Faces of Chad

Children are an important part of our work at Guinebor, under 5 mortality is amongst the highest in the world at 120/1000 children.  We are playing our role in improving this with a vaccination and under 5's growth clinic, started earlier this year, which has just enrolled its thousandth child. Preventing disease is best but we also have curative treatment for malaria, diarrhoeal illness, malnutrition and pneumonia. Sometimes I have the impression that these diseases are all that  paediatric medicine is about in Chad. Certainly these are the major problems and along with the other hospitals  and clinics in the city we are working to combat them.

So today is an unusual day, I did the  Saturday morning ward round and  there are 3 empty beds and more surprisingly none of the  5 children that are here have the usual diseases.

 In the first bed there is Ahmat, a  young boy who has not walked for a couple of months. He arrived a fortnight ago in a lot of pain unable to straighten his hip. He hadn't been to hospital before but had been with traditional healers. As our equipment isn't working h e was taken by ambulance to the city hospital to have an X-ray and some blood tests. His hip was dislocated and there were signs of infection in his pelvic bones.  There was little change with initial antibiotics and pain killers; he cried whenever we went near him.  After  manipulating and draining the hip in the operating theatre and applying traction he is making good progress and has started smiling. Another X-ray is needed and there is still a long way to go to get him walking again but he has turned a corner and is on the mend.

 In the next bed is Idriss he  has been with us for 2 months! He had an injection at a clinic which it got infected.  The infection spread from the abscess  and killed most of the skin on his buttock, down his thigh to below the knee. He spent a couple of days at the Mother and Child  hospital and then left to come to us. His  father said that nothing was being done. Once with us he had three trips to theatre to remove all the dead tissue, thankfully most of the muscles were exposed but unaffected. A first skin graft took well but only covered the lower  half of the wound. He has been up walking, at first with a frame and then unaided. He has just had his second skin graft and is stuck in bed for a few days. Another child transformed from fear and pain to smiles and laughter. His father came and thanked me the other day, and said that the reason they left the other hospital was because they wanted to amputate the whole leg. He is so happy and says they will stay a year if necessary to get his son healed. Thankfully it won't take that long.

The third is Djidda  an amazing young boy, he has shown such determination. He was admitted 10 days ago. A week before that his left leg was weak after a game of football, a couple of days later he couldn't walk and his left arm was contracted. Again 2 days later his face became weak and he lost the power of speech. He had been at the  Mother and child hospital and treated as an out patient with lab tests sent to exclude polio. When I saw him it was as if he had a stroke he was paralysed down one side,  semi conscious and agitated. What could it be? Blood tests were normal. I suggested a CT scan, but did say that although it might show me what the problem, a tumour or abscess perhaps, but that we may well not be able to offer a solution either here or elsewhere in Chad. There is no neurosurgeon in the country. The CT scans at the 2 government hospitals were broken so the father got a private scan at twice the price that I expected ($300, 2 months wages for our non medical staff). It was worth it, the scan report suggested a deep seated infection with small abscesses and swelling and the need for an urgent referral to a specialist centre.  A good report from the new ' Modern Hospital', unfortunately it is very expensive and doesn't treat pregnant women or children, but they did do our scan! Where did they expect us to send him? I thought it was probably too late to expect a good result but gave high dose steroids to bring down the swelling, and strong antibiotics. He was fully awake in 36 hours. On the ward round it should have been good news , but his mother wasn't there and he was awake, and crying.  Was he crying for his mum or because he realised his state and couldn't talk. I nearly cried too, and gave him a hug and said a silent prayer. Next day he tried to walk and was caught as he fell over, then he could walk and today he is even starting to talk. What can we say- Al hamdu lilah- Praise God! He still limps and his hand is clumsy but such progress and still improving, such courage and what a lovely, for the moment  lopsided, smile.

Moussa  is a 14 month old baby with his father and grandma. His mother died after he was born. About 6 months ago and accident when cooking scalded his leg and the result was a severe contracture with only his heel able to touch the floor.  He was operated a couple of weeks ago followed by a skin graft and is set to go home on Monday. His foot and ankle will now be free to move normally, and its time learn to walk. Dad smiles much more than grandma .

The last case is also unusual, Bechir has diabetes (maybe tropical African variant), a very high blood sugar, off the scale of our machine, and is surprisingly well but it does need to be  corrected by insulin. He was in hospital a few months ago and had 'decided' to stop taking his treatment. It must be difficult to live with chronic disease in Chad both financially, his family need to find about $12 a month ( about 1/2 a week's wage) to pay for his insulin and finding time to come for occasional tests.  He lives a long way from the hospital to the north. His stabilisation treatment can be free but what will happen long term?

As you can see we have 5 complicated cases at the moment, only the baby with the burn has a quick solution and even that will need follow up to make sure that the contracture doesn't it doesn't recur as he grows, but we hope and pray for healing for all of them. What's the chance of having 5 such cases on one small ward? I don't know. I do know that the chance of having 5 boys and no girls, is 1: 32. We normally have the same number of each, and normally have only  one unusual case with 7 more normal ones.

We give thanks to God  for what, with His help, we have been  able to do with our limited resources,  but also we give thanks  for the help from the other hospitals. It would be good to be able to do more tests and simple X rays here and we are trying to get our equipment working again  but we have no plans for a CT just yet!

( Both parents and children were happy and consented  to have their pictures and stories shared)