Africa Vision 35

Africa Vision 35

N’Djamena, January 9, 2008

Drunk as a truck.

The 16 year old rolling in on a motorbike between two friends is bleeding profusely from his eyelid. As he is carried into the examination room he needs to be constrained by 4 men as he is rolling all over the place. Spitting left and right and so drunk whenever he tries to sit up he comes crashing down. In between moans he is about to die and ready to be received in paradise he is able to tell us he was out drinking with three buddies and then got onto a bicycle to crash head first onto the road. His buddies were more or less ok but our youngster needs suturing under anesthetic otherwise he will not need to buy a Halloween suit he will look the part.

Luckily for him his family was forgiving (at least in the hospital). But after he spat at our nurse for the fifth time I called it a day. Our friend was to be carried to a isolated room, left guarded by 2 relatives, sleeping on a mat because he would fall out of a bed. The next day he could be operated.

Drinking is or has become a big part of life here in Bebedja. In the weekends and festive days but as the case shows also on a Wednesday. And it is not restricted to adults. Local beer drunk from a bucket with a straw is a good way to get plastered for very limited money by all ages. One of the nicest building in the village is a newly constructed bar dancing.

Dr Gusto is getting a well deserved rest in the afternoons as I do the afternoon, evening and night rounds. Today it seemed very calm in the hospital and one of the nurses told me that as people spent all their money during the festive season. For an admission to the hospital there is limited cash so many patients await their pay slip at the end of the month.

Another group of patients in the hospital are those with burn wounds. Right now we have two with burn wounds up to 40% of the body. Last night one of them woke up a relative sleeping in the room. It seemed someone was urinating in the room. But in fact her burn wound had burst open and likely an artery or a vein had burst. At least a liter of blood was scattered on the floor. And then the next morning you need all your negotiating skills to assure that one of the family members will give blood. Her haemaglobin had dropped to dangerous low levels. And then she had another bleed. At last a relative stepped up and offered to be a donor. As her bandage was changed I could not but feel how much pain the lady must be going through. She is an epileptic and had fallen into the fire while convulsing.

Good things also happen. An eight year old who had fallen into a waterwell 15 meters deep and then went in to a coma woke up today and he wants to drink and eat. Kids have such a capacity to rebound it is a pleasure to see. And then the young lady, HIV positive and the echo revealed she was pregnant of twins. As there are antiretroviral drugs she will start with the medication this week.

Bebedja always remains a good place to reflect. At 21.00 electricity is switched off. I have a great place to drink a fruit juice every evening. The nurses are fun to work with and I hope to start with some small trainings maybe even this time and otherwise the next visit. And my little bungalow is visited in the morning by my two neighbors goats.

Peace,

Ashis

Africa Vision 34

Africa Vision 34

N’Djamena, January 9, 2008

Back to Bebedja

In a wink of an eye we were in Mondou. Racing across the smooth road from Ndjamena I managed to sleep nearly all the way. Lady fortune decide to intervene and we spent 3 hours in a garage for Toyota old timers well at least we have a new cooling fan in the motor of the car now and I managed to plunge through Robert Fisk’s ‘The great war for civilization.’ If not to read it can double as a pillow. I went for a bike road across the neighborhood and now know how it must feel to win a stage in the `tour de France. From all nook and corners people popped up to watch the nasara (white man) rides a bike. There are plenty of nasar in Mondou but I guess most of them use a 4 x 4 or a donkey.

The first patient I saw this morning after the morning rounds was a 3-year old boy. As the nurse had taken a finger prick to establish the blood group and I put the stethoscope to the chest to listen to the heart there were no beats. No breathing movements, nor response of the pupils. The child had died. In the hospital we are very restricted in reanimation. Partly because of lack of materials or capacity to treat for example with a ventilator. Partly because patients are presented in such a late stage that the outcome would not be good. In this case the mother waited for a month to come to the hospital while the child had fevers and had not eaten for over a week. It is not always easy but it is as it is.

