Waiting for Christmas

So here we are still in Ndjamena and not yet sure when we will return to Bardai, we are praying for a peaceful resolution to the conflict the start of which caused us to come to Ndjamena 6 weeks ago. It’s a strange feeling because being in Ndjamena, which was previously our normal Chadian place to be: It suddenly seems a special and luxurious place almost half way to being in England!

So in true Christmas celebratory spirit lets tell you about the 12 days of fun.

No1.Watching Hippos by the river

We spent a week in a new missionary retreat centre by the river and while we there not only did we see lots of beautiful birds and sunsets but a family of Hippos too. They announced their arrival very loudly the night we arrived and their departure the night before we left.

No 2. Having the chance to go to a wedding.

We had heard that Yola one of the nurses at Guinebor was getting married and were wondering how to send her a gift. Well we were not only able to do that but to be at her wedding too it was fun to be there with the other staff from Guinebor and celebrate with her.

No 3. Being at the Team conference.

We spent a great week being taught more about Jesus our shepherd and how to follow him and hearing how others are doing that all around Chad. We also had fun together visiting the farm we used to go to with Ruth and Rebeca horse riding for a barbeque amongst other things .Including Mark wearing a Manchester United outfit(very stressful) as there were no others available at the market and we had to dress up in something representing our country.

No 4. Going Swimming.

A relaxing day was spent at the pool with only 3 colleagues to share the 25m pool for most of the day. Mark finally managed to achieve a target that he set about 5 years ago with Ruth and Rebecca, to swim the same number of lengths as your age. (They had the advantage of youth) .

No 5. Having a washing machine.

Actually this is more than one day you’ll be glad to hear, but it’s very nice not to do our own washing by hand.

No 6. Eating out.

We have been out a few times notably for Thanksgiving where half of us were Americans but also recently to have a sandwich in N'djamena’s latest newly decorated café where you can eat in a taxi bus.

No7. Having (even book) shops to visit.

From the same café come bacon and ice cream, delicious treats not available in Bardai. Except for the one time when we turned our solar fridge into a freezer and it valiantly fought outside temperatures of 44C to make ice cream at -14C, a staggering 58C difference inside and out. We have also been to a bookshop and managed to buy some great medical books to take back to Bardai.

No 8. Having language lessons.

Well it’s not exactly a treat but it is good to have the time to do this without other demands on us and we have found a teacher who is really patient and helping us to progress.

No 9. Going to the theatre.

We were hearing about Rebecca's theatre trips in London and thinking how nice that would be- now since being here we have been to one guitar concert. a play about child soldiers and some modern dance. All at the French cultural centre in town in an outside theatre, it has been a real pleasure.

No 10. Having Whats app and internet in the house.

Its lovely to be in more frequent contact with our family and we are really enjoying this but trying not to get too used to it.

No 11. Not being freezing cold.

Actually at first we were a bit warm but now temperatures have dropped to a cool 33C by day and 15C at night. It’s certainly easier than wrapping up every night and sleeping under layers of blankets, Bardai is 4C overnight. However we know what we would really prefer.

No 12. A Christmas craft market

This year there seem to be several of these. Last Sunday afternoon we went to the Hilton an experience in itself! An opulent 21^st century version of a large Roman villa. They had a craft fair including a stall from the Acacia project that Rebecca worked with and a huge tree and lots of decorations. There will be another with products from around Chad at the French cultural centre later in the month and yet another at another hotel later on. There are Christmas carols playing in the supermarket too.

This year we are going to enjoy celebrating here in Ndjamena with an English carol service by candle light and Chadian church celebrations. Although we would have equally if not more have enjoyed this in Bardai and actually the mincemeat and Christmas pudding are still there. Not to mention our presents and decorations. Despite this the Grinch hasn’t stopped Christmas coming. We like you will be celebrating the birth of JESUS.

We have a ‘tree’ and are using it as a reverse advent calendar putting on one decoration a day. I am going to try and make acake and homemade mince-meat so we’ll see how that works. I’ll be lucky if it’s as good as my solar cooker cake last year

 We pray that you like us will be able to celebrate and know the presence of the Prince of Peace this Christmas where-ever you are.

After the War - Lest we forget.

