Simple things matter

November 20 ^th 2017 was time to face the future, the first day back at Bardai hospital and at last working full time.; would there be any patients to see? There have been plenty but here is the story of one from that first morning.

His name is Bardai Eli, an unusual name perhaps the only one. It was chosen by his parents, part of the military garrison, who are far from their home in the south of Chad. He learnt to walk early as children often do here and at 9 months of age eager to explore the world he fell into a cooking fire. He suffered burns to 2% of his body, not much in terms of size, but the burns were to his entire face and forehead. Two days later I saw him on my first morning, his face was a mess having first been painted with gentian violet to dry it at the hospital and then an additional treatment of goats fur had been stuck on at home creating a thick black matted crust. The wound was getting infected and he had a fever.

Dr Abdul Karim with Bardai

His worried parents agreed to a hospital admission, and I told Andrea we already had a case for the operating theatre and so she set about cleaning it up, sterilising instruments and swabs and getting equipment ready for an anaesthetic. The hospital generator can no longer power the autoclave so she had to make do with the hot air oven for the instruments and clean but non sterile swabs and towels. Meanwhile he had some pain relief, anti tetanus serum and antibiotics. The hospital has no creams or ointments so his father went to town to get some Vaseline, but came back with some perfumed very yellow petroleum jelly. This was not a good idea, so he went back to town and came back with a tube of fusidic acid cream from a little shack of a pharmacy on the main street.  

Bardai was first on the list of 3 patients for the next morning. (The notion of a list in itself was a novelty as only one case had been operated in the 4 months of our absence, a victim of a landmine who unfortunately lost his leg.) Once Bardai was asleep we gently soaked and peeled away all the crust and found that there was raw burnt tissue all over his forehead, nose and upper lip. He must have had his eyes tight shut and this had protected his eyelids which were simply blistered. Once it was as clean as we could make it his face was lathered in cream and left open with this moist potentially healing dressing.

Twice more that week he went to theatre and at last it was clean. He was clearly feeling much better running around outside the ward oblivious of his white and pink face, Thankfully the wounds were only deep partial thickness and being young he had extraordinary healing capacity and soon his red raw bleeding cheeks were healing and he was able to go home. I didn’t take a photo at the beginning, you wouldn’t have wanted to see it anyway, but here he is as an outpatient coming back for a check just 2 weeks after his accident when his Mum said she was very happy for me to share his story. It’s not normal to smile for photos round here.

It was such simple medicine, but in my experience of strange dressings of toothpaste, tomato puree and probably worse gentian violet, can lead to infected wounds and full skin loss so simple things can make a big difference. Two adults, gold miners, with much larger burns to legs (10%) and arms and chest (20%) are also doing well, this time with home made non perfumed petroleum jelly (vaseline) gauze dressings. Clearly teaching our colleagues burns care is going to be an important part of our work and thankfully our colleagues are keen to learn.

As you can see from the description above even doing simple things takes time as supplies are not automatically to hand and many things need organising to make the hospital efficient. We are a long way from Ndjamena, in need of help, and so were delighted to receive a large pressure cooker which MAF were able to put on one of their flights chartered by the EU for a fact finding trip. They were followed by a UNHCR team who came in their own plane. Both teams were interested in displaced people, be they gold diggers plenty of whom are coming from all over Chad and beyond; or migrants who don’t seem very common in this part of the Sahara. After looking round the hospital the lady heading the UNHCR team noted we were sterilising in a pressure cooker. She had also received a request for a young boy that we were treating for a septic arthritis and probable osteomyelitis ( bone and joint infections) to be flown on to their next stop Abeche where he could have an X-ray as our generator is too weak to make the brand new machine function. Her not surprising conclusion for her report was that for the hospital to function well it needs a good 15KW generator for general power such as lighting but especially so that the good equipment in the sterilisation and X-ray dept are able to work.

 The report will probably just gather dust, things tend to do that in Chad! However it was good to see that although they really there to assess the bigger picture they could also make the effort to help a small child get access to care about 1000 miles away. So last Saturday morning. Dr Abdul Karim and I were able to take our young patient and his father to the airstrip. (His mother and younger brother had to stay behind.) and put him on their plane. We had done a lot to improve his situation, operating to drain the pus and giving antibiotics, but because of the lack of a simple thing like electricity we were unable to complete the care he required.