The burn patient I talked about earlier in the blog has slumbered into a deep coma. After 5 weeks of treatment the pain and the infections have become to much to bear and the family wants to take her home so she can die in peace in her own environment. The two nomadic kids with bullets left the hospital after several days doing well. Right now we are entering the period of meningitis and the first choice medicine ceftriaxone is out of stock. So far there are three cases in two weeks. One child brought in today may be having meningitis as well.

The hospital has received two state of the art echo-graphy machines. One will be placed at the delivery ward so pregnant ladies and those who have gone through a miscarriage do not have to be hauled all through the building. The old one has gone to the out patient department. So a quick echography can be done (that is off course only true if the solar panels are lit). I sped my morning going through all the goodies these new machines can deliver.

Our surgeon is still missing in action and the state doctor pops up or not depending on his blood sugar and/or his mood. Apparently there are some American social scientists working on HIV in Bebedja. I hope to meet them later today or tomorrow. The work art John’s Hopkins a nice public health school. As my fellow doctor Gusto has been all call all the last month he was quite happy to see me. Finally a day not on call. I guess most doctors working in Africa know that feeling. The work just never stops and if you want you can go on and on. We even managed to discuss a bit about telemedicine. There is a prospect of having Internet at the hospital so images and case history can be shared with experts worldwide. We also went into a potential area of our mutual interest: leishmaniasis. I think I might have found leishmaniasis skin test good to do some diagnosis here. And then we talked about potentially the biggest menace in the area HIV. We are thinking about a workshop for the nurses on the social aspects of the disease. The mixture of bars, money, poverty, lack of education, youth, curious believes is a good feeding ground for a HIV outbreak.

Peace,

Ashis

Africa Vision 33

Africa Vision 33

N’Djamena, January 8, 2008

The greatest Good

My buddies Victoria, Dawn and Ceasar made it back to N Djamena just on time to catch their flight, They had visited the refugee camps in the East run by IMC and it was good to hear their perspective on the medical care in the camps. Eye care is key in their assessment of the camps. There are so many young and old people suffering from eye disease it is hard to see where to start the work. A thing that caught their attention were the young kids hanging around the camp. There is no secundary school in most camps in Chad (11/12) but for the camp of Oure Cassoni near Bahai. And then there was a feeling of loss of hope. Refugees with infected wounds staying in their houses because there was no treatment available. I have not been to these camps but I can imagine that at a certain point in time there is a loss of believe in a solution of the core issues.

Four years now and a whole batch of children has never been to Sudan. Born refugee! While the world is well aware of what happens. Darfur has been a conflict with a lot of media coverage. Political initiatives are also numerous. The root cause of the conflict a murderous regime that has been in power for over 19 years however has never been addressed properly.

While we turn our attention to Iran (not for the first time by the way, thank you George W. Bush and thank you sheepish international media, CNN, FOX, IHT and other newspapers).
When Iran was invaded by Iraq in the nineteen eighties, in a gruesome lethal war the USA supported Iraq.
When Iraq used chemical weapons international eyes were closed.
When the US Vincennes shot down an Iranian civil airplane with 290 passengers without any reason Iran was to blame.
I have been reading Bob Fisk’s book and the parallels of history are uncanny and sad.

Geopolitics before anything.
And so I am trying to understand the value of a regime that has fought in the East, West, Center, North and South of Sudan for nearly 20 years.
A regime that uses rape as a common weapon of war.
A regime that uses malnutrition and starvation of civilians lightly.
A regime that bombs bravely with Antonovs from the skies.
A regime that uses proxy fighters to ravage entire provinces, villages and cities.
A regime that is so forked tongued that it cannot even speak truth anymore.
A regime that abuses religion as a reason for war.
A regime that should have been isolated and changed a long time ago.
A regime helping out only their own tribes.

And yet that same regime receives or has received weapons from members of the Security Council.
It flaunts international human right law.
It laughs at the UN, Ban Ki Moon, George Bush, Gordon Brown, Sarkozy and other puppets.
African Union troops are humiliated and killed.
UN troops are delayed and delayed until further notice.
Refugee camps are shelled and attacked.
Refugees are killed and raped under the eyes of peace keepers
While we sit quiet there will soon be an entire generation of youngster who have grown up in a refugee camp. The Lost boys of Sudan will have a sequel Lost Boys 2.

