Monday, 12 November 2018

Return to Guinebor: dust, patients and ‘cold’ season

Greetings from Guinebor!  I arrived safely back on the evening of 2nd November, with, surprisingly, both my suitcases on the same plane as me.  I was astounded but grateful!  As I shuffled along the plane aisle towards to exit, I took off my hoody and my cardigan, leaving just a t-shirt.  I was preparing myself physically and mentally for the wall of heat to hit me as I left the plane to go down the steps to the bus.  I was surprised to feel nothing but a bit of warm air around me.  Hooray, cold season had arrived!  This girl, fresh from almost-freezing Britain, was relieved.  It was ‘only’ 30C at the time we landed (9.30pm). 

I hadn’t even left the airport building before a Chadian porter, helping me with my luggage, had exclaimed his surprise and disapproval at the fact that I wasn’t yet married and had no children.  Nothing like a swift welcome back to the culture…….

The rains have long since finished and already all the green I left behind in August has disappeared.  The hospital lawnmower has been packed away for another year.  The dust has returned.  The last rains were late October and it won’t rain again now until next May/June. 

I joined the ward round with the Chadian doctor on Thursday morning.  That was a shock, as it hit me once again what the Chadian people go through that would almost never happen in the UK.  Malnourished children.  A possible attempted murder of a teenager with a poisoned drink.  Psychosis triggered by a night-time household burglary.  Just three of the 40-plus inpatients in our hospital that morning. 

Women's ward at Guinebor Hospital

Another patient was a young girl of 17, in the bed at the top left of the photo above.  She and her father had been travelling in the back of a vehicle (probably a hilux) with their legs hanging out over the side of the vehicle.  We see this so often here, as people make the most of any form of transportation to get them from A to B.  Unfortunately, on this occasion their vehicle was hit by another and the legs of the girl and her father were crushed.  They both underwent surgery at Guinebor.  One of the father’s legs was so smashed up it had to be amputated.  The other was fixed.  The girl had her broken leg fixed too.  Sadly, the father had post-operative complications and passed away :(

The lady in the next bed looked a lot older than her family said she was.  According to them she is 48, but she looked nearer 60.  To prove how old she is, they told us that her oldest child is 23.  Given that most women have children young here, that’s considered enough proof of a lady's age.  This lady was stick-thin, vomiting and couldn’t get much food or drink down, so was also dehydrated.  On symptoms alone, the Chadian doctors had diagnosed some sort of oesophageal or gastric tumour.  She may possibly be able to have a camera down her throat (at a clinic in N’Djamena) to see if that diagnosis is correct.  But she’s not well enough to tolerate it at the moment and can the family even afford to have it done?  To be honest, it would only be to have a more definitive diagnosis.  There’s no cancer treatment here in Chad so whether it’s confirmed as a tumour or not, treatment will remain the same: treat symptoms, ensure hydration and keep the patient as comfortable as possible.

These are just a few of the hundreds of patients that Guinebor Hospital will treat this month, doing the best we can for the Chadian people with the resources we have available.  The fact that patients keep coming to us is hopefully a sign that we’re considered reputable and that we treat people with dignity and respect.  Something that anyone can do, even with minimal resources.

Monday, 29 October 2018

Heading back to the desert

After having spent a lovely two months in the UK, my thoughts are now turning to returning to Chad on Friday 2nd November.  I am looking forward to getting back to my 'normal', despite that not actually being too 'normal' for a girl from Devon!  

It's been great to see parts of the UK I've never been to before, while doing my home assignment Church visits and talking about the work of Guinebor II Hospital.  Thank you so much to the Churches, groups and individuals who have welcomed me, given me a meal and/or a bed for the night, and overwhelmingly told me of your ongoing support of both me and the hospital.  It's been great to meet so many people who are interested in the work of the hospital.

It's also been great to see family and friends while I've been here, as well as experiencing my first autumn for three years.  I really miss the changing seasons and it's been good to see the beauty of the leaves changing colour:

So, as the weather here in the UK is getting increasingly colder, I am now preparing both practically and mentally for returning to the heat and dust of Chad.  As of next January, I will have been in Chad as a long-term mission worker for 3 years.  The culture shock has largely worn off but I read a really good article recently that a friend shared on Facebook about culture stress.  It's a slightly different phenomenon than culture shock and is constantly part of my life.  If you'd like to read this short article on culture stress and learn another angle of my life in Chad, click here

Thanks for following my life and work in Chad.  My next blog will be sent from Chad, so keep an eye out for it!

