Big drop in children under five dying, says UN report: BBC August 2012

The good news is that the health of the little children of the world is improving according to UNICEF, that means that instead of 12 million deaths in 1990, there were only 7.6 million last year. The numbers are overwhelming, and  we shouldn't lose sight of the fact that each one is an individual tragedy.

Our hospital at Guinebor has always had a special place for children, that is at the front of the queue: the same place that Jesus put them . Like him  we got some  initial protests  from the adults who didn't understand, but is now  accepted that the under fives can' push in' at the front as they are often our sickest and most vulnerable patients.

I was initially going to start this blog share with the  exciting news that   we have recently  operated on 2 very young babies and they have both  survived. . One aged about a week  had a meningocoele , a fragile  pouch of spinal cord lining over her lower back; and the other a pyloric stenosis aged 5 weeks , a blockage to the stomach that causes persistent vomiting. Both will now have a normal life expectancy, for Chad. I hadn't done either operation before so as a surgeon I am encouraged because  the reality is that there are now 2 young children who will have the chance to grow up loved by their parents. We can all rejoice and give thanks to God.

However as a project manager I need to see things a bit  differently and keep things in perspective. I need to remember that the vast majority of children die of preventable disease such as  malaria, diarrhoea, malnutrition, pneumonia measles and tetanus. World wide 21 000 die each day and each week some of them are at our hospital .  Unfortunately the  good news  of the title to this blog doesn't apply  if you are born in Chad.  iIt  now reports the highest childhood death rates in the world  209/1000 (over 20%) and  actually is one of 10 countries that are getting worse.

What can we do?  Operating on newborns feels good but isn't the answer. According to UNICEF/WHO  the children of the rest of the world are doing better because of better access to health care and well run immunisation programs so we need  to keep the children at the front of the queue and we need to get integrated into the fledgling national immunisation program.  Last year just before the re-launch there were no vaccines in the country, I know that  has changed and we need to play our part. I will take some time off from clinical medicine each week to visit offices, write letters and establish projects so that we can get involved. Administration saves lives.  

We will also step up our identification and treatment of malnourished children suffering due to the famine following on from poor rainfall in the Sahel last year, BMS are again  collecting special funds for that. And finally what about a really crazy  idea passed on to me by a retired GP friend  whilst I was in the UK ;  using good malaria prophylaxis as well as a  mosquito net prevents deaths in seasonal malarial ( BMJ news section august ) Giving my patients the same protection my children have always had, what a strange idea!

 Whatever next?

Chad is wetter than Britain! (at least some of the time)

Having spent a very enjoyable time on UK assignment with its unpredictable weather, we returned to Chad last Thursday and guess what- it's raining So I thought I would stick to our national stereotype and send you a  quick email  postcard.

 

Everywhere is green and the any slight dip in the  usual baked mud of the roads has turned into  pools of  deep slurry. That is not  what you would probably  expect  me to say about this place just south of the Sahara that is so hot and dry for most of the year.  But a look at the table below will show you that this  is normal; N'djamena gets an astonishing  76% of the annual rainfall of our home town, Wakefield UK.  Nearly all this water  is crammed into 3 very wet months with up to  7 completely dry months each year.

average rainfall mm / month

 

This annual deluge makes   travelling to and around the  city difficult,  for example  a couple of our vehicles have been dug out in the past week, but  all this rain  not a bad thing: it brings life. Last year the rains were light but thankfully  this year has been the wettest since we have been in Chad, and as a consequence there should be l be a much better crop of millet and other essential foodstuffs.

In a normal year  the WHO estimates that 40% of Chadian children are stunted due to poor diet and it doesn't take much to make them fall into frank malnutrition The  consequences of  last year's  failed crops are still being felt  with  famine declared from west to east right  across the Sahel including Chad.  This has  resulted in increasing numbers of severely  malnourished children attending our hospital. BMS is committed to seeking funds to enable us to carry on with our refeeding program so that we can continue to give the needed high energy/protein (milk, sugar and oil) feeds to the hospitalised children for up to 3 weeks of intensive treatment. The diet of those less severely affected can be supplemented as outpatients  with a flour made of  dried beans, carrot, sweet potato , millet, and peanuts..  Let us hope that this year's harvest will be better and that the children won't go hungry next year. Meanwhile we will continue splashing through the puddles.