Susu

Susu is a traditional form of banking in Liberia. The goal is financial management, and the investors act more as a support staff than as investors. That is to say, money changes hand, but no profit is generated. The benefit, still, is huge. Just ask Jonathon.

Jonathon is a self-made business man. Just three years ago, he took a loan from a Lebanese man to buy a car. At the time he had neither prospective clients, nor the expectation that he would be able to pay his loan any time soon.

Today Jonathon is the sole proprietor of Jonathon’s Internet Café. His facility dons three computers with high speed internet (high speed, as in 128 kbps … enough to make a skype call) and a Vonage phone (a phone with a US number to that allows callers to pay US long distance rather than international roaming fees).

Equally impressive, is the booming taxi business Jonathon has built for himself. He is one of only a handful of drivers whom internationals call for transportation throughout Monrovia. His reputation has grown through word of mouth – as has his social capital. His clients routinely send him to the Roberts International Airport (RIA) where he is often the first face that new arrivals to Liberia meet.

Though Jonathon’s story is a success by any “up from your boot-straps” standard, he is faced with a challenge. Word of mouth and client-by-client growth is important, but how can he elevate his business to the next level? Taking a loan from a local bank is ill-advised; even keeping money in a bank account is considered risky (most people have a safe at home, or an alternate storage system).

This is where Susu plays a turn.

The “susu” is a group of like-minded business folk (men, most often) who enter into financial partnership. They agree to each devote a decided amount of money per day (maybe 200 Liberian Dollar, about 3.25 USD) to a Susu manager who holds the money for safe-keeping. At an agreed upon time interval (maybe once a week), that lump sum is given to a member of the Susu to use in a way that will promote his business. The cycle repeats until each member of the Susu has received his due.

“So you don’t actually make a profit,” I asked.

“Noooo, you put in as much as you get,” he says with a smile of understanding. Jonathon has infectious good humor – the kind that seems almost impervious to hard times, though I know he’s seen many.

“The advantage is that you make progress in a big way, like you couldn’t on your own.”

With Jonathon’s next Susu receipt, he plans to upgrade his car – an achievement that seemed wholly untenable only three years ago.

Giving Thanks in Liberia

On Thursday evening at the 16th Street apartments, I had the pleasure of sharing (and preparing) perhaps the most delicious and bountiful Thanksgiving meals ever to be enjoyed by 30+ internationals in Monrovia, Liberia.

The meal capped off a glorious day-and-a-half marathon of cooking and working (mostly emailing while bread baked and turkeys roasted). Preparing for the meal had been most unconventional, but everyone’s efforts (and the good fortune of snagging the last three turkeys that the Grand Prix Grocery store had to offer) resulted in what felt like an evening in the States for one of the greatest holidays.

In fact, our Thanksgiving table was complete with turkeys and gravy, potatoes of all kinds, cornbread stuffing (both veggie, and turkey filled), grilled veggies, cranberry sauce (usually the hardest thing to find over seas) and a slew of desserts.

As we hunkered down for round two, one of my roommates made a valiant efforr to start the “I am thankful for…” game – you know, when everyone goes around the table and lists one thing for which they’re inspired to give thanks.

The table was long, and mouths were full, so the game didn’t make it very far. But, looking through pictures of this night, and the past few months, I felt it appropriate to devote a post to the “I am thankful game.”

Note: Many are Turkey-Day related, some are most random, a few are cliché, and all are sincere

1: I am thankful for a city where many of the cars that pass have steering wheels on the right side of the car… and others are just as likely have them on the left. (Random, I know, but endlessly amusing)

2: I am thankful that IS the bread I baked on Wed night FINALLY dried enough to be used in stuffing the next evening. Note: the air is so humid that it took 36 hours, and to keep the bugs away I dangled the bread, hanging from a colander, from our kitchen (picture below)











3: I am thankful for turkey roasters in Liberia









4: … and for pizza amuse bouche.













5: The comfort of spacious apartments, in a city so congested, where so many have so little for themselves….













6: …. and for friends to fill the room and share the table.













7: The chance to learn so much from such talented and generous minds.
(this is a picture from one of the many days of training that Clinton Foundation has facilitated)










8: And, for talented, guitar-playing roommates.










9: The chance to see the sun set over the Atlantic….









10: And, for those reading at home, having seen the sun rise over those same waters.











Happy Thanksgiving Everyone.

Blue

Taxing home today, I looked out the window to see a bright blue puppy toddle across the road. While I think, at this point, very little in Liberia surprises me, I found this peculiar.

When I inquired of the driver as to the source of these puppy blues, he explained to me that there is a substance called “blue,” is available in most grocery stores, which is used for “shining” fabrics. Many people couple it with laundry detergent or soap to add a sheer finish to their clothing or materials.

Blue also doubles as a flee-repellent – so they say. It’s commonly believed that dousing an animal in the liquid will rid them of the pesky bugs.

I’ve no reason to think one way r the other about how successful an anti-flee treatment this may be – but it seems as good a reason as any to be blue.

On Ice

Walking next to the Barclay Training Center this morning, I saw a young girl approaching at a fast jog. She was holding her arms out and fiercely gripping a boxed shaped object in her palms.

As she got closer, I read her desperate, yet amused, expression and noticed a stream of tears pouring down her face. Completely confused, I couldn't understand what was happening until she passed by and I realized she was running with a block of ice the size of a standard shoe box.

It's about 28 degrees in Monrovia - who knows how far she was carrying this icicle.

Suppy Chain Troubles

... seem to be a hot topic these days.

This Sunday NYTimes article profiles a case of mismanagement in Iraq. I don't know much about artillery supply chains, but I wonder if they have the cold chain issues we experience.

African lightening through African rain

I spent this evening's thunderstorms dancing to Cuban music with friends Carlos and Victor (de Peru), Milan i Vladan (iz Bosna), and a happy assortment of others at an ICRC (International Committee of the Red Cross) party in Sinkor, Monrovia.

The rains have been "heavy" in the evenings for the past few weeks - but it was hot enough tonight that the showers were welcome. What never ceases to amaze me about these Liberian storms, is the intensity of the lightening. Twice in three months I've awoken in the "small, small" hours of the night to booming thunderstorms - but not because of the thunder. Rather, the lightening flash has shown so brightly in my room that I've thought the lights were switched on (which, incidentally, is entirely impossible because we don't have power between 2-7 in the morning).

I've always loved lightening storms.

Perhaps I was acutely appreciative of a gorgeous Saturday night because the day, 'til that point, had been a long one. Morning began at six with a run round the Embassy, up Benson street and back through Mamba Point on UN Drive; I met my friend Joe (student at University of Liberia studying business management) for a jog. Per usual, the smog/humidity ensured that breathing/ gasping was a challenge.

