' In the name of love'

A couple of  years ago the hospital received a gift from the Ministry of Health, an ambulance. As you can see it is suitable for the road but finds mud and water  bit difficult so it has to be laid up for about three months each year. It is the dry season now and so it is back in use and it is getting quite a bit of use taking patients to the hospital in the city for X-rays (as our equipment is broken) non obstetric ultrasounds ( as our doctor is out of the country) and patients in need of emergency surgery on the weekends like this one (1:2) when Andrea and I are not at work.  Dogo, the hospital driver takes our children , Ruth and Rebecca, to and from school and sometimes combining tasks they too get a ride in the ambulance. They are not too keen, travelling sideways in the back can be nauseating and hot.

When it arrived it already had our name painted on the side, Hopital Americano, Amsinene.  I know Noel the CEF Chief executive does come from Seattle, the home of Starbucks, but do we really need to sound like a cup of coffee? Amsinene is the next village, 3 km to the south where there is a big Chadian Amy Base, which we used to use as point of reference if people haven't heard of Guinebor, now after 3 years our area is much more developed. We repainted it with our name and logo, after all branding is important.

We have branded the hospital in many ways, all the paperwork for patients notes and  prescriptions carry the logo, as do the guards uniforms and the cars. It all builds recognition and makes us look serious. It even gets imitated by people around us, Quartier CEF as I have heard it referred to refers to the shops outside our front door, look carefully and you can see our logo at the shop and the hairdressers.

 All this  copying our CEF logo  is quite funny even flattering, should we protect our name?

         Ask for a share of the profits? Perhaps not. More seriously what is the real brand that we are here for? We hope that one day we will be recognised as disciples or imitators of Jesus, and people will choose to  copy that.

 

AK 47 Icon of fashion : London-Moscow-Ndjamena

International women's day :  AK 47 carrying women gendarmes

London August 2013 ; Fashion :  David Bowie was making  a comeback ,  with a retrospective exhibition of his clothing and posters at the Victoria and Albert Museum ,the release  of a critically acclaimed  new album,  and perhaps a world tour? Well no, not aged 66. The iconoclast, who stood up and  sang 'We can be heroes just for one day'  has simply kept reinventing himself and now  risks becoming a national treasure. Did the change come  when  he took  on the  job of introducing  Raymond Briggs  'The Snowman.' ?

Yesterday we travelled 500  km to Koutou just outside Mondou in Southern Chad for a five day stay during  half term .It's our first visit to 'Tchad Utile 'as the French liked to call it, and we can begin to see why. As we sit on our guest house veranda look at the green surroundings , the abundance of guavas lemons and grapefruit on the trees and the bird song  is overwhelming.  Competing with the birds is 'Heroes', a digitally remastered  MP3 download on my lap top. When it first came out (in 1977) it was as a 7''single spinning at  45 rpm giving a  mono- aural sound. My first copy  was on a cassette, either copied from the radio or a friend.  Now 40 years later my two recent MP3  purchases from Amazon are  in English and slightly stilted French ( On peut être héros pour jusqu'une  journée) . Technology changes  good music remains.

Music on the move is a great thing which we now take for granted. It really all began with the Sony Walkman.  That  icon of 1980's design went out of production last year, obsolete. Now if you want one you will have to bid against the likes of V&A who are no doubt planning  to do an exhibition about them. Even cassettes  are hard to find these days.
 

I wish it was the same for the AK 47 assault rifle. Like David Bowie it also had an exhibition in London, on  the South Bank, just beside Tate Modern.  Decommissioned Kalashnikovs were painted with flowers, gold plated, painted with stripes so as to blend in with the background etc. Designed in the mid 1940's just after the atom bomb,  it is small in comparison but  it has proved far more deadly than Oppenheimers creation. A  magazine of 30 rounds  can be fired at 40 to 100  per minute, accurate at 400m.  Imagine if each of the 100 million AK47 manufactured has killed just one person.  Ashes to ashes.

