Happy Mother’s Day!

Last night was the celebration for baby touristic at one of the smart hotels in town .The plan was to meet two of the midwives wearing our best clothes and join in the celebration for the first babies born this year at various hospitals around the city. This year we managed to have one born in the slot between midnight and five am and they were going to receive along with many others gifts and money funded in part by the tourism office and with the aim of encouraging safer delivery.

Unfortunately it was not to be for me and I ended up getting involved in the practical part of safer delivery instead. As deliveries do nothing but increase here since we opened the new maternity I had failed to appreciate that I might not be able to leave the hospital and go to the party. The night was extremely busy with 2 caesareans and 2 miscarriages and a normal delivery and a difficult delivery of a baby already dead when the 17 year old young girl arrived. Every time I thought I could leave something else occurred.

It was a happy day for 2 ladies but although not happy at least a safe end to the complications the others suffered. We were struck by the privilege we have here as more women come and we are able to help them .One of the ladies with a miscarriage initially refused a curettage as she had heard they were not a good idea. When we explained that it was also not a good idea to bleed excessively she agreed and was surprised to find how easy it was- hopefully she will tell others now.

It contrasts greatly to the situation we found in Goz Beida in the East of the country  near the border with Sudan.  We visited recently to see if God is calling us to work there, in a small border town with a Darfur refuge camp next door. Amongst the deliveries of which there were about a third as many as we have here 25 % were by Caesarean and the same number were stillbirths although the percentage of caesareans is normal for England here it represents women coming in in labour late on with complications and the high maternal death rate of   3% showed this.

 

Many women live far from the hospitals and the  180 km journey from Abeche on the main road took 6 hours6 hours and had to be done in a four by four vehicle because of the sand and is impassable for 2 months of the year due to flooded wadis.  We were welcomed by the hospital staff and it is clear there is a great need so we are wondering whether God is calling us there. 

                         

 

In the meantime after getting to bed at 5 am I was woken by a cup of tea and a paper daffodil from Rebecca (no flower shops here) and am glad to say all patient are doing well and today is calmer so far. I hope to find out tomorrow how the celebrations went and as for Goz Beida we continue to seek Gods guidance for the future.

 

 

Félicitations et Encouragement

 

So it’s a New Year, and  the  first thing to do as a doctor in the UK  is drink a cup of  tea in bed, leaf through the BMJ and  the Times and check that your obituary has not been published. Provided that’s OK, it’s time to get out of bed and start the New Year with one or two resolutions.  You might, if you are particularly eminent, check that you haven’t been named in the New Year’s Honours list, but I guess you get asked about that in advance.

In Chad it is more or less the same, except that the BMJ arrives about a month late and the Guardian Weekly doesn’t post obituaries, and the honours list?

 Last Thursday morning at 9:15 am  I was doing some admin in the office when Mbai gave me a letter that had arrived the day before, it was from the mayor’s office inviting me to a ceremony to mark the New Year, seating of guests was between 8 and 9:30 with the ceremony scheduled to begin at 10 am. Should I go? It wasn’t very convenient, was it just a circular and I didn’t need to be there?  I had a ward round to do followed by a busy clinic which I was hoping to finish early so that the staff could take part in the annual hospital union elections. I rapidly decided that I should go, we are here to be part of things and get involved in Chadian life and that is what is needed so be it. 

After a quick dash to the pharmacy and wards to explain my absence I was back in the office when Mbai said, the mayors secretary had just rung, ‘are you coming, the mayor  has something to give you.’ Great I’d made the right decision.  Straight into the car and a 10 minute drive along the dusty tracks until I arrived at Farcha and the Commune of the Premiere Arrondissement at 2 minutes past 10. It looked busy,lots of people, lots of police and other official 4X4 vehicles. After a quick emptying of pockets and once over with a metal detector I was shown through to the yard beside the offices to where couple of hundred invited guests were waiting for the Mayor to arrive They were seated on plastic garden chairs under a brightly coloured temporary cloth covered shelter  listening to arab style music from  a large PA system. I was ushered to a place of honour, with various police officers, gendarmes etc. We were sat  in rows,facing the main crowd, behind an enormous vacant sofa where the mayor would be seated. About 10 minutes later the mayor arrived and in front of the assembled TV cameras and press  the ceremony began. After a short introduction by the General Secretary it was the turn of the Mayor to speak. He thanked everyone for finding the time to come to his modest ceremony and wished everyone a peaceful, prosperous and healthy New Year. Then he outlined the improvements to the Premiere Arrondissement over the past year, new roads,  improved electricity supply etc. and then the difficulties due to reduced budgets with the falling price of oil, and the  new problem  of combatting terrorism and the need for all citizens to be united in their efforts to be united against it. He then announced that the ceremony would continue with the presentation of certificates to thank and encourage people who have made a particular contribution to the arrondissement in the past year.