The rest of the morning and most of afternoon was spent at NACP for the final day of the training on the new "Integrated Guidelines for Prevention, Care and Treatment of HIV/AIDS." The training, overall, was a success; representatives from hospitals throughout the country seemed enthused about the material and likely to share the material in their home institutions. We'll see.

Participating in this training was particularly useful for me because it offered insight into workshop "dos and don'ts" that I can hopefully apply during the December trainings for the Procurement and Supply Chain Standard Operating Procedure (PSM SOP). The workday was a preview of the magnitude of the preparations required in the coming weeks...

Handshakes and Applauding

First, let me preface this entry with the disclaimer that anyone living in (or who has ever lived in) West Africa will find this a bit ridiculous.

Second, I feel perfectly comfortable saying that, unequivocally, the Liberian adaptation of the everyday handshake and a round of applause ... just plain rocks, and it needs to be shared with those who haven't yet experienced it.

The Liberian handshake is one of the cultural goodies you find right as you step off the plane. It's a full arm process that involves the following:

1 - grasp the hand of your counterpart:









2 - slide into a thumb-to-thumb grip:









3 - pull back to clutch the finger tips of your counterpart:









4 - release with a loud snap of the middle fingers:









Note that the handshake can be abbreviated by jumping straight from the quick hand shake to the snap.

Perhaps the best thing about this handshake, and the fact that I found most surprising, is that it is uniformly universal, throughout much of West Africa, at least. Just as you would snap fingers with your neighbor, or doorman, or local "ground pea" (peanuts are called ground peas) vendor... you would also snap fingers with a County Superintendent (the equivalent of a state governor), a Senator, Minister, or... well, I'm unsure as to whether you would initiate a snap after a handshake with President Ellen.... But you would definitely be exceedingly flattered if she did so with you.

The Liberian applause is equally awesome - and it, too, is a bit of a production (notice the pattern of dramatic performances).

As I've seen it observed, among the crowd there is typically an applause leader. This person takes it upon him or herself to call everyone's attention. Then, slowly, and quietly at first, he or she rubs his/her hands together. As the energy builds the leader calls out the person for whom the commendation is intended, thanks them for whatever it is they did, counts out a series of claps which the crowd follows - then "pushes" or "tosses" the good energy to the person receiving the applause. This you have to see to fully appreciate. The below clip is from a recent employee appreciation outing to Barnes Beach (just southeast of Monrovia).

Bochalo

“Hey missy, what’s your name?” This, from a boy of maybe seven years old. I was walking past the American Embassy, returning from a lunch meeting at the Crystal Ocean View Hotel. He was carrying a very big jug of water.

“My name’s Amanda, what’s yours?”

“Me? My name’s Bochalo [at least that’s what I heard, I could be wrong]. I like your form, missy.”

“You’re too little to like my form.” How else do you respond to a seven year old?

“I could be good for you missy.”

No comment.

WAWA

I’ve developed this very awkward way of lighting my oven. I have a gas stove, but the lighter doesn’t work and the knob to control the amount of gas that comes from beneath the burner is broken… so inevitably the gas comes out full blast. My technique, therefore, has been to have a match ready, turn the gas on, duck beneath the level of the stove and toss the match towards the gas... hoping not to singe my hair/eyebrows/self.

One of my flat mates, an UNMIL military observer, laughed to no end as he witnessed me doing this.

After showing me a slightly safer stove top strategy (of placing the match on the burner, then starting the gas), he also taught me my new favorite phrase:

WAWA. WAWA stands for West Africa Wins Again - not the football frat, for all us Hopkins alums, or the chain convenience store for all those in living in the mid-Atlantic.

WAWA should be used to express the frustration that comes with the common inconveniences of life in Liberia (and neighboring states).

“For example,” he explained, “If, after the end of a long day working outside in the heat and humidity, you come home for a shower and the water’s been turned off, that’s a WAWA situation.”

Or, you come home all excited that you found fresh apples at the grocery store… but then you find a worm in three out of four of them.

Or, you pay 10 USD for a sandwich at a hotel restaurant (which would cost 3 USD anywhere else) just so you can use their Internet… but the moment you turn the computer on the power goes out.

Ah, WAWA.

Malaria, and the curative powers of cornflakes

Yup, cornflakes. Well, maybe it was less the cornflakes and more the 1250 mg of Larium and 30+ hours of sleep that actually did the trick. Regardless, only four days after testing positive for Malaria (of which strain, I'm unsure) I felt almost 100%.

Leading up to Wednesday of that week, my work schedule had been pretty busy and sleep schedule a bit erratic. When I lay down Wednesday night at about 8, I assumed I just needed a few extra hours of rest. But, after a sleepless night of a 101 temp, chills, body aches, and a very upset stomach, I had an inkling I'd received an unfortunate mosquito bite.

At roughly 8 am the next morning, I dragged myself to the car and our driver "carried" (the operative term in Liberia for "drive" or "bring" is "carry," and variations thereof) me directly to a local hospital. There I met an American doctor I knew working at the facility who helped me hobble towards the lab in the in the maternity ward to get a malaria smear. I remember taking a seat in the lab next to smiling, older lady who eyed me quite curiously.

I vaguely remember hearing the positive results and wobbling my way to the car, and eventually the spare bedroom in a friends apartment just a couple blocks away. I slept from about 9:30 Thursday morning to maybe 3:30 Friday afternoon, at which time I made my way back to my apartment and slept some more.

All in all, it was draining, but short-lived – definitely not the drawn out discomfort of getting shingles in Bosnia. However, I can’t imagine malaria being a routine concern. I have a friend here who said he gets “the malaria” about three times a year. It comes in different strains (and varying degrees of intensity) and can cause long-term liver damage if contracted multiple times. Not good news.

While the side effects of the prophylaxis are a bit intimidating, I think from here on out I’ll risk it with Malarone…

Riverside

On Saturday morning I bought a pair of Fila basketball shoes along Riverside market for 22 USD. The vendor wanted 26, but a friend of mine persuasively bargained him down. Just northwest of downtown, Riverside market is a hubbub of activity on Saturdays. It had been the largest market in Monrovia before the war, and has just recently been outpaced by Red Light.

Local commerce in Liberia is somewhat of a wonder to me - mostly because the national infrastructure is prohibitively underdeveloped. Where there are roads, it is conceivable that goods and services will follow. The goods may be well worn - at least several points removed from their point of origin and, mostly likely, destination - but if there’s a near by road then patience will eventually yield profit.