 

In Chad it would seem that they are the ultimate fashion accessory. Soldiers on guard outside the palace and ministries carry them as do the gendarmes and the police . I must have seen 30 or more as I drove through Ndjamena yesterday morning.  They are ubiquitous even appearing on peaceful parades like International Women's Day.  Manufactured in Moscow, worn legitimately in Ndjamena , fired in the air to celebrate weddings and national holidays, the AK 47  is now  on display in London. Sixty  years after it was first made it is still by far the commonest weapon on the planet , carried by armies, gangs and poachers everywhere in Africa. There is never any  difficulty getting hold of the 7.62 mm ammunition. It is robust, cheap, easy to use and  simple to maintain.  An icon of Soviet utilitarian design,  long after  the union itself  has ceased to exist

In the London exhibition there was one unmounted rifle with a sign inviting you to pick it up. I hesitated, discussed it with Andrea Ruth and Rebecca, and decided 'Yes'. I was amazed how light it  was in my hands , 3.9 kg ( without ammunition),  it didn't seem right put it on my shoulder and squint down the barrel so I quickly put it down. It would be frighteningly  easy to carry and use even for the girls, they declined to try.
I have seen too many people dead and injured by this icon of the 20th century. The year of the millennium I lost a Guinean friend and colleague plus all his family to its deadly efficiency. The world would be a better place if it could go the way of the Sony Walkman, let us all work and pray for that day.

PS:  The exhibition 'History Interrupted' by Carl MCcrow was at the OXO Tower. You can read more about it and his campaign on his website.

 

 

 

Delirious @ Cutting Edge, Furious? Curious?

It was 2004  when we first made contact with Bert Oubre about working in Chad. The hospital was still on the drawing board, and the land an undeveloped area of scrub and dry mudflat on the edge of the city,  so we declined the offer of a job, preferring to continue in the NHS. Five years later, 2009, ,we could only remember that it was in Ndjamena , Chad and that it was called Cutting Edge. That  name had stuck as we  had four albums of Cutting Edge music, the name  first used by the band that became Delirious whilst writing such songs as 'Did you feel the mountains tremble' and 'I can sing of your love forever' (c. Martin Smith Curious? Music 1994). A quick google search for 'Cutting Edge Chad' and contact was made, and now we are here 'over the mountains and the seas'  'dancers who dance  on  injustice' of health inequality and hopefully sing of Gods love to  the people of Chad.  

So much for Christians like me singing and dancing there are some things in life that should make us angry (Furious?) and motivate us to do something, and one of those is seeing children die. It is malaria season and there is the usual annual explosion of cases. Malaria is a disease of poverty, it and was eliminated as a public health problem in the Southern States of the US  and southern Europe during the 20th Century, by spending money on water management and mosquito elimination. Meanwhile in the 21st century each year when the rains come Chad experiences a further  epidemic of Malaria. It has even made the BBC news with MSF reporting on the number of cases in Eastern Chad. Here is our own graph, although lacking some data the trend is clear and follows the arrival of the heavy rains which leave pools of water for mosquito breeding.

 

 

We, the privileged, live in our mosquito screened houses, sleep under an insecticide  impregnated mosquito net, take prophylactic anti malarials and have rapid access to diagnosis and treatment. Since we have been in Chad none of our family has caught malaria. We are fortunate, but most of the population are not so blessed. Last month was I hope  the peak and we treated 685 cases of which 69 (10%) were admitted to hospital and 6 (1%) died. There were according to official figures 8743 cases of Malaria in Ndjamena North treated in official centres in the last 3 months.

Which brings us to the title of the blog, delerious@cutting edge. We receive children each day who have been running a fever and been off colour for a day or two and who have suddenly got much worse, being at best delirious or worse having fitted and become  profoundly unconscious. Many astonish us and recover and we give thanks for that: others don't such as the one year old girl I was called to on Wednesday morning. She came in 24 hours earlier and despite antimalarials, antibiotics, sugar and saline drips, and anticonvulsants she never regained consciousness and slowly ebbed away. Heartbreaking for her mother to lose her only child. Each tragic death could be  prevented by the simple precautions above  that we take for granted.