First a number of police chiefs and gendarmes were honoured, as it was noted without them where would we be in these troubled times. Then the Mayors body guard, and other members of his staff, local  chiefs, school teachers, religious leaders and members of the local business community including David, a Chadian who with his Swedish wife Sarah  owns the farm where Ruth and Rebecca used to go horse riding. They have an expanding cheese making business. And finally as it was said, ‘’la santé avant tout’’, Dr Soloukna, the District Medical Officer and Dr Mark, the medical director of L’hôpital de Guinebor II.

As is normal there followed a ‘petit cocktail’, and an announcement was made to say who was to go to which area to eat.  I didn’t quite know where I was to go, but the secretary general picked me out in the crowd and took me in the mayor’s office a large room with all the chiefs, minus its usual sofas and in their place on a large table were two whole roast stuffed goats. Each person cut off their own portion, absolutely delicious as was the cous-cous and vegetable stuffing. The Chief from Alllaye was sat next to me and put what I took to be a delicacy on my plate. Rounded at one end and concave at the other, yellowy brown, I couldn’t tell what organ it was ,an eyeball a testicle?  It felt rubbery and I bit in to it with a certain trepidation only to find out that it was simply an egg white changed in colour by the stuffing!

On the way out there was lots of handshaking and congratulations, a few photos (sorry I didn’t take a camera)  and then it was back to the hospital to see some patients. I reflected in the car on the way back that although I am not a big fan of honours in the name of an anachronistic colonial institution but there does seem to me to be a place for civic recognition of the work of organisations and individuals for the good of society.

The next morning I showed the certificate to the staff and thanked them all, cleaners, doctors, grounds staff, guards, laboratory technicians, midwives nurses and pharmacy staff from the part of the Mayor for all their hard work in serving the hospital and the local community. It is after all the hospital team ,composed of many parts that functions together that represents the body of Jesus that should be thanked and encouraged.

 

So this is Christmas

And what have you done ……... It is a busy and a special time, waiting for the dawning of the light, the turning of the year. So what does it mean to people in Chad?

Lycee Montaigne, Rebecca’s school being secular completely ignores it and just carries on with normal lessons. This year Rebecca’s didn’t have any tests but the year below had a 2 hour Maths test, making counting down to Christmas take on a new meaning (Baah hoomboog –Sharl Deekens,  si je ne me trompe pas).

The Christmas lights around the city, the tree in the place des nations, occasional young men in shirts and Santa hats hawking inflatable reindeer and minions, add a western consumerist touch

This year is a busy time for the security services. As we drove Ruth to the airport at midnight on Tuesday for her flight back to the UK, we were stopped 4 times. A hospital car and the fact that we have been on the radio and TV recently means we are easily recognised and the last policeman even wished us ''Joyeux Noel Docteur''. Normally our church along with many others has an all night vigil, but this is not recommended this year given the security situation, so there is a service from 4-8 pm tonight, Christmas Eve and a service between 6-8am tomorrow morning. We all pray for peace at Christmas each morning.

This year I have been making sure, along with Alan and Ndilmbaye, that the staff get paid on time. Some still get paid in cash whilst others have been waiting anxiously for the bank to process the payments, placed rather late on Friday 18^th and eventually in the accounts for Tuesday 22^nd evening. Yesterday, the 23rd , was a bank holiday for Maalud, the birthday of the Prophet Mohammed; all the bank ATM machines ran out of money causing quite some anxiety.

So what do people spend their money on? Most people get new clothes which means that Jonas and Honore (lab technicians) Raha (midwife) and Helen (sterilisation dept) are busy as they are all part time tailors.  Working in the evenings must be difficult, its dark at 6pm and most people don’t have electric lights. Just as well that the sewing machines are pedal power. Holidays are also celebrated with special meals at home and at church. Ruth, Dr Isaacs daughter, who will be coming to Christmas dinner commented that our tortoise has grown a lot (about 10kg now) and wondered when we are going to eat him. We are sticking with tradition and having roast chicken.