At Monrovia's Riverside, there is an endless stream of pedestrian traffic and international contractors to provide a market. What’s puzzling, however, is where the goods came from in the first place. There’s an endless variety of American throw backs: from squeaky clean Air Jordans, college football jerseys, Tupperware, dishware, Singer sewing machines, etc. Equally represented are Middle Eastern and German goods – though these nationalities have a stronger hold in grocery and convenience stores than street side markets. The goods themselves are seemingly new. Granted the dress shoes may need a polish, but on whole, merchandise appears to be stream into the country on a regular basis.

To my knowledge, however, the road to Riverside isn’t any less mogul-ish than those in the rest of the city. There are two traversable roads that run the length of Liberia, and they are often impassable during rainy season, so commercial vehicles are rare. Roberts Field International (the airport) is the end (or beginning) of every flight that passes through Monrovia – and I can’t speak to ever having heard of a rail system. Further still (and largely by consequence), Liberia completely lacks manufacturing capability. Though resource rich, Liberia’s raw materials are shipped abroad for processing and manufacturing. Not even Firestone (as I understand it) has a manufacturing plant in country. What’s left, then, as the commercial portico to the country, but its seaports? My guess (which I’ve had confirmed by just two acquaintances) is that certain “rights of passage” are understood between merchants and those working the docks. A small offering of incoming merchandise may ensure the safety of the rest of the shipment.

The coast is hub for various spokes of commercial exchange - legal and extralegal. In the earliest morning hours, young men push wheelbarrows of sand from the shore towards inland neighborhoods, where they reinforce structures and walls with sand bags. Smaller boys carry buckets of snails to the markets, and fisherman frequent the waters from dawn to dusk. So, I suppose, it’s reasonable to image goods of all kinds, from all countries, making their way to Riverside.

The shoes fit, that’s for sure – but I’m withholding further judgment until I see how well they wear.

Work in Transit

I’m sitting in the Nissan pick up on Benson Street just East of downtown Monrovia; we’ve been motionless for 30 minutes. Our driver, visibly flustered, is trying to coordinate with the office manager to see how to get the rest of the staff to a three o’clock meeting on the other side of town.

Resigned to passing the afternoon in the car, I decided to pop my laptop and get some work done. As I’m opening Excel files full of distribution plans, our driver exhales, disgusted, and gets out of the car to go encourage a taxi driver to move through the intersection.

So, I’ve found myself sitting in a Nissan pick up, typing on my MacBook… motionless in the middle of a street that is overrun with vendors and students on their way home from school. An atypical, though not unprecedented, day at the office.

Banking on Broad Street

There are two, relatively convenient ways to withdraw US Dollars from a bank in Monrovia: writing a check to yourself or wiring money to a local account from a bank in the US. This afternoon, I chose the former of the two and found myself carrying an uncomfortable amount of cash as I exited International Bank onto Broad Street.

One of four commercial banks in Liberia, IB was located within an UNMIL held area during the war, and has been active throughout the past 15 years of turmoil. This was also the case with the other four, commercial banks in Liberia, as well as the state owned Central Bank. International Bank sits across from the Executive Compound and Palm Hotel (and Chinese Restaurant). It is an American owned bank that acts as an intermediary for those wiring funds from abroad and cashes personal checks. At the teller wind charged me $18 for an “import tax,” which he explained was necessary because International Bank must import American Dollars. Though I hesitated at this explanation, the local accountant I was with assured me this was commonplace – and, more importantly, a lesser fee than I would have paid to wire the money.

My experience, on whole, was perfectly smooth. For most locals, however, this is generally not the case. In a recent conversation I learned that applying for a loan is a prohibitively complicated process. Take for instance, the process of property appraisal at the Liberian Bank of Development and Investment.

The Liberian Bank of Development and Investment (LBDI) is the largest Liberian run bank in the country. According to one Liberian friend, to have his property valued as leverage to take out a loan, the speculation process would take (“easily”) over a year. Furthermore, the bank would take the property at face value – meaning they would value an acre at the current price of an acre, rather than granting the owner a loan that would enable them to build on that acre. I am, admittedly, unfamiliar with the speculation process, and therefore unsure as to how common of a practice this is. I’ll do a bit of research on the topic, but I’m more than interested to hear any comments on this subject from anyone reading. Regardless, my friend attested to the fact that the process would be far easier and more lucrative for a Lebanese businessman or other international.

It will be interesting to follow LBDI transactions over the course of the year – or perhaps open an account to get a more intimate perspective.

Merit and Peace

This past weekend I moved from the apartment in Sincor where I had stayed for two weeks to a new residence in the Mamba Point district of Monrovia. Before leaving the the Sincor neighborhood, I went for a stroll through the streets surrounding the JFK Hospital.

As I wandered from the compound gates towards the seaside, I met a young UNMIL soldier sitting under a palm tree shining his shoes. He was on duty for the morning, he remarked, but it had been a quiet day thus far. He asked about the work I was doing and where I was moving. This banter led to his description of his own home in Nigeria and the tours in which he had served as a UN peacekeeper. He also volunteered a comparison of his time spent in West Africa, which didn't fare favourably for Liberia:

"Ooh, it's so heavy here," referring, I presumed, to the humidity of the rainy season.

"And it gets so hot," I found this comment surprising, given he'd lived all his life within the region.

"But, most of all, the city is so sad. Freetown, in Freetown, there is much to do." I'd heard this observation made many times before. The capital of Sierra Leone is rumored to be much more developed (better roads, more reliable utilities) and recreation-friendly (the options for R&R in Monrovia are limited, with fewer local/international hang outs that other capital cities).

"But, I found him here, and that makes me happy." With this, the solider nodded to a small german shepard which, to this point, had been lounging in the shade nearby. I don't typically use names in this blog, but in this case, I asked special permission of this new friend to share this detail.

"His name is Peace, because that's what I bring."

"That's an excellent name," I responded, offering the solidier my own name, "and what is yours?"

"Merit. M-e-r-i-t."

Maybe Merit was being poetic, or maybe he just enjoyed injecting irony into conversation.

Or, maybe, Merit really did find Peace in Monrovia, and they're keeping careful watch over a compound in Sincor.

A Monkey Named Soup… And, Lessons in Management

Tonight, at a dinner party in a house overlooking UN Drive, I met a monkey named “Soup.” The owner, our most generous host for the evening, had adopted the small female monkey in Madagascar to save it from an alternate fate as dinner course. While native Liberian monkeys hail from the Northern Lofa County, I’ve seen a number of pet monkeys over the past few weeks; most are kept on leashes, though I’ve seen a couple tied to trees. My first impression of this particular chimp was that her cage was far to small – but I suppose it beats a soup bowl any day.