Simple things matter.

One planet, two worlds

 We spent a lot of time this summer seeing what it is like to be on the receiving end of care in the NHS, and quite frankly we have been very impressed. On holiday Mark’s mum slipped on a grassy bank and broke her ankle badly. It was a bit of a shaky start with a 1 hour wait in the cold and rain for a paramedic due to excess demand for services on a Sunday afternoon. Fortunately Mark had already put the badly dislocated ankle straight and we had got under cover by the time he arrived. The car born paramedic was excellent , but his car was so full of life saving equipment that he couldn’t provide transport; and so although a stretcher was really needed, he escorted our car to hospital with Marks Mum across the back seat us as there were no ambulances available.

 

 

Thereafter the care was excellent. Surgery was performed on Mums broken ankle and she was quickly mobilised and within 2 weeks was back at home. Community care provided impressive array of different carers, physiotherapists, occupational therapists and nurses who have all been coordinating with each other and providing exactly what has been needed for Mum and Dad and now 3 months later she is walking and we are heading back to Chad.

Ambulance at market next to pickup

As you can guess that set us thinking about what would have happened in Chad. First of all of course there aren’t so many octogenarians around; average life expectancy being 52 years. Given that there are still some older people, how long would you expect to wait for an ambulance? The ambulances at our hospital can be difficult to start. Mark needed one for an emergency and as the ambulance driver was absent, tried to start it up. No luck, it seemed that the battery was flat or the wires loose but on opening the bonnet that the battery was simply not there. It had been removed the night before to start the hospital generator. The driver may well have been absent on one of his trips to buy supplies for his market business from Libya. The vehicles are often used to ferry officials around the town or to get supplies of firewood from the countryside to cook for the hospital staff. Sometimes they take sick patients who need evacuation to Ndjamena, a tortuous journey of 1700km. We remember the one occasion that an ambulance arrived with seven young children from 2 families from a nearby village. They were suffering from food poisoning and were all sent home later in the day. However as there is no 999 service most patients arrive at the hospital, following road crashes, military events, or other emergency in the back of their own or someone else’s pickup.

Mark checking out equipment in
 the operating theatre

Having arrived at the hospital with a broken ankle what could have been done. Well there is no X ray available yet, the equipment is there but no radiographer, developing fluids or films. There is not even someone who is used to putting ankles straight either in or out of theatre. We do have plaster in the pharmacy but that wouldn’t have really helped. So it would have meant a 3 day journey with a simple splint to Ndjamena or 12 hours over the desert to Libya. At Ndjamena there is some good care available but often patients choose to use bamboo splints put on by local healers. So even having survived the trip across the desert an 80 year old might still struggle to get a good result.

 



A typical group of homes in Bardai, including
including ours with a thatch.

The family would be there to support the matriarch but they would be untrained with no knowledge of how best to rehabilitate and get their mother walking again. The patient would simply rest in bed and hope for the best. One young girl we met in Bardai has a slow growing tumour causing paralysis and  has spent the last 2 years of her life in bed. Unsurprisingly she has bed sores and life is not easy. The family are there showing their care and concern so at the end of Ramadan the family held their celebration around her bed and the room she was in was full of women chatting and eating. A moment of joy in a difficult life.

So as you can see, now that we will be working full time in the hospital there is going to be plenty for us to do when we get back to Bardai. It will be interesting to see what we can do to make the orthopaedic care better. However that won’t be all we need to do, there will be plenty of medical cases too. Even with our short time there we have already seen serious cardiac disease, alcohol related disease, plenty of fevers and much where we can provide care with our Chadian colleagues.    

The maternity unit

Since we have been in Bardai  the maternity services have been quite quiet.  All deliveries have been normal except for one poor lady who went into labour, unattended and at home. She had a breech delivery all alone which ended with a still birth. Despite living close to the hospital she didn’t get good care till the next day and was still slowly getting better when we left. We did help quite a few women having difficulty during miscarriages and were supported by one of the local Teda workers when she encouraged her daughter in law to have the care she needed and wasn’t keen to have.  

So far we have not had any Caesareans but the need for these to be done well and good care afterwards has been brought home by the death of a friends wife whom I delivered in her first pregnancy by Caesarean for pre-eclampsia and twins. She recently bled after surgery for a second delivery and tragically died. Another missionary also mentioned in prayer letter of the death of a previous colleague in the North of Chad in the same way.