Why can Omer el Bashir get away with all his bogus?
What is his value in geopolitics?
Is he the bully of the playground that gets away with everything?
Or is there a strategic interest in Sudan? Oil, Uranium, Cobalt, water, trees?
I wish I could explain, but I cannot..

The greatest good would be a peaceful transition to benevolent democratic governments in Chad, Sudan and Central African Republic.
To have no children grow up with lack of a school, eye care or threat of rape and death.

Until the day the world musters the courage to say no to dictators around the world be it Burma, Chad or Sudan kids will suffer.

Peace,

Ashis

Africa Vision 32

Africa Vision 32

N’Djamena, January 7, 2008

First university session.

I started working on my classes (4) for the 6th year of medical school a week ago. I was hoping to talk about public health in refugee camps but somehow I did not manage to download the book I needed so I changed my mind and will be talking about a malaria outbreak in Burundi, an influenza outbreak in a senior citizens home in the Netherlands and my passion Leishmaniasis and its public health implications. Teaching is something I love to do and even if I was a bit buzzed about teaching in French, mainly about my poor spelling, it went well. The hours were actually booked by a teacher of computer science & epidemiology and a teacher of Primary Health Care as well. But both kindly rescheduled.

And my instincts were right as long as you show up on time you can always wing a projector. The course organizer whisked away on his scooter and came back with a fine specimen for me. This after a wild goose hunt through the medical faculty putting class representatives of different years on the spot where the mighty machine was. From the tour in the USA I learnt that a doogle is quintessential if you want to work with a Mac. Just love the highlighted apple.

The students here are in 8 different classes with roughly 50 students per year and they have to share 10 computers, a library with less book than I possess and a laboratory without the basics. Yet entry to the medical faculty is highly competitive and coveted. Recently a private medical college popped up. I am hoping to visit that institute soon. My attempt to Socratic teaching was not always understood but next time I will make sure that the classes have a component of group work and problem solving. I managed to download the required book with help from a friend. Now let us hope that Adobe works on my Mac as well. Question and answers led to some extended silences but also to interesting answers. Somehow not all students were aware of the class so about 20 out of 49 showed. Next time the more the merrier.

This morning I will head for Bebedja. At night there (if I have enough electricity during the day) I can prepare well my next 8 hours. It is lovely and quiet over there. And this time I have a car with me so I can do some field visits again. I am finally hoping to start using my video camera.

In the evening I was invited to a family of Bahai (the religion). Together with another physician and believe it or not he is Dutch and a surgeon working for the British Navy. In his spare time he does numerous short missions for the Red Cross and I sat in awe listening to the stories he had to share about working in Rwanda in 1994. Operating on the perpetrators of the genocide and how to deal with it. The story of the Congolese prisoners of war captured by the Chadians in 1999 when they drove a convoy of tanks through Central African Republic to Congo to compete in the battle for the goodies in 1999. Or his up and coming visit to Gaza and his recent stay in Kurdistan He is married to an Iranian who is a Bahai and he met his wife on a mission in Angola.

The Bahai religion merits more than the paragraph I am writing now and I will come back to it but in brief. It comes from Iran where the followers have been persecuted since the fall of the shah. The diaspora has been dispersed in over 100 countries. One of the main themes in the religion is the acceptance of all religion. The Koran, the bible, the bhagavad gita all sought as inspiratin to the believers The religion was founded around 1850 and the first time I heard of it was when I passed by the teple near New Delhi. Haifa in Israel is a holy place as it is there that the founder of the religion spend a large part of his life.> I will try to learn more about this religion and let you know.

