Welcome

It’s Monday morning, about 10am. As I walk by, I hear chatting, laughing… there are women coming and going, some looking anxious, others exited, others calm, some carrying huge bundles of cloths and mats, many wearing swathes of material that cover them from head to toe. I enter the room, the activity is frantic; people pass to and fro in a blur, some are writing, others giving orders, questions are asked in one language before being translated into another before the response is translated back again, others sit quietly watching, waiting.

Just then, a door to my right opens, out walks an older lady proudly carrying a bundle from which a small fist protrudes punching the air, followed by a strong cry demanding attention. A young tired looking girl gingerly is led out by a vision of pink to a bed in the corner where other women who have been sitting, shift to make room. As the young girl collapses and is given a well-deserved coke to drink, the pink vision whisks her baby off to be weighed.

Welcome to the Maternity Unit of Guinebor II!

While Monday morning is a particularly busy time for the unit as this is one of the two days the antenatal clinic is held, November proved to be the busiest month yet. We welcomed 103 new little ones to the world, including twins and our first set of Triplets!

Unable to resist joining the fun, my friend Louise who is a community midwife in Bradford, came and spent 2 weeks working alongside the midwives. She delivered babies, took blood pressures, mopped, helped with the clinic, doing whatever she could, all with a smile on her face and a word of encouragement at the ready. 

At times some rather graphic acting was required to overcome the language barrier, which although was not always easy, did create a lot of amusement and Louise was able to form good relationships with the midwives, even managing to do some training in neonatal resuscitation.

As busy as November was for our Maternity Unit, it looks like a trend that is set to continue, but in all the activity, we look forward to welcoming more little ones to the world.

A crazy last hour or two of a busy day

Two babies: 1 born today 2 months premature and oxygen dependent. The other, 5 days old just out of the operating room following a formation of a colostomy and who suddenly stopped breathing. 

1 oxygen concentrator, 1 sats probe to measure their oxygen levels and an ambu bag. 

Queue what would have been a scene of comedy, if it hadn't of been so critical, of lining babies next to each other, equipment between them, giving each baby a turn and attention depending on which was the most serious at the time!

It was evident that we needed a way to give both babies oxygen. With a bit of creativity and a modified nasal cannula, I was able to construct something that worked well while the resuscitations continued.

Sometime later,  they were both looking pinker and stronger, and although the premature baby continues to need oxygen, they were both maintaining good oxygen levels.

Now to move them to a place where they can be cared for during the night.

Shifting patients around freed up a bed on the ward, a generator with fuel found, extension leads located and with precision planning of a military operation, one person grabbed the heavy oxygen concentrator, I and another nurse carried a baby each and then after a count of three, we were off. In record time, the babies were safe on a bed, receiving oxygen, having their oxygen levels checked.

By this time the day light was going, so we finished setting them up for the night wrapped up in hats, woolly jumpers, socks and blankets by torch light, both breathing well.

A Painful Beginning

I still have a very clear imagine in my mind of a picture I saw in a school text book years ago showing an old pencil drawing of somebody suffering a tetanic seizure. Their body contorted and the agony graphically etched on their face as every muscle in their body contracted horrified me. Having grown up with vaccinations being a routine part of life, I never expected to see anybody with Tetanus, naively imagining it was a disease resigned to school text books to scare children into getting their vaccinations.

With only a 58%[1] tetanus vaccination uptake, Chad is listed as one of the top 28 countries to contribute to the 110,000 deaths a year from neonatal tetanus[2].

Tetanus is an illness that results from spores entering the body through puncture wounds, or in the case of babies, commonly through cutting the umbilical cord with a dirty instrument. The resulting bacteria produce a neurotoxin which causes painful, and eventually life threatening, muscle spasms. Even with hospital care, the mortality rate of tetanus can be high as 60%.

Just over a month ago, a little baby girl, of 6 days old, was bought to the hospital experiencing full body spasms with even the slightest stimulation. It was incredibly distressing to see and her chance of survival looked slim. We treated her with a concoction of drugs, including incredibly high doses of muscle relaxants, minimal stimulation (no unnecessary touch and whispered ward rounds) and lots of prayer! A week on, though the spasms persisted, she began to turn a corner and we were able to place a feeding tube into her tummy so she could begin to receive her mother’s milk. A couple of weeks on from that, her spasms much reduced, she was feeding normally from her mother, tolerating being held and beginning to act more as a baby should. A further week on, discharging home was in sight.

Incredibly she went home last Wednesday. Praise God!

