Africa Vision 28

Africa Vision 28

N’Djamena, December 28, 2007

The year’s reflection -2-

Trust your instincts. Follow the heart. While coming here I turned down two jobs in Sudan. Why? Because I felt in Chad I could combine the different facets of work I like. Teaching, writing, project management, work in a hospital. But that was not the only reason. It gave me an opportunity to work with a friend. And there would be the working on small scale with local staff on local issues with local solutions. An approach that in other settings sometimes does not get enough attention. But most important because it felt the right thing to do.

In my mind if I could describe the ideal working year. It would consist of 8 months of work in the projects in Africa. Twice in a year a period of a month an awareness and fundraising tour through the USA and then 2 months of recharging time. No major organization will give a working schedule like that so I need to create my own source of income to assure this rhythm.

Then there is the dualism between public and clinical health. Between both, both are best. Yet if forced to choose today I would choose for the first. Luckily here in Chad working in a hospital and teaching public health is covering both ends. The ngo work is supposed to be on the end of public health as well.

Chad again? Yes Chad again. I think after bumping around the world for a bit is would be nice to get to know one place a little bit better. It is a country that often raises eyebrows. Chad where is that? What is going on there? It is also a country with immense needs and a government (or dictatorship) not working on making the country a better place. Many people I have talked with have told me neighboring countries have progressed by abandoning war. Here in Chad the only prize the people can take is a big prize in fighting wars. For whatever economist may say about the benefits of war I believe it to be a whole lot of Malarkey.

The ruling clan in power is engrained into the power structure and cannot abandon it for dear life. It sounds all too familiar. It sounds like neighboring Sudan. Nepotism is so common t is not funny. People in powerful positions who cannot read or write. Land being sold to foreign investors. Oil money being plundered. War economy being fueled. A cynic would say the weapons you fin here on the battlefield are from the 5 permanent members of the Security Council: Russia, China, USA, France and the UK. No wonder the despotic ruler can continue to indulge and disinvest in his own country. Make former camel herders into owners of fancy villas in Cameroon, Chad and Switzerland.

Yet there is always hope. Hope that there will be a peaceful transition. It is not that there is no capacity in Chad. The people are just tired and are choosing a non-violent path. For the people read those not coming from the East of the country.

What went well this year is the development of creative skills and also the increased time to develop a spiritual path (in other words meditation) also on the mental plane balance is much more evident. Let me make 2008 the year of the overall wellbeing. Add some sports to the equation. And never forget to laugh. The laugh I hear from Faizal so much. The bigger the problem the harder the laugh



Ashis

Africa Vision 27

Africa Vision 27

N’Djamena, December 26, 2007

The year’s reflection -1-

Well that a roller coaster it has been. Let me write down where I have been and what I have done over the last 12 months. Country wise: Cameroon, Chad, India, the Netherlands, the UK, Canada, the USA and Mexico. Activities: writing a blog, a book, hatching eggs, holidaying, working in a refugee camp, networking, touring the USA talking about resilience, humor and dignity of the refugees in Chad, dancing, sleeping, meeting new people, meditating, sweat lodges, horse back riding, beach football, hug campaigns, daily appreciations, random acts of kindness, seeing a documentary winning an Emmy, hearing from 19 year olds organizing events for Darfur, having great meals, planting trees, planting seeds, being inspired, being touched, feeling out of touch, being in a flow, teaching public health, doing deliveries, choosing to follow the heart, helping out the setting up of a new NGO Africa Vision, opening the heart again, try out a hand of patience, becoming a god father and a gazillion things more.

Things new to me or at least things I am doing with more devotion now are the following. Every day in the morning one hour of meditation. The technique is called the Divine and the Immersion. It gives a sense of balance and also a focus to do the day what needs to be done.

Then there is writing. As a friend quipped it is hard to keep up with the output. I write this blog roughly every second day and then there is the exchange of thoughts with Elizabeth Garcia-Gray on the Utmost. Why we do the work we do. Disaster and relief work across the globe. Moments of contemplation mixed with mischief. Writing is fun and it is a good way to get rid of negative energy or better turn it into positive energy. It feels like a good habit. Reflection of the day, what did you feel, what did you do, who did you talk to. There are some many interesting people you meet here from all walks of live. And Chad has myriads of different cultures and tribes, clashing and cohabitating.

Small intermezzo

Faizal just asked me to see a patient. Two traditional healers had seen her and they had treated her with herbs in the eye and scratches to the legs and arms. With a smile on her face the 20-year-old girl is telling me she is blind. But observing her from close by and seeing her walk at the arm of her mother something is fishy. After the inspection of the eyes by ophthalmoscope and heavy duty eye measuring machinery it is clear that the problems do not come from the eye. It is the second case of voodoo or witchcraft I have encountered in 2 days. It sounds a bit like hysterical blindness. We asked her to come back in three days to monitor the progress and send her off with some minor antibiotics. I think reassuring here will help more than the medication.

Trying to learn patience. This to me is hard. Things can take forever to get going here. Yet I am seeing the point of step-by-step approaches. If you force the pace you will end up losing time and energy. If you follow the flow things may change. Little by little.

Networking has been a joy this year. From the USA to Chad and all the other countries in between. Meeting fascinating people doing great stuff. People of all ages, like minded souls and putting them together gives a great multiplier effect and great joy to exchange experiences and laughter.

On to the next Africa Vision.