Armistice Day, 11/11/1918, was rightly commemorated last weekend around the world. At last, after four years of terrible industrialised fighting and unprecedented death and destruction, the war to end wars was over. 
An old weapon, the underground tunnelled mine had been perfected and was used with devastating effect at Messines Ridge in 1917 when 19 nearly simultaneous explosions of a massive 455 tonnes of explosives killed an estimated 10,000 German soldiers. (ref 1). But as the war drew to a close, these traditional mines were being replaced by the new much smaller, at first improvised and then factory made, landmines. These were placed in the ground to defend against the new chariots of war, trench busting tanks. They have become an indispensable part of the military arsenal.

In the late 1960’s and 70’s our family made an annual visit to my aunt and uncles farm at Burgh le Marsh. We visited nearby Skegness and played on the beach for days on end. I have many happy memories but a couple of things fascinated me, the faint memories of WW2. A small number of ex-army landing craft which rolled along the beach giving rides to fun loving tourists, and a disarmed sea mine acting as a collection box to help shipwrecked sailors. Old military equipment being put to a better use, memories of a distant war. But it was only 25 years since the end of WWII, the beaches at and around Skegness had been part of the 1,997 minefields laid around the UK in 1940 (ref 2). In total about 350,000 mines were laid to prevent an invasion, and then removed, often with considerable difficulty and cost in human life. Around Britain accidents happened through the 1950’s with residual munitions, I don’t recall hearing of any in my lifetime, certainly they weren’t frequent. However, whilst writing this I found that in a controlled explosion an old anti-tank mine was destroyed at Gibraltar Point not far from Skegness in 2015 (ref 3). The de-miners had done a good, brave, but imperfect job. 

Driving into the Tibesti on a white stone lined road

As we entered the Tibesti from Zoar-Ke last year we saw a destroyed tank and other vehicles from another past war, the Libyan- Chad war of the 1980’s. We also saw the white stones by the roadside which mark areas of potential minefields. It was all from some conflict some 30 years before and yet as we entered Bardai there were zones either side of the road which were unsafe to drive on. It all seemed a little unreal, but we asked questions and were told that as long as we stayed on the roads we were reassured that we would be fine, that there were no mines in Bardai itself, and there were many less accidents than there had been a few years ago. The local demining team was still active and once in a while there was a controlled explosion of collected anti-tank mines. The people in danger we were told, were incoming goldminers who didn’t believe the local Teda when they said that a zone was dangerous.

A controlled exposion in the Tibesti -MAG

The task of demining the Tibesti is more difficult than the beaches in the UK. MAG have worked here since 2004 (ref 4). The British minefields had been marked and surrounded by barbed wire and other defences so as to avoid accidental entry to the minefields. The mines were laid above the tide line and in many cases the mines were wired together to facilitate eventual removal and prevent migration. I don’t know how the minefields in the Tibesti were marked, but mines in wadis get washed downstream when the dry river beds flood, and through years of rebellion and civil unrest mines have been lifted from their original sites and used to booby trap roads. For these there are no reference charts. Naturally the roads, dirt tracks, have been swept for mines, but nothing is static.

One day we went to a neighbouring village for a wedding, there were many pickups parked by the mosque. Our Teda friend parked as neatly as possible to save space but was told to go no further forward as there was a mine buried, in a small area marked by white stones, right in the middle of the village. An hour or so later, on leaving, our vehicle was hemmed in, and so a man stood in the circle told us to drive forward over it, there’s nothing here he said. We decided to wait all the same, best not to take a risk. Is there really a mine there, who knows, apart from the man who laid it.

A short while later there was an explosion on a well travelled road to another village, just up the wadi from Bardai. A large lorry heading to market with many passengers on top had set off an anti-tank mine. Thankfully only the tyre was blown off, perhaps the mine had sunk deep into the sand. A fortunate escape, but all the same there was an impressive hole. A colleague of mine from the hospital lives about 200m off the road at that point on a small rocky hill. He doesn’t have a car but rides a motorbike.

So how common are landmine accidents around the world? The Nobel Peace Prize winning International Campaign to Ban Landmines collates statistics from each country and publishes The landmine and cluster munitions monitor. (ref4). These and following statistics for Chad come from their 2017 report.

