Three years later

 December 9^th 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,

NO ROOM IN THE WARD, 

 which has more than a faint echo of the Christmas  story.

' 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.

 

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.

 

 

 

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.

Yom al Sabit (the seventh day)

Its Sunday morning 8 am and I am lying in bed relaxing, It's difficult to doze as although the sky is blue there is a persistent roar of not too distant thunder. Military jets are exercising, probably French as they are the noisiest, circling  over the city. You would think they would take one day off each week and why not the Sabbath?

In fact  Yom al Sabit ( Chadian Arabic ) was yesterday, its timing in the week, and the words themselves make clear  the Semitic roots  of the language. Sabit is so close to Sabbath  and when you hear Yom Kippur ( the Day of Atonement)  do you think of warplanes , always butting in as above or goats? Google it and see what you get.

So if today Sunday is not my Sabbath rest, (I am on call and have to  do a ward round), what did I do with the actual Sabbath yesterday? 

At 7:30 Andrea woke me to let me know that she couldn't contact the anaesthetist, his telephone was clearly resting and not available.  The wife of one of our guards needed a caesarean  and I stood in to put her to sleep. The  4 kg baby boy was delivered and by 10 o'clock  I was back at the house having a quick breakfast and coffee before getting on with the day's work.

On the mens  ward there was only one man with heart failure ready to go home, he left and was replaced by  semi conscious  man with malaria from the Emergency Room. Another man who had a definitive  amputation of his hand a week ago came in for a dressing ( he was trying to prise open an old hand grenade with a knife, don't ask why, he initially claimed it was an exploding cigarette lighter). There were  five  empty beds, the sixth bed had been put on the children's  ward.

There were  three women on their  ward, one with heart failure due to rapid atrial fibrillation , a second with liver disease (cirrhosis and bleeding  varices) needing a blood transfusion, and the last after a mastectomy for breast cancer.  There  should  have  four empty beds ,  but there was  only one. Another  had been taken into the children's ward,  and once that room really was  full  the children's ward  overflowed  into the women with the presence of a   new child with malnutrition and one who was getting better quickly from her severe malaria.

 This  month children's health is at more serious risk than ever,  and this year we are prepared for it. Last year's autumn harvest is a long time ago and the next one is keenly awaited, the rains fall a source of  benediction. in the meantime food is short and malnutrition common in the under 5's. But the same rain makes the puddles  and the   mosquitoes flourish in the puddles stagnant water becomes  a curse. 

There were five more severely malnourished children on the children's ward, some wasted and stick like, others bloated with retained water and peeling skin. All are on the  intensive feeding program, and if the families can spare the time they can be cured.   An older girl who had been profoundly unconscious for 5 days with cerebral malaria had  amazingly opened her eyes and said a word to her mother. Another 7 year old clearly had tetanus, all his muscles have gone stiff,  it wasn't obvious the day before. So he was  immediately transferred to a single room for ant tetanus serum, antibiotics and sedatives. Finally there were two surgical cases from earlier in the week a girl with a perforated gall bladder and peritonitis  which I presume occurred during the convalescent phase of typhoid, she was doing well:  and the other another with a bowel obstruction due to an internal hernia through the small bowel mesentery.

It's an  unusual and interesting mix of cases for one  doctor and it is great to see so many getting better.

By 2:30 I was home for lunch and I got a bit of rest between calls to the Emergency room and checks on the sickest patients. . The evening was calm and we sat down as a family to watch the current favourite ,Call the Midwife, on the computer. I am not sure if it  counts as  recreation or continuing medical education after all the day had  that started with 'Call the Anaesthetist'.  So the Sabbath was a quieter  day with no non essential work  but not exactly a day of rest.  It was our  6th consecutive   days of 24 hour on call,  only six more to go until next Saturday which really will be a day of rest , Yom al Sabit.

