Lights, Camera, Action!

Lights:

Giving out medications, assessing a child bought into the Emergency Room, delivering a baby. Just some of the everyday tasks that are performed at the hospital which in themselves are routine, yet when performed at night, in the dark, can prove to be near impossible and potentially hazardous.

Two huge, gas guzzling monsters of generators had to be switched on as absolute need dictated, but torches and lamps were used when possible. This was hardly an economical or efficient system, but it was what we had and we used it the best we could.

However, one thing that Chad does not lack is sunshine. And so we are in the process of harbouring its power to bring light the hospital 24:7. We are going solar!

So far we have solar in the Emergency Room, the Maternity Unit, the laboratory and the administration offices. This week has seen the wiring being installed in the four wards and this will be connected up to the batteries and the solar panels by the end of the week.

The staff and patients of the hospital are seeing the light!

Camera:

In other news, our long awaited and much anticipated x-ray machine has finally been installed in our brand new Radiography Unit.

Ousman, Moussa and Victorian have been trained up in taking good images and the necessary safety measures. Since the installation of the machine about 4 weeks ago, the three have been busy snapping away enabling the diagnosis of several lung infections, broken limbs and the worse pelvic fracture any of the ex-pat doctors here have ever seen.

Ousman prepares for a morning of taking x-rays

The machine is not only enabling quick diagnosis of problems and being a source of income for the hospital, but it is also saving, at times very sick, patients travelling 5 km into town for their required x-ray.

Action:

Each and every day here continues to bring new challenges, breakthroughs, surprises as well as the mundane. The past few weeks have seen us treat and care for, amongst many others, several cases of severe cerebral malaria, temporary paralysis from various causes, amputations, skin complaints, babies born, some by caesarean section,  fractures, routine hernia repairs, rheumatic fever, complex chronic wounds, cleft lip repairs, many mysterious illness and the one closest to my heart, children with malnutrition. And this is just a small selection of patients in the in- patient service.

The laboratory continues to churn out result after result for the many patients requiring a whole host of tests, the pharmacy has dispensed many drugs and the outpatient clinics are frequently overrun with many seeking help, while those in administration and other supporting roles have worked tirelessly to enable the hospital to continue to function.

Manga working in the lab

Patients waiting for their appointments

Activity, as always, ebbs and flows, but overall seems to do much more flowing than ebbing!

With this in mind, plus the fact that hot season is making its presence known, I’m very much looking forward to a short escape from the activity and my upcoming 2 weeks retreat and holiday in South Africa!

Every two hours this little baby required syringe feeds. She is now home growing well!

Faces Behind the Numbers

Before coming to Chad, in a bid to prepare myself, I read lists and lists of statistics. I read of poor literacy levels, high maternal and under 5's mortality rates, as well as just how high the temperatures could get. Of course, statistics can only tell some of the story and over the past 18 months, I have met just some of the people who are the human faces of these, at times, incomprehensible numbers.

According to WHO (2010), 15% of children in Chad are affected by severe malnutrition, a shocking statistic. But, as I meet just a few of these children, the enormity and tragedy of the problem continues to hit me. Let me introduce you to some of them.

Moussa was admitted to the hospital with skeletal features, too weak to cry. The outlook for him looked bleak and he was at great risk of becoming one of these statistics. He was immediately started on our programme of intensive re- feeding and treatment. I was surprised and overjoyed to see in the following weeks his little body strengthen and eventually he was discharged home with free enriched porridge, plumper and happier.

Ajit was three years old, admitted desperately thin and weak. He was even too weak to drink his milk, so we gave it via a feeding tube. After some time, despite our best efforts he continued to weaken. As a team, having done all we could, we prayed and waited. Amazingly, the next day when I went to check on his progress, he looked stronger and more alert than he had done for days. This however, made it even more upsetting when the next day I went to check on his progress over night to discover that hours earlier, he had died.

This was one of my lowest moments last year. I was devastated. The statistics were no longer dry numbers on a page, they were becoming alive to me and it was painful.

The causes and influences of malnutrition are extremely complex and cannot be solved by one single action. However, one of BMS World Mission's latest relief grants is committed to preventing further needless deaths and has raised an incredible £36,000! See www.bmsworldmission.org

This year, I will be working alongside Chadian nurses in using this money to provide a comprehensive hunger prevention programme. The programme, as well as continuing to provide inpatient re-feeding and free enriched porridge, will facilitate early identification and intervention for malnourished children. A Malnutrition Clinic will offer support and education, including cooking lessons for the mothers, while their children's progress will be recorded regularly  Blank walls will be decorated with health promoting messages and we hope to shortly offer vaccines.

At this time of year the number of children coming to us with malnutrition is small, but we are making the most of this time preparing for the increased numbers that the upcoming dry, hot months will bring. It is my hope that this year, with early intervention, the number of children dying with acute severe malnutrition here in Chad will be reduced, even if it is just by a few.

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