Two different worlds on our shared planet. In the UK , despite ambulance delays, there is no doubt we are very privileged. Meanwhile health care in Chad remains difficult to access and when you do arrive at the hospital the care provided may lack the quality and level of provision that is really needed. We need to continue to aim for a just future- One planet, one world.

Aerial view of Bardai hospital which is on the edge of the town

 

 

A picture is worth a thousand words



A not so  old camel

 

Art in Bardai has been around for a long time, 5-10 thousands of years in fact. Pictures of elephants ostriches and panthers together with their hunters are found all over the rocks near the town. Not quite so old, but equally fun to see are pictures of camels also etched on the rocks a mere 2500 years ago.

But you don’t need to go back thousands of years to see art in Bardai just 30 years ago a French Artist decided to make an art installation not far from Bardai. We visited twice while we were there, huge rocks in a valley painted with what seemed to be red, white and blue a peaceful place to spend a Sunday afternoon. One day we hope we will walk there, the last time Mark played golf with some of the other missionaries and Chadian friends -only 2 clubs and dig the holes yourself so interesting.



Art in the desert

 

Amazing views

 

 

 

 

 

 

 

 

 

 

 

Browsing the internet whilst back in England ,we even came across a copy of the guide to the rocks as they were in the beginning, bright colours startling against the austere brown rocks which surround the valley. We discovered that they had been purple as well and that there were small signs on some of them-we’ll have to look and see if they are still there next time.

Nature too brings its own art work as the colours of the mountains change under the light of the setting and rising sun from brown to orange to yellows. The view from our house is stunning each evening as the sun sets behind the mountains.


Setting sun on the rocks

Occasional clouds too change how the mountains are perceived  and highlight layers previously unseen.



View from our house

 

 

 

 

 

 

 

 

The local people may not be so aware of the colours of the mountains or the changes of light, they have been watching it for a long time. However they are aware of the changes of the colours of the ripening dates and our Teda language lessons are teaching us all the names for the dates as they change from white to green, then yellow and brown and we’ve also found out how the different seasons are closely tied in with the date harvest. Showing how the Teda have always been so dependent on the dates for their livelihood.



How to pollinate dates

It’s hard to remember all the words and that’s not the only complex thing about the language. The first thing we had to remember was that the sentence seems to be the wrong way around with the verb at the end – not a totally unusual thing but needs remembering. Then you have the same word meaning more than one thing depending on how you say it- was that a cloud in the sky or a dog or a drum? Well it all depends on the tone.

The verbs too have proved fun with each verb having two forms depending on whether you are putting down or buying or picking up or so on, one or more things and the two words  don’t even bear any resemblance to each other. Add in the fact that if I give you or I give him something the verb also changes at the front and our brains are swimming.

Nature walk as a lesson looking at  parts of trees
 



Looking at the volcanic rocks













So we thought we’d be sensible and concentrate on the medical terms for a bit as that’s why we especially want to know the language. However, still more complication it’s not as simple as saying I am vomiting but rather the vomiting is happening to me which makes the verb extremely long and almost impossible to say never mind remember.

Despite all this we are making some progress, someway towards a thousand words, or one picture. It always seems worthwhile when we are able to use a little and get a smile from our patients and neighbours.

We are hoping we have not forgotten it all and looking forward to getting back to our hill top house but we have to be a little patient and wait until mid November as at present we are ensuring that Marks Mum and sister who have both been unwell are back on their feet again and not needing us around.

That means chance to see more art work as the seasons change here in England and the Autumn colours begin something we haven’t seen for 7 years.

Autumn beginning in Scotland

 
 
 

A Theological Gardeners Question Time

And now this week's letter question to the panel is from Mr and Mrs Hotchkin, in Chad, which is, if I'm not mistaken, somewhere down south.

 

 ''In hopefully a wise move, we are in the process of acquiring a new home with a west facing rocky hillside garden at an elevation of 3000 feet in the Sahara.  It has only a small amount of poor soil that has been imported to the plot arranged in two small beds. The first in the middle of the yard contains a flourishing young fig tree, the second has a tenacious small vine that is starting to grow over one of the outhouses.  What other suitable preferably edible plants would the panel suggest to complete this biblical picture of peace and prosperity. A photo of possible candidates from our current plot beside the local wadi (dry river bed) is attached.''

