Saturday 24 March 2018

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?
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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.