Table of Content1.Introduction....................................................................................................................................3

From Groningen to Freetown: My internship with Doctors with Africa CUAMM in Sierra Leone

By: Hiske Doornekamp – S3504328

Home University: Rijksuniversiteit Groningen, The Netherlands Host University: Universidad de Deusto, Bilbao, Spain Internship Organisation: Doctors with Africa CUAMM Sierra Leone -

22 Wilkinson Road, Freetown

Supervisor Organisation: Giampaolo de Notaris Period: September 2018 – February 2019

Table of Content

1. Introduction...3

2. The Internship Organisation...4

3. Tasks & Activities of the Internship...6

4. Supervision of the Internship...8

5. Living Conditions...9

6. Conclusion...11

6.1 Learning experience...11

6.2 Expectations and difficulties...12

6.3 SWOT Analysis...12

6.4 Fit into NOHA program...13

6.5 Job market...14

1. Introduction

At the roots of my interest in humanitarian work, lies my strong belief in human equality. We are all world citizens, and each individual – regardless the country of origin - should have the same access to basic services such as health care and education. In the world we are living today, despite the Universal Declaration of Human Rights, equality is far from reality. I see it as my responsibility, to reduce this gap between reality and human equality, in both my personal and professional life.

CUAMM its effort to improve (access to) health care for everyone fits my values. Additionally, I believe in its holistic approach. Besides working in African countries with less developed health systems and high numbers of maternity and child death, they also focus on (field) research and promoting a culture of cooperation in Europe that contributes to a world where the universal right to health will be guaranteed to all. They network with different institutions to inform the general public and raise awareness on the value of health as fundamental human right and essential component for the full development of human potential. Another part of my motivation for this internship is coming from my strong agreement with the organization its focus on respect. Human dignity is in my opinion one of the most important aspects of humanitarian work and should be central in every project. Also, the commitment to work without distinction, with the patient at the center of its work, is essential for me.

This internship has been made possible through the cooperation between NOHA and CUAMM.

Different vacancies with CUAMM have been posted on the Graduate Platform. After writing a motivation letter, I was asked to compile the ‘Informative Dossier’ with questions about my motivation, work and professional life, social and family situation, psychophysical wellbeing and experience. After this, an interview with HR people from the organization it’s headquarters in Padova, Italy followed, and I received the good news that I was selected for the internship in Freetown, Sierra Leone.

Before I started with the internship, my expectation was that I would learn about the procedures in the

administration department of a NGO, but also about the general workings and dynamics of a NGO in a

setting like Sierra Leone. I hoped to be able to attend meetings with the whole team to see what daily

activities, challenges and issues would be. Finally, I hoped to not only be in the office but also have

the opportunity to see the projects of CUAMM.

2. The Internship Organisation

The internship has been facilitated by Doctors with Africa, CUAMM. To explain the work of this organisation, please find below their vision, mission and objectives and activities.

Vision

A world where health is accessible and guaranteed to all human beings, especially the neediest and the suffering.

Mission

Our mission is to advocate the universal right to health and promote the values of international solidarity, justice and peace. We work to protect and improve the wellbeing and health of vulnerable communities in Africa with a long-term development perspective.

Objectives and activities

1. To improve the health status of communities in Africa, in the firm conviction that health is not a consumer good, but a universal human right, and that therefore access to health services cannot be a privilege.

2. To promote a positive attitude and solidarity towards Africa — the duty of fostering interest and hope for the future of Africa, and commitment among institutions and public opinion.

To achieve these objectives, in line with our strategic priorities, Doctors with Africa CUAMM:

 Designs and implements long-term health care cooperation projects to create or strengthen health systems that:

– are centred on people, families and communities – value local personnel

– give substance to primary health care – aim to improve their performance – support programs integration

– strengthen collaboration between nfp and governmental sectors – invest in innovation, evaluation and operational research

 Focuses its action on reproductive, maternal, new-born, child and adolescent health; nutrition;

infectious diseases; NCDs; and Universal Health Coverage (UHC)

 Trains and re-trains health care providers in Italy and Africa

 Conducts and disseminates scientific research in the fields of just global development and health, particularly with regard to African countries

 Carries out awareness- raising and educational activities on global health for the general public, national and international institutions

 Promotes socially responsible philanthropy and investment by individuals and institutions

CUAMM in Sierra Leone

CUAMM intervention in Sierra Leone is focusing on reactivating a strong health system within the

national response policy in the aftermath of the Ebola epidemics. Specifically, fostering mother,

newborn and child health, with the objective of improving access to quality health services and

strengthening the local health system in 6 districts: Bo, Bombali, Bonthe, Pujehun, Port Loko and

Western Area. The Country Office is based in Freetown, which functions also as the operational hub

for the projects implemented in the Western Area. Main Donors are UNICEF, UNFPA, Vitol

Foundation, WDF, Manos Unidas, private Bank Foundations.

3. Tasks & Activities of the Internship

In the vacancy, the objective and tasks of the internship have been described as following.

Objective

To master administrative/logistics procedures for the implementation of development projects in compliance with organization and donors regulations.

The Project Administrator Intern will closely work with the Country Administrator to support ensuring the correct management of all administrative aspects of CUAMM projects in collaboration with Project Managers. The Project Administrator Intern should follow the local and international legislation and should always comply with CUAMM and donors procedures.

Tasks and responsibilities

The following tasks are shared with the Country Administrator, who will supervise and teach the intern on how to carry them out throughout the internship period

ACCOUNTING SYSTEM

 To keep updated accounting data

 To ensure detailed documentation about payments (receipts and bills) and bank transitions

 To manage the project budgets and the bank accounts, and to ensure all the referred documentation

 To take care of all rental and bills payments

 To monitor the projects financial trends

 To ensure all documentation about the material and equipment procured

 To support Project Managers on timely reporting

MONTHLY FUNDS REQUEST

 To support Project Managers in defining quarterly requests of funds LOCAL STAFF

 To ensure local staff contracts compliance with the national law

PURCHASES

 To support Project Managers in complying with any procurement procedure in place

TRAINING

 To make sure that all financial aspects of training activities are reported and documented

VEHICLES

 To verify the correct use of project vehicles

 To ensure vehicles? proper documentation is in place

 To supervise the correct maintenance of all vehicles

COSTRUCTIONS

 To ensure the collection of all the information needed (pictures, plans, communications) to document the construction activities performed

REPORTING

 Ensuring all supporting documents certifying the delivery of goods to the counterpart

 Supporting project managers in any reporting activity in compliance with donor?s guidelines

 Ensuring all supporting documents for financial audit?s purposes

PLANNING

 Supporting Project Managers, Country Office or HQ in case of new project proposals will be submitted for future projects developments in the area

 Supporting Project Managers for any amendment needed to ensure the achievement of expected results

 Being able to identify financial gaps to be covered by the

organization

4. Supervision of the Internship

Since my internship was in the administration department, it was supervised by Giampaolo de Notaris, the country administrator of CUAMM Sierra Leone. This meant that Giampaolo was my point of contact in the organization. Before the internship started, my contact was mostly with people from the headquarters, but I also already was shortly in contact with him through email. When I arrived in Freetown he welcomed me in the guesthouse and gave me some more practical information about my stay. During the internship itself he was the main person that was explaining my tasks to me, the person I would direct my questions to and the person that was checking my work. Besides Giampaolo, the other four colleagues in the administration department also supported me in the form of explaining their work to me, answering my questions and supporting me in my tasks if I asked for help. After being introduced into the work of the department, I had the opportunity to manage the administrative aspects of the ‘Support Regional Resident Midwives 2018 Transitional Phase’ project myself.

Giampaolo and my other colleagues supported me in this.

I have experienced the supervision as well-balanced. I felt like I had enough space and freedom to

discover things myself, to make mistakes and learn from it, but also felt well-supported and never had

the feeling I was left in the dark. Looking back at the supervision, the only thing I would have

appreciated would have been a monthly conversation to discuss how things are going, as a moment for

feedback/questions/suggestions from both parties.

5. Living Conditions

Doctors with Africa provides interns and other employees or visitors who stay short term with accommodation in their guesthouse. In the case of Freetown, there is a building with the country coordination office downstairs, and the guesthouse upstairs. These two spaces are not really separated though: during my time in Freetown, two of the four rooms upstairs have been rebuilt to offices.

Besides this the kitchen is used by the cook of CUAMM to prepare lunch for the international staff, who have their lunch in the living room of the guesthouse.

The two rooms left are spacious with their own bathroom, a van and air-conditioning (both very welcome seen the tropical climate in Freetown), and large two-person beds with mosquito nets. There is a washing machine available and linen and towels are present. The house is connected to the city line with a battery and generator as back-ups during power cuts. The house has a water tank so there is (almost always) water to wash, shower etc., and good (!) Wi-Fi is available as well. Another luxury is that the person that cleans the office four times a week, also cleans the rooms. The cook cleans the kitchen and boils and filters tap water so it is safe to drink.

The location of the office/guesthouse is very safe and central, with easy access to supermarkets, restaurants and other facilities. The other side though, is that you live along a very busy road, so you are quite exposed to noise and pollution. One other downside of living in the guesthouse that could be experienced is the limited privacy. Quite a lot people walk in and out of the house every day of the week, and there are a lot of people who stay for just one night before they travel to the place they are based.

More generally about Freetown, I think it is quite an expensive city to live. Housing that meets

requirements such as safety, connection to electricity etc. is more expensive than in most European

(student) cities. Local food is very affordable, but super markets are more expensive than in Europe. If

you go to local places, going out for dinner with drinks can be done for just some euro’s. If you are

going to places with a more European menu and standards, you will pay between the 15 and 20 euro

for a main course with one or two drinks. Public transport is cheap. There are taxi’s, okada’s

(motorbikes) and keke’s (knows as tuktuk in Thailand) for which you pay 15 to 20 cents for ‘one-

way’. In the provinces the same prices apply for public transport, but the prices for housing and food are lower.

The group of expats in Freetown is varied. There are people staying short term (< 1 year) but also

longer term; with African, Asian, American and European backgrounds; and working in both business

life and the non-profit sector. Then there is a big group of Lebanese people living in Freetown. Their

roots can be traced back to an exodus caused by a silkworm crisis in the mid-19

century. This means

most of them are born and raised in the country, speak the local language (Krio), etc. In my

experience, they do mingle with both the international community and Sierra Leoneans, but they

remain a very close community on their own. I think there exists a gap between the international

community / Lebanese community and the ‘common man’ due to the difference in income and

education. With a Human Development Index of 0.419, Sierra Leone is one of the least developed

countries in the world (ranked 184 out of the189 countries measured) (UNDP, 2017). This makes it

sometimes difficult to have equal friendships and creates certain expectations with regards to your

financial means and how you would share that with others. As intern who has not yet a salary and still

needs to pay university fees, this, in combination with high costs of living and hanging out with

colleagues/people who do have a paid job, can be difficult from a financial perspective.

6. Conclusion

6.1 Learning experience

I can divide my learning experience into two categories: the part of learning about the (administrative) work of a NGO and the part of experiencing the dynamics of a NGO and expats in a context like Sierra Leone. From both seeing what the administrative department was doing and managing my own project, I learned a lot about administrative procedures, accountancy and donor requirements. No matter if your function is country director, project manager or logistician, I’ve seen that administration is part of every function within a NGO. NGO’s are (often) dependent on their donors, and donors are dictating the procedures and rules that need to be followed by everyone in the NGO.

My colleague that works as Human Resources Manager and functions as the contact person for the banks, the National Revenue Agency and other (public) institutions CUAMM works with, showed and explained me a lot of these places. This has really contributed to my understanding of how a country like Sierra Leone is (dis)functioning. Besides working at the office, I got to attend some meetings with donors, the ministry and other NGO’s. This has been really interesting because I had the chance hearing different perspectives on the difficulties faced in the healthcare sector of the country. It was also good to see how meetings like these are working, what kind of jargon people use and how different actors cooperate or work along each other. Also, I had the opportunity to be for a week with the project manager in Lunsar, a small city in Sierra Leone. Since my interest lies actually more in project management than in administration, this was a very useful experience. I’ve seen how a week as project manager could look like, what kind of tasks and responsibilities could be part of the job and seen some activities coordinated by CUAMM. What was certainly interesting as well, was to see Lunsar, since the provinces are completely different from the capital of the country. Facilities are very limited: outside of the hospital where CUAMM is working there is barely electricity or running water, the town consist of one street, vegetables and fruit are only limited available and there are not many options for activities. Nevertheless, I really enjoyed my week there and I returned two times for some days to spend more time with the people I met, and enjoying the clean, green and silent environment.

Having had the opportunity to spent time in both the capital and in the province, gave me insight in the pro’s and con’s of living in these completely different places.

The experience of being in a country where many NGO’s are operating and where many expats are

living also gave me insight in how it is to be in such a context. During my first year of NOHA, I got quite critical about the efficiency and effectivity of NGO’s and learned about the numerous cases where NGO’s do more harm than good. It was highly valuable to see how this is in reality. Not only by seeing how CUAMM and other NGOs are working, but also by experiencing how the relation is between locals and internationals. I got the opportunity to talk about this to Sierra Leoneans from different social backgrounds and to international and local staff of CUAMM and other organizations. I had a lot of interesting conversations and the different opinions helped me to form my own opinion and herewith to shape my future ambitions.

6.2 Expectations and difficulties

Though the tasks were not exactly as outlined in the job vacancy, the internship was how I expected it to be. I knew that the internship would be in administration, am was aware that this is not the most exciting department of a NGO. I really appreciate the opportunity of managing the administration of 'my own’ project: I learned a lot from this and I enjoyed it. Some other tasks like stamping, scanning and checking documents were sometimes a bit simple and monotonous. Before I started this

internship, I did expect that these tasks would be part of my work, but maybe for a smaller part of the job. Something I expected/hoped beforehand but what not happened, was attending internal meetings of the organization. Not because I would need to participate in these, but it would have been an addition to the learning experience to be - through these meetings - more up to date about what was going on in the organization.