Around the world in 2016 there was an increase in the number of incidents related to mines and discarded munitions with 8605 casualties, at least 2089 were fatal. Most casualties were civilians (78%) and 1544 (42%) of those were children. These are the highest figures since the Mine Ban treaty of 1999 which bans the laying of mines that are activated by human contact (antipersonnel mines) but not yet those activated by vehicles.

There have been 3011 casualties recorded in Chad by the Landmines and Cluster Munitions Monitor with 1179 deaths. Recently a decreasing trend has been apparent with 27 casualties in 2016, with no reported deaths. Thirteen were caused by mines and 12 by old shells etc and in 2 cases it was not declared.

In the last 6 months these numbers on a graph have become real to me. Twice I have been called to the hospital to treat young men who have been in a pick-up truck that ran over a mine whilst off road out of town. They both died of multiple blast injuries. Whilst I was in the UK in the summer another two people died in another couple of incidents. In the first a young man who took a different route into town because of the flooded wadi, and in the second the wife of a friend of the ADP was killed. She had been at a busy meeting place under a tree on the edge of a local village and was killed as she was driven away.  All of these were local Teda people and all caused by anti-tank mines laid over 30 years ago, but which can still be laid under the Ottawa Protocol.

A fifth young casualty was a gold miner. He was at work when he came across something unusual, a plastic canister that he didn’t recognise. It was an antipersonnel mine. These are designed to maim and not kill as the injured require help from colleagues further depleting an attacking force. It blew up in his left hand. He arrived at the hospital the next day after a long drive with improvised bandages over both of his hands, he looked terrible. Once he was stabilised we operated the same day, amputating the remains of his left hand at the wrist, and cleaning up his badly injured right hand plus all the other shrapnel wounds and flash burns to his chest arms and legs. He was cared for by his friends who had to feed and wash him every day. I was amazed that how cheerful the young victim was as I visited him. He was it seems simply glad to have survived and to be receiving treatment. What more he was going to get a functional right hand. After 2 more trips to the operating theatre and finally skin grafts to his thumb and fingers he was able to hold a spoon and feed himself. He left the hospital exactly one month later returning to his home town in the east of Chad.

A young man who doesn’t smile for photos

These five families and many more like them will never have the possibility of forgetting the danger of landmines.

1. World War I underground: unearthing the hidden tunnel war. Peter Jackson. BBC News . Magazine 10 June 2011
2. Evans, Roly (2017) “World War II Coastal Minefields in the United Kingdom” Journal of Conventional Weapons Destruction Vol 21 Iss 1 Article 9
3. Anti tank bomb explodes at Gibraltar point- Skegness Standard .Facebook Jan 14 2015
4. w.w.w.maginternational.org/what-we-do/where-we-work/chad/
5. Landmine Monitor www.the-monitor.org

It's raining again...

Half way through our trip... only two more days to go!

It’s raining again – we happily sang along to the words of Supertramp at a concert 3 days after arriving in the UK for a British summer. As weather forecasts it was a bit wide of the mark, the driest summer in England since we were 15 years old, scarcely a drop of rain. What’s more it was pleasantly warm, with temperatures in the low 30’s.

It was only two months later as we flew into Chad that we encountered rain. It was not unexpected in Ndjamena as it is wet season in the Sahel, the life-giving annual rains that enable the millet to grow. As we flew in we saw that the usually flat brown landscape was green with large areas of flooding. Soon we would be travelling North across the Sahara  to Bardai and we wondered if Ruth and Rebecca who were travelling with us, might even experience a rare shower in the desert, just enough to to wash the dust of the windscreen.  

Setting off from N'djamena

At 6 am 6 days later we set off in a loaded pickup with our 2 Teda guides to cross the desert. All went well until we reached the end of the tarmac road at Massakory 3 hours north of Ndjamena. The sky was black and when the storm came it was impossible to see so we stopped the truck.  As the rain abated the road ahead resembled a huge lake and it was clear we couldn’t go on. A rapid decision was made to turn round, retrace our steps on the tarmac road  for an hour and go a little further north east and find a longer but drier route to head onwards to the desert and Moussouro. We all agreed we didn’t want to risk getting stuck in the mud.

Not at Massakore

The rain pounded down and it seemed like we had made a good decision to have turned around. After a couple of hours it was again time to leave the tarmac, we were in the right village Angora, but  had no idea where the other road /track was. It was only after a few false turns and some helpful Chadians that we wound our way amongst the houses and eventually on to the track to Moussouro. This was Chad as we had never seen  it before, green and lush and abounding in animals, herds of goats ,cows, sheep and camels all around.