Number 28

Hooray
Ashis

Africa Vision 26

Africa Vision 26


N’Djamena, December 24, 2007

Ramani’s Christmas bash.

Ramani has more or less adopted me. Seeing my ever sliming body she has decided to single handedly assure that I remain in good health. Every time I go over to ponder on our experience in Chad I end up with belly full of great Indian grub. She works for the United Nations and through her I have met a whole new set of people. I have written about some of them in the past. They are here to set up a mega training school for police officers in Abeche. If I understand it well it will be a regional center for Chad, Sudan and CAR.

One of the people I met today was Emmanuel a white African, French origin born and raised in Gabon. Holding passports from Chad, CAR and I believe Gabon. He is only here for a month but was in Chad in 1996. A time when besides the French military there were no other whites than him. There were no foreigners at all. As he drove around at night he would be shot at with Kalashnikovs. He used to own a villa in Mondou in the South. But as a family of Zaghawas moved in 10 years ago he no longer does. Asking for help is asking for trouble. He was telling how crazy N’Djamena used to be in those days. The ruling party would just run around and confiscate what ever they wanted. If some one would resist they would be shot point blank. If a thief was found on the Central Market with out any ceremony he would be shot on the spot.

Clearly a lot has changed. Chad is flooded by NGO’s and people of all nationalities can be found in all corners of the country There is a bit of law and order. Then again as I reflect on my own experience in the East and the current status of the East a certain level of lawlessness apparently belongs to the country of Chad as it is. Since the oil has been found and is being exploited at least those areas are conflict free. As you can read in all magazines Chinese are popping up all over Africa and also in Chad.

But back to the barbeque. There were several old hands sharing mighty stories of the failed invasion of the USA in Somalia, the conflict in Bosnia and Kosovo, Lebanon, Sierra Leone and more of the well-known conflicts of the last three decades. There has too much of bloodshed and destruction of civil society in these countries. It is not always easy to remain optimistic hearing of the sad tales and realizing that several of the countries mentioned have been in conflict for over decades.

Next thing to pop up is the role of the United Nations in all these conflicts. It is easy to be critical about. the organization Yet it is the best tool we have mediating between nations and within nations in conflict situations. Never easy and always as strong as the weakest link in other words the conglomeration of nations together to decide where and hen to intervene. Perhaps a good venue to explore in the near future. Something to ponder over in the festive season.

Namaskar

Africa Vision 25

Africa Vision 25


N’Djamena, December 22, 2007

Eid and Christmas

The mighty wheels of the Chadian come to grinding halt for one week. After all in Chad both Christian and Muslim holidays are celebrated and this year it means the third week of December is one big festive season. Street vendors have added plastic Christmas trees, blow up dolls of Santa and even one or two Rudolph have been found to wander the streets freely.

At Id there is the sacrifice of the lamb. Before I managed to get to Faizal I was stuffed with intestine, liver, kidneys, brains and other special treats of the lamb. Being an honored guest there is no refusing. Most of the above organs are actually quite tasty. I just struggle with the rubbery consistency of the intestines. The mama of the Senegalese restaurant was complaining of her long existing pain in the knees. Resolutely I asked for a knife and offered to cut her legs. Every Tom, Dick and Harry has similar complaints or the ever-present acidity. My reply is pretty much always the same amputation for the first complaint, dietary restrictions for the second. If it does not help at least I will have scared them away.

The courtyard is becoming more and more like a little home. There are the friendly two brothers with whom I am becoming ever more close. Sipping tea and exercising my rusty Arabic and there are their 4 kids always jumping up when I come back or leave the house. The boy I use as a weight lifting exercise. As to his requests for gifts I always ask him for my own gifts. So far I am empty handed. But I hope my campaign will eventually lead to some major presents.

There is also a criminal element. Young unemployed elements looking for each and every opportunity to steal what ever is not looked after. After all this is the main street of N’Djamena and like anywhere in the world you will find pick pockets, dacoits and other bandicoots.

Then there is my neighbor Stephan a young engineer student from Cameroon with a very big interest in women. He is a nice guy when you manage to switch off the one- track mind. Also living on the court are doctor Polycarpe a former IRC colleague now at the United Nations Family Planning. Then there is one more family with 2 kids and then my Indian brothers Mr. Mooni and Mr. Bashir. The first is my Internet hero. As I am renowned worldwide for my technical prowess and my immense patience he must endure a lot. Mr. Bashir is the travel agent fixer and also the official document man. Which reminds me! I have a six-month working permit and also a travel permit for 2 months. Despite the holiday season all has come eventually. Is it true? Will I finally manage to feign some patience? Hmm let us wait and see.

Namaskar

Ashis

Africa Vision 24

Africa Vision 24

AIDS & CAR

N’Djamena, December 20, 2007

Today I visited the World Food Program. The sisters of Bebedja had handed in a project proposal end of August for supplementary food for HIV positive patients with an emphasis on pregnant women. At the doorstep I bumped into the gentleman responsible for the evaluation of the project proposal and in his slipstream I slipped into the office. Once in his office I started my hard sell technique for the project. But alas, to no avail. The end of the year is also the end of the money so my dear sisters have to wait until the third week of January until they will get a potential positive response. We then meandered on about the different programs in the South, one for the refugees and one more specific in Mondou and for sero-positive patients. Bebedja however is another district and province than Mondou so there needs to some scratching of heads to be done so as to accommodate this project.