 

The graph is mainly the work of Moussa, one of our nurses, who each week checks the registers and files an infectious disease  report for the District Medical Officer. Probably due to this effort we have received 3000 mosquito nets from the Health Ministry and UNICEF. So now every pregnant woman, every case of malaria and every hospital inpatient is given a new net to take home and hopefully avoid the next case of malaria. Statistics are not always boring, they can help save lives. I must tell Ruth that next time I am helping her with her Maths homework.

Yom al Sabit (the seventh day)

Its Sunday morning 8 am and I am lying in bed relaxing, It's difficult to doze as although the sky is blue there is a persistent roar of not too distant thunder. Military jets are exercising, probably French as they are the noisiest, circling  over the city. You would think they would take one day off each week and why not the Sabbath?

In fact  Yom al Sabit ( Chadian Arabic ) was yesterday, its timing in the week, and the words themselves make clear  the Semitic roots  of the language. Sabit is so close to Sabbath  and when you hear Yom Kippur ( the Day of Atonement)  do you think of warplanes , always butting in as above or goats? Google it and see what you get.

So if today Sunday is not my Sabbath rest, (I am on call and have to  do a ward round), what did I do with the actual Sabbath yesterday? 

At 7:30 Andrea woke me to let me know that she couldn't contact the anaesthetist, his telephone was clearly resting and not available.  The wife of one of our guards needed a caesarean  and I stood in to put her to sleep. The  4 kg baby boy was delivered and by 10 o'clock  I was back at the house having a quick breakfast and coffee before getting on with the day's work.

On the mens  ward there was only one man with heart failure ready to go home, he left and was replaced by  semi conscious  man with malaria from the Emergency Room. Another man who had a definitive  amputation of his hand a week ago came in for a dressing ( he was trying to prise open an old hand grenade with a knife, don't ask why, he initially claimed it was an exploding cigarette lighter). There were  five  empty beds, the sixth bed had been put on the children's  ward.

There were  three women on their  ward, one with heart failure due to rapid atrial fibrillation , a second with liver disease (cirrhosis and bleeding  varices) needing a blood transfusion, and the last after a mastectomy for breast cancer.  There  should  have  four empty beds ,  but there was  only one. Another  had been taken into the children's ward,  and once that room really was  full  the children's ward  overflowed  into the women with the presence of a   new child with malnutrition and one who was getting better quickly from her severe malaria.

 This  month children's health is at more serious risk than ever,  and this year we are prepared for it. Last year's autumn harvest is a long time ago and the next one is keenly awaited, the rains fall a source of  benediction. in the meantime food is short and malnutrition common in the under 5's. But the same rain makes the puddles  and the   mosquitoes flourish in the puddles stagnant water becomes  a curse. 

There were five more severely malnourished children on the children's ward, some wasted and stick like, others bloated with retained water and peeling skin. All are on the  intensive feeding program, and if the families can spare the time they can be cured.   An older girl who had been profoundly unconscious for 5 days with cerebral malaria had  amazingly opened her eyes and said a word to her mother. Another 7 year old clearly had tetanus, all his muscles have gone stiff,  it wasn't obvious the day before. So he was  immediately transferred to a single room for ant tetanus serum, antibiotics and sedatives. Finally there were two surgical cases from earlier in the week a girl with a perforated gall bladder and peritonitis  which I presume occurred during the convalescent phase of typhoid, she was doing well:  and the other another with a bowel obstruction due to an internal hernia through the small bowel mesentery.

It's an  unusual and interesting mix of cases for one  doctor and it is great to see so many getting better.

By 2:30 I was home for lunch and I got a bit of rest between calls to the Emergency room and checks on the sickest patients. . The evening was calm and we sat down as a family to watch the current favourite ,Call the Midwife, on the computer. I am not sure if it  counts as  recreation or continuing medical education after all the day had  that started with 'Call the Anaesthetist'.  So the Sabbath was a quieter  day with no non essential work  but not exactly a day of rest.  It was our  6th consecutive   days of 24 hour on call,  only six more to go until next Saturday which really will be a day of rest , Yom al Sabit.

