running basic health units and mobile clinics to allow free access to health care to those in need, in addition to revamping operating theatres in local hospitals. Non-food item distribution is another activity that we are fond of, providing blankets, temporary housing and soaps to fleeing refugees. The area was home to many internally displaced persons (IDP) who fled the recent military operation in Swat Valley and previously we were running some IDP camps in the region. These camps closed for two reasons, firstly the army wanted to assist in their management whereas we do not condone any military or political associations, nor do we accept arms in our places of work, and secondly because most IDPs preferred to stay in local homes. The Pakistani culture of privacy for their women is such that life living in camps all in the same tent is not easily accepted, thus they choose to find shelter with other families in a house. This can mean many families under one roof, with hygiene conditions that encourage the spreading of disease.

We also have further activity in the Kurram Agency, in the Federally Administered Tribal Areas (FATA) bordering Afghanistan. Again managed by remote control, we have activities in a region that is plagued by sectarian Shiite-Sunni conflict. The road into FATA is too dangerous to cross with a high risk of kidnapping, even for locals, as the area is under Taliban control. Our medical activities support local hospitals, and are run out of two towns, one Shiite and one Sunni.

Our latest project is just in its birth stages. The focus of military attention has shifted from Swat to Warziristan where we expect bloody violence and consequently a new movement of refugees. We had originally intended to take over a disused hospital in the city of Dera Ismail Khan and had obtained permission from the local authorities to do so. During a meeting to finalise this permission, the District Police Officer received a phonecall and then informed us that we had 30 minutes to evacuate the region with a police escort. We are now in the process of setting up a trauma centre and operating theatre from a Punjabi town bordering the Dera Ismail Khan district. We will operate from there and will rely on ambulance shuttles to access the area bringing patients for treatment.

This makes for a lot rupees needed, and a lot of rupees spent. I plan to visit those fields that are accessible to meet the team and enhance my comprehension of the technical operations, as I don't have any medical background whatsoever. During my first week I was responsible for drawing up the budget. This is a task that should normally take about three weeks for one cost centre. In Pakistan we were responsible for producing budgets for eight cost centres in just one week. We worked fifteen hour days for ten days solid. However, this was a great way to understand exactly what we are doing and what it is costing. Not working for profit is very different to working for the private sector. I am used to deciding what can be spent based on an arbitrary budget allowance. Here we are deciding what to do then estimating how much it will cost and thus we have our budget. Completely the other way around but not altogether foolish.

Our cholera treatment centre and staff

Islamabad Ain't So Bad

I have arrived in Islamabad and it isn't half bad. Though it was not was I was expecting. The city bears little resemblance to other cities I have visited on the subcontinent with life everywhere, much disorderliness and hustle and bustle. Islamabad, meaning "abode of Islam", is a relatively new city built in the 60's to move the capital from Karachi. The neighbourhoods are divided into sections and roads are laid out in a grid system similar to American cities. Driving around the town it seems mainly to consist of clean, leafy avenues with the odd police checkpoint here and there, and large, modern houses.

I live in a large house too. I have been lucky to bag a room of my own (for now, as there is a second bed for perhaps a roommate in the future) with an en-suite bathroom. I cannot complain at all about the living conditions as we have air conditioning, cable television and wireless. There is some communal space and even a private garden, but most of the time it is much too hot to sit in. I may convert it into a badminton court in the winter if there is space!

As our working hours are gruelling we have our own drivers, a cook and a cleaner. This is a luxury I have never known, very different to how I was living in Burma. I hope that I will not forget my skills in the kitchen while I am here and hope to spend some time with the chef learning some of the local dishes.