I wish the project all the success. What is clear is that nutrition I one of the most vital parts of arresting the progress of HIV to AIDS (HIV and complications thereof) It is not for nothing that the old name in many parts of Africa was SLIM disease. Patients are wasted as if they come from areas with chronic droughts and food shortages. The benefit of taking regular antiretroviral medication will be undermined when suffering from malnutrition. A person who is HIV positive also needs qualitative better and a large amount of food than a healthy person. Malnutrition on its own is a risk for opportunistic infection imagine what it means in a person’s who’s immune system is suppressed.

In Bebedja St Joseph Hospital the wards are still filled with malaria patients. The hospitals of doom as I have seen in the past with nearly all the beds taken by patients co-infected by tuberculosis and Aids are not yet the case in Chad. Although the infectious disease ward in the General Referral Hospital in N’Djamena (happily mixing with dermatology and mental health) is and a dire indicator for the epidemic that is about to unfold in Chad.

Broken down health services, civil strife, war, lack of resources, rape as a weapon of war, rape as a common part of society, labor migration, polygamy, prostitution, poverty, lack of education, refugees and displaced people are a potent mix for a massive epidemic of Aids. Also the proximity to Central African Republic where the Northern part of the country has suffered from a neglect and destruction that makes the South of Chad look like the land of milk and honey does not help.

Last night I went through the report of Human Right Watch of September 2007. The following struck me as extremely sad. Calling it a forgotten conflict would imply there was a prior understanding of the plight of the people in CAR. Clearly nobody knows or wants to know. The scale of the atrocities in numbers may not be as in Darfur but there are also hundreds of thousands of people living in the bush. Haunted down by groups of bandits, persecuted by government forces and exploited by ‘liberating’ groups of rebels. Another thing that comes to mind after reading the report was that how deeply involved the French are involved and responsible for the mess in CAR. There is a military agreement and as a result it is the French who decide which dictator will get the chance to do his time until it is deemed better to replace him with the next crook. All transitions in CAR since independence have been military coups.

Obviously it is not only the French who are to blame. There are long standing conflicts between Christians and Muslims, pastoralists and agriculturists, North and South, bands of bandits, incursions from Chad and Sudan.

Yet it seems that before the end of the colonial phase in many cases the French did as the Belgians did in Congo. Absolutely not prepare the countries for independence. Fifty years later and CAR and Chad are still struggling to find their feet.

Namaskar

Ashis

Africa Vision 23

Africa Vision 23

N’Djamena, December 17, 2007

Youth takes lead.

The sentiment I had in the USA I went through again today. Three young American reaching out and traveling to Chad to assess and find how they can best help out this country. For Caesar it is his third visit. Victoria has been twice and it is the first visit for Dawn. Two are medical students from San Antonio and one is interested in Public Health. They shower me with questions about Chad, Sudan and the health system in Chad. Tomorrow we will go out to meet some medical students at the faculty. I need to go there as well to arrange some teaching dates for my classes.

Their website is www.thegreatestgood.org

As we dine in the Carnivore I recognize the eagerness to learn, to be part of the solution, to undergo the experience. It also showed me that the world is a small place. They have met Gabriel Stauring my buddy from Los Angeles, who tours the USA with an exposition of tents on genocide. Several other names of Darfur activist past through our conversation as well. They told me of a documentary maker and Rosemary whom I had the pleasure of meeting already in Bahai (www.) who will both come by before March.

One of the things they wanted to do is hook up with medical students in N’Djamena so there can be an exchange of ideas and start up a link up with their medical faculty.
Another thing is a need assessment of what can be done for Chad. I need to tell them about Benjamin Plener as well tomorrow (www.24hoursfordarfur.org)
They will visit an American doctor running a hospital in the East near Abeche. A doctor I would like to meet. Then they are off to some refugee camps. Some revisits and some new visits. If they get all the paperwork done.

I am happy today. Happy that the youth is taking issues in Chad and Sudan serious and are even traveling down to visit and see with their own eyes where they can contribute. There seems to a genuine interest to do something about crises in the world and doing it self and not necessary by donating money to existing bigger ngo’s.

As I started the day today I had seen a large quantity of medication and materials in the storage of our office. To my delight I met the driver I came down with from Bebedja and the medication is for the hospital of Bebedja. Good news indeed!

Tomorrow a day of paperwork. Collecting stamps and visa so I can stay another year in Chad. I almost forgot to tell about another dear friend. A former associate of Hissen Habre (former president) and the current president (Idriss Itno Deby) and a true intellectual. He must have been too honest to climb further up in the ranks. It is great to hear a critical and honest opinion for that matter about the current state of affairs in Chad. We ended talking about the role France still plays in Chad. According to him Chad is technically independent but it is clear who decides what happens in Chad. The French still have Mirage fighter planes and several thousand troops in the country. And there are large economical investments. He will be off to the USA to visit his son who studies there and I will be happy to meet him after two months when he comes back.

Ade

Ashis

Africa Vision 22

Africa Vision 22

Bebedja, December 16, 2007

I am dreaming of a white X-mas.