CHAI Liberia welcomed three new staff members today; two doctors and a nurse, all Yale Fellows. The event was occasion for convening a number of the Deputy Ministers, inviting a slew of introductions and ad hoc speeches, and reviewing the CHAI development model and mission in Liberia. There were two key themes for the day, both came in the form of toasts: first, this is a time of reform in Liberia, rather than reconstruction; and two, the role of the “trusted adviser” hinges on keeping one’s distance from party politics.

On this latter point, Liberia today offers great opportunity to build and employ a-typical management skills. There is a vacuum of experience for many mid-to-upper level ministry positions and, subsequently, a high demand for consultants. Because internationals, those “without a dog in the fight,” are perceived as offering objective advice, they have the ability to positively impact policy on many levels. While it is tempting, at times, to take a more aggressive approach to meeting goals and deadlines, it is vital to the long-term success of development initiative here (and elsewhere, for that matter) to achieve success through local implementers. The Clinton Foundation places a great deal of emphasis on the practice of “reform through government.” In fact, CHAI programs are established exclusively at the bequest of host governments. CHAI employees work as government employees, offering technical support and promoting the institutions they advise. My impression, thus far, is that this model has achieved impressive results in the field public health and hold great potential in other sectors.

In short, lessons in management (or development negotiation) thus far include:

1. Never enter a meeting without knowing the outcome
2. Reform through local government, rather than acting as an implementing partner
3. Treat every draft as a final draft - I've already had one instance where a questionnaire I "drafted" was implemented as a final copy
4. Know your customer(s)
5. Publicizing objectives only limits the scope of your work
6. Aspire to remain under the radar; anonymity offers leverage

and more to follow...

Orange Limes, Green Oranges...

... and snails bigger than your fist.

On saturday morning, in a market directly across from the former army barracks on UN drive hundreds of vendors gather to sell fruits, vegetables, nuts, spices, meat, fish, and a variety of other items. I went this morning with coworkers and couple Liberian friends to find produce and see what the local market had to offer.

There are a few men who trade American and Liberian dollars, but they typically offer a worse exchange rate than you would find elsewhere (maybe 50 LD to every USD). I saw a handful of men selling fish as well, but majority of those “behind the counter”, so to speak, were women of varying ages. The “uma” (an affectionate term for older ladies) are more than willing to offer advice on how to prepare the food. A coworker and I bought two dozen crawfish for 200 LD and were told that they were best if boiled and dropped into a peppery soup. The range of seafood is impressive - there are lots of snapper, what look like string ray (scuttlefish, maybe), and eel, among others. The meats are equally diverse - and at times, difficult to distinguish. Tens of people hurried through the market with trays of pigs feet and a range of chicken parts. I can’t vouch for when exactly the meat is chopped - I did see one pile of chicken wilting on a scale that had a greenish hue to it. In some case, there is still animal hair on the bones. Most notably, we passed a small stand of what I hope were monkey arms. Meats are available both fresh and dried. In preparing either form I was told to clean the meat and either fry it or boil it thoroughly before including it in any recipe.

The fruits are fantastic - more specifically, plantains may be a staple of my diet over the next few months. The grilled plantains and cassava (which tastes a bit like a potato grilled) off the side of the road that are delicious if cooked all the way through. I’ve seen fresh bananas consistently and pineapples and papayas the size of small watermelons. There are tiny eggplants, large squash, and greens of all kinds. I’m also looking forward to the freshly ground peanut butter which is mixed is a 10+ gallon bucket and spooned into small plastic bags for individual purchase (I’ve heard it’s best to bring your own bag). In short, I’m looking forward to experimenting with different dishes.

Outside of roadside stands and these downtown markets, the majority of commercial activity seems to be done by Lebanese companies though I’ve noticed a few Liberian brands on the shelf (I just purchase Mamie’s Peanut Butter, which is at least packed in Monrovia). There is a large Lebanese merchant population in Monrovia which owns a number of the more prominent apartment buildings, hotels, restaurants, office buildings (including a J-Mart), and grocery stores. Other West African countries have a solid presence as well, such as West African Telecom; as does the Danish shipping industry, Maersk. There are, of course, a myriad of oddities (french ice cream mix, for example) and the ubiquitous international brands, such as Coca Cola.

I think commerce in Monrovia is particularly dynamic because is serves two very distinct markets (local versus international) and has a vibrant supply chain - the size of the shipping industry keeps the ports actively complementing the already rich the natural resources.

One week in...

Today, during my evening run, I had a close call with a machete. Though typically imposing, the instruments are quite practical for cutting through dense grass and plants (or anything else for that matter) and are common along the streets in Monrovia. I was jogging with a CHAI coworker and a South African pilot in Sincor, a neighborhood in eastern Monrovia, and was jumping around potholes in the road which had filled with mud. I hopped, not-so-gracefully, towards a corner of the street covered by plants and stepped forward just in time to see a machete clear the path. If anything, this first week has proven that the year ahead will keep me on my toes.

I returned to Liberia one week ago as of last night, landing at Roberts International Airfield on schedule and with all of my luggage. I enjoy landing at RI; it’s a small airport and passengers disembark via ladder to pour into a very crowded customs office. I’m looking forward to completing the necessary paperwork to warrant stand in the “resident alien” line.

Wednesday was a day of logistics. I headed into the office, delivered all technology I packed for the office (I carried three laptops, an MP3 player, and a phone), bought a phone, talked to a couple landlords, priced office supplies, and took a very excited trip to the tailors. One of the CHAI employees is working to refurbish a room at the JFK Hospital in the Sincor neighborhood and subsequently making curtains for the pediatric ward. The primary cost is the cloth itself. Two or three yards may cost 10-15 US Dollars, depending on the material, and the service charge may range from 7-15 USD, depending on the order. Typically a shirt it less than 15 USD.

Friday proved to be a fast orientation to both the M.O. of meetings in Liberia and some of the key issues of the next couple weeks. I arrived at the National AIDS Control Program (NACP) for a 10 o’clock meeting; we started at 10:30 and ran (at a steady clip) until about 3 before everyone’s attention started to wane. The focus was on creating indicators with which to measure the quality of services offered by health facilities throughout the country. While I am working directly with the NACP Supply Chain Manager, much of our work will relate to the process of Monitoring and Evaluating (M&E).

At the close of business Friday I went with a couple coworkers to a happy hour at the American Embassy. The embassy, despite being of smaller size, sits in an enormous compound - fit with a helicopter pad in case an emergency evacuation is necessary. Apparently, during the war, the apartments nearest to the American embassy were the most expensive in the city because tenants were willing to pay premium for the security offered by the embassy and nearby UN buildings. To a certain extent, rent in apartment in this Mamba Point neighborhood are still high. Happy hour was... happy... with plenty of Heineken to go ‘round.