PS  A little time for Arabic, I think I'll learn the days of the week

 

Casual Conversations

 

Earlier this year coming back from town through the streets of Guinebor  some women waved asking for a lift. They were carrying their shopping home and were happy to be helped the last mile or two home. The conversation was very limited

Me :    Assalaam alekum                            (peace be with you/hello)
Women:   Alekumm assalaam                  (peace be with you/hello)

Me: Tamci wen                                              (where are you going)
Women:   Namcu fi luptaan americanno  ( we are going to the american hospital)
Me: Arcaabu                                                   ( Get in)

Not much more to say really, about the limit of my Arabic, but they then decided to try their English on me

Women:   you american, you speak English
Me: I am English/ British

Women:   Grande Bretagne! Tony Blair, King Elizabeth

Lots of laughter and smiles,

And with that we arrived in GuineborII , and they got out

Women:  Chukran katir                                     (thanks a lot)
Me :   Afwan                       (thats OK)

 I never did find out what they thought of Britain, Tony Blair or King Elizabeth, but they seemed happy enough, at least they weren't scowling. As for the monarchy I  amazed that they knew it existed.  They are probably still laughing about the white man who stopped and asked a 3 women, where are you (singular) going as If I only wanted to take the first one. ( Tamci should have been tamcu). Or perhaps they haven't even thought of it at all.

A trivial encounter, but a point of contact all the same, Jesus knew how to take such a cross cultural situation , (asking for water at a well), and speak of something profound, the essence of life.

Can it be done  here without causing offence? Would it be understood?  We would need the language  first.

We are back in Chad after a visit to the UK for a holiday and a retreat. , Ruth and Rebecca are enrolled in a Chadian Arabic course 4 hours each morning for 5 weeks, the rest of their summer holiday,  We are trying  to  speak some Arabic each evening and are managing to do so as the hospital is very quiet due to the fasting month of Ramadan and the annual rains.

 Last week when I asked if there was anything to share at the morning staff meeting, Moussa a Muslim nurse congratulated me on the arrival of a new Prince In England. Thanks very much I replied, it was good to be informed  but I hadn't been looking for the news, because unlike the crowds outside the palace in London   I am more interested in royal babies that are born in a stable.

I wonder what Moussa made of that, and you?

 

Time for a break

Did you buy a snack today I guess if you did it might have been a bag of crisps or a chocolate bar or seeing as its Easter even a crème egg .We just ate a Cadburys Egg and Spoon rather melted  but still tasty .May be you are on a diet  or just being healthy or avoiding chocolate for Lent. If so then Chad could be the place for you snacks in Chad are definitely not chocolaty and not crisps either Pringles cost more than anyone can afford.

 A few weeks ago it was International Women's Day and we were marching again in front of the presidents palace , as it was school holidays Ruth and Rebecca joined us too .This time we had been well organised so we thought, with groups meeting to plan the food and the buying of material only to then  be rather upset by the fact that after the nurses spent 2 days waiting none of the especially printed  material was left.

A quick trip to town revealed that some had been sold on to the market and for a mere 2 and a half times the price it was available .The preferred option was to all buy the same material with another design and wear that instead and we were not alone when we arrived at the march in having to do that .Did they not make enough? Did it get bought by wholesalers? We will never know. Our house help who also sews as well cheerfully stayed up half the night to sew the material as we only got it at the last minute and all was finally well.

Any way back to snacks what was available to sustain us as we cooked in the sun and drank gallons of water, here are a few pictures bananas from Cameroon relatively expensive, bread and cakes Locally made hibiscus juice to drink and carrots which are in season and eaten raw (four for the price of a banana), at other times of year it is bitter yellow aubergines in wheelbarrow loads!