For Rebecca our cook it is an especially busy time. Cooking for the hospital Christmas celebration on Tuesday afternoon, only a couple of weeks after the fete to open the maternity with food once again for 200 people. Its  more or less the same menu as before which makes the timing easier. Then its  more cooking for church . It’s all rather tiring and she is also  a seamstress and has recently started baking biscuits to sell to friends as well. At least she won’t be helping to feed the church at midnight this year.

And so amidst all the business of the season, I have to give the ‘mot de Directeur Medical’ for all our guests and colleagues assembled to hear the story of Christmas. Its the 5th time and  I guess that makes it a tradition. As usual it was translated into Arabic by Ndilmbaye. This year , sadly, will be his last time as he is leaving for a new job at the end of the month. Perhaps this time next year I will be able to speak in a local language and won't need a translator? The times they are a changin.

So what would you say to a gathering of local Muslims, and visiting Christians from elsewhere in the city. It is good that they continue to come, some have been every year so they must know the story by now, perhaps they even like it, I hope so.

‘’Village chiefs, faith leaders, invited guests, friends and colleagues, once again I have the pleasure of inviting you to our Hospital at Guinebor II. A couple of weeks ago we all gathered together for the opening of our new maternity unit. We thought of the thousands of mothers and babies that had been helped in our old facilities and gave thanks for the fact that even more can be helped in the new unit. In the final week before the move was made a baby was born that was given the name Emmanuel which means ‘God with us’. It is an ancient name that was first used over 2500 years ago, a special name to bring hope in a time of trouble. Today I want to look briefly at the first baby to be called Emmanuel in the Bible.

King Ahaz was certainly in trouble, he was besieged in his city of Jerusalem whilst all around his country was being ravaged by two kings and their armies who sought to overthrow him. He didn’t know what to do and was seeking an alliance with another stronger king so that he might receive relief. Isaiah the prophet came to him, with a message,-'' put your confidence in God not men or kings''. It was not a message that Ahaz wanted to hear, he wanted to be strong and active and when he expressed doubt that God would help, Isaiah offered a sign, a young woman would become pregnant and once her child was weaned the trouble would be past. The child was to be named Emmanuel ‘God with us’ a prophetic sign. It was a sign that King Ahaz chose to ignore, he  made his alliance and later everyone regreted it.  God organised the deliverance of the city and its people all the same.

What about us, how does this story have meaning today? We too live in troubled times, there is much insecurity in the world and even here in Ndjamena. There are financial problems as well and life is hard as the price of petrol falls and prices rise, and then each of us have our own particular difficulties at work in our families. What can we do? Do we behave like King Ahaz and seek to make compromises and alliances with others disregarding the both cost and what is right? Or do we rather decide to put our trust in God, as Isaiah recommended. A baby, appropriately for here, could be a reminder that God is with us even in all our difficulties and trials, a sign of hope. Can we see it?

We are here today because the ultimate sign of hope, in a magnified echo of this prophetic story, was born of a virgin at Bethlehem 2000 years ago, Jesus also called Emmanuel. God with us in a new way. We can learn more about him and his birth in the play that will follow, pay attention to him and his story, let us try not to be like the ancient king who didn’t want to see the sign that God had given.

Jesus, born at Bethlehem,  Emmanuel, God with us.

May God richly bless you, your families and Chad at this time and in the year to come with peace and joy.



The new maternity a sign of hope for the New Year




 

Here’s to the babies in a brand new world




The first baby born in the new unit on the 2nd December 2015

 

The Official opening of the

 

Guinebor II Maternity Centre

and the

 5^th anniversary of the hospital

 

                                                      9th December 2015 

                                                                Let the day begin  : The Call   

                                                                                   (Control right 4 music)

 

Here's to the ladies who prepared the food 

6:00 am Rebecca, Odette and their team arrive early, but there is plenty to do. They plan to cut, boil and then pan fry 35kg of meat purchased the evening before in a huge upon an open fire in the back garden. The potatoes, and prawn crackers will be cooked in our kitchen. The savoury donuts were made in advance. Will it all be ready in time? 10:30

Here’s to the team who made the plan

7:00 Pastor Djibrine has already organised the canopy and chairs for 200 people and has gone in search of blocks of ice (20X20X80cm) for the soft drinks ice buckets.