I live with the other expatriates who are based in the capital, and we also house staff from the field who visit at weekends for a much-needed break. Everyone is living in peace and in the evenings after work we often share an aperitif of Coca Cola on ice while we muse over our day and the evolution of the projects. There is a wide range of personalities present; from Swiss surgeons, softly-spoken logistics managers, a doctor from Australia with the blondest hair possible (not very low-profile!), and many other medical and administrative staff. I am a newbie compared to some of the old-timers who have a history of over half a century of MSF work between then; they have worked in places like south Sudan, Lebanon in the 80's and Kabul. Already I have heard some impressive stories about what missions used to be like in the olden days, when there was barely a tent, let alone an internet connection, helping people who had never heard of Coca Cola before. Everyone speaks French, and it is a change to be living as a full-time Francophone again after my time in England. My vocabulary of slang is already improving!

My office is similar to my home, it is a converted house and located very close to a mosque, naturally. The team of national staff are very nice, and more importantly, competent. Unlike other countries in which MSF work, there is no shortage of qualified staff in Pakistan. Made up of mostly men, some of them have years of experience in the field with MSF and they seem to know the system well. As Islamabad is so new, not many are from the city. Some have been poached from MSF Belgium or Holland, the other sections present in the country, some had security problems in the field where they were been directly targeted, some have been promoted and are working their way up the MSF career ladder that we have in place. My direct report is young and motivated, reminds me of a Bollywood movie star, and I have a good feeling about him.

So far, so good!

Je voudrais que quelqu'un m'attende quelque part

The first book that I ever read in French was a collection of short stories, one of them described a character who always hoped that someone was waiting for them whenever they arrived somewhere new. I travel through airports and stations a lot, and often alone. For each new arrival I too have a hope that someone will be waiting there for me. Preferably a loved one, but if not, a card held out by a stranger with my name scrawled on it will do. It took me a while to find my driver at the airport in Islamabad, but I was glad to have somebody expecting me this time.

Well, I have arrived safely in Pakistan and now I am wondering what I was worrying about. Although behind the scenes there may be some danger, there doesn't seem to be any discomfort for now, in fact it looks like quite a nice place!

The Phone Call

After deciding this summer to work for MSF and having successfully passed the training, I spent August waiting for them to call me back and tell me which mission I was to be assigned to.

Then it came. Pakistan. 12 months. The role of Financial Coordinator. "That is great", I replied upon learning the news.

I thought about what I genuinely know about Pakistan...Not very much apparently:
1) They have a strong cricket team.
2) There are small pockets of London surburbs that are considered as detached states of Pakistan.
3) It lies next to India - a country I know and love, thanks to frontiers carved out in 1947 after the wrath of the British. The country also borders Afghanistan for that matter.
4) Oh yes, did I forget to mention? There is a long history of Taliban and sectarian conflict in Pakistan, especially since the 'war on terror', plus it is thought that Osama is hiding there.

"Actually it is not so great" she said. "Are you familar with the security context over there?". I gulped as she proceeded to tell me the risks. Later on, once I had made up my mind to go, I comforted myself with one other thing I knew about Pakistan. At least the food would be good even if it isn't that safe.

From Riches To Rags

As you may or may not know (if anyone is actually reading this) I recently decided to throw in my capitalistic towel and opt for a more self-fulfilling job in the humanitarian sector. Actually, the story doesn't go quite like that, it was rather my former employer who abandoned me and my excessive salary in the face of the global recession.

But those who know me well will testify that I have always harboured designs to pursue a more meaningful career path in aid work. In fact I was recruited by Médecins Sans Frontières (MSF) almost two years ago but wasn't quite ready then to take the plunge.

I blame my Catholic upbringing; all those God-fearing years in high school raising money for CAFOD. And so I have stopped serving the fat cats in the London rat race and am now working for a politically neutral, non-profit medical organisation based out of Islamabad, Pakistan. When I signed the contract, there were admittedly some zeros missing from the annual salary figure, I doubt I will even reach the lowest income tax bracket! But I am hoping the gains over the next twelve months will be worth much more. Not only is it for a worthy cause, but it will be the ultimate test in endurance and self learning. In the absence of photos, these entries document a personal account of my experiences out in Pakistan. Here I go...!