Heather has been in Chad for 10 years as a teacher of English. Every year she and her husband Michel organize a X-mas party. In the relative heat of N’Djamena. Bing Crosby belts his Christmas carols. A gathering of about 30 people of all walks of life coming together to celebrate the Christmas festive season. I met some new people again tonight. Debby a Canadian English teacher who wants to construct water well and has been walking around with a bundle of money to do it for the last 4 months. Talk about synchronicity when I was just telling about my friend Elizabeth, a psychiatrist who does mission work in Africa, Asia, South, North and Central America who is also involved in organizing a water conference in July in Uganda when Liz just happened to call.

There was a chief medical officer and professor from the American military who was very interested in the public health aspect of the program I am working on to establish. He is a specialist in emergency medicine and landmines. Unfortunately many of the warring partners in Chad use this horrendous weapon of war to wound and cripple mostly innocent civilians. The typical story is of a goat’s herd’s man who finds a metal object. Picks it up, examines it uses a stone to see if he can open it and kaboom. Gone is the leg, arm, eyesight and in cases the life of someone. It renders large swaths of land into destitution; as one cannot work the fields, pass with the animals. Amongst weapons of war this is one of the cruelest forms. Yet what was very interesting to hear was that he found it important to emphasize in his interactions with colleagues back in the USA the need for preventive medical interventions. Covering the sewers, making good drainage systems of water, protecting water puts will safe many more lives than the work on landmines. All are important clearly. I will hope to meet him again before he leaves for further discussions and he will be back in and out of Chad.

The food was a traditional X-mas dinner with turkey, the potatoes, the pies, salads, cakes and all you get to yearn for after a while in Chad. The cook did an excellent job. And chocolate, chocolate is what I love and piece of it makes me smile for more than a while and there were mountains of them. Believe it or not I had to pass on desert, despite knowing it was a great variety of cakes. The food was succulent.

And the second highlight of the night. A game involving gifts, thefts thereof, and chits of paper with a number. In short when your number shows up you are allowed to either take a gift from the table, or steal a gift of anyone who took a gift before you. After an item is stolen three times it remains with the fourth owner. Several items like two paintings, a bathing set, Italian coffee changed hands until they finally remained in their final owners hands. One lady had her gift stolen 6 times and finally ended up with her first object. Myself I was the lucky winner of three manly cotton leopard print hankies made in India.

Merry Christmas and Happy New Year
Ashis

Africa Vision 21

Africa Vision 21

Bebedja, December 14, 2007

N’Djamena time

It feels goods when the kids in the courtyard rush up to you as if you a loved uncle who has returned far a journey far away. Four little monkeys were using me as their play tree and I enjoy it. Coming from the tranquility of Bebedja it is great to be back in the hustle and bustle of N’Djamena. It seems it is relatively calm for a country in the midst of civil war. Remember the fighting is taking place in the far East an drive by car of at least 16 hours. What you notice in the city is an increase of military checkpoints and frequent checks of cars for possible gun smuggling.

All it takes to avoid this hassle is a driver who knows the back routes. It saves harassment en route to the local disco’s. The road back from Bebedja showed again how dangerous traffic can be. Besides animals aplenty a young boy had been run over at night by a truck. Awaiting the parents before this issue can be solved the body was still lying on the road.

But first back to Bebedja to tell you about some more or less typical patients arriving at the emergency department. First we received two young nomadic Bororo. A girl about 7 years and a boy of about 12 years. The trek from Niger all the way down to the South of Chad with their herds of cattle. Theft of cattle is common and although the parents did not tell what exactly happened what we received were the two youngsters with bullet wounds. The girl received a shot with a Kalashnikov automatic riffle in her neck. Miracles still exist as none of the vital structures were hit. The boy was less lucky. He received two bullets in his buttocks for which he needed surgery. Even if it must have hurt our young man did not flinch when his wounds were cleaned.

The day before one of the visitors of the patients went out after dark to return home and in the unlit road she got hit by a motorbike with two passengers. All three lie next to each other. When I left to return to N’Djamena she was still in a coma and one of the men on the bike had bled from his ear. This a sign of fracture of the skull. Not good news when neurosurgery is not available but for the capital.

Traffic accidents and gunshot wounds are pretty common. When you see and experience the use of the roads you understand why. Protective gear, helmets, seat belts are rarely used. A pickup is used to transfer up to 20 people at one time. Sometimes with beautiful contraption adding another 20 goats on top of several people. No lights on the road, no lights on may vehicles. Cars without brakes rolling around the countryside. The state of the road may be rapidly improving once you leave the main road you leave the asphalt and entry potholes, manholes, bumps, grinds, slides and all kinds of animals on the road using the road in their on unique way. In a way it reminds we of India. Kids playing on the road, animals crossing left and right, shops on the road side or on the road, maintenance in progress. Dust from dusk till dawn and beyond. The red dust that envelops you when you travel.

Next week when I am back in Bebedja I can report back on the wounded. As one of the sisters said it is amazing to see the recovery some people make here despite our limited treatment facility. One other man who was in a coma after another motorbike accident is ready to go home. Let us hope for the others as well.

Namaskar,

Ashis

Africa Vision 20

Africa Vision 20

Bebedja, December 12, 2007

Doba dub.

It has been a while since I have written about the prime reason for my being in Chad; Africa Vision. Well today I went out to introduce our selves (me and the organization) to the local health authorities. I visited the health delegate (big fish) and the medical head of the district (medium big fish) in Doba. At least the health delegate seemed interested in our tentative plans to roll out a support network in training health worker, bed net distribution, clean water, basic medical supplies and vaccination. The region is pretty big and specifically in the rainy season not accessible in many areas. There are 5 medical head of the district but none have a vehicle to inspect and support the health posts in their proper areas. Often there is a rupture of vaccines coming from the central government.