 

 

PS: the fig tree is currently bearing fruit, however the vine has yet to show any sign of doing so, any suggestions as to how to resolve this unusual problem''

 

PPS: basically this is a quiz, how many edible plants can you spot? (answers at the end of the post).

 

You will have gathered that we are moving house, we have been borrowing our current home from a Swiss couple who work as linguists for the project and are due back at the beginning of June.  We have told you a bit about the garden but for those of you that don't listen to radio 4, let's try another tack for the house itself.

 

Location is apparently  all important in the choice of a new property, and then although it may not yet possess all the features that are required for modern living if it has potential it can be bought up to scratch without too much effort and expense. So how does our new house measure up?

 

Location, Location, Location -Yes .The view is fantastic, the house is in the foreground above, and the place is  ideal for us, being attached to the other  properties of a friendly local family .It is within 5 minutes walk of the hospital, ideal for call outs at night without being too close. Finally  being half way up a hillside, that nicely eliminates the possibility of flooding that is believe it or not a real risk amongst the date palms in the floor of the valley.

 

 BUT what about the house? The main building of the house itself  is a traditional local stone built flat roofed structure, ideal for retaining warmth in winter months, but rather hot for the summer. No problem as there are a number of semi-permanent rushing covered outhouses in the walled yard  that can be useful for day time shade and sleeping when needed. (the rushes grow in permanently damp areas of some of the Tibesti wadis, as climate changes and the water table falls,  they are harder to find, and no longer grow at Bardai).Just a small change needed inside with a concrete floor to replace the sand.

 

The kitchen is basic, with a low reed roof and poor ventilation. So more changes this time. The walls are being raised, and rendered and a less flammable metal sheet roof has been made. The removal of the open fire, and the replacement with a kerosene burner takes away some of the charm but will make it much less sooty. Soon a concrete floor will replace the sand making it easier to keep clean and rodent resistant. Wood for simple shelves will have to come from Ndjamena at a later date, meanwhile we can use metal trunks to store our food -it will soon be high standard living for the area.

 

 

 

Water now that was a different issue - here we nearly had to change our minds. The town water supply has an open pipe about 50m from the front door, a long way to walk to fill the kettle so 4 large barrels have been obtained (ordered especially from Libya) that we can replenish on alternate days when water is pumped. To save us having to carry it in buckets we have also bought a small pump to boost the intermittent supply up to our house.

And then the all important bathroom, being less than basic it needed improving. There is a simple outdoor shower but no latrine. With difficulty one had to be dug/hewn from the rock and an outhouse will be built around it- a perfect solution.

 

All this takes time but thankfully we do have an expert Changing Rooms team of 3 Chadian builders and local team members as well, giving supervisory and logistical help. One of them is related to our new landlord, what more could you need? There is no shortage of sand and gravel here, and cement was for sale on the local market, but all the wood and roofing sheets had to be brought specially from Libya and all we have to do is provide the builders tea (green, no milk and lots of sugar) and money for bread and sardines for lunch.

 

So for us this fits the bill and we are excited to be moving in soon.

 

Meanwhile we are free to continue to learn the Teda language, help to reorganise the work at the hospital and  do a weekly outpatient clinic there too. Putting down roots and getting bedded in takes time, perhaps that is what the vine is doing too.

 

 

Answers to the plant quiz:   Basil, male melon flowers ( can be fried), flowers from local rocket salad, yellow sprouting broccoli, moringa ( an edible tree leaf). The Zinnia is ornamental only as far as we know.

 

 

 

 

 

 

Cool Camping

 

Words can have more than one meaning, so cool camping may not mean what you think it does. But lets first take an example in Tudaga, Kûdi, it   can mean dog or drum (falling tone), and with a slight change (rising tone) bed or cloud. No doubt this can lead to confusion, but beating a dog in church would not be a normal activity so I guess the context usually makes it clear. English is less complicated, there are no tonal meanings that I am aware of, but words such as ‘cool’ can all the same lead to confusion.  Cool camping is a website that we have used  in the UK, cool in the sense of special, less frequented, beautiful and often simple. I guess a campsite in  Bardai would probably fit the category quite nicely.  It could also have a difference sense of the word ‘cool’ that is ‘chilly’ with night time outside temperature down as low as 2° C ( yes only  just above freezing) since we have been here, that would fit as well. Therefore camping might not seem to be such an attractive idea, but I am not sure that it is a lot different from how we live.



The house we are living in at the moment

 

Andrea unpacking our trunks just arrived from Ndjamena

So welcome to Cool Camping Bardai, (in as many senses of the words as you choose to understand). It has received ***** reviews for its spectacular  situation but rather less for its facilities.  We are living in a simple breeze block house, borrowed from a linguist couple who are out of the country for a few months. It consists of a main room and a bedroom each of which have a  small ( 30 X 30 cm) shuttered window. There is a veranda and a separate kitchen. The roof, doors and windows are all made of corrugated aluminium and there are no ceilings. It is fully equipped so we only had to bring our personal items from Ndjamena with us, clothes, books, household objects, some medical supplies and equipment, and  dried food etc.. in 3 large metal trunks which now double as cupboard space.

 It has a reasonable sized yard with a small garden plot and we have some tomatoes, aubergines, hot and sweet peppers plus some herbs growing. So far only a handful of each but hopefully more with regular watering.

 We are a 15 minute walk up a sandy road to the hospital, it is  like walking in snow in that it takes more effort than normal.  The main street with its collection of lock up stores all of selling  the same collection of tinned and dried food is about 200m away.

Having spent our first night at Bardai it was rather chilly and so we decided to have breakfast outside, the air temperature rapidly rose and the sun felt warm. Next we organised the house, made book shelves in the lounge with large dried milk tins and planks. Then we  put some postcards on the wall.

In addition to sponge mattresses on the concrete floor of the bedroom we have a large pop up mosquito net. Due to lack of water there are no mosquitoes, but scorpions are a real problem. A four seasons sleeping bag from the UK along with bedsocks and a rug, is enough to keep us warm.

The kitchen is also pretty simple, having a single kerosene stove supplemented by the solar cooker. There is  no running water in the kitchen but the stand pipe in the yard has an intermittent town  water supply, 4 hours every 2 days so we keep a couple of  large 150l drums full. We wash our pots and clothes by hand and all the waste water gets poured onto the garden.

We have electricity from a solar panel on the roof and a single large truck battery. The computer and phone can be charged by day and the 12v fridge in the kitchen is amazingly efficient, but then again it is the cold season. As I write this the light bulb has gone out, we usually have one on at a time.

 

Finally the bathroom, always a selling point in a house, it has a fantastic view and the sun warms you by day. It is situated  next to the garden, just behind the  washing on the line in the picture above. Bucket showers with solar heated water are very nice. The toilet, a simple pit latrine, is  separate  being just outside the  wall and again it has a fantastic view of the stars.

So as you can see living here really is rather like camping, but that’s fine as that is something that  we have always enjoyed  doing. Now that the weather is warming up it is getting much easier, dressing for dinner no longer requires thermal underwear, which is a nice change. Strange to think that in  a couple of months time we will be sleeping outside as it is too hot to be  within the walls of the house.

However we are not really camping and we are settling in to our new routine, from the first week that we arrived we have had a 2 hour Teda language lesson in the  morning, followed by private study. Also we have been  helping out at the cultural centre some afternoons a week and are spending a couple of afternoons  working at the hospital mainly sorting out and organising all the material. In between shopping, going for walks in the hills, visiting neighbours  and watching a football match. Its a cool place to be!

Key:  A : Hospital

          B: Water Tower

          C: Telephone Mast

          D: Church

          E: Mosque

          F: Our home is somewhere in the date palms

This is not a holiday………..