A green and pleasant land

Not leaving Moussouro

With the delay we had thought we might need to spend the night at Mossouro and we had telephoned ahead to some missionary friends who live there. In the end we made good time but all the same took them up on an offer of coffee and cake and then drove on.Yet again the road had vanished what was normally a straightforward track towards the desert was invisible under the pools and even lakes of water.  We were getting seriously lost when we encountered a friendly local ambulance driver who offered to show us the way, taking us back to Mossouro and then going out of his way to make sure we were on the right route. 

Setting off in the middle of the night

When we stopped for the night it was late and it seemed it might rain again so a meal of bread and tuna fish was in order and then we camped out under the -no not stars this time but flashes of sheet lightening as the rain threatened again. By 3 am it came again and a rapid dash was made for the car and we drove on. We were entering the desert in driving rain splashing through pools of water until one was one too many and we were stuck in a mixture of mud and sand.

Stuck!

Thankfully by then it was only raining lightly again as all our bags were unloaded and digging started . After 3 hours and a lot of hard work we were out. The rain had stopped so we drove on a little then had a break for a meal (tuna again this time with pasta) and a well earned rest. We were now in the sandy desert amongst the dunes but even here there were pools of water.

Picnic after being stuck

Stuck again!

 After lunch as we drove on we came across other vehicles stuck in the sand, and we too were stuck again briefly. The rest of the day went well, including a stop at a well and a ‘service station’  for a coca cola and this time the rain stayed away and we arrived in the dry desert near to Faya camping just outside.

A well - good chance to fill up water bottles

Service Station

A tasty meal of tuna and pasta was good before falling asleep this time under the stars and staying in bed until 6 am luxury indeed.

Outside Faya

No shade..

We drove through Faya and felt we were heading for the real desert experience this time. The sky was blue and cloudless, the sun beat down and the sand dunes on the horizon were floating in the mirage. When we stopped to eat (tuna and spaghetti) our Teda guides even made a shelter for us with a tarpaulin as there were only a few tiny trees around.

We were close to the Tibesti mountains now and as we skirted around them it was no longer a mirage but even real desert rain and the Wadis were full of water after the rain on the mountains. The first looked like a large ford and we crossed without a problem .The next caused us to wonder if we were going to make it that day ,a car and a lorry were completely  stuck with a narrow gap between. Helpfully someone called us forward and whoosh we were through just enough space to spare and we didn’t slip!!

Squeezing through

Wading the Wadi

However there was still more to go and to our right was a huge storm cloud over the mountains which we seemed to be racing. The Wadi ahead looked shallow but to be sure our driver tested the depth and we crossed without a problem only to be completely blacked out by a dust storm which had caught us up. We had to struggle to find the higher ground and not stay in the dangerous Wadi bottom. As the rain came it washed away the dust and we could see our way at last. 

On towards Zoar K where the sight of cars half buried in sand just outside town showed us what force the Wadi can have when full. The cars were wrecked, hopefully everyone got out alright. Here at last was a respite from tuna and pasta and we had fried chicken, bread and a cold coke for tea at a local market restaurant, a very welcome change and then a nights sleep on the edge of town thankfully without rain.

Chicken not chuna

Our last day was up in the mountains without a drop of rain but the plants growing on the side of the road showed that even here it had rained.

Water in the mountains

Wadi at Bardai

Later that afternoon we drove into Bardai along the path of the Wadi which had also been full a few days before. We were on time just as expected despite all the rain and adventures. Four days and three nights under the stars, quite an experience which make us appreciate even more the alternative which we often use, a MAF flight.The six hour flight in a small plane albeit rather bumpy over the mountains that was scheduled for the return of Ruth and Rebecca in a months time, suddenly seemed very attractive to them.

...and a much quicker trip back

A month later...

The next afternoon as we were settling in what a surprise, It was raining again- this time a light shower leaving drops on the sand and a confusion as to where exactly we were, the fertile land of England or the barren and dry Sahara.