Enough work therefore for an NGO to jump in. Let us hope that UNICEF feels the same about it and will decide to supply the necessary project funding in January and onward. By now I am completely out of any news loop so it remains to be seen how hot the issue of Zoë’s Arc still is. I am also curious to learn if the European troops that are supposed to come this week to protect the camps in the East can make a major impact straight away.

Why Doba dub well live in the village has a slow regular pleasant beat to it.

06.30 wake up, meditate for an hour
07.30 ward rounds
08.30 echography
09.30 consultations
12.30 lunch
13.30 pondering & patients
15.30 mini rounds
16.30 walk around town
19.30 pop over to the nurses with a papaya
21.30 see how many babies the nurses have taken to the hospital
22.30 cream the computer in chess
23.00 write and eventually snore

All the time in the world to read, write and ponder. Besides that there is the constant flow of patients. Despite patients coming very late so far this week there have been 3 deaths. All three patients died within several hours of arrival and they were usually severely ill for more than a week. Yet the majority (an estimated 70) has rotated through and is now home again. About 10 children were born.

Bare in mind the laboratory is closed after 12.00 & and the surgeon is in the capital. We treat malaria without doing the proper diagnostics and our senior nurse does the most common operations.

No worries man, tomorrow people where is your best.
Well our best is in the hospital it is the dedicated staff working through lack of electricity, stock ruptures, non-complying patients and all other obstacles as if there are none.

Talk to you later,

Ashis

Africa Vision 19

Africa Vision 19

Bebedja, December 10, 2007

One week in Bebedja

Time flies when it is quiet. What a great week it has been. Getting to know more about the province of Longone Oriental, the people that live there and the hospital in Bebedja. Tonight I left the hospital terrain to go for a fruit shake. A lovely papaya, banana and guava shake. It was so good I took two huge jugs. Dromir and I paddled at bicycle speed through the back lanes of Bebedja on his motorbike as the manholes here as big as men. Road construction and it may take some months more.

Bebedja lies on the main highway (big word for a two-lane dusty road) and it is from there that some of it specific problems come. All over town are little bars and restaurants. Truckers and travelers from all over the country on the way to the south east of northwest drop by. For as little as 2 beers or a meal or two to six dollars girls sell their services for the night. It is not surprising that Bebedja has such a high number of HIV positive people living in town. Some estimate may be up to 20% amongst the group of young adults.

A second boon with some major ramifications is the oil that has been found nearby. Men come from all over the country to work in the region and when while their wives are still in the cities they come from in Bebedja or Doba they find solace in mistresses or girlfriends for the night. Fights and traffic accidents at night are also common as is alcohol intoxication. There are campaigns ongoing to prevent the further spread of HIV. But it is clearly an uphill battle. In that context the work I saw in the HIV clinic was very positive.

I sat in part of the morning for the consultation of those patients included in the program of antiretroviral drugs. It was impressive to see how serious most of the patients are with their life long medication and how much they adhere to the monthly drug controls. For a check up of their CD4 (an indicator of cells in the blood showing how successful the drugs are in suppressing the virus) they need to go to Mondou a costly day trip up and down. Mexican sisters (2 nurses and a doctor run this program) and they work in a building next to the hospital two days a week.

Even with the best of care and treatment opportunistic infections are still frequent. Tuberculosis, fungal infections and malaria are common. The treatment of these infections is not always straight forward as there is interaction between the antiretroviral drugs and the other drugs.

Several of the patients are admitted to the hospital. One of them is pregnant and has been coughing for 3 weeks. None of the antibacterial drugs have helped until now and the suspicion is that she has tuberculosis. In an ideal world this lady would have a caesarean section, would not breastfeed but feed by bottle, and after delivery the newborn would receive antiretroviral drugs for a week. Our surgeon however has left for the capital two weeks ago and it is unlikely that she has enough money to afford powder milk.

Bottom line remains that several hundred patients are receiving affordable life saving drugs in a setting where basic drugs or vaccinations are often missing. All in all this is a major feat.

See you soon,

Ashis

Africa Vision 18

Africa Vision 18

Bebedja, December 8, 2007

Deep wound

Yesterday night I visited the hospital in the evening visit. To my great surprise all the doors to the rooms where the nurses posts are were closed. I decided to pretend I was a patient looking for help and barged in to the first room. One of the nurses woke up with a sigh and with her were both a baby and a baby sitter. The cute little baby with a Mohawk was protected by a mini mosquito net. To assure that in case of heavy work load mom could not take care of the baby a baby sitter was. The second door I knocked on led to the same result a sweet baby not ready to sleep yet crawling around the maternity room. The third room however was the most fun. As I knocked a sleepy nurse opened the door to slam it straight shut in my face. Terror spoke in her eyes. Who was this hairy monster waking her up at 21.00? Only after 2 minutes she could compose herself. In the mean time Dromir (one of the male nurses) and I could not stop laughing.