Peace
Ashis

Africa Vision 31

Africa Vision 31

N’Djamena, January 5, 2008

Crime pays

The two dacoits who robbed me are well known figures in this part of time. They spend a lot of their time in jail and in between sentences they create havoc. One is called grand dame and the other Mohammed Walia. After they snatched my phone and money they went on a drinking spree in Kabelaye. It is the home of many Cameroonian girls and of plenty restaurants and bars. Our two bandicoots at one point got into a fight. One smashing his beer bottle and the other using his knife. The reason was that one wanted to sell the phone and the other wanted to keep it. Grand dame has been snapped up and is in jail right now. Mohammed Walia is still slithering through town awaiting arrest. He can slither and slide but for sure he can not hide.

As the left hand washes the right hand I went to see the daughter of my friend police inspector Pap of the special crime unit. She seems to be the victim of some magical incantation. As she returned from church a month ago an elderly lady touched her shoulder and she collapsed to remain in a coma for 2 weeks. Admitted in hospital the doctors went on a shotgun approach. Try anti malaria drugs, when that does not work try antibiotics when that does not work say she has tetanus and nothing can be done. All the time asking for lab exams and computer tomography and what have you not. Unfortunately nobody n the hospital knows how to use the machine so no images can out. What did come out of the pocket of my friend was bundles of money. It is sad to see medicine being used as a money-making industry but also in Chad you can find these practices. Who well go and discuss with a doctor when we are talking health.

The largest scale of criminality remains however the dictator ruling the country. It is amazing to see how much money flows into arms and the army and how little is invested in education, health care and infra structure. These criminal expenditures are justified as a struggle for life for the government, a means to peace in the country. The sad part of the story is that conflict is fought between a very limited number of tribes; Zaghawa, Goran, Tama and some Arab tribes. Numerically they are also a minority in Chad. Because of these bloodthirsty crooks the country needs to go through decline. While neighboring countries mange to climb up the ranks of the Human Development Index Chad remains a happy bottom feeder.

How does the power dynamic work in this country. It is not that complex. The French with a mere 3000 troops in Chad have the final call here. If they so wish there can be regime change or peace. Somehow the current dictatorship is a good marionette of the French. The most recent example are the idiots of Arc de Zoe. They have been convicted to hard labor for 8 to 20 years in Chadian jail by the Chadian Criminal Court . They left after only a few days to without a doubt luxurious cells in France. I wonder if they or the larger political world in France realizes what these people have done to the image and reality of work for humanitarian aid workers in Chad.

The point is at all levels you will find corruption, criminality in Chad. But it is about looking forward seeing those individuals and groups that do want to make a difference in Chad. It cannot be the case that a bunch of war minded criminals rule this nation until the end of time. Even Kenya has had some clashes lately but there is hope always the hope and reassurance that Africa is far better off in many ways than only 20 years ago. Criminality will only pay off in the short term. Long term solutions require harmony and people with vision. I have not seen that many people carrying a gun with that vision.

Namaskar

Ashis

Africa Vision 30

Africa Vision 30

N’Djamena, December 30, 2007

Complacency

This afternoon I had the pleasure to talk for about two hours with police inspector Pop. He is about 6 foot one inch and is built like an ox with a matching deep laugh. He has been around the block and his work involves organized crime in Chad. He never leaves home without Magnum .375 and a bag full of bullets. As he was telling several years ago the street where I am living was off bounds even during daytime. It is the main street but there were so many robbers that even in clear daylight leaving your car was a risk. Over the last years they have managed to clear up a lot of the small criminality. But the big criminality often gets away. Certain people in Chad are beyond the law. They may serve several days for an armed robbery and then be released. After which they go after the policeman who had the nerve to arrest them.

He then went on to describe his experience with UN police work in Haiti involving drug trafficking. Two of the big police fish in Haiti were involved themselves in the business. Corruption to the core. Sounds like a familiar theme here.

Dressed in trainers and riding a low rider motorbike imported from the USA he rode of in to the sunlight off to catch hoodlums. A friendly giant who decided not to become a lawyer but a servant in the police force. It reminds me of the police force in the Netherlands. When I worked with them I realized that many officers have a deeply rooted sentiment to serve the people.