PS  A little time for Arabic, I think I'll learn the days of the week

 

Casual Conversations

 

Earlier this year coming back from town through the streets of Guinebor  some women waved asking for a lift. They were carrying their shopping home and were happy to be helped the last mile or two home. The conversation was very limited

Me :    Assalaam alekum                            (peace be with you/hello)
Women:   Alekumm assalaam                  (peace be with you/hello)

Me: Tamci wen                                              (where are you going)
Women:   Namcu fi luptaan americanno  ( we are going to the american hospital)
Me: Arcaabu                                                   ( Get in)

Not much more to say really, about the limit of my Arabic, but they then decided to try their English on me

Women:   you american, you speak English
Me: I am English/ British

Women:   Grande Bretagne! Tony Blair, King Elizabeth

Lots of laughter and smiles,

And with that we arrived in GuineborII , and they got out

Women:  Chukran katir                                     (thanks a lot)
Me :   Afwan                       (thats OK)

 I never did find out what they thought of Britain, Tony Blair or King Elizabeth, but they seemed happy enough, at least they weren't scowling. As for the monarchy I  amazed that they knew it existed.  They are probably still laughing about the white man who stopped and asked a 3 women, where are you (singular) going as If I only wanted to take the first one. ( Tamci should have been tamcu). Or perhaps they haven't even thought of it at all.

A trivial encounter, but a point of contact all the same, Jesus knew how to take such a cross cultural situation , (asking for water at a well), and speak of something profound, the essence of life.

Can it be done  here without causing offence? Would it be understood?  We would need the language  first.

We are back in Chad after a visit to the UK for a holiday and a retreat. , Ruth and Rebecca are enrolled in a Chadian Arabic course 4 hours each morning for 5 weeks, the rest of their summer holiday,  We are trying  to  speak some Arabic each evening and are managing to do so as the hospital is very quiet due to the fasting month of Ramadan and the annual rains.

 Last week when I asked if there was anything to share at the morning staff meeting, Moussa a Muslim nurse congratulated me on the arrival of a new Prince In England. Thanks very much I replied, it was good to be informed  but I hadn't been looking for the news, because unlike the crowds outside the palace in London   I am more interested in royal babies that are born in a stable.

I wonder what Moussa made of that, and you?

 

Time for a break

Did you buy a snack today I guess if you did it might have been a bag of crisps or a chocolate bar or seeing as its Easter even a crème egg .We just ate a Cadburys Egg and Spoon rather melted  but still tasty .May be you are on a diet  or just being healthy or avoiding chocolate for Lent. If so then Chad could be the place for you snacks in Chad are definitely not chocolaty and not crisps either Pringles cost more than anyone can afford.

 A few weeks ago it was International Women's Day and we were marching again in front of the presidents palace , as it was school holidays Ruth and Rebecca joined us too .This time we had been well organised so we thought, with groups meeting to plan the food and the buying of material only to then  be rather upset by the fact that after the nurses spent 2 days waiting none of the especially printed  material was left.

A quick trip to town revealed that some had been sold on to the market and for a mere 2 and a half times the price it was available .The preferred option was to all buy the same material with another design and wear that instead and we were not alone when we arrived at the march in having to do that .Did they not make enough? Did it get bought by wholesalers? We will never know. Our house help who also sews as well cheerfully stayed up half the night to sew the material as we only got it at the last minute and all was finally well.

Any way back to snacks what was available to sustain us as we cooked in the sun and drank gallons of water, here are a few pictures bananas from Cameroon relatively expensive, bread and cakes Locally made hibiscus juice to drink and carrots which are in season and eaten raw (four for the price of a banana), at other times of year it is bitter yellow aubergines in wheelbarrow loads!

Then it was on to the march and back to Alice's (one of our nurses houses) for  chicken and bread deliciously cooked and enjoyed by all including the babies. Washed down of course with the obligatory coca cola.

We were down near the bridge to eat so made a quick successful trip to look for hippos here they are trying to keep cool lucky them.

Then back to the hospital where we found more snacks for sale in the shop, crunchy crickets  apparently they may be in fashion soon as they are full of protein so watch out in your local corner shop.