Lessons from the market - Part 4

Lessons from the market -  part 4

‘Give us this day our daily bread’

Fresh bread baked in our solar cooker

Whether that be a quiet prayer to God, or the cry of a hungry revolutionary mob demanding social justice, bread is seen as essential for life, either as blessing or as a right. It is an everyday staple in many parts of the world, and comes in many different forms. Some types are better for you than others, white flour fortified with iron, wholemeal, multigrain, sour dough are all beneficial in one way or another, but none, as far as I am aware is usually considered a harmful part of our diet. (Gluten-free bread is hopefully still available to those in need it as treatment on the NHS).

When we lived in Ndjamena we could get fresh baguettes each morning from the local lock up store. This is rather surprising as there is little or no grain grown in the French speaking parts of sub-Saharan Africa that I have visited, but in all of them, as a hangover from colonial times, subsidised flour is used to bake a standard priced baguette that is widely available. It presumably helps with social justice and the maintenance of a peaceful society. (Can all this really date back to the famous quote from Marie Antoinette and the hunger riots prior to the French revolution? I like to think so, but it is probably a convenient fiction)

At our home in Bardai, a mountainous mid Saharan oasis, you rarely see a baguette, but you may remember from a previous post that there is delicious local flat bread that the Teda women make using an oven of a simple half oil drum buried in the rocky hillside.

Teda bread being baked

What is really surprising is that until 20 years ago the people here used to grow their own wheat using the underground water from the wadi to irrigate the crop. They now use cheap white flour imported from Libya and many women make not only enough for their family but supplement their income by supplying bread to the growing number of shops and restaurants that are springing up due to the gold rush.

Bread is a daily staple, but can I ask how many days a week do you eat meat?

Every day? Twice a week? Never?

Some of you will be vegetarian, as are mountain gorillas, others will be meat eaters as are chimpanzees. Both are our close evolutionary relatives so what are we supposed to be?

I understood from school that it natural for us to eat meat as we have canine teeth to seize our prey and incisors to cut it, but they seem to work quite well on an apple so I don’t think we can argue either way based on our dentition.

A platter of special Ramadan food

Having a regular source of fresh meat in Bardai is something new. We mentioned frozen chickens last time, no doubt there always were a few chickens scratting around in the sand but never enough to sell. Red meat was even rarer, until last month when Ramadan began there was no meat stall on the market; it may well close at the end of the month.

Traditionally meat would be eaten after sacrifices at religious festivals or special events such after a birth, a death or a wedding. Knowing all of this last November, in preparation of our time in the north, and being carnivores seeking a balanced diet, we dried 8 kg of minced beef in Ndjamena. It looks like coffee granules, and we have been adding it a couple of times a week to our stews. It is fine but we have especially enjoyed the times that we have been invited to a wedding and had roasted camel.

Hay arriving from Libya

It is difficult to keep large herds here for even weekly meat, but the recent arrival of large trucks with hay again from Libya, to feed a growing number of goats, sheep and camels, suggests that, brought about by market forces, a change may be afoot. The power of gold is creating an increasing number of shack like restaurants, and they need meat to sell and not only chicken. Maybe I am wrong and the hay is normal and it is just enough to fatten the one sheep needed for every family to sacrifice at the Festival of Tabaski. (The Muslim commemoration of Abraham’s sacrifice of a ram in the place of his son on Mount Moriah Jerusalem.)

The world is changing, as it has done before.  The megafauna (elephants, rhino’s, and giraffes) along with herds of cattle carved into the rocks of the Tibesti at the time of the green Sahara, 5-10 000 years ago, attest to that.

Ancient rock carvings

 According to the British Medical Journal, in a commentary, (BMJ 2017;357: j2190) another great change has happened in the industrialised world over the last few generations. Instead of the estimated 5-10 kg of meat a year in ancient Greece and traditional European agricultural societies, our supermarkets now supply us with 10 times that amount, to the tune of 110-120kg a year (U.S.A/ Australia). Cheap meat is produced in large factory farms, using grain to fatten up corralled beef cattle. These are on the increase in the UK and have recently been in the news due to justified questions about animal welfare. The article in the BMJ points to even greater dangers. In a world of limited resources, it apparently takes up to 110 000 litres of water to make a kg of meat and fresh water is getting scarcer not only in the Sahara. In addition, a staggering 97% of global soy meal production is used as cattle feed, even though soya also tastes good as human food. We have mixed it 50/50 with our dried meat and as a consequence we still have 2 kilos of dried mince left after 7 months. In a world where protein energy malnutrition is common can we in all conscience use the worlds soy protein supply on the inefficient transformation of vegetable into animal protein simply because we prefer the taste of meat?