I asked the nurse what was next? Would she take her chicken, goat and husband as well? I guess my silly sense of humor was not understood. But Dromir and I were giggling like two little schoolboys scheming to plan something mischievous. I must say that the nurses here do a great job. Workload is heavy. Patients do not always comply very well. There can be big issues with the patient’s family. Today a young man was brought into the hospital with a head injury after a motorbike accident. He did not wear a helmet. In fact if I see them they are mainly elbow decoration. His 30 (I am not exaggerating) relatives and friends nearly stormed the emergency room and when he started to convulse a wall of wail broke out deafening the hospital. When we wanted to transport him to a room a scuffle that would have looked good in any Monty Python Fling Circus episode.

Tonight my silliness reached peak levels. It must have been the fact that outside I can hear the steady sound of a sound system churning out Congolese zuk while I am hanging out in my little bungalow. On the street I had met this huge clando man (motor taxi driver) talking to his friend who was about 50 centimeters smaller. I offered to cut off the giants legs and attach them to the midgets so the could at least talk face to face. Tonight that same motor taxi man popped up with a seriously wounded patient. A young lady had a beer bottle explode in her hands and as a consequence we found a lesion about 3 millimeter deep and 1 centimeter long on her index finger after scrubbing of the wound area. Dromir and I look at each other and started joking about the wound. Perhaps it would be better to admit the young lady given the severity of the wound. That we would whip out a good old decent plaster for her. This would immobilize her and assure her finger to rest tranquil while she continued her drinking spree. I quipped that in case she would go dancing she should keep her arms still. At least Dromir and the motor taxi man understood my exaggerations.

To end my night on a funky note I requested Dromir to give any and all patients at night a free Paris plaster. He had just told me how many patients with fractures go home remove the plaster have the local traditional healer attach tree branches and then return to the hospital to collect medication. More about the local practices in the next blog. The first visitors are coming in a week’s time. I hope to take them south a bit so they can see what is gong on there..

Ashis

Africa Vision 17

Africa Vision 17

Bebedja, December 6, 2007

Early end.

“Ashis take a look at the uterus. There is something wrong there. The echo shows a mass, which should not be there! Perhaps a extra uterine pregnancy or some of the intestines that have kitted together with the uterus due to a sexual transmitted disease together” The girl Dr Gusto and I are talking about is 17 years old has had 2 previous spontaneous abortions at 5 and 6 months. Now she came with some vague complaints of abdominal pain. An operation (laparotomy) to check out her abdominal organs was proposed to the family and they agreed. During the operation done by our senior nurse it became clear that there was a massive infection of the peritoneum and that as a consequence both her ovaries were tangled up in a mass stuck to the uterus. There was no way out but to take out both ovaries effectively rendering her into surgical menopause at this young age. Also making it impossible for her to get children in the future. If the operation had not been done she could have died at any moment due to an infection of the abdominal cavity (peritonitis)

Imagine coming for some abdominal pain and leaving the hospital no longer having menstrual periods or the chance to get a child at the age of seventeen. It shows that sexual transmitted disease is rampant her as is child brides. She must have gotten married at 15. Her story reminds me of other women I met in Africa who had similar problems. Infertility when there are also many women with a football team of kids. Not a position to envy. I sincerely wish that her husband does not abandon her. It is something that happens all too often unfortunately.

Then at night I am doing a late night round of the pediatric ward. One of the young girls (3 years) is anemic and we are giving a blood transfusion. To assure she is ok I check her heart and lungs trying to assure the transfusion does not go to fast for the febrile and weakened young girl. As I move on to check another new patient 3 minutes after my checking the girl the nurse comes to me and says the child has expired. Cerebral malaria kills fast. Even under treatment with anti-malarial drugs. Her parents had walked 11 kilometers to make sure that their child was all right. The girl had only been sick for les than a morning when they visited their local health post. It shows how lethal malaria is even today.

A third patient with a third story. At the young age of eight she cannot walk far, is easily tired and has difficulty breathing while lying down. She has been having these problems for several years but it is now she comes to the clinic. On examination you can hear a murmur over the heart. You can see and palpate. Her heart is enlarged. It is what the echo and the ECG show. One of her heart valves, likely the mitral one has been well destructed. Children get a skin infection or a throat infection and during that episode of illness the bacteria passes on to the valve of the heart and there nestles and destroys part of the valve. In Europe she would have been to her general physician in an early stage who would have treated her original infection thereby prevention damage to the valve. Even with damage there would be the option for valvular surgery and replacement by an artificial one. Also she would have received prophylactic antibiotics to minimize further damage to the valve. Here in Chad it remains to be seen if there is an opportunity for an operation (likely not) or even if the family would have enough financial resources to sponsor an operation (unlikely).

One patient has died early, one has become menopausal and one has a reduced life span. All three had preventable or at least in the beginning curable disease.

Namaskar,

Ashis

Africa Vision 16

Africa Vision 16

Bebedja, December 5, 2007

Hospital St Joseph.

The morning brings burning leaves. Outside by little bungalow they are being burned in heaps. I slept like a little baby. It is strange with no electricity after 21.00 the village and the hospital terrain get really quiet. Being a newbie I managed to miss out on the daily ward rounds. What to do? Tomorrow I have been asked to do the ward rounds for the adults (and join our part time doctor, in other words he is also the chief medical officer for the district and he has a lot of different tasks besides working in the hospital). Dr Gusto is the doctor who has been doing his best to keep the hospital floating. There is a Mexican nun who is also a doctor who works 2 days a week with the HIV sero-positive patients. And apparently a Chadian surgeon has just been hired but he is off to take care of family business in the center. We are hoping he will come back soon. As it is the senior nurse in the hospital is doing all the emergency surgery in the house. The only knife one should give me is to carve a chicken and our other colleagues are also minor surgeons also. It is clear that women requiring a caesarean are blessed with our dedicated senior nurse.