This past weekend was a welcome time to wrap my head a few work project - then unwind while getting to know a bit more of the city. I went to a Hash run on Saturday (a story unto it’s own), followed shortly after by a party hosted by a number of UNMIL characters. As the Liberian police force is still in its infancy, the United Nations Mission in Liberia (UNMIL) has thousands of men and women on the ground to train local officials. Logically enough, each battalion is referred to as the first syllable of the country name followed by “bat”. For example, a battalion from Ghana may be called GhanBat. “BanBat,” a battalion of women from Bangladesh guards the Ministry of Foreign Affairs.

Monday brought more meetings - though the discussion this week has been a bit more lively than I’d seen earlier. The top priority for the coming weeks is preparing for the LFA (Local Fund Agent) to inspect the Global Fund mission here in Liberia. The Global Fund to Fight AIDS, TB, and Malaria (GFATM) is the primary donor of antiretrovirals (ARVs) in Liberia. The United Nations Development Program (UNDP) is the primary recipient of these fund and thus the chief procurement party. UNDP works with the National AIDS Control Program (NACP) to forecast the demand of supplies and I, in turn, am offering technical support to the Supply Chain Manager at NACP. The report submitted by the LFA may significantly impact the funding Global Fund devotes to Liberia, and subsequently the supply of ARVs in the country. Thus, we are all putting the majority of our energy into ensuring that the hospital facilities the LFA will visit are prepared to demonstrate their capacity to manage HIV/AIDS tests and treatments.

Amidst the focus on this more serious topic, everyone enjoyed brief comic relief at the expense of a small mouse in an NACP conference room. In the middle of her sentence, a UN speaker gasped a bit, shook her head and, pointing across the room, said, “I’m sorry, I can’t speak, there is something moving over there!” The remainder of the meeting went much more quickly in spite of the distraction.

Tomorrow I will go to the Firestone Hospital (of the Firestone Tire & Rubber Company) in Margibi County for the first of several visits to prepare for the LFA inspection. No doubt, it will be yet another day of something new and unexpected.

Corporate (Mis)Behavior

I have found, already, a number of instances of corporate behavior in Liberia that I would love to research further – some that align with traditional corporate social responsibility (CSR) campaigns and others that are more unique.

For instance, use of the Determine test began under the guise of a CSR platform. Abbott Technologies, the producer, set out to avail a cheaper, sensitive, specific HIV/AIDS test to developing regions, and in fact donated a large quantity. Consequently, a number of developing nations became accustomed to the test and now rely almost exclusively on Determine for first round testing. In this way, Abbott created a market in which it had an almost monopolistic presence. Axios International is the implementation arm of Abbott’s Access to HIV Care Program, and is responsible for donating Determine, Kaletra, and Novir.

Another example is the activity of Firestone Tire and Rubber Company, which sources a great portion of its rubber from Liberian plantations. Driving through Bong and Nimba counties, in particular, offers occasion to see some of the 2,000 square acres of rubber tree plantations Firestone has throughout the country. The process requires slashing the trees to drain sap for processing rubber into portable buckets. (here’s a link to see the process if you’re interested). Firestone has found itself in trouble in the past with the International Labor Rights Fund for violating child labor laws and international environmental protection agencies. The company responded that it strictly follows international conventions and works to uphold living standards and employment services for those working the rubber plantations (see the Wiki article for more ). Firestone has since launched several initiatives to combat the negative press. One example is Firestone Health Services in Margibi County, where employees and local residents can access counseling, testing, and medical services. As of 2006, however, UNMIL reports that Firestone is not fully upholding its corporate policies. Learning about the relationship between Firestone (well, Bridgestone now, I suppose), its workers, and the Liberian government may be an interesting project for the year.

On a cross-industry note, Liberia plays a central role in marine transport by serving as the second largest registry of ships in the world (behind Panama, and leading number three rank, The Bahamas). Established by US shippers after WWII, Liberia’s registry process is reported to be fast, efficient, relatively cheap, and simple. For info on the process check The Liberian International Ship & Corporate Registry. Apparently it costs only $713.50 for registration and first year dues. Who knew?

That’s where the time goes… or, an ode to potholes

It doesn’t take long after disembarking from the plane at Roberts International to realize that transportation in Liberia is complicated by cavernous roads, sporadic vehicles swerving at high speeds, destructive rains (from May to October), and “resident” dogs, goats, and chickens who defiantly strut across the street. Driving is especially difficult the farther you get from Monrovia, but even moving throughout through the city can be treacherous. There is one crossing called “Red Light” that swells with such congestion (of people, taxis, buses, vendors, animals, etc.) during the early evening that it's been know to take as long as an hour to move the length of a football field.

As such, the roads become a definitive element of life in Liberia. The insfrastrucutre requires a slower pace by car, which permeates the rest of business transactions (with other factors contributing, of course). In general, meetings are late and schedules are suggestive.

Luckily for CHAI, we have excellent drivers and trusty Nissans to maneuver through the streets. I have a new-found respect for the suspension in Japanese automobiles (though I’ve always been a Subaru fan).

To Nimba and back, the first time...

The end of this first week in Liberia has confirmed that my days with the Clinton Foundation will be hugely diverse.

On Thursday morning I met with the Chief Pharmacist at the National Drug Service to discuss data regarding the first line test, Determine. We reviewed a couple key figures before heading to the warehouse to do a second count of the inventory – I was amazed by how helpful in conceptualizing the current supply chain process it was to work in the warehouse and handle the tests. There are so many practical challenges that need to be addressed; many of the HIV tests, for example, are stored in unmarked refrigerators, making it difficult to count the stock with any certainty. Though someone may be keeping track, there needs to be a standardized inventory management system. At about 10 o’clock, as I was finishing taking inventory, I had begun to wrap my head around this new job.

I left from NDS to go to an M&E (Monitoring and Evaluation) workshop at Thinker’s Island, a beach roughly 20 minutes away. The workshop convened various Deputy Managers and Officers of the MoH, as well as facilitators from CHAI, UNDP, and the Global Fund, on a beachside conference area just north of Monrovia. The rest of the day was completely stimulating – due to both the content of the meeting and the setting itself.

Participants broke into groups of varying healthcare capacities, such as Home-based Care (HBC), Antiretroviral Treatment (ART), Information, Education, Communication (IEC), Behavior Change Communication (BCC), etc. I attended the HIV Counseling and Testing (HCT) section, and facilitated an exercise where the representatives discussed Liberia’s performance against HCT metrics and brainstormed action steps to addressed areas of underperformance. Moderating between the varying perspectives was fun, actually. Everyone was lively and opinionated, and only occasionally in agreement. By two o’clock we had listed five key steps, identified key actors and responsibilities for the steps, and estimated sources of financial and technical assistance.

At two we took lunch on the beach. Lunch in Liberia tends to be mid afternoon, and often takes more than an hour. So far, I’ve liked all of the dishes I’ve tried, save the lamb stew - though in all fairness, I think I got the unlucky bowl because mine came with a hoof. My favorite side, hands down, is fried plantain. The staples are rice and fufu, ground cassava root folded into a paste that seems a bit like a finer form of polenta. Sauces and stews vary, but always come drenched in oil (typically, palm or vegetable) and with plenty of spicy pepper to be mashed into the starch – if your nose doesn’t run, then it just isn’t hot enough.

We were lucky on Thursday, that the sky was perfectly clear and we could eat outside overlooking the beach. May through October is rainy season in Liberia, and the coastal regions can get 170 inches of rain during those months while inner counties receive less than half that. It’s cooler during the rainy season (about 27/28 C, or 80ish F) but unbelievably humid.

The rest of the afternoon was spent listening to each group present their next steps so we could formulate an aggregated action plan. Common themes through each presentation referenced the need for improved and standardized training of trainers (TOT), a national registry to track users of medical services, and a protocol for quality control. The action plan seems pretty daunting, but balanced by the recognition within the MoH of the need for these changes. We listened to most of the presentation but ducked out around four to head back to Monrovia to prepare the cars for the next day’s trip. On Friday, we planned to drive to the northeast counties of Nimba and Bong to distribute requested supplies, pull back at risk stock (materials about to expire) to redistribute to other counties, and assess whether the local facilities were following the testing algorithm and using resources efficiently. To do this, we had to collect the necessary supplies from Monrovia before the warehouse closed.

After gathering supplies we headed downtown for Chinese. There we met with a number of Yale fellows who were in town for the week to lead a conference on management strategies. To the surprise of many, Monrovia has a couple of reliably tasty restaurants. I’ve had good Chinese and sushi so far, though the fact that a CHAI member ordered in Chinese may have won us special treatment. The highlight for me for the night was a saying one of the fellows relayed from his time spent in Ethiopia. Apparently, when people come across hard times, it is common to say, "like a thorn from a monkey's butt." The logic is this: if a monkey falls from a tree into briers, then the first thing he must do is remove the thorns from his back side so he can sit down and get to work on the rest of his body. Essentially, the saying means "first thing's first." I think I may have to adopt it.

Friday started pretty early. We had to hit the road at seven to ensure that we had enough time to reach Ganta (our farthest destination in Nimba county) and get back to Monrovia before dark (because of the road conditions, it isn’t wise to drive after dark). It was great to get outside of Monrovia, get a sense of the counties, and see a couple drug depots and hospitals in person.

Liberia's country side is lush, green, tropical rain forest. The country is rich in natural resources - and not just diamonds. There are many farms of rice, fruits, and vegetables. The cash crop, though, is rubber. I'd heard of rubber cultivating techniques, but definitely never seen it before. To tap the rubber, manufacturers slash the trees making a large V mark, then drain the sap into bowls that are transported to second stage development. Manufacturers used to pay rubber collectors according the weight of their bowls until they realized people were placing small stones at the bottom - not they just cut into the thick sap to ensure the weight isn't thrown somehow. Firestone Tire and Rubber Company sources an enormous amount of rubber from Liberia. It's a very cool feeling to see the beginning of a good that we take for granted but has such an effect on our lives.

I saw two drug depots and hospitals during this first trip out into the counties, and I'm having trouble verbalizing my impressions. The first depot was managed with great care, but the basic needs were still just overwhelming. The same can be said of the hospital and second drug depot we visited. Because the counties operate on limited electricity, it is difficult to ensure the conditions necessary to store tests, treatments, and medical supplies and address the need of patients. For this reason, it is even more important that a process for assessing county needs and communicating to Monrovia is in place. Officials at the National AIDS Control Program have made a number of key reforms to their communication processes and supply chain management which have improved the flow of resources and information between Monrovia and the counties. The hope is that as we continue to work with the NACP and MoH, the process improvements made in these institutions will have a lateral effect on other government bodies.

I am still, admittedly, a bit overwhelmed by the breadth of material I need to absorb. My plan is to, while I'm in the States, do as much background reading as possible, about HIV/AIDS, antiretroviral treatments (ARVs), supply chain management, Liberia, and the Clinton Foundation... and any other relevant sources that I can get my hands on.

Sour Grapes

I heard an interesting story today from one of our CHAI Office Coordinators as we were driving from the Ministry of Health to the UNDP headquarters. It goes something like this:

A wolf is wandering the forest looking for dinner when he looks up and sees, as if from no where, a big bunch of grapes dangling from a branch. The grapes are green and plum, no doubt burst with sweetness. The wolf spends hours jumping to reach the grapes, but always in vain. The bunch hangs just out of reach. After hours on ends the wolf submits – exhausted and, without grapes, decides to look elsewhere for food. “The grapes,” he decided, “were probably sour anyway.”

The past two days, my first in Liberia, have been pretty discouraging with only moments of inspiration scattered throughout. My surroundings, more or less, are as I expected. Airport and border were elementary, and baggage claim was chaotic but functional. Ironic, that the only international flight which hasn’t lost my luggage was to Liberia – well done, Brussels Air. Because we arrived at night, I could see much during the 40 minute drive from the airport to the apartment in Sincor (a neighborhood in Monrovia). I went with the current Supply Chain Analyst for dinner where the menu was western/Lebanese (there’s a huge Lebanese influence in Monrovia) and we only lost power once. The apartment building is fortified by high walls, barbed wire, and guards; the tenants are mostly Clinton Foundation, Red Cross, and Canadian and Ukrainian helicopter pilots. I fell asleep quickly, after a brief conversation with the Country Director and a short moment of reflection on the porch looking out over the beach.

On Monday morning one of the drivers, drove us to the CHAI headquarters at the Ministry of Health (MoH) where I met the rest of the team and got a pretty preliminary overview of office. During the drive I got my first glances at Monrovia. The city is just as you would imagine a community reemerging from total disaster: the roads are pot hole covered, sewage and trash run through the streets, skeletal frames pose as buildings, street vendors push trinkets that are god-knows-how-old, and the streets are packed (recall the 85% unemployment figure). Any further description is really unnecessary – imagine the worst case scenario and you almost have a visual. From the Ministry we went to the National AIDS Control Program (NACP), where I met the Supply Chain Manager, before heading to UNDP.