7:30 Helen and Andrea work with the midwives to make the maternity tidy and get one room ready for viewing with the CTG, oxygen concentrator, oximeter and BP machine.

08:00 Ndilmbaye arrives and confirms that the Minister will attend in person, in collaboration with their secretaries, he has written the speeches for the officials. The sound system has arrived with a friend from church who runs a small business that has also supplied the polo shirts, banners and he will be the master of ceremonies, whilst Ndilmabaye will receive the guests and make sure everything goes to plan.

Here’s to the police who help keep the peace

08:00 The eight armed police from a team who are specially trained for this role arrive, along with a couple of local policemen. They are on the gates along with our usual unarmed guards and also around the perimeter of the new unit. A sad necessity for    these days of heightened security.

Here’s to the staff with healing hands

08:00 The staff come for work as usual as the work of the hospital must go on. Outpatients are always less on a Wednesday, and the only change from normal is that the morning operating and the antenatal clinic are cancelled. A bit of extra cleaning is required, and everyone helps out. Staff who are day off or on holiday come in for the fete as well, and all except emergency staff will pause and take their places just before the Minister arrives.

09:00 The maternity is not busy but one baby is born, ready to be a star on TV later in the day

Here’s to the guests who shared our joy

09:00: The first guests arrive and are shown to their seats, by half past nine the District and Regional Medical Officers are here plus representatives from the government hospitals, national and regional pharmacies, and the W.H.O. The TV crew arrives in the hospital ambulance with all their equipment.

.09:30 The mayor of Ndjamena North arrive with his personal body guard who is wearing a surgical mask against the dust.

09:45 We heard by phone that the minister has been busy in meetings and has not yet arrived at the Ministry on the far side of the city and will let us know when he sets off. This is very good news as the food is not ready, but will be in half an hour or so. Also people are still arriving including many local chiefs and Imams and many women who help with the maternity outreach program in the villages. There are representatives from the Evangelical alliance of missions and churches and our own home church EET no2 Francophone at Farcha. There is a real buzz about the place the music is playing and last minute preparations are underway.

Here’s to the Minister lending his support

10:30 The Minister arrives, and his route is lined by staff looking smart in their Maternite Sans Risque shirts and the midwives in their special outfits for the day. The speeches are delivered by the Mayor, Mark, Andrea and the District Medical Officer. The latter gives a very positive speech telling the Minisiter how we are well integrated into the local health services and that we could do with some help, notably with personnel and an all terrain 4X4 ambulance. The Minister replied saying that Maternal/Child health is the number one priority both of the President and himself and that the doors of his office are open wide to us and he will help anyway he can.

 

Here’s to all who worked so hard

 

Thanks were expressed to Aaron and his team of builders, the architects and everyone who contributed time and gifts to the project

 

Here’s to the party and the fun we had

After the cutting of the ribbon, tour of the unit and the inevitable politician with baby pictures for the TV (and there isn’t even an election on) we shared a meal, the meat cooked to perfection. As I escorted the Minister back to the car I found that we share a common language, English. He had studied at an Arabic University in Jordan and is more at ease in English than French.

Here’s to the babies in the brand new world



There have been 4200 babies born at Guinebor in the first 5 years, the conditions were cramped and inadequate, some women had to labour on a mattress on the floor, and only one delivery room. Now thanks to your generosity we have a new spacious unit with 4 labour ward beds and 4 equipped delivery rooms. It really is a brand new world for an expected further 10 000 babies that will be born here over the next 5 years. A real cause for celebration and a dance.



                                       Here’s to you my little loves

                                        With blessings from above,

                                              Now let the day begin,

                                                   The day begin,

Let the day start.    

 



The first baby born in the new unit on the 2nd December 2015



 

 



Smile

 

 

What is it that makes you laugh, is it Charlie Chaplain, Monty Python or someone else’s silly walk.  Anyway it’s best to   ''always look on the bright side of life'' so here we go

We had a good laugh this week when we decided to buy a star light for the veranda. It was in the local supermarket and we had all agreed it would be fun and a tasteful addition to our Christmas decorations. Arriving home we unwrapped it and excitedly plugged, and burst out laughing, it was multi-coloured and flashing quite a disco experience and not quite the white subtle look we had hoped for but probably much more to Chadian taste.

