Wednesday, 19 March 2014

Little by Little

Sometimes when you get caught up in the day to day business of consultations and complicated deliveries and operating it’s hard to see all the changes that are happening around the hospital .

A few weeks ago I was showing a visitor around and I realised that instead of saying we hope to do this and that, I was able to say this is being done or even that has been done.

So what are these ‘small’ changes. Some you might not notice like having the documents available all the time to keep the notes up to date and keep the out patients running smoothly. Having a steady stock of drugs in the wards, maternity, operating block and emergency room even with a degree of control when the nurses remember to fill in the forms .Getting the paint touched up when it’s peeling and other small repairs. You wouldn’t notice too unless you had been before that there’s no longer chaos at the cash desk as the patient form an orderly queue on the benches after they are let in the gate.

Other things are more obvious like having curtains on the ward to give patients much needed privacy. A new desk instead of a plastic table in the maternity. Having solar lights in the single rooms as well as the wards and also plumbing that works. Painting of the wall between outpatients and inpatients looks good and we soon we will be adding pictures for health education and evangelism. We have boxes next to the beds too with bibles in Arabic and French and a place for the notes.

Our recent bigger change has been offering vaccinations. Finally the solar fridge is working the vaccines have come and we have mastered the paper work. It’s great to see the new born babies and pregnant women vaccinated and the children coming as now it’s not too far away. So far we’ve seen over 100 women and the same number of babies in just over a month.

Most of these changes have happened as we have become a bigger team with a pharmacist and administrator and two nurses. It’s great that we can all work together to improve things. Malc and Sue are having a well earned rest and home assignment in the UK at present and Claire will leave next week so I hope we can keep things up now with our reduced team.

We continue as well to improve the medical care we offer in other ways and little by little the midwives and nurses take on more responsibility. One doing her first D and C for a miscarriage last week and our anaesthetist now confidently doing spinal anaesthesia. A few weeks ago we managed to save the life of a patient by giving her a blood transfusion in record time and then later attaching her to both oxygen concentrators to get enough oxygen into her blood after her lungs filled with fluid when her kidneys stopped working. She went home well 10 days later.

 It’s a good job God is with us turning our little by little into something bigger for him.

Saturday, 15 March 2014

Man is but a drop of dirty water

So began out first ever physiology lecture at medical school and Marks recent teaching o
n fluid balance and dehydration. Thursday mornings at 8 o’clock is teaching time so far we have had courses on diabetes and malnutrition Malaria Hypertension and diarrhoea all things we see a lot of. This time it was back to basics and calculations on the blackboard borrowed from one of our staff who is having French lessons to help him be a more effective administrative aid.

Water has been in our thoughts these last few weeks as the dry and hot season is upon us. The water bottle taken to the hospital is now coming back empty and often more is needed We took a lot, about 80 litres with us on our recent holiday as we travelled   850 km to Zakouma Chads safari park.

On the road we passed many camels and lots of cattle and sheep and goats. What was most impressive though were the collections of animals and people around the water holes and wells outside the villages .Most of the countryside is dry and parched and it’s hard to see where they get enough for the animals to eat but the water sources are all too clear.

The dry season means it’s the best time to go to the park as the animals are looking for water and we had a great time seeing all sorts of animals including 100’s of giraffes on our early morning safaris and huge collections of cranes pelicans and Maribou storks gathering at the waters edge in the evening. At night we passed a leopard in the bush and several hyenas out hunting.

Our trip back passed through Bitkine where the water for the town comes from the Ouadi dry at this time of year but filling intermittently in the wet season. Time to consider how much water you use when it’s all brought up the hill by a heavily laden donkey.

Time too to consider where does our real source of life giving water come from as we sat on the hill overlooking the town and watched the sun go down.
We may be a drop of dirty water in physiological terms but we are also fearfully and wonderfully made. 






Saturday, 18 January 2014

So what makes a Chadian Christmas different?

Well of course to start with we think its cooler but actually its rather like a summers day in England around 17 at night and 30 in the day.

Apart from  the temperature then:

Well there's the tree Sunday the 16th had us scouring the compound for a suitable branch to paint gold and silver and  make glittery, a bit different from a green fir tree but perhaps more suitable here and certainly easier to find apart from the plastic ones for sale by the hawkers outside the supermarket with lights already attached. It looks good once we've decorated and there are no needles to clear up.
Then the films we watched two different Nativities the first with the staff and the second with patients and their relatives not snuggled up in the warm by the fire but projected onto the perimeter wall, sitting on wooden benches under the stars. 

Christmas eve shopping almost felt similar to England  in that it was so busy. It too was outside, the market having doubled in size as it spread up the surrounding roads. Women sat behind  piles of locally grown vegetables on mats on the floor, frozen chickens (from Brazil) were defrosting in the sun , live ones were squawking and amongst all this  motorbikes were weaving in and out  threatening to knock  us over. We enjoyed the buzz of anticipation as we bought our vegetables for the next day.