As the things are moving and shaking in Chad I shall be spending one week per two weeks in this missionary hospital. Remember the nearest hospital is a two-hour drive and the official district hospital at 23 kilometers is closed. The red earthen road makes the air very dusty. As if one is playing tennis on a gravel court. At the end of the day I went for a small walk to the village to see what is available and to reflect on the findings of today.

What did I do?

Well at first I joined a nurse in the health center and together we saw about 30 patients. The most memorable were an 18 year old who was convinced he had lung cancer. This is an easy entry to make him stop smoking. Another young man in state of confusion (a typical case of malaria). A young lady with a sexual transmitted disease. Her newborn had an eye infection and as her husband has 2 wives (yes polygamy exist in the South even among Christians) all 4 needed treatment.

Then I went through all the files of the patient to see what kinds of diseases/operations were frequent at the different departments. There is the maternity (today 2 deliveries), surgical department, pediatrics and internal medicine. There should be about 70 patients in the hospital today. It seems 80% has malaria and then typhoid fever. The big but however is that the test (Widal) for deciding it is typhoid fever or not is not available due to lack of reagents. What to do common things are common so treat as if.

I shared a chicken and boul the local dish with some nurses and talked about how they view their work.

And finally in the afternoon as a good student I did my first dilation and curettage under guidance of Dr Gusto of a lady who had gone through an intra uterine death of the embryo.

This after we had done a punction of the pericardium as to remove 220 ml of fluid for a young 30 year-old male patient suspected of tuberculosis. It means that around the heart there is a strong bag like structure called the pericardium. In his case for some reason (suspected TB) that bag fills up with fluid every 3-4 days. As a consequence his heart cannot beat easily and fluid pools everywhere; his liver, jugular veins, abdomen, legs and lungs. He has difficulty breathing when he lies down. Even if under guidance of an echo it looks pretty intense sticking a needle about 10 centimeters under his sternum towards his heart. Even more impressive is when the patient tells you after removing the first 100 ml of fluid that he feels as if he can breath easily again.

The most impressive realization however was the fact that out of two deliveries today one of the ladies was sero-positive and her baby had to receive anti retro viral drugs to reduce his chance of becoming HIV positive. AIDS is rampant in Bebedja the nuns estimate looking at their sentinel voluntary tests of pregnant women that up to 30% of the population may be HIV positive. Something to think about…

Tomorrow more about the nuns/nurses working here.

Love and peace,

Ashis

Africa Vision 15

Africa Vision 15

Bebedja, December 4, 2007

Chicken on the roof

Today it became perfectly clear to me why Chadians travel with their chicken on the roof of the car. As we slugged our way to the south every 100-kilometer a bag dropped of the roof. Clearly the chickens are confused and guard the bags as if they are eggs. As you notice I am not in N’Djamena. Here in St Joseph’s at Bebedja there is a 90-bed hospital where tomorrow I shall plunge into service. I live in a little bungalow and despite the electricity being turned of at 21.00 all else is brilliant. The sisters received me with a late night salad and a warm conversation. We talked about their experience of Chad since 1977. One sister told me that over the last years since the oil has been found a laisez-aller has developed. Somehow with the mineral richness in their environment and yet for many no improvement in their day-to-day life something has snapped. To quote a sister: ‘People say we are poor and have been so for so long it does not matter if we die early’ She clearly talked about a change of mentality for the worse.

A certain dependence attitude I need to find out more about this. For now I need to plunge back into the tropical medical textbooks as well as create a mini medical wordlist to understand the patients when they speak their local language or Arabic. Luckily I shall be working with the aid of a nurse translator who speaks French. It has been a while since I saw patients but with the patient load it will not take long to be in full swing again. And of course common things are common. What happens here a lot is that patients present very late in their illness. When a baby comes with an anemia of 3 (severe) and in coma and convulsing it is difficult to treat. My last visit I saw many children and adults with progressed disease and then HIV is a bi issue in this area.

In short a lot of work cut out for me here. I shall return to N’Djamena to give my first class at university and lobby for funding of course. The journey today was with 10 staff members of World Vision. They are to be found all over the south. As we drove around N’Djamena the last two ladies managed to pile up an impressive number of 21 bags and suitcases to be taken their home. The whole trip this sheer endless luggage was the cause of a lot of hilarity. On many occasions when yet another bag dropped of the top of the Land-cruiser proposition were made to chuck of some luggage or to send someone up to the top of the car to guard the valuables. Our queen of the vehicle was a lady of my size. A true queen as traveling light meant our car’s axels almost broke.

As N’Djamena - Mondou is 700 kilometers there is the obligatory flat tire. Today one exploded and it took a great team effort and two Rambo knives to carve it off the axis. Three other heavyweights and my self mounted the back of the vehicle. This is usually the place for 1 or 2 golden retrievers. Truly sardines have a better deal. One thing about my Chadian friends no matter what comes on the path there is always something to laugh about. The easy and well felt laughs in Chad ring well in my ears.
From tomorrow I shall be writing about the activities in the hospital of St Joseph. For now sleep well. Perhaps I can post this from Bebedja and otherwise you shall have to wait a bit.