Friday, 7 September 2018

A change of scene

The air is relatively dust-free.  There's very little mud on the ground.  I am wearing multiple layers of clothing.  I am eating exciting things like bacon, cheese and berries. This can only mean one thing:  I am no longer in Chad!  

I landed back in the UK a little under two weeks ago to start a two-month period of home assignment.  I am enjoying not sweating and catching up with friends and family who I've not seen in over a year.  Tomorrow I start my home assignment Church visits.  Below is a list of all my speaking engagements over the next two months, should you wish to hear more about the work of Guinebor II Hospital from me in person.

Saturday 8th September, 7pm, Upton Vale Baptist Church, Torquay

Saturday 15th September, 10am, Ampthill Baptist Church, nr Bedford

Sunday 16th September, 10.15am, Union Baptist Church, High Wycombe

Sunday 23rd September, 10.30am, Prince's Drive Baptist Church, Colwyn Bay

Tuesday 25th September, 7pm, Griffithstown Baptist Church, nr Cwmbran

Thursday 27th September, 7.30pm, South Molton Baptist Church, North Devon

Sunday 30th September, 10.30am, Mansfield Baptist Church

Sunday 7th October, 10.30am, Brighton Road Baptist Church, Horsham

Saturday 13th October, 9.30am, BMS cafe event at Bethesda Baptist Church, Rogerstone, Newport (click here for more information about this event)

Sunday 14th October, 6.30pm, Barnstaple Baptist Church

I look forward to seeing you!

Wednesday, 22 August 2018

The day sixty military and two government ministers came to Guinebor II Hospital

Last weekend started out like any other.  I relaxed at home on Saturday morning after a busy week at the hospital.  Then I went to a friend’s house to have lunch and watch a film.  Lunch included some bacon that I’d stored in my freezer since February.  Yes, you read that right!  Bacon isn’t available here, so I’d squirreled it away when my Mum and Dad brought it out when they visited in February!  I returned to my house on the hospital site around 6pm before it got dark.

I was just thinking about what I was going to eat that evening and how I was going to continue my relaxed weekend, when my phone rang.  It was Allain, our hospital administrator. 

‘Claire, I just received a phone call from the (network cut out and I didn’t hear title of person) at the ministry of health.  (Network cut out) is coming to the hospital tomorrow at (network cut out)’

I go next door to my Cameroonian colleague Kalbassou’s house and together we call Allain back.  Turns out an inspector at the ministry of health had called Allain, at 7.30pm on a Saturday evening, to say that the first lady of Chad was going to visit the hospital at 7am tomorrow (yes, Sunday!) morning.  It was all part of ‘citizenship week’ that ran from 13 – 19 August here in Chad.

We ask Allain to ensure he’s at the hospital before 7am the following morning and then go up to the hospital to make sure things are as clean and tidy as possible.  We all knew *something* was going to happen on Sunday morning, but we weren’t totally sure what.  Or exactly when.  Or even if the first lady *really was* going to turn up.

Sunday arrives and I must admit, I had to drag myself out of bed to go up to the hospital for 7am.  Allain, Kalbassou and I continue cleaning.  I’m looking slightly overdressed for the task, having decided to already wear my ‘special clothes’.  Kalbassou, being more culturally aware than I’ll ever be, knew that nothing would actually happen at 7am and turned up in house clothes to do the cleaning and then went home and got changed!  As the first lady was supposedly visiting, I decided to wear my ‘women’s day 2018’ outfit.  It was nice to wear it to a special occasion, because I was ill on women’s day itself (8th March) and didn’t get to wear it then.  I thought it would look good to wear this as I heard that the first lady helps design the women’s day fabric each year.  I may be wrong on that.  But hey, I thought it would show female solidarity with the first lady, in a male-dominated society.