I was right to be horrified by the picture of a man in a tetanic seizure in my school book, but the reality is far worse. Tetanus is entirely preventable by a simple vaccination. My hope is that, one day, tetanus will also be something just confined to the school books of Chad.

Baby and Mum at the end of a painful beginning

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[1] WHO. 2008. Chad. Factsheet of Health Statistics.

[2] WHO. http://www.afro.who.int/en/clusters-a-programmes/mte/tetanus-elimination.html

Christmas Comes Early

Christmas has come early to the hospital this year.

A few weeks ago the hospital received two much anticipated and long awaited presents. But they were not made quietly in the dead of a frosty night by a man dressed in red, who arrived and left unnoticed. No, in contrast there was a great deal of curiosity at their arrivals and the accompanying entourage as they drew up to the gates of the hospital under the baking sun.

Two huge shipping containers, transported from America by ExxonMobil finally came to the end of their eventful and long journey. Having collated and packed the many generous donations, the containers sailed across the Atlantic to the shores of Cameroon, where they then embarked on a long journey by road to reach the borders of Chad many months later. Further long journeys by road were required to reach the capital city, on the outskirts of which is the hospital. Finally, we got the exciting news that, yes the containers were only 7km away!!!! Excitement and expectations rose, they were finally arriving. And then, no. The heavy rains that we saw over the months of July to August had left the roads impassable to such large vehicles and so further delays were necessary. So near yet so far! The anticipation was building.

A couple of weeks on, the rains had subsided and the roads had impressively quickly returned to sandy tracks and the arrival of the containers was once again expected any moment. It still however was a great surprise and joy to hear the roar of lorries and to look up and see an enormous crane type vehicle crossing the yard! This was then soon followed by the first container, having completed a 38 point turn in the road to get lined up for a run up to the hospital gate! With impressive speed given the size and weight of the vehicles and the comparative small space of the hospital, the first container was soon being lifted into the air and guided (extraordinarily, by hand of two guys pulling on a rope!) onto the its final resting place. 

One down, one to go. But it would seem the adventure and challenges were not quite over yet. The crane, in the bid to get out of the second lorry’s way, drove, and then promptly sank, into a patch of soft sand. While the unique ability of the vehicle to use its hydraulics to life itself out of the sand, thus allowing an ever increasing amount of wood, rubble and then whole branches of trees to be placed under the wheels, it only managed to dig itself deeper and deeper. An hour and half later, after much sweat, effort and frustration (on the men’s side, I provided water and took the photos!), it was eventually free. Twenty minutes later, the second container was in place and thirty minutes on, the lorries roared into the distance, crowds died out, the work of the hospital continued and our new containers were in place. They had finally, safely arrived!

After an Opening Ceremony, during which a governmental minister arrived to the resounding notes of the Alleluia chorus, speeches were made, a tour of the hospital given and then finished off with a mini feast of meat sandwiches and drinks (to the back drop of my drying underwear on the clothes line! Opps), the fun could start! Time to unwrap!!!

Stuffed full of generous and countless donations from people across America for the use of the hospital, from gauze compresses and drip stands,  to a new digital x ray machine, two generators, wheel chairs and theatre trolleys, unpacking them is proving to be a medical Christmas extravaganza!

The unwrapping begins

Life in the Desert

About 2 years ago, L’Hôpital de Guinebor II, was yet to be opened and looked like this:

Now, however, it looks like this:

The recent rains have transformed the desert, but as the hospital has opened up, it has also attracted businesses to capitalise on the captive audience, homes to be built and a little community is growing on a daily basis!

Of course, closer up, within the hospital, lives are also being changed (excuse the cheese!). This little boy is 6 days old in this picture and is just about to undergo major abdominal surgery.

Here, a month on, you can see that he is growing well and although there is still future surgeries ahead for him, he now has a future.

Moussa with his Mum

The Summer

From Administrators to Surgeons, Builders to Pastors, Students to Nurses, we have had a summer of many visitors coming and going through the great blue gates of L’Hôpital de Guinebor II, totalling 26! That’s a lot of trips to the airport, beds to make, mouths to feed and people to acclimatise to life and work here. But, it has also been good fun!