What about the food....                                             well  on the 25th we did manage a  traditional Christmas safari dinner with a slight twist of a watermelon nativity it would still have been excellent in England However the nibbles after the Christmas presentation earlier in the week  were prawn crackers, chunks of roasted  beef and a type of donut.
Donuts were also on offer along with sweet and strong  tea during a pause in  the Christmas eve service and we had a gift of sweets prawn crackers and biscuits from one of the midwives. One or 2 mince pies were also eaten thanks to supplies from England and our retired guard who came to greet us loved the Christmas cake eating two  slices and taking a third home for his wife

I wonder what time your Christmas eve service started ours was at 6pm and got going about 2 hours later lasting till 7 am! We only managed until 11pm as we were on call the next day but did enjoy the Bible quiz even if Mark, representing the hospital  got his question wrong.

Christmas day was spent part at home but also we managed a Caesarean and a chest drain amongst other patients needing our attention. It did stay quiet for our Christmas meal though and it was not all work, we enjoyed handing out gifts to the patients: sweets, balloons, more biscuits, oranges, knitted hats and booties, balls, crayons and outfits for the little babies and  no Father Christmas  in sight .

Our Boxing day walk was where we really knew we were in Chad we decided to go and book our New Year camel ride but we were in for a surprise. We arrived at the golf course, which is where the camel rides take place don't worry about the greens, there are only browns and were asked if we had come to see the Hippos. Half and hour later we were watching a group of 15 hippos in the water just down from N'djamena's main bridge one chomping the greenery making a terrible noise.
So that was our  Christmas was it really so different what made it good was sharing with others and having fun celebrating the wonderful news that Christmas is and that doesn't need any special food or place or weather does it?





Tuesday, 17 December 2013

Three years later

 December 9th was the third anniversary of the opening of the hospital. We still remember how unsure we were about how the hospital would develop, would anybody choose to come to our small hospital off the beaten track on the edge of the city. Even the staff were complaining about the distance and they were being paid to come!

Three years later we are able to celebrate the fact that the hospital continues to grow and we are able to serve them in the name of Jesus of Nazareth.  In honour of his birth and the hospital anniversary we had a sandwich supper behind our house last Saturday evening attended by about 50 people.  Malc and Sue went into town to get the sandwiches , thankfully the wheel didn’t fall off their car this week. I got 2 crates of soft drinks, they were warm so I got a motor bike taxi to get me some ice, he came back with 2 blocks ( 90X30X15cm each) strapped behind him on the bike. I needed a pick axe to break them up. The presents had been wrapped already with all the BMS team pitching in.  

So we gave thanks for the 1830 babies born and 35000 new outpatients treated  since the hospital opened and prayed for Gods blessing on the future and then we settled to  watch a  BBC version of the Nativity story dubbed into French. As night fell it was projected on to the perimeter wall.  It made everyone laugh, especially when a pregnant  Mary returns to Nazareth and tries to explain to Joseph that things are not quite what they seem. So you’ve hidden a watermelon up your dress as a joke then? exclaimed her  incredulous husband to be.  Pastor Djibrine gave a running translation in Arabic to some visitors from the village who being Muslim were less well versed in the story and two midwives tried to calm their crying babies and the moon rose overhead.

As the Christmas party was finishing there was a cold wind from the desert, temperatures are falling as low as 13C overnight at present so everyone was keen to get home, as is traditional during the festive season, a minibus taking people home got stuck in a drift on the road and needed pushing out but being Chad it was a sand rather than a snow.

 The miracle of Christmas, God with us, and he certainly has been this month. Half way though  there have been 53 deliveries , more than 3 a day, and two caesareans really stand out.

The first a woman who had 2 previous caesareans but no living baby was due to have an elective caesarean at term before going into labour and avoid a third dead baby. Despite lots of explanation  the mother failed  to come for the appointment and arrived 4 days late on a Sunday afternoon , in advanced labour but   unable to deliver. Speed was required to save the baby and a caesarean was quickly performed but on opening the abdomen the scar on the uterus was found to have ruptured and the baby was lying lifeless among the intestines. No spontaneous breathing and a very slow heartbeat. A third dead baby looked very likely and a seriously sick mother. Somehow, read more in Rebecca North’s blog an amazing turnaround took place, with resuscitation the babies heart started to beat faster, the woman’s uterus was repaired, and mother and baby made an uneventful recovery leaving hospital at 5 days. Praise God for his mercies.