8am arrives and Allain comes looking for Kalbassou and I who’ve returned to our homes, somewhat dubious as to whether anything was actually going to happen.  ‘Come, quick, the military have arrived’ he says.  Kalbassou, in his freshly pressed smart outfit, emerges from his house as I pass by and the three of us go to greet the military.  There were *loads* of them.  We shake hands with the more senior looking ones and they tell us that, as part of citizenship week, they’ve come to ‘clean the hospital’.  What they actually meant by this was that they wanted to pull up all the grass and anything else green they could see.  Because, according to them, it’s not good to have grass around the hospital as it attracts mosquitoes.  We white people quite like the grass to be honest, as it’s only here for 3-4 months in rainy season and then it dies and the ground is brown again.  I thought it was a bit ironic though, that 30 minutes after the army general told us it wasn’t good for the hospital to have grass as it attracts mosquitoes, about 10 soldiers are discreetly smoking cigarettes……

Some of the military vehicles outside the hospital

There must’ve been at least 60 military in the hospital grounds, armed with shovels, wheelbarrows and rakes.  They set to work ‘cleaning’ the hospital and making it look tidy and brown again.  At this point, I must interject and tell you that our hospital groundsmen mow the grass that appears in rainy season and generally attempt to keep the place looking tidy.  It’s not like the grass was 6 feet tall and looking a mess!

The soldiers starting work

More soldiers starting work

After finishing the first part of the work they did

Selfie with military in the background.
Decided there's unlikely ever to be another time when I can
take this kind of picture without having a gun
pointed at me or my phone confiscated!

Allain is told by one of the generals that he’s waiting on a call and maybe the first lady *and* president are coming.  I’m thinking that that’s a bit far-fetched but, this is Chad, anything can happen.

After the military have ‘cleaned’ the main area in the hospital, they decide it’s time to plant a commemorative neem tree.  Where should they put it?  All eyes are on me.  I remember that we had to uproot a small dead tree next to the men’s ward a month or so ago and so decide we can plant the new tree there.  They all want the nasara (white person) in the photo of the planting of the commemorative neem tree, so I oblige, under some duress, to show willing.

Planting the neem tree (photo taken after I'd already
posed near it, pretending to help plant it)

Selfie with Allain (left) and Kalbassou (middle) while
the soldiers took a break

After a snack and water break, the generals then get wind of the fact that we have a caregiver village and so decide they want to go and ‘clean’ out there too.  To be honest, this was actually a great thing they did because the grass does get a bit unruly out there.  The military get started and around 11am the call comes in to one of the generals.  The minister of health and minister of defence are on their way (so no sign of the president or first lady, after all).  The military continue to work hard clearing the grass and weeds, watched by some bemused caregivers, who are there preparing food for their family members who are inpatients at the hospital.  Thirty minutes later the call comes in that the ministers are two minutes away.  The generals, Allain, Kalbassou and I all go to meet them at the main hospital gates.

Ministers' convoy arriving

We shake hands and are introduced to the two ministers.  The generals then give a whistle-stop tour, literally, of the hospital.  None of us who work there are actually asked anything about the hospital and the generals just lead the ministers around the buildings, showing off all the brown they’ve created, the rest of us trying to keep up. 

Start of the whistle-stop tour with the Minister of Health
(in the middle with white t-shirt) and the Minister of Defence
(almost out of shot on the left next to Kalbassou)

We arrive out in the caregiver village.  The rest of the military are still there finishing off.  The generals and ministers punch the air in solitude with the soldiers and as a way of demonstrating their appreciation.  The ministers are then photographed wheeling a wheelbarrow of pulled-up weeds, which they promptly empty outside the hospital gates, in a puddle, to try and ‘dry it up’.

Minster of Health helping with the tidy-up

We then pose for a photo with the ministers before they drive off again, no more than 15 minutes after arriving.

Allain, Kalbassou and I with the
Minister of Health (in white t-shirt next to me)
and the Minister of Defence (next to Minister of Health)

The military, who by now have been at the hospital for four hours, are still going for it and are in good spirits.  After another thirty minutes they decide they’ve thoroughly ‘cleaned’ the hospital and are ready to take off.  Not before, however, we pose for yet more photos.  Then a small group of military form a circle around yours truly and ask for a speech.  One of them is pointing a mobile phone in my face, ready to film.  I look at Kalbassou, who knows I’ll be slightly panicking inside (I was a tiny bit, but not as much as I would have been when I first arrived in Chad 2.5 years ago.  I guess I’m learning to expect the unexpected).  He tells me to just say thank you and that we’re grateful that they came.  I did just that, even saying some words in Arabic (it didn’t seem to impress them though).  The military all seemed happy with my short speech.  As we waited for them to load up in the back of their Toyota pick-ups, I quietly asked Allain if what I’d said was ok.  ‘It was ok’, he said, ‘but a bit short’.  Thanks for the encouragement Allain!  I say to him that I’m not great at giving impromptu speeches.  He told me that I need to always be ready to give a speech.  Great.  I’ll bear that in mind for the next time……

We stand at the hospital gates and cheer and wave the military off as they drive away, swerving around the puddles of water that are a feature of the roads here right now.