Many of the visiting doctors came to cover for Mark and Andrea who took a well-earned break and enjoyed a fantastic summer of sport in the UK. Not that I am jealous or anything! I managed to watch the last half of the Wimbledon final (having missed the first half thanks to getting stuck in the mud on the way into town, more on that later) and the brilliant Opening Ceremony, alongside others of varying nationalities. I felt proud!! We also managed to have a little sporting summer of our very own here, with the hospital staff playing football against the village. Not being a real football lover myself, I went along obligingly to offer my support to the hospital team. However, with the sight of the hospital team proudly wearing their new kits (footwear was optional and of varying styles!), watching the local children join in with their own version of encouragement (welcomed or not) and the most sophisticated referee I’ve ever seen, it was hard not to enjoy the game, despite the disappointing score.

The Hospital team and The Ref!

The baby a week after surgery

But back to our visitors. The doctors had a challenging summer of treating the vast number of patients, many suffering with severe malaria thanks to the high rain fall we have experienced this summer. The on-going strikes that hit the public services also had, and continue to, impact our patient numbers. The surgeons amongst them were busied with a long list of patients needing a variety of procedures, including prostate surgery, amputations and cleft lip surgery. And I also joined in the surgical fun, the most rewarding of which was assisting in the formation of a colostomy for a 6 day old baby.

Organising surgical instruments

The visiting nurses were real troopers as they took on the ominous task of cleaning, categorising and restocking cupboards on the wards, in the Operating Bloc and most impressively, two of the three shipping containers that serve as our stores. Entering these metal containers is no mean feat as they soon heat up under the Chadian sun and within hours closely resemble walk- in furnaces!! Although this does not sound particularly glamorous or exciting work, I am truly grateful for what they achieved in the week and a half they were here, as jobs like that we simply cannot do at the same time as the day to day running of the hospital and treating patients.

The builders amongst the team worked from dawn until dusk, erecting the roof on my soon to be home, or as I like to call it, my ‘Little Oasis’, and doing general maintenance around the hospital. Although it was yet another never ending list of tasks for them to do, and each time they saw one of us approaching them they ducked their head in fear of being given yet another job, they did everything with an enormous amount of joy and whistling!

Getting involved in the daily running of the hospital, taking regular administrative trips into town, assisting in the launch and initial weeks of a new triage system, encouraging others in their work, however each of these 26 visitors got involved this summer, they did so with energy, passion and enthusiasm which meant that the summer flew by in a whirl of activity and fun.

But (haha, you thought I had finished!), the visitors were not the only major feature of my summer. So too were the 3 cats and 4 unhouse trained kittens that I was left in charge of! And I feel, as a none cat person, that to say that at the end of the summer I had 7 cats to hand back over, all still alive and just about healthy, a major achievement!  

And the third, but by no means least major factor of the summer has been the rain. Chad has no rain at all for 7 months of the year and then over the course of the remaining 3 soggy months, 76% of the annual rainfall in Yorkshire descends.

Preparing to tow out the hospital ambulance stuck in the mud

This has meant that leaving the hospital and traversing what was just a few weeks ago sandy tracks into town, has now become a major test in guts and determination; puddles have now formed lakes, concealing large craters and the thick sticky mud risks you getting stuck. I have many a time now driven into puddles that have then flowed right over the bonnet and waved up the windscreen leaving me with a view, not of where the puddle ends, but just more of the puddle! And one of our visiting surgeons, after a long long flight here from America paid the ultimate price for my moments hesitation, when the 4 wheel drive Toyota got completely stuck in thick, stinky, insect ridden mud. I know the mud was like that because I saw it…. as I watched Jim descend bare footed, knee deep into it ready to push the vehicle out!!!!! Ooops, not my proudest moment… but then, it was also one of those moments when I didn’t mind pulling the “I’m a girl” card!!!! After much revving, rocking, pleading and praying, we got out and Jim clambered back in covered in the thick, stinky, insect ridden mud having thoroughly earned his long awaited shower and successfully passed The Chadian Initiative test! I feel though that I redeemed myself, when on the trip back to the airport (during which, can I please note, we did not get stuck) and I asked Jim what his highlight of his 3 weeks had been, he replied “Getting stuck in the mud”!

Food Glorious Food

Food is very much a part of daily life worldwide, and with any venture into a new country, the different cuisine is always a source of entertainment, surprise and sometimes, regret! Here the national dish I affectionately term as ‘Boule and Gruel’, is basically a solid white tasteless lump of paste with a slimy green sauce made of okra and containing either meat or fish. It’s more the consistency I struggle with rather than the taste.  Needless to say, I don’t cook this for myself.

However, in my first few weeks at working at the hospital, I was struck by the blessing I have of being able to choose what I do and do not eat. Malnutrition is a real issue in Chad affecting thousands of children and killing many. 