The second lady also needed a caesarean as her baby would not deliver but just as she was to be put to sleep she had an unexpected eclamptic fit. That was rapidly controlled but now we could not put her to sleep as her blood pressure was dangerously high and our anaesthetic (ketamine) makes it go higher and can itself cause fits. The woman was restless and semiconscious and could not be transferred to the hospital in town as it was one o' clock in the morning and any delay may cause her and the baby serious problems. So she was gently sedated and with trepidation the operation was performed with local anaesthetic injection, similar to that used for a minor operation or at the dentist. Amazingly the mother was calm throughout, her baby cried as it was delivered through the scar and she made a full and rapid recovery. Thank God that even in very basic conditions lives can be saved, we are sure his presence with us helps.

Let’s thank God for these births and trust Him to be with as we plan the next phase for the maternity services with our newly funded Program of Community outreach, in-service training and subsidised maternity care.  We have drawn plans and are starting to seek funds for a much needed Maternity building as we are often full to overflowing. If not we may soon have women delivering babies in the entrance lobby,
 which has more than a faint echo of the Christmas  story.

Thursday, 28 November 2013

' In the name of love'

A couple of  years ago the hospital received a gift from the Ministry of Health, an ambulance. As you can see it is suitable for the road but finds mud and water  bit difficult so it has to be laid up for about three months each year. It is the dry season now and so it is back in use and it is getting quite a bit of use taking patients to the hospital in the city for X-rays (as our equipment is broken) non obstetric ultrasounds ( as our doctor is out of the country) and patients in need of emergency surgery on the weekends like this one (1:2) when Andrea and I are not at work.  Dogo, the hospital driver takes our children , Ruth and Rebecca, to and from school and sometimes combining tasks they too get a ride in the ambulance. They are not too keen, travelling sideways in the back can be nauseating and hot.

When it arrived it already had our name painted on the side, Hopital Americano, Amsinene.  I know Noel the CEF Chief executive does come from Seattle, the home of Starbucks, but do we really need to sound like a cup of coffee? Amsinene is the next village, 3 km to the south where there is a big Chadian Amy Base, which we used to use as point of reference if people haven't heard of Guinebor, now after 3 years our area is much more developed. We repainted it with our name and logo, after all branding is important.

We have branded the hospital in many ways, all the paperwork for patients notes and  prescriptions carry the logo, as do the guards uniforms and the cars. It all builds recognition and makes us look serious. It even gets imitated by people around us, Quartier CEF as I have heard it referred to refers to the shops outside our front door, look carefully and you can see our logo at the shop and the hairdressers.
 All this  copying our CEF logo  is quite funny even flattering, should we protect our name?
         Ask for a share of the profits? Perhaps not. More seriously what is the real brand that we are here for? We hope that one day we will be recognised as disciples or imitators of Jesus, and people will choose to  copy that.


Sunday, 27 October 2013

AK 47 Icon of fashion : London-Moscow-Ndjamena

International women's day :  AK 47 carrying women gendarmes
London August 2013 ; Fashion :  David Bowie was making  a comeback ,  with a retrospective exhibition of his clothing and posters at the Victoria and Albert Museum ,the release  of a critically acclaimed  new album,  and perhaps a world tour? Well no, not aged 66. The iconoclast, who stood up and  sang 'We can be heroes just for one day'  has simply kept reinventing himself and now  risks becoming a national treasure. Did the change come  when  he took  on the  job of introducing  Raymond Briggs  'The Snowman.' ?

Yesterday we travelled 500  km to Koutou just outside Mondou in Southern Chad for a five day stay during  half term .It's our first visit to 'Tchad Utile 'as the French liked to call it, and we can begin to see why. As we sit on our guest house veranda look at the green surroundings , the abundance of guavas lemons and grapefruit on the trees and the bird song  is overwhelming.  Competing with the birds is 'Heroes', a digitally remastered  MP3 download on my lap top. When it first came out (in 1977) it was as a 7''single spinning at  45 rpm giving a  mono- aural sound. My first copy  was on a cassette, either copied from the radio or a friend.  Now 40 years later my two recent MP3  purchases from Amazon are  in English and slightly stilted French ( On peut être héros pour jusqu'une  journée) . Technology changes  good music remains.