Then it was on to the march and back to Alice's (one of our nurses houses) for  chicken and bread deliciously cooked and enjoyed by all including the babies. Washed down of course with the obligatory coca cola.

We were down near the bridge to eat so made a quick successful trip to look for hippos here they are trying to keep cool lucky them.

Then back to the hospital where we found more snacks for sale in the shop, crunchy crickets  apparently they may be in fashion soon as they are full of protein so watch out in your local corner shop.

 

 

 

All fingers and thumbs (counting down to Christmas)

( mid November to December) This is no doubt going to be a boring blog, few pictures just graphs, and the subject matter will  move between statistics and  pure maths, (or math for our  American readers). Words, incidentally, are not the only things that change between cultures, how you count with your fingers and thumbs also does. How do you do it? (Guardian Weekly 6/7/12) Starting with the fist closed or open? Little finger first or thumb? Most Western Europeans usually use closed fist and thumb as starting points. A local builder started palm open and counted from his little finger .  Mostly my Chadian colleagues prefer to use the calculators in their mobile phones, so perhaps the world is changing and these little cultural  differences will disappear.

 The title, all fingers and thumbs, is a bit strange  for a letter written by a couple of doctors who spend much of their lives doing surgery. Andreas dexterity was much in evidence as I assisted her at one o clock one morning as she rapidly did a caesarean section, her 3rd in 3 days after a fifteen day period when none were required. No fingers and thumbs but plenty of counting needed, checking the swabs before closing the operation and again the baby who  was the 56th so far in November. I risk being accused  of repeating myself, but here is an update of a graph from our September blog, the green line is a computer generated estimate for the future. In reality it looks like an underestimate with over 3 babies born each day so far, we may even reach a hundred.  We can be thankful for all the women and babies helped but it makes the unit very crowded busy place.

I don't know how my computer generated the rapidly rising  trend line. I have however recently learned that  Descartes, famous for 'I think therefore I am' was also the inventor of  analytical geometry, which uses algebra to describe geometry in graphs. Ruth and I have been getting to grips with this as she works through her homework. Maths is fine, and many Dads must try to recall their teen age education to help out.  But Maths from another angle and in a foreign language can be a bit challenging. I am usually alright and able to help  once I have understood the question. Running the hospital can be like that too.

What are we supposed to be doing? This question  has to be asked before we can decide whether we are doing it well. Planning is important and therefore 'I think therefore I am' may be practically useful as well as being a  profound piece of philosophy. We have been planning, budgets especially for the pharmacy, malnutrition programs, an X-ray dept ,a possible safe motherhood project and the recurrent problem of how to keep the hospital clean, with only one relative sleeping with each patient overnight.

 Plenty of planning  but surely what we do is more important in the real world, 'I do therefore I am' is an apt paradigm for modern  mission where we want to measure outcomes. We are seeing record numbers of patients, and having record receipts(but still remain financially dependent on outside aid for 20% of expenditure)  But despite this good news as the letters hit the page an alarm is ringing we follow a God whose name is ' I am what I am' not ' I am what I do'.

Back to the counting, we are in Advent waiting to celebrate the beginning of His greatest expression of this,  Jesus ,God with us. A highlight in our count down to the festivities will be a hospital nativity play and songs followed by the Jesus film on the 20th December. Pastor Djibrine is organising it we hope it will go well and that more people will come to understand the true importance of the baby in the manger. Jesus didn't set out to  change the world by building institutions , but he came as the servant of all, taking the way of love.(I Corinthians 13)  This should surely  be our ultimate plan and outcome measure, to become loving servants like Him. I sometimes feel that I am only just beginning.

Mark and Andrea

PS: Since the first part of this blog was written November has ended, we counted exactly 100 women in childbirth, so much for predictive graphs! There were 103 babies born, the first one pictured below is the first for Charlot and Sarah both of whom work as nurses here at GII,  there was one set of triplets, also pictured  and the hundredth mother had premature twins.  They sadly died shortly after birth which made for muted celebrations of the milestone. Individuals mean so much more than statistics both in their joy and their sadness.