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