Music on the move is a great thing which we now take for granted. It really all began with the Sony Walkman.  That  icon of 1980's design went out of production last year, obsolete. Now if you want one you will have to bid against the likes of V&A who are no doubt planning  to do an exhibition about them. Even cassettes  are hard to find these days.
I wish it was the same for the AK 47 assault rifle. Like David Bowie it also had an exhibition in London, on  the South Bank, just beside Tate Modern.  Decommissioned Kalashnikovs were painted with flowers, gold plated, painted with stripes so as to blend in with the background etc. Designed in the mid 1940's just after the atom bomb,  it is small in comparison but  it has proved far more deadly than Oppenheimers creation. A  magazine of 30 rounds  can be fired at 40 to 100  per minute, accurate at 400m.  Imagine if each of the 100 million AK47 manufactured has killed just one person.  Ashes to ashes.
In Chad it would seem that they are the ultimate fashion accessory. Soldiers on guard outside the palace and ministries carry them as do the gendarmes and the police . I must have seen 30 or more as I drove through Ndjamena yesterday morning.  They are ubiquitous even appearing on peaceful parades like International Women's Day.  Manufactured in Moscow, worn legitimately in Ndjamena , fired in the air to celebrate weddings and national holidays, the AK 47  is now  on display in London. Sixty  years after it was first made it is still by far the commonest weapon on the planet , carried by armies, gangs and poachers everywhere in Africa. There is never any  difficulty getting hold of the 7.62 mm ammunition. It is robust, cheap, easy to use and  simple to maintain.  An icon of Soviet utilitarian design,  long after  the union itself  has ceased to exist

In the London exhibition there was one unmounted rifle with a sign inviting you to pick it up. I hesitated, discussed it with Andrea Ruth and Rebecca, and decided 'Yes'. I was amazed how light it  was in my hands , 3.9 kg ( without ammunition),  it didn't seem right put it on my shoulder and squint down the barrel so I quickly put it down. It would be frighteningly  easy to carry and use even for the girls, they declined to try.
I have seen too many people dead and injured by this icon of the 20th century. The year of the millennium I lost a Guinean friend and colleague plus all his family to its deadly efficiency. The world would be a better place if it could go the way of the Sony Walkman, let us all work and pray for that day.

PS:  The exhibition 'History Interrupted' by Carl MCcrow was at the OXO Tower. You can read more about it and his campaign on his website.



Friday, 11 October 2013

Delirious @ Cutting Edge, Furious? Curious?

It was 2004  when we first made contact with Bert Oubre about working in Chad. The hospital was still on the drawing board, and the land an undeveloped area of scrub and dry mudflat on the edge of the city,  so we declined the offer of a job, preferring to continue in the NHS. Five years later, 2009, ,we could only remember that it was in Ndjamena , Chad and that it was called Cutting Edge. That  name had stuck as we  had four albums of Cutting Edge music, the name  first used by the band that became Delirious whilst writing such songs as 'Did you feel the mountains tremble' and 'I can sing of your love forever' (c. Martin Smith Curious? Music 1994). A quick google search for 'Cutting Edge Chad' and contact was made, and now we are here 'over the mountains and the seas'  'dancers who dance  on  injustice' of health inequality and hopefully sing of Gods love to  the people of Chad.  

So much for Christians like me singing and dancing there are some things in life that should make us angry (Furious?) and motivate us to do something, and one of those is seeing children die. It is malaria season and there is the usual annual explosion of cases. Malaria is a disease of poverty, it and was eliminated as a public health problem in the Southern States of the US  and southern Europe during the 20th Century, by spending money on water management and mosquito elimination. Meanwhile in the 21st century each year when the rains come Chad experiences a further  epidemic of Malaria. It has even made the BBC news with MSF reporting on the number of cases in Eastern Chad. Here is our own graph, although lacking some data the trend is clear and follows the arrival of the heavy rains which leave pools of water for mosquito breeding.

We, the privileged, live in our mosquito screened houses, sleep under an insecticide  impregnated mosquito net, take prophylactic anti malarials and have rapid access to diagnosis and treatment. Since we have been in Chad none of our family has caught malaria. We are fortunate, but most of the population are not so blessed. Last month was I hope  the peak and we treated 685 cases of which 69 (10%) were admitted to hospital and 6 (1%) died. There were according to official figures 8743 cases of Malaria in Ndjamena North treated in official centres in the last 3 months.

Which brings us to the title of the blog, delerious@cutting edge. We receive children each day who have been running a fever and been off colour for a day or two and who have suddenly got much worse, being at best delirious or worse having fitted and become  profoundly unconscious. Many astonish us and recover and we give thanks for that: others don't such as the one year old girl I was called to on Wednesday morning. She came in 24 hours earlier and despite antimalarials, antibiotics, sugar and saline drips, and anticonvulsants she never regained consciousness and slowly ebbed away. Heartbreaking for her mother to lose her only child. Each tragic death could be  prevented by the simple precautions above  that we take for granted.

The graph is mainly the work of Moussa, one of our nurses, who each week checks the registers and files an infectious disease  report for the District Medical Officer. Probably due to this effort we have received 3000 mosquito nets from the Health Ministry and UNICEF. So now every pregnant woman, every case of malaria and every hospital inpatient is given a new net to take home and hopefully avoid the next case of malaria. Statistics are not always boring, they can help save lives. I must tell Ruth that next time I am helping her with her Maths homework.