All of this is not necessarily new to you, and some have disputed the figures. A Swiss bio-farmer, grazing beef cattle on the mountainside, says he uses no outside water to make his beef as it all falls on his land and they eat only grass and forage from the farm.  A Guardian Data blog gave a more conservative estimate that on average 15000 litres of water is needed to make a kilogram of beef, which still sounds a lot to me. That is compared to chicken which uses a mere 4000 litres per kg. Soon a cry of

 ‘Four legs bad, two legs good,

Four legs bad, two wings good’

will be heard through the land. (apologies to George Orwell)

However, the BMJ commentary accompanied a piece of original peer reviewed research ‘Meat consumption and risk of mortality’ (BMJ/ 2017;357: j1957). The bottom line is that eating a diet rich in red and processed meats increased death rates due to heart attacks, diabetes, liver and kidney disease and cancer. So, it is not only the altruistic who should change their habits but also those with an enlightened self-interest.

The chimpanzee which I mentioned earlier as a meat eater is really only an occasional meat eater, if he could talk, he would probably call himself a flexitarian. Flexitarianism, which I only Iearnt about last year, is a mainly vegetarian diet with some meat. It could be seen as the latest faddy diet, but it seems to me that it is not the case; it is how we are really supposed to eat. Perhaps you, we and the Teda could all do well to resist the market change bought on by supermarkets and post WWII agricultural policy, or the gold rush, and help the planet by eating 10-20 kg of meat a year. That would be a big increase for the average Teda and a big decrease for the average westerner. It is something that we have been forced to do by circumstances, but not only that it seems like the right choice. Why not be part of a revolution as we say ‘pray with the world ‘

                                        ‘Give us all this day our daily bread’.

If that’s not for you, then at least in a spirit of self-interest, stick to chicken. It carries a lower personal risk than red meat and, as you know, it is the latest fashion in Bardai.

Lessons from the market – part 3

The entrance to one of the restaurants on the main street, Bardai

Chicken is popular the world over and it makes a welcome addition to our diet at Bardai. It is not surprising to find them as, in Africa, a few chickens around the home are good as they eat scraps, lay the odd egg, and are ideal as gifts. The meat takes a bit of time to get used to, there is less of it   and it can be a bit tough, with prolonged boiling or pressure cooking needed to soften it up.

But the deep-fried chicken in Bardai is a bit of a surprise, all the chickens weigh about 1.2 kg in weight and are nice and plump.  It comes frozen from Brazil (yes really, I have seen the packaging). The chicken presumably is shipped across the Atlantic and into the Mediterranean, arriving at a port in Libya, Tripoli or Benghazi. It is then delivered by a refrigerated truck to a depot in Murzuk, a Teda town in southern Libya.  The last 600 km of the journey are the most interesting, a dash across the desert and through the mountains in a large domestic freezer strapped to the back of a Toyota pick-up truck. It takes about 14 hours and so they often set off at dusk and travel by night to avoid the heat of the day.

The chicken split down the breast bone is cooked in a large vat of oil heated on a wood fire, up to 10 at a time.  This is great from a food hygiene point of view as it is much easier to cook it through this way. It is then served with bread, salt, and some tomatoes and onions on a metal plate. It is not cheap costing 5000 CFA (£6.50) for a whole chicken but It is popular with the gold diggers who are in town for a break from their hard life on the gold fields and a monotonous diet of macaroni with tomato paste and tinned tuna. There are now four chicken restaurants in town and it is the presence of these mainly young men   that has made such business’ profitable. Men and women have very separate social lives in Bardai and the restaurants are very much a male preserve, and so sometimes I go and buy a take away on Sunday after church.  

Last month I had to go to a different restaurant as the one I had been to before had no chicken (They were serving omelettes but I can make those at home). They helpfully pointed out their competitor down the street. At the new restaurant, they were very friendly and even allowed me to take a few photos of the kitchen to go with this blog, I think I may well go back there, especially as they actually do have some chicken.