I was lured in to complacency today and actually over the last months, weeks and days. I have been slack on security and I guess it was my time to be slapped in the face with a wake up call. A taxi driver I knew asked me if I wanted a ride and I said nope I need some fresh air I would walk the 1-kilometer. And so I just strolled home at 04.00 in the morning from the VIP nightclub.
Two men came up to me. I felt instantly that it was not good. They asked for 100 CFA and in a flash I had taken the keys out of my purple lizard bag and started to run. One of them hung on to my leg and it felt like slapstick. I slammed the other guy in the face and wrestled myself free losing a shoe in process. But as I arrived near the gate of my house I saw a knife in one robber’s hand. For a moment I considered throwing my bag over the gate but logic finally prevailed and I just handed over the bag. As a parting gift the dacoits left me with a Zaghawa knife holder and a dented ego.

The lesson of the day was clear. It is never too late to turn around a series of bad decision. Walking at night, fighting back two robbers, trying to outrun them knowing the gate is closed. The best decisions were to accept the loss of my cherished bag plus the material possession there in and to cherish my life halting the need to be a silly hero. Dead heroes cannot write after all. No writing no fun. Writing this puts a smile on my face. Silly me, then again you live you learn. At least I try to.
My stubborn cocky ego needs to be flattened once in a while.
For all of you who worry about my health and well-being.

I PROMISS

No more strolls.
Taxis only.
Next robbery I will be a good boy and hand over my belongings straight away.

Perhaps the visit to the police bureau will lead to some comedia dell arte. We will see and I will report back on the process of reporting a theft in Chad. There was a reason I met the jolly police inspector today. I did not expect to need his help so fast.

I love being alive after a robbery with only a scratched arm and knee.

Peace to you all,

Ashis

Africa Vision 29

Africa Vision 29

N’Djamena, December 30, 2007

Two ophthalmologists.

In one morning I had the pleasure of talking with 67% of the eye doctors in Chad. The first is a lady doctor called Zeneba who has done her specialization in Senegal. I think I wrote about the fact that there are no specialist training programs for doctors in Chad. Any one who wants to specialize needs to go abroad. As a consequence many do and never return to Chad. The salary for doctors in almost all countries in Africa is better than in Chad. The starting salary is 260 dollars and as all have received a student scholarship of 40 dollars per month for the entire study (as well as free study) there is a requirement to remain working for the public service for at least 5 years. As the compensation the government has allowed doctors to open up private practice. This leads to for example the hospital in Doba to have no doctor after 12 in the morning .

Dr Zeneba however seems dedicated to do some good in Chad. She has started her own NGO working on preventable disease. In ophthalmology there are several preventable conditions. To name a few strabismus (squint eye), trachoma (inflammation of the inner eyelid leading to strictures, or scotch tape eyes and eventually blindness), and vitamin A deficiency (eventually leading to blindness as well). Besides that there are the common problems of cataract. With an intraocular lens that cost no more than 20 dollars a lot of good can be done. She has visited several refugee camps in the Eastern part of Chad and is looking for partners in the West to collaborate with.

It so good to get to know highly motivated young colleagues, not at all jaded going against the odds, swimming against the stream. Too often people take the secure path and in Chad that can also mean going outside of the country as more money is to be made there plus the advantage of countries that are not plunged into civil war.

Dr Djada is the dean of the medical faculty as well as an ophthalmologist. He is also the chair of an organization keen on doing operations in areas where there is never access to doctors let alone eye doctors.

In the afternoon a representative of ophthalmologists without borders came from Kouseri across the border to buy some inter ocular lenses at Faizal’s shop. They have 6 centers in Cameroon of which four are in the Northern part. It would be a nice idea to go and visit. Clearly there is just as much need in Chad in proper eye care. Given the massive amounts of ophthalmologists it remains to be seen if that will happen any time soon.

One of the member s of the greatest good Caesar is interested in troubles of the eye so perhaps I can hook up these individuals with each other. And then there was the ophthalmologist Tim I met in Detroit. Good to put people together and see the outcome.

A merry new year and most of all a healthy one to all of you….Ashis