Harmony,

Ashis

Africa Vision 14

Africa Vision 14

N’Djamena, December 3, 2007

Musings.

Guns and roses. All you need is just a little patience.
Do I have that?

It has been a while since I am here and as I wrote about before I came to head a Chadian NGO working in the field of public health.
Have we started? Mm well yes there have been several field visits but no money no funny. That is the crunch. Donors need to be convinced and as a new organization that is not easy however good your intentions are or your track record in previous jobs or your network. A new kid on the block is a new kid on the block.

As to assure I spend my time wisely in Chad it has to be said it did not take me long to find good alternatives (or rather supplementary work) until the main job begins.

First there is the challenge of teaching Public Health to sixth year medical students. Forty-nine thereof. I cannot wait. My first class will be within one month of my arrival here. The opportunity to discuss what I call creative public health, simply using common sense combined with experiences from other countries and what is realistically available budget and resource wise to implement health policies and programs is a boon. The discourse, the interactions with these future health leaders of Chad I sincerely hope I will be able to tickle their imagination as to become the best possible doctors for their own country. So many Chadians have to go without any medical service at all. Medicine is such a gift. A gift to serve. Not meant to serve as an opportunity to receive gifts. A healthy child, a smiling mother after a delivery gives a lot of satisfaction. And the opportunity to work with people is in my eyes a blessing. People who share their stories their plights.

Second there will be the work in the Hospital St Joseph in Bebedja. For the last days I had been awaiting paperwork. Now the waiting is for transportation. As there are cars plying south from other NGO’s and the diocese it is good to pool resources. Going back to full on clinical practice is exciting. Specially in a French speaking area and an area that has all the tropical disease you can think of. As a quick general referral there is always the MSF clinical guidelines and for the rest I will depend on the nurses and other doctors. Chad being Chad however cars may not move tomorrow, but the day after. Good old kalke (Bengali for tomorrow or never) If nothing materializes tomorrow I will rent a camel and depart early in the morning. Too much city is not good for this bush doctor.

Zen like thoughts meander through my mind.
Before great action comes great rest.
A broken tooth will cause delay in travel.
Practicing mental ludo is good for health.

That or these are the chits of paper in the Chinese fortune cookies of last night’s dinner. Across the street there is a cake and fruit shake bar. Until I have my own mixer I can hop over for the essential vitamins. In case I get lazy at night there are my neighbors who run a Senegalese restaurant. Easy food.

Delay, decay, delay.

No transport today or tomorrow. A camel or a donkey does start to feel like a good alternative.

Ciao

Ashis

Africa Vision 13

Africa Vision 13

N’Djamena, December 2, 2007

Party on!

It has been a gastronomic and dancing weekend. I was very fortunate to get introduced through my cousin Babu to Orlando and his wife Rita they are from Venezuela. Both are working in the oil industry and Rita will stay in Chad for a long time I hope. Esso has its facilities in the South where I will be driving off to on Tuesday. My travel permit is in the pocket. But back to my new friends. A feast of palate tickling exquisite gamba’s, Thai beef, chicken, tiramisu like cake, wines, liquors, great hosts and most important sweet guests.

Ruben is a young Chadian who has been in the USA for 16 years. Yet at one point in his life he decided to come back for a year to get to know his ancestral roots and do some social work. Six years later he is still here and has been the founder of two NGO’s working on women empowerment and an English language learning center/library.

We started talking and it so fine to meet similar minded people. His entire family is in the USA yet he is in Chad. He is working at women empowerment and education. Two themes close to my heart. I am very curious to hear more about his work. I have been told on numerous occasions that Chadian run organizations are rare and here is a young guy starting two. Just as important is the fact that he plays basketball every Saturday so I can work on my fade away three point jump shot, drives to hoop, nasty blocks, heartbreaking rebounds and my sky hook. John P. better be well prepared when you show up in N’Djamena again. Game on.

So over the last weeks I have been hovering around town. Making friends in the Indian community, Chadian old colleagues, Chadian business people living abroad, NGO workers, IRC and IMC colleagues, university staff, doctors, UN peeps, my neighbors kids, Embassy staffs (USA and South Africa), party people and brothers and sisters from the Church (in the South). As there is a limited amount of restaurants, hotels, nightclubs, sport clubs and events it is quite easy to get to know a lot of people in a short time. Today I made my first ride as a customer of a clando (motorbike). For two dollars I was whisked across town. I had just come back from Plantation. It is the out door club to be on a Sunday afternoon. Last night I spent dancing my heart and lungs out on Saturday night at Blue. The 5-star hotel’s Kempinski’s fancy nightclub. There was a singer from Ivory Coast and my he managed to whip up the crowd.

All this partying is a good distraction. But also a good way to meet people and see what others are doing at a grass root level for Chad’s civil society. Ranging from the international NGO’s to the Government to foreigners and Chadians working to make a difference in grass root organizations. The longer and deeper you search the more initiatives and opportunities you find.

From the domestic front there is good news. I have found a young man named Clement to help me out keep the flat sand free, washing clothes, running errands and receive guests/visitors once the office will be functional (as Africa Vision takes off). It is when you ask what is the minimum monthly salary in Chad that you realize how blessed we are in Europe. Here you get 20000 CFA or 40 dollars per month and you are supposed to work 6 days 12 hours for those peanuts.

Buenos noche,

Ashis