Africa Vision 9

Africa Vision 9

N’Djamena, November 24, 2007

South versus East

Doctor Djada is an experienced ophthalmologist who has practiced for years in France and came back to assist his country in developing a medical school. He is the dean of the medical faculty and from our first meeting there is a very warm connection. We discuss the state of the health care system in Chad, the medical educational system and how at all levels there is large scope for improvement. Today we discussed the field visit I did in the south. Who I met, what were the findings, what are my suggestions. It is great to have such an experienced doctor to team up to share experiences. He is well connected and came with a very good suggestion for the next weeks. I should write up a small report on the planned interventions in Longone Oriental. We will discuss these plans together and see if we can find local support to fund some of these initiatives.

As I wrote about awhile back simple things can make a major difference:

1. Helping out with a sustainable method to transport vaccines and medication to and from the health post will prevent cycles of outbreaks of measles and malaria. Sustainable in this sense means community owned and with a community that is willing to participate in the maintenance of for example a motorbike.
2. Basic health education to local village health workers. What are danger signs to the detriment of the child? When to rapidly refer to a health post or a hospital?
3. As only the sun rises for free there needs to be an agreement that at least part of the cost need to be recuperated from the local population. Often non-governmental organizations have the tendency to flood the health market with free care for all. In the long run this undermines the capacity of the governmental health post to generate funds and provide care. Yet explaining to local populations that a contribution for health is required when several kilometers away all care is for free is often not easy.

Some of you have asked me to comment on the differences between the East and the South. As I am new to the South is shall give my preliminary findings.

1. A Christian or animist South versus a Islamic East
2. Refugee issues in the East roughly of a ten fold scale (220.000 refugees, 180.000 internally displaced people versus 25.000 refugees and several 10.000 IDP’s)
3. In the East pastoralist, nomadic, trading culture versus in the South sedentary, agricultural, educational focus
4. Nutritional scarcity in the East versus bountiful nutrition in the South
5. Sand versus trees
6. Dry riverbeds versus fast flowing rivers
7. Saharan / Sahelian climate versus Savannah / Rain forest climate
8. No nightlife versus a well developed club scene in the oil rich areas
9. Camels versus monkeys
10. Low population density versus dense habitation patterns
11. Arab speakers versus French speakers

At the end of the day between East and South both are best. Yet the differences are like night and day. At times you wonder how this one country with such a large difference in day-to-day life, belief and physical environment. Despite differences and ongoing conflict many in the South to quote Leon: ‘are still Chadian first and much later Southerner.

To return to Dr Djada I will be happy to assist in teaching public health at the medical faculty for the 6th and 7th year students. Monday I will go to a lecture by a French HIV expert. It is always good to keep on learning. Amidst reports of the World Health Organization that the number of HIV positive people has been estimated to be 33 million instead of the earlier announcement of 39 million the disease is still a major threat. Oil rich areas are known to attract people with money and it gives opportunity to a lively entertainment industry in all its richness. Clubs, gambling, bars, brothels, nightclubs are plenty. This is another good entry point to prevent needless deaths caused by this killer disease.

Peace and love,

Ashis

Awaiting teaching cap