A difficulty experienced has been the language. Since the majority of the expats in the office was

Italian, the language most used was Italian. The biggest part of the formal communications and

internal meetings were in English, so it was more about the quick conversations between people. I

think those chats and consultations would have been interesting and actually essential to follow, so I

would have known better what was happening in the organization. The language barrier was not only

felt on a professional level, but it was sometimes also difficult in my personal life. My colleagues from

CUAMM were very welcoming and friendly to me, but since the Italian community in Freetown is

very close, it was sometimes difficult to fit in without speaking their language.

6.3 SWOT Analysis

Please find below my SWOT analysis of the internship with Doctors with Africa CUAMM in Freetown.

Strengths

+ Tangible skills in admin and accountancy are taught

+ Two days of accompanying all colleagues at administrative department as introduction + Well-balanced supervision from supervisor and

colleagues

+ Briefing at headquarters in Padova *

Weaknesses/Limitations

- Missed the opportunity to attend internal meetings

- A wider variety of tasks would increase the learn experience

- Monthly progress / evaluation sessions with supervisor would have been appreciated

Opportunities

+ Support and see the work of one of CUAMM its project managers

+ Attend external meetings with MoHS, donors and other NGO’s

+ Responsibility for doing admin and accountancy for ‘own’ project

Threats

Not sure if the word ‘threat’ applies, but an obstacle experienced has been the language

barrier since I do not speak any Italian.

* What could have been a strength, is the briefing at the headquarters of Doctors with Africa in

Padova. Due to time constraints following my stay in Central America which meant I had only one

week in the Netherlands before I would go to Sierra Leone, this briefing was cancelled. I think it

would have prepared me better for my internship, not only in terms of the tasks, but mostly about the

context. I think in general that it is really important that people have knowledge about the country they

go to and get sensitized about its cultural context. Intercultural communication is something a lot of

people (consciously or unconsciously) struggle with, but a component is crucial for the relations you

have with local partners, employees and beneficiaries.

6.4 Fit into NOHA program

I am not sure to what extent this specific internship fits into the NOHA program. The NOHA program prepares students for an international career in the humanitarian field, so an internship in a NGO in a context like Freetown is super relevant, and administration is part of every job one will have in the humanitarian field. The misalignment is more between the internship being completely in

administration and the study being focused on project management. I followed for example the course called ‘Management in Humanitarian Action’ at the Rijksuniversiteit Groningen and the courses

‘Strategic Management in Humanitarian Action’, ‘Legal and Management Challenges in Humanitarian Action’ and ‘Ethical Management in Humanitarian Action’ at the University of Deusto in Bilbao.

Administration and accountancy on the other hand, have never been a subject in the master. If I remember it correctly, part of the CUAMM internships advertised on the NOHA platform were in project management, and part of them in administration. What I understood from the students who had their internship in project management, they could really apply what they learned in their first year NOHA to their internship with CUAMM. I would suggest for the future, to aim for offering

internships in project management or all-round. With the latter, I mean an internship that introduces

the intern to all departments of the organization. For example: first a period at the administration

department, then at the logistic department, then a period of supporting a project manager, and finally

a period to support the country director.

6.5 Job market

The internship gave me on the one hand more insight into my plans, but on the other hand also raised more questions. I am still in the process of finding out how I can contribute most to a world in which the values of human equality and dignity are better fulfilled. I have had moments during my internship that I was sure working as an expat in the Global South would not be the way to do that. There have also been moments I experienced how an external view and specific expertise are from high value.

I’ve seen how NGO’s can create employment and can stimulate economic growth, but also have seen the negative sides of the presence of NGO’s, such as in some cases/ways the contribution to neo- colonialism. On a personal level, I experienced times in which I felt like work and life like this would really make me happy, but also times that I thought it would not suit me. However, looking back at my time in Sierra Leone, the positive feelings are overruling the insecurities and doubts for sure. I am keen to have another experience in a developmental setting such as Sierra Leone, and I am motivated as well to discover how it is to be working in a humanitarian crisis. I think exploring the dynamics in other countries and settings is the way for me to find out what my career path will be.

On a personal note, I spoke with a lot of people about Cash Programs. The approach of ‘just giving money’ is something we discussed in some seminars at the University of Deusto and that really triggered my interest. These conversations confirmed my belief in this approach and after writing my thesis on this topic upcoming semester, I would like to look for jobs in this field.

Finally, I would only want to work for an organization with values and norms that align with my

personal beliefs. After being with CUAMM for five months, I am convinced about their approach, and

I would definitely be happy to work for the organization.