The funding for HIV/AIDS test and treatment procurement comes from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Because UNDP is the primary recipient of this grant and NACP is the key implementation partner, I will spend the majority of my time working between UNDP and NACP (with occasional trips to field offices). On this Monday afternoon, I worked through a couple of the forecasting tools that will be essential to my job and continued doing back reading. My orientation was somewhat stunted by the fact that CHAI and UNDP had to attend to a stock out of one of the drugs - but I have no doubt that I'll orient myself quickly come September.

Tuesday morning was refreshing – as mornings tend to be. It was pouring. Apparently the rainy season lasts from May to early October. With a much clearer mission for today, we set out to meet James at NACP and look over a number of the Health Status Reports and Drug Requisitions from a number of the local facilities. I felt this level of involvement helped slightly to clarify my daily activities, but the afternoon session proved far more productive in this regard.

We split the afternoon between two activities: reviewing the Procurement and Supply Chain Management (PSCM) Standard Operating Procedure (SOP) Working Plan and reviewing the ARV Quantification Tool.

Limbo in Brussels... and thoughts on IP

The flight from DC arrived at Brussels International at 7:30 this morning - and as of 3:30 in the afternoon we were still waiting for our connection to Monrovia. The crowd has been building around the Brussels Air check-in stand as more and more people are beginning to suspect that we won't fly out today. Actually, the controversy is over whether the "replacement" jet will fly to Dhaka first, or Monrovia. At their most impassioned, the crowd had split and was chanting back and forth, in the airport, "Dha-ka," "Mon-ro-vi-a." Personally, I think I'd almost rather leave tomorrow morning at this point than arrive at 2 or 3 this morning.

On a positive note, I've had more than enough time to dig into the background reading I received from the CHAI team (and augmented with a couple books from the World Bank Library). Reading about the impact of intellectual property rights to HIV/AIDS treatment in development countries has been among the more interesting subjects of today. A significant part of crafting an efficient/effective supply chain for any medical treatment is selecting the proper product line. The controversy comes in determining how much flexibility [the host country] has in purchasing generic drugs. While big name manufacturers (such as GlaxoSmithKline, Merck & Co, Roche, and Bristol-Myers Squibb) have generated HIV/AIDS tests and treatments that are more specific (meaning they produce a fewer false positives) and sensitive (meaning they detect HIV before it has reproduced large quantity antibodies), these innovative drugs come at a price. A price that aflicted populations in developing nations (and developed nations at that rate!) cannot pay.

Subsequently, public policy has intervened. During 2001 negotiations in Doha, Quatar, the WTO wrote a clause into the Trade Related Agreemnet on Intellectual Property Rights (TRIPS) allowing developing nations to source generic forms of patented drugs. Generic competition has since been hugely successful in driving down the costs of ARVs (antiretrovirals) in many developing nations. In fact, the generic supply has reduced the costs globally from 10,000 USD/patient/year to 350 USD/patient/year. Brazil, for example, has used generic brands to dirve down the ARV costs by 82% in 5 years. Kind of sheds a dimming light on how over-priced drugs must be in developed nations like our own, eh?

Naturally, pharma-lobbiests argue that such concessions threaten the incentive they offer their research and development teams. I see little merit to this argument because the patent holders still increase their revenues through sales to developing nations. In most instances, either international organizations or the developing country governments offer an "honorarium," if you will, to the patent holders. In more recent years, country and county governments have engaged in parallel trading. Parallel trades occur when developing nations coordinate with developed nations to import generic drugs that are neither produced domestically nor available at a subsidized cost from the patent holders. The patent holder profits from these sales as well because the exporting producer of the generic drug already paid its royalties. All of which leads me to wonder in what form pharmaceuticals lobby the WHO (World Health Organization) and what happened in 2001 to generate more development-friendly trade agreements.

This was just one of a handful of new topics I'm exploring as I prep for this job. I'm continuously excited about how "scaleable" this experience will be. The stated objective is the improvement of the HIV/AIDS procurement and supply chain managment standard operation procedure (PSM SOP) ... but I feel like this experience will be relevent to more diverse work down the road.

On a (way) lighter note - I get to play in Brussels tomorrow! Our flight was rescheduled for Sunday a.m. (fingers crossed) which gives me more than 30 hours in Belgium's capital. I'm headed to the city center tomorrow with a few unbelievably interesting people - one Stanford professor of management, one UNMIL (UN Mission in Liberia) officer, a World Bank-er, and a carpenter from Oregan who's headed to Liberia to meet his newly adopted daughter. We'll hit a couple tourist sites, and keep waffles and beer top on the list... but maybe not together.

Malarone, Mefloquine and Malaria... O My!

I've never been a very big medicator; in fact, I'm of the opinion that most ailments can be cured with a lot of water, a lot of sleep, and maybe a jog if you feel the need to sweat something out. However, I'm willing to bet that Malaria is somewhat of a more formidable opponent that your average winter cold. At the suggestion of my friendly vaccinator (whom I got to know well as I sat for the first rounds of Yellow Fever, Hep A and Typhoid), I decided to use an antimalarial for this first week.

The options are not inviting.

Mefloquin is a lariam-based antimalarial that you take weekly starting 1-2 weeks before your trip - which is clearly not an option for me. Mefloquine is the most common, the strongest, and a comparatively cheaper antimalarial treatment. The potential side effects, however, are pretty off-putting. They include, in no particular order, nausea, dizziness, headache, weakness, insomnia, "strange dreams," nightmares, depression and anxiety. Mefloquin has also been suspected of causing long-term liver damage. Hmmmmm. As appealing as hallucinogenic dreams are, I decided to seek an alternative.

Doxycycline is a daily tablet which one must begin 1-2 days before a trip to a malaria prone region. The cheapest of the antimalarials, one must continue the medication for a month after returning and should refrain from taking a tablet with dairy products or before bed. Doxycycline's side effects include nausea, vomiting, diarrhea, dizziness, headache, photosensitivity (recall the title of the blog), vaginal infections, and intracranial hypertension. Once again, I passed.

Malarone is a daily tablet with "low incidence of side effects." Dosage begins 1-2 days beforehand - much better timing for me. The down side, in this case, is that Malarone is a whopping $6/tablet. Hardly sustainable for a year.

The ideal antimalarial (in my untrained opinion) is Chloroquin. A weekly tablet, the side effects are milder than those of doxycycline and mefloquin (though it may cause blurred vision), and one tablet costs the same as the daily malarone. The downside, for me, is that the strains of malaria found in West Africa are resistant to chloroquin. Bummer.