Chubby Cheeks!

On my first day working at L’Hôpital de Guinebor II, a little 18 month old boy with severe malnutrition, weighing at just over 4kg was bought by his mother. He was skin and bone and looked terrible. The chances of him living looked slim. However, after just two weeks of treatment and being fed enriched milk, he piled on the pounds and looked like a different boy; he had a fuller face, he smiled to those around him and even, occasionally, when he was feeling particularly brave, he would wave at me! He was discharged at the end of his third week over 2 kg heavier and has been returning each week for follow up checks and a refill of enriched milk, each time looking plumper.

My first few weeks at the hospital have been busy, tiring, frustrating, exciting, overwhelming and many other emotions, but throughout it, it has been the contact with patients and especially the little children such as this boy and another little one who has had surgery to release scarring tissue from around his neck following a severe burn, that has made my time here so far so enjoyable and fulfilling.

My little friend

At Long Last, the day is here

 Two years ago this month, I was accepted by BMS World Mission to work with them at L’Hôpital de Guinebor II, in Chad. Tomorrow, Monday 21^st May 2012, I start!!!

Some of the friends I've
made along the way

Following two years of pre- overseas service training in Birmingham, a Diploma in Tropical Nursing in Liverpool, an intensive summer French course in Paris and then 8 months of French lessons, as well as lessons in life in the culture and climate of Chad, the day has FINALLY come- I am joining the team at the hospital! While the last 2 years have been ones of preparation, unpacking and repacking, frustrations, excitement and dreaming of what it might be like, tomorrow marks the end of the waiting and the beginning of a new, much anticipated adventure.

Thank you to all of you for your support and encouragement over the past two years and I look forward to sharing with you all that lies ahead… whatever that may be….!  

Some of the nurses I'll be working with
(looking glamorous at a party)

Some patients of the hospital

Holiday under the Chadian Sun

Last week I had the immense pleasure and joy of welcoming my Mum to sunny and increasingly hot Chad. Before coming here, I spent much time trying to convince people that Chad really is the next up and coming tourist attraction so they should really come here to visit. I suppose my Mum is biased as she’s the only one that has fallen for it and arrived with two suitcases stuffed full of goodies and letters!

Having shown her all the top tourist attractions in the city (the main square, the impressive selection of roundabouts, the hospital, my neighbourhood, friends and very excitingly, the newest ‘supermarket’ and patisserie), we headed off to a little hotel not far out of the city for the night. The next morning (after an eventful night of broken air con and scorpions!), we went in search of Elephant Rock,

The track to Elephant Rock

which does what it says on the tin-it’s a rock that looks awfully like an 

elephant! We drove there “en brousse” (through the bush) along a track which quickly descended to a path, and then to an indistinguishable, rough direction towards another bit of space, occasionally interrupted by a camel caravan. This proved to be, as well as being extremely fun (I had the Top Gear theme tune running through my head much of the time!), afforded us with some beautiful sights of Chadian village life; women in bright red scarfs riding donkeys laden with fire wood, women gathered around the scarce wells drawing water, chatting away and children playing in the sand on the outskirts of the occasional village made up of groups of round mud and straw huts.  

Then suddenly, from the seemingly endless flat, a group of rocky looking elephants emerged! I climbed up with my self- appointed guide, a little girl from the nearby village, and took in the view of infinite sand. We learnt after that boats on Lac Chad used to be tied to the elephants trunk. It would be another 45 minute drive by tarmacked road to reach the shores now.

Following all that intense physical activity, the only thing left to do was to spend the rest of the week by a pool, catching up, relaxing and jumping into the cool water to escape the 47C heat. We had a wonderful time together and I can’t thank my Mum enough for her love, support and encouragement.

International Women’s Day.

Le 8 mars… there was an ever increasing rumble of expectation and excitement as the day approached. After many discussions as to what the official material would look like, it suddenly burst onto the scene in vivid pink, yellow, green or blue, complete with flowery statements on the worth and role of women in ‘rebirth’ and ‘progression’. Then followed the flurry of activity as the tailors of N’Djamena rustled up an extraordinary variety of designs. And suddenly, it was upon us. In all its vibrancy and celebration, International Women’s Day had come to Chad and La Place de la Nation, the impressive centre of the city, was to be the location for a grand parade, of which the workers of Hopital de Guinebor II were to be a part.

While this photo (left) would win no prize for artistic skill, I enjoy it because it sums up for me the whole spirit of the day. First and foremost, some of the astonishing fashion statements that were being made; never before have I seen a lady wear, with such pride (or without come to think of it), a head scarf, plus a baseball cap, finished off with a pair of diamanté encrusted sunglasses! The tailors of N’Djamena did themselves proud; in the throng of thousands of women, I did not see 2 identical styles.

The second reason I like this photo is the women in the background. You can’t tell, but they are surrounding a car full of men and refusing to let them through. Amongst good nature cheers and only semi- serious arguments, the car was surrounded and held hostage for a good 10 minutes as it tried to cross the road packed with empowered women, ready to march.

These intrepid men were not the only minority that found themselves in the marching mass. For as we approached the dignitaries, flanked by brass bands, journalists and thousands of spectators, while being directed with curt whistles and the barked orders of 2 officials, whose aim was to install such fear in us that we would not dare to let the presence of long flappy skirts and flip flops inhibit our marching, I looked up and saw a cow too had joined the parade. Draped in the official material, of course!

The day was rounded up over a feast of fish, potatoes, dancing and singing. Amongst all the sights, sounds, activities and antics of the day, it was great to be a part of such a celebration as this with my future colleagues in Chad.

A Little Road Trip

Last Friday, I excitedly set off for my first weekend away from N’Djamena since I arrived in September, to a ‘resort’ for a retreat about 1 hour away. The direction to which were as follow: Go North out of the city, take the left road opposite the Castel Beer sign and then the next left. The chances for getting lost were minimal, what could possibly go wrong?!

With a car load of fellow Nasara’s, 5 hours later we arrived! My car was obviously also very much looking forward to a decent run out of town and in its excitement totally froze- that’s right, the rear wheels decided to stop turning while driving at 60mph! Not good. Thank God there was no one on the road at that precise moment or else the results could have been very different. But I managed to keep the car on the road and we came to a grinding metal, burning rubber filled stop, diagonally right across the middle of the road. The road then refilled with its usual traffic and we were soon surrounded by lots of animated Arabic chatter as various passer-by’s stopped to provide their opinion on what went wrong and after lots of shoving and banging of hammers to release whatever had frozen we were pushed off the road.

Amazingly, in the midst of the chaos I looked up to see the familiar face of my neighbour’s taxi man and he took control of the situation, phoning for the Fifth Emergency Service- i.e. The hospital’s driver and a mechanic. As we waited for our ‘knight in a not so shiny white, not running very well Nissan’, we watched the sun near the horizon, while dreaming of the swimming pool that awaited us and enjoyed the kindness of the chief from a nearby village, who had taken his wife to our hospital just the month before!

When Dogo the hospital drive turned up I could have kissed him! Instead I did a little dance- he laughed as he is used to me, the mechanic however looked slightly scared!!

As the sun set my car was driven away (still grinding and not smelling very healthy) and we were fetched by some other friends for the weekend’s retreat, during which I reflected how well protected and looked after we had all been!

You have to worry when your 'rescue' car looks in as bad shape as the one it's rescuing!

Camels and Christmas... (better late than never!)

From Taxis to another form of Chadian transport… camels! What better way to pass a warm Christmas eve than bouncing along on the back of a camel enjoying the sights of the Chari river from our little trek across N’Djamena’s golf course. Yep, you heard right, camel riding across a golf course! The green was, well not green, and though the welcome sign warned us that golfers took priority, there weren’t many of those either. And so I, along with the Hotchkin family, passed a pleasant hour or so bobbing along, occasionally breaking out into the compulsory “We 3 Kings ..”.

Decorating a twig with tinsel, giving and receiving presents, singing carols and cheesy Christmas songs (I’m dreaming of a white Christmas being a particular favourite), watching the Snow Man and eating roast chicken complete with all the trimmings- stuffing, gravy and even (tinned) Brussel sprouts (which were truly disgusting!) meant that Christmas was passed in a similar, if not warmer way, “just like the ones I used to know”!

However, one of my favourite parts of the day was handing out presents to the children who were inpatients at the hospital over Christmas- the delight and awe that shone from their faces when they realised they could keep the little toy was so humbling and a real pleasure to behold. Of course, there were also the little ones who were just down right terrified of the Nasaras (White People) coming  towards them that no amount of present giving could diminish their screams!

It was a great way to follow up the Oscar winning performance from the hospital staff who, as angels in white lab coats and shepherds in Arab dress, recreated The Nativity, Chadian style, for the inpatients, relatives and villagers of Guinebor. Meanwhile, just behind the action of the birth of Jesus was action of a similar kind; a baby was born!