A crazy but kind-of fun morning.  In all honesty, overall, it was a privilege to have the Chadian military and government officials here at the hospital.

Wednesday, 25 July 2018

An update on my random life

Yesterday was a great day!  Why?  You may recall from my blog entry last month (click here to read it) that we had a visiting maxillofacial surgeon with us for a short while.  During his clinic on the Saturday, we saw a baby girl (we’ll called her Ache, not her real name) with a haemangioma on her face that covered her left eye and a lot of her left cheek.  Here’s how Ache looked when we first saw her:

Ache - 23rd June 2018

Well yesterday, her parents came back in for follow up.  It was a bit of a fluke (or was it?) that I bumped into them while they were here, because I’m often not in the consultation clinic and don’t see patients.  However we crossed paths as they were leaving the hospital and they came to show me the baby’s face.  The simple treatment of propranolol is working!  It was so great to see how much the haemangioma has reduced already in just one month.  There’s still a lot of time and medication required until it disappears completely.  But the parents are overjoyed.  The mother, a beautiful young Arab girl dressed in colourful clothes, bracelets and necklace, was beaming.  The father, an older Arab man, couldn’t stop saying ‘shukran’ (thank you).  With my limited Arabic I couldn’t really converse with them, apart from replying ‘afwan’ (you’re welcome) and ‘da adil’ (that’s great).  The gratitude was evident despite us not exchanging many words.  It was a humbling experience to know that a simple treatment such as propranolol was making such a difference to this young girl’s life.  The father gave me the rest of the tablets he bought last time and I cut more up for them to take home and continue the treatment for another couple of months.  We urged them to come back and let us know how Ache is getting on.  As I’ll be on home assignment when they come back, I handed over the propranolol dosing and tablet-cutting to my Chadian pharmacist colleague and introduced him to the family.  This will mean they can get more tablets cut up when they return for follow-up.  Because the tablets are 40mg and the child only requires 1/8th of a tablet per day at the moment, the box of 50 tablets which the father bought on their first visit is lasting a long time.  Bargain treatment, as the whole box of 50 tablets cost around £3!

Ache - 24th July 2018

Carrying on with my update of my last blog, I’m sure you’re all riveted as to what happened in the end with the pit latrines!!  Well, all the bottles and nappies got removed (by hand using shovels) and buried.  A local septic-tank-emptying company came and emptied the pit.  Alphonse our hospital handyman, along with two guys to help him, re-laid the floors in each of the 3 latrines and put a thin metal bar across the hole down into the long-drop to try and stop people pushing bottles and nappies down there.  We can but hope…..

Oh, and I managed to curb the enthusiasm of the physio and we just ordered 30 pairs of crutches rather than the 95 pairs he wanted!  They’ve been made and delivered to the hospital ready to help with the rehab of our orthopaedic patients.

Thursday, 28 June 2018

A random blog that attempts to reflect my random life

It’s often hard to explain what I ‘do’ here at Guinebor II Hospital.  My role has changed a lot since I arrived and I’m not just responsible for the pharmacy.  I have a myriad of other roles too, that are required in order to keep the place functioning.  My American colleagues are currently on a break in the States and so a bit more than normal falls to me right now.

Here’s an example of a typical hour and a half for me, all this happened to me this morning:

6.45am – staff prayer/devotion time.

7am – I’d already planned to speak with Michaela, a recently arrived short-termer, working part time at the hospital with her husband.  I asked Michaela if she could give me 15 minutes to catch up with Kalbassou, acting hospital director, before his busy day starts.

7.15am – Patrice, triage technician, comes up to me while I’m talking with Kalbassou, to say a patient has arrived who has been sent for an outpatient consultation with Kalbassou by a mission worker from another organisation in N’Djamena.  I’d already been informed that this patient was coming this morning.  I was to pay all his fees and the mission worker in town would reimburse me.  I go and find the patient and sort out paying his consultation fees.  I apologise to Michaela who, fortunately, is very easy going and goes off to do another task.

7.30am – While helping the patient through the triage/payment process in the outpatient area, I notice the pharmacy isn’t yet open.  I spot the staff member due to start work at 7am.  I ask why she’s late.