In the end, I opted to take malarone for this short term trip. I figure once I'm on the ground in Monrovia I'll see what everyone else is doing.

If anyone reading this has any suggestions (or better yet, experience with any of these drugs) then feel free to post them up!

A little backdrop...

Monrovia, Liberia lies 6 degrees north of the equator, making it officially the closest to the Southern Hemisphere I've been to date. I leave on Thursday for 9 days to observe the work I will be doing over the next year as the Supply Chain Analyst for the Clinton Foundation. I have no doubt that the expeirence will present challenges of an overwhelming variety. I'm hoping this blog is a fun way to share those moments and, perhaps, entice one or two of you to plan a trip to West Africa. But, before diving striaght into the details of life on the ground, I wanted to share just a few of the reasons that I'm thrilled about this opportunity.

Cum Grano Salis: All of the following is from an exterior perspective; I fully expect to eat more than a couple words throughout the next year.

Liberia
I knew next to nothing about the country as of a month ago. My knowledge was limited, more or less, to the coverage of Charles Taylor's extradition to the Hague. However, over the past few weeks I've been absolutely captivated by stories of the progress being made and unique challenges facing the newly elected government.

Liberia's recent history is nothing short of heartbreaking (for more info, Wiki Liberia). In late 1989, the authoritarian Samuel Doe was ousted from the presidency and killed by followers of Yormie Johnson and members of the Gio tribe; from that point forward Liberia has been rought with civil strife. Warring factions competed over the capital until 1997 when Charles Taylor, backed by Libya's Muammar Qaddafi, was elected President. Civil war intensfied in '99 and lasted more than five years, during which time more than 200,000 people were killed and the country's infrastructure devastated. Monrovia fell in 2003, shortly before Charles Taylor was exiled to Nigeria. UNMIL (the UN Mission in Liberia) assumed a supervisory position over an interim government led by Gyude Bryant. Liberia's transitional government was enrolled in a unique anti-corruption campaign (GEMAP) and successfully held elections in 2005. Ellen Sirleaf Johnson was elected in November 2005. The first popularly elected female head of state in Africa, Johnson is a Harvard-trained economist and former Citibank and World Bank employee. This "Iron Lady" has established herself as a force for reform in West Africa; check this site for a preview of a documentary on Johnson out in October.

While Johnson's administration has led impressive reconciliation and reconstruction efforts, Liberia still has a great way to go before returning its infrastructure and public services to their pre-war, operational levels. In a few statistics: Liberia has the highest unemployment level in the world (85%), 75% of the population is without means for sanitation, 40% are without water, 230,000 children have been orphaned, half a million do not attend school, preventable diseases such as Malaria and Measles are the leading causes of death, and more than 6% of the population is known to be HIV positive( for more info, check the UNICEF country page). The good news is the current administration is committed to reforms and many of the international efforts have been well received. In speaking with friends at the Bank, USAID, and other international orgs. I gathered that Liberia's government is among the most progressive in the region. Furthermore, those working with the Clinton Foundation HIV/AIDS (CHAI) program in Monrovia report that, while there are daily challenges and setbacks, the Ministry of Health has made great progress over the past year in establishing a more accurate and efficient way to assess health needs and deliver treatments to facilities in the regions. The challenge they face is an increasing need for someone to focus exclusively on supply chain issues, freeing up others to concentrate on programmatic and clinical challenges. Given the chance to do so, I think this as a truly unique opportunity.

The Clinton Foundation

At present, the Clinton Foundation is hoping to bring a fresh, private sector approach to international development. More specifically, the Clinton Foundation is targeting young professionals with management consulting backgrounds and a passion for development to staff its various initiatives around the world. The idea is to employ talent on the ground for extended periods of time such that they can act as extensions of local partners - embedded in the challenges that local implementers manage and invested in the success of each project. This is in contrast to many development efforts wherein the turnover is high and the actors serve as "consultants." The concept is hardly novel - what is unique, however, is the resources Clinton can garner and the reception CHAI has experienced thus far. The primary initiatives of the Clinton Foundation include: the Global Initiative, the Climate Initiative, Healthier Generation, The Clinton Hunter Development Initiative, and the Economic Opportunity Initiative, and (where I'm headed on Thursday) the HIV/AIDS Initiative. I see myself happily engaged with each of these initiatives, currently employed with the final intitiave, and working towards involvement with GI, HG, or EOI in the long run.

The Clinton HIV and AIDS Initiative (CHAI) is focused specifically on availing lower cost HIV/AIDS treatments around the world and partnering with local government to establish large scale treatment and prevention plans. Liberia is one of nine partner countries in Africa, with a relatively new (2 years) and quickly developing program. Though I'm maintaining sobered expectations about what I will see on the ground, I also believe that the Clinton Foundation may just facilitate the kind of institutional reforms that have a sustainable effect in post conflict regions. Most of you reading this blog have heard me babble about my long-run interests in rule of law initiatives. My hope is that, in this job, I will not only observe key elements of institutional reform in post-conflict areas but also be a part of a uniquely effective team. And what role, exactly, I'm I playing in this team...

The Job

I've been offered a position as the Supply Chain Analyst. While I expect this role may evolve and develop as I go, my primary responsibility is to provide the Liberian Ministry of Health with "best practices in the procurement of products related to antiretroviral treatment (ARVs), including medicine and diagnostics, with the ultimate objective of ensuring the scale up and effective management of high quality ARV treatment for patients."

I can hear most of you right now: "Amanda, what are you doing. What in the world do you know about supply chains?" Well, luckily for me, in my past position I had access to a wealth of business resources and a number of quite random assignments. On more than one occasion I've wandered onto the Supply Chain Executive Board site to read the latest info and, nerdily enough, was pretty fascinated by what I found. One of my premier interests in the work at CEB was observing how companies were responding to the growing Corporate Social Responsibility (CSR) pressures. While the bulk of the CSR burden often falls to the Communications or Marketing C-Suite, there is also a growing trend to "green" or "lean" (both are positive steps) the supply chain to demonstrate more environmental, social, and fiscal responsibility. As such, I've been actively reading supply chain material.

In Liberia, however, the focus will hardly be on "environmentally friendly" procurement methods. As I understand it, the chief challenge is to create a tool that local facilities in Liberia can use to more accurately forecast the ARV tests and treatments they will need the following year. There are a number of contributing factors: communication barriers, transportation failures, and equipment mismanagement to name a few. I will work daily with four parties: Liberia's Supply Chain Manager, the National AIDS Control Program (NACP), the National Drug Service (NDS), and UNDP (the primary ARV recipient). As for the daily activity ... well... we'll just have to wait and see...