The supply chain is all important and if it fails the business is in trouble and customers are not satisfied as Kentucky Fried Chicken found out in the UK last month. At one time they had 420 of their 750 franchises shut due a lack of chicken.  Colonel Saunders had decided to cut costs and presumably increase profits by changing the company that distributed their frozen products to the fast food outlets. The supply chain completely failed making very unflattering headlines. Some people clearly thought it was a disaster prompting Tower Hamlets police to Tweet

Please do not contact us about the

 #KFCCrisis - it is not a police matter if your

 favourite eatery is not serving the menu

 that you desire

 Tower Hamlets MPS(@ MPSTowerHams)

 February 20, 2018.

It is however much more serious when a hospital runs out of essential medicines. You can imagine what happens when there is no insulin in Bardai as happened last December.  We are a long way from Ndjamena and the Central Pharmacy (CPA}, communication is not easy and, even there, stock levels there are sadly at an all-time low. At Guinebor we used to supplement the CPA supplies with purchases at private depots and pharmacies. The latter, situated opposite the Central hospital and medical school are well stocked albeit with rather expensive medicines and make lots of money as often the medicines prescribed in the hospitals are not available in the hospital pharmacy. In Bardai, we have less choice, there are just some common remedies for sale on the local market, many of dubious provenance.

Claire Bedford BMS pharmacist at Guinebor II has helped us out with an emergency stock of insulin and other essential drugs, including those to stop severe bleeding after childbirth to prevent a repeat of the earlier tragedy. She also supplied us with one 6-month treatment course for TB tablets for a newly diagnosed patient. The small package of medicines arrived in early January on a MAF flight and has been useful.

 Dr Abdul Kerim has just returned from his annual leave in Ndjamena and has managed to come with a year’s supply of TB and HIV drugs so we are making some progress. But as the hospital gets busier and attracts sicker patients the supply chain will have to improve. Small amounts of medicines from the Northern Regional depot in Faya and from Ndjamena will not be enough. We need a proper system of stock control, ordering and delivery.

There is already a supply chain for vaccines which is independent of the hospital structures. It’s a bit like the chickens, a dash up from Ndjamena with special cool boxes to maintain the supplies in good condition. The rest of the space in the vehicle could be used to send up drugs, it just requires some coordination, and organisation of the finances. Other avenues still need to be explored. Meanwhile Claire has made a brief visit to Bardai, using a spare place on the plane. She met our local pharmacist, it may be a fruitful relationship as they share experiences and contacts. Hopefully she will be able to help us out from time to time.

My brother Nick summed up the problem yesterday in a WhatsApp message

‘a chicken restaurant without chicken is not a chicken restaurant’

It may be obvious, like the emperor’s new clothes, but it needed saying and sorting out before it became an embarrassing problem.

And more importantly:

What of a hospital without drugs?

                                                    -----------------------------------------------

PS: One of the most spectacular improvements that has happened in my lifetime is the near eradication of polio from the African continent. I remember seeing acute polio a couple of times in Guinea in the early 1990’s and saw many more young children who came with paralysed legs requiring operations for contractures. The annual mass vaccination programs where all children under 5 years of age get doses of oral vaccine over a 3-day period in every, town and village each year have had a major impact in halting this disease.

It is a major distribution challenge, getting vaccines to places like Bardai and then having trained health workers, many local assistants, going from door to door. Most African countries including Chad have not had any confirmed cases in recent years. I think the last cases in Chad were due to refugee movements from war torn Northern Nigeria in 2014.  Vigilance is still required especially as most babies still do not access their routine childhood vaccinations and so the immunity of the population relies on these special campaigns.

A week after the rest of the country the campaign started in the Tibesti mountains, the vaccines had arrived late and also Dr Abdel Kerim had not been here to organise it.  Due to the dispersed population and lack of staff it took a week rather than the allotted 3 days. There was a modest ceremony at the hospital to start the campaign with the governor of the region giving a speech and vaccinating the first child and giving a dose of de-worming medicine. Various other dignitaries were called forward to give a dose of vaccine to a line of children many in their mother’s arms. Last of all I was called forward, and I didn’t immediately recognise the young child that had been set aside specially, it was Bardai Eli, the young baby with facial burns from last November. Even with the de-worming medicine smeared on his lips he does look amazingly better.