7.45am – I go to find Michaela.  Alphonse, our hospital-employed handyman, stops me on my way.  We’re having serious problems with the pit latrines that the patients use (I won’t go into too many details!).  Many patients shove empty plastic bottles and nappies down the hole into the pit, rather than putting them in the bins provided, and the pit is now full of all of this stuff.  Meaning that the general level in the pit is high.  This is causing problems with the plumbing in another area of the hospital.  All the bottles and nappies need removing from the pit.  Alphonse has found someone who is willing to do this job.  We have to pay him well to do it, which is fair enough.  I chat with Alphonse about the price, and we both go and tell Allain, our administrator, what’s going on with the pit latrines.

8am – I go to find Michaela again.  I spot her and we start walking to a quiet area to chat.  I’m stopped on the way by Matthieu, one of our physio’s.  He says we’re running out of the locally-made wooden crutches and please could he order 95 pairs?!  I suggest that 95 pairs is a bit excessive and where would we store them all?  After ten minutes of discussion about the cost of making the crutches, how much we ask patients to pay for them, how much the patient gets reimbursed if they bring them back in a useable state once they’re done with them, and how many pairs we actually do need to order at the moment, he agrees to go away and think about how many pairs we actually need to order of which size.

8.20am – Michaela and I finally get chance to chat and catch up about hospitality for the three sets of short-termers arriving sequentially in July and August!

And now for something that’s actually pharmacy related.  Warning:  don’t scroll down any further if you’re squeamish.

This week we’ve had a visit from a maxillofacial surgeon from the USA.  He’s been to Chad multiple times before.  He did an outpatient clinic on Saturday morning and I went to sit in on it.  Not thinking that I’d need to use my pharmacy skills.
A couple bring in their 3 month old girl who has a growth on her face, right around her left eye and on her cheek.  This couple has travelled from the Lake Chad region to seek treatment for their baby.  That’s a long way, on terrible roads that aren’t really roads (Google a map of Chad if you’re interested!).

The surgeon knew straight away that this was a haemangioma and that it’s not treated by surgery but by a drug.  Cue some searching to find the drug and dose – propranolol 1mg/kg/day.  Here’s where I came in, everyone was looking at me!  Propranolol is available in Chad but unfortunately we didn’t have any (a long story I won’t go into).  So the baby was given a prescription and the father was asked to go and find it in a pharmacy in town.  We see some other patients and little over an hour later the father is back.  Good news: he’s found and bought propranolol.  Bad news: it’s 40mg tablets.  Pharmacy and medical people among you are probably wondering ‘why didn’t they prescribe a liquid?’  We can’t get propranolol in anything other than 40mg tablets here in Chad.  The surgeon and some others were now turning the sorting of this out over to me.  Patient weighs 4kg.  So she needs 4mg per day.  We decide two divided doses will be fine.  Ok, so those who are quick with maths will be thinking – chop the tablets into 10!  Yes!  However they are round and about 1cm in diameter.  Fortunately in the pharmacy we have a pill splitter that I brought back from the UK.  Also fortunately, the tablets were scored into four parts.  I decide (with agreement from the surgeon) that I’ll chop the tablets into 8.  So that the child gets 5mg per day if they take one piece per day, half of it in the morning and half of it in the evening.  I reasoned that by the time the Mum has ground the tiny shard of tablet down to get it into the baby, some will go astray anyway and the baby wouldn’t actually get 5mg per day.  They are due back for follow up in a month.  Hopefully they’ll come back.  This kind of ‘thinking out of the box’ and ‘making the best of the situation in hand’ is typical of my life here in Chad.  Trying to help people with the little resources available to them and us.

Wednesday, 23 May 2018

Celebrate good times!

As most of you know, I am a pharmacist and part of my role here at Guinebor II Hospital is to oversee the pharmacy.  I work most closely with a Chadian pharmacist called Audrey.   Audrey (pronounced Aud-ray) is actually a guy and not a girl…..I know, confusing, ask me about my ‘funny story’ about that from when I interviewed him for his job back when I was here short term in 2013.  Audrey is great.  We get on really well and I can basically leave the everyday running of the pharmacy to him.  Alongside Audrey, there are three other members of the team: Elisabeth who is the ‘mama’ of the pharmacy, Cleopas and Missi.  These three are pharmacy assistants and have worked at the hospital for many years, they were all here when I was here short-term in 2013/14.  Missi is a fairly recent addition to the pharmacy though, having been redeployed from elsewhere in the hospital when we needