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