 

……………. but if it were it would be the holiday of a lifetime.
So here we are in the Tibesti mountains that we had first seen from an Air France flight to Ndjamena in 2009 with a spectacular sunset. Could we ever make a visit we wondered, as we looked at the beautiful sunset with long shadows from the mountains in the midst of the desert. Eight years later, having been invited to in the hospital, we are making the journey to our new home at Bardai and on the way passing by the spectacular Trou de Natron. We are stood on the rim of an old volcano, at about 2500m (8000 ft.), it is chilly despite the cloudless sky and eerily quiet. It is 700m to the base of the crater where there are scattered trees, large white mineral deposits and just above Andrea’s head in the picture a volcanic cinder cone that is actually 200m high. The entire crater is 7 km across, so about 22km to walk around or perhaps take the track to the base and greet the hermit that lives there? But not today, this isn’t a tourist trip after all.  It is midday and were are still 4 hours from Bardai so after a 15-minute break we set off again on a rocky track travelling at 20km an hour, having to walk at times to ease the load on the vehicle. And just in case you wonder about visiting we have been on the road for two and a half long days from Ndjamena heading north, setting off before dawn and stopping after sunset sleeping rough.

In Ndjamena a few people asked me how I was going to drive to Bardai, try getting a route on Google maps, it will tell you that there isn’t a route, and it’s quite right or at least not one that you can take by yourself. Thankfully we travelled with 2 very experienced colleagues, and another chadian who would do the cooking. They made all the preparations, the necessary paperwork, a barrel of petrol, a barrel of water, food for the trip, our trunks, other project materials and other necessities such as material for an upcoming wedding plus my guitar were all loaded onto the Hilux 4X4 the night before. (Yes it is petrol driven, the Teda apparently prefer that as they get more power and acceleration) We set off early next day heading North passing villages on hills with walled fortress type houses.

 After  midday we stopped at Mao, used the facilities of the small town-  the last petrol pump and eating place. Women don’t eat in restaurants so a back room was found so Andrea could eat as well. Then we set off into the wastelands thankful to have a sat nav, and sat phone with us. There is a track but it is not always easy to follow, I guess this is desert, but it is not sandy yet, scrubby hills with occasional nomad settlements, a few camels and goats.

By nightfall we arrived at the edge of the sandy desert, where the north south track meets and east west track and there are a few small shelters and a handful of trucks parked for the night. In the dark our guides cooked a lamb stew with macaroni, it smelt and tasted very high and gamey, having travelled with us from Ndjamena in a plastic bag. They saved the rest of the raw meat for the next day.           

Usually everyone sleeps outside, it can be cold and is often very windy and dusty, but we were fortunate with clear skies and Andrea and I were offered a hut made of matting to sleep in as again Andrea was the only woman around.

Setting off the next day was quite different, the track disappeared in the soft sands and we stopped and let some air out of the tyres to help with spreading the load. Every few hundred metres large tyres had been left to show the way. This is a truck route from Libya and we saw a few, often undergoing repairs or stopped to cool down an overheated engine. The soft sandy desert with dunes gave way to a vast flat featureless landscape.

We stopped to refuel at a service station  (spot the yellow hose in the picture syphoning the fuel), stretch our legs and find a bush (quite a difficult task).

Early afternoon we stopped at this small oasis, at the most amazing picnic spot ever, nearly everyone (4/5)  agreed the lamb was too far gone and so it was tuna and spaghetti, Andrea eating apart from the men as is traditional.

A few more hours and we approached Zohar Ke on the edge of the Tibesti mountains, a small trucker’s town and having found a small hut/restaurant serving roast chicken with coca cola this time 2 men in a back room were asked to move to make way for our strange party with a woman. We again camped out on the edge of town, this time in the open air. With our two fourteen hour days we had made good time so we slept in and had breakfast, bread brought with us  from Ndjamena and some dried salted beef, as the sun rose. Our colleagues warmed their hands and feet by a fire before tying the ropes over the load on the vehicle.

 Once out of the town at the foot of the first mountains we again stopped and reinflated the tyres and then it was the long hard climb through the mountains, walking from time to time so as not to damage the vehicle. Here in this barren landscape we saw wild donkeys, camels and even deer in the distance.

 Our highest point was rewarded with one of the most spectacular views in the world and then we began the slow descent to Bardai. The trip had only taken 3 days, we had planned for 4, but we had not even had a puncture.

The sign in the road outside our home shows where we are, 1734 km from Ndjamena. We slept well inside and woke to a cold sunny morning, 10C inside 3C outside, welcome to Bardai (which means cold in Arabic). The holiday is over, now it’s time to get ready for work.
PS: Don’t be fooled by this blog into thinking that the internet functions well here, this has been sent from a smart phone as several attachments to an email and then posted by Rebecca in the UK.

Moon rise from our yard, first night at Bardai.