 

Crickets (insects plural and not the singular game) have also featured strongly in making us smile this week. They are a popular and apparently very tasty fried snack. At the management meeting being British we prefer to offer locally made roast peanuts bought in old coke bottles.  I offered some around saying the problem with these is once you start you can’t stop –yes says Pastor Djibrine just like crickets mmm I said not quite what I meant.

Different people different tastes. In a similar vein, Ruth Gwan, the daughter of Dr Isaac our Cameroonian colleague, told Rebecca that she was wondering how on earth any one could live on honey like John the Baptist as it was so sweet. We too have problems with his diet but it’s the locusts that stand out rather than the quite palatable wild honey!

Anyway what’s really making us smile this week is the opening of the new maternity unit. It is looking great with all the equipment in place and the new curtains and furniture. We moved in a week ago and tomorrow is the opening ceremony we will have all the local dignitaries and will officially cut the ribbon. But nothing ever goes completely smoothly round here. Yesterday we checked a shirt at the team meeting and discovered that the 80 newly arrived T-shirts were misprinted. They had the same message front and back.

                       CEF Hôpital de Guinebor II,

                    Pour une  Maternity Sans Risque

The health education message for the back encouraging antenatal visits was missing.

Disappointed we decided that Ndilmbaye would have to take them back and ask that a further message be quickly added. The printer was surprised and pointed out that only one was misprinted, so he had put it on the top of the pile. Naturally it was the one that Ndilmbaye had pulled. The 79 underneath were as planned and perfect!!  Whoops! Good news and so they were distributed as planned to the staff today ready for tomorrow. And so, the donuts are ready, meat is in the fridge, there are piles of drinks and boxes of prawn crackers ready to be cooked. We will need to start early as official time for opening is 9 am.

We had better go and write our speeches.

 

Spot the spelling mistake and don't forget to smile.

Images moving out onto space- picture links

Here is a link to download our November Prayer Letter and direct links to the relevant works of art in the exhibition at Tate St Ives Images moving out onto space.

 

Bridget Riley Op art
 

Lilian Lijn Koans
 

Bryan Wynter IMOOS VI


Rivane Neuenschwander  I wish your wish

 

We hope you enjoy the pictures

Changes

 

 

It’s arrived! At last, ten days ago, a small lorry drew up with the new equipment for the maternity unit. Using quite a lot of man power and a few coca-colas the pallets were transferred to the unit and Helen and I set about unpacking .

''It’s like Christmas'' said Helen

 ''Better'' I replied.

 

Then it was time to test our Ikea skills as we put together the flat pack normal beds and delivery beds, drip stands and wheeled support for the baby bed. Everything seems to be fine and just what we need. It fits well in the space we have and begins to make it all seem a reality.

 

 

 

There are a few final touches to be made to the building and then we can distribute all the equipment around, plan for the opening and get ready for the rush. This month has already been busy and with around 4 babies a day we always looked likely to pass our previous maximal number of deliveries, 120. 

 

In our cramped and basic existing unit we have managed to assist even more women than we expected with a safe delivery. Today with 15 hours of the month left there have been 142 births with 3 women currently in labour! Looking at the graph puts it in context and it looks a little less amazing and  more like a logical trend, helped this year by the community outreach project. However it is more difficult to predict the quantum leap that may well happen once the new maternity unit with its shiny new beds and spacious rooms is opened.

 

Hopefully with the new equipment we can now provide even better care. We have more of all the basic tools and also a new oxygen concentrator/small surgical lamp/pulse oximeter/electronic baby scales/electric blood pressure machine and most exciting of all a CTG machine to enable us to monitor a difficult labour and see when the baby is in distress. We hope this will help us to avoid some still births especially when the women have come with other signs that the baby may be having problems and up till now we only had very basic ways of checking all was well. It will remain to be seen if the women will accept a caesarean under these circumstances but we can only hope and pray.

As you know our work in Chad will be changing over the coming months. This gives us plenty to think about as we unpack and organise, make local purchases and get the final touches done before opening the new unit. There is the potential for a further big increase in the number of women and babies helped and plans for the future need to be carefully laid so that all goes well during this time of transition and beyond. The hospital needs to  be well prepared to meet the challenge of the numbers whilst maintaining quality of care. Please pray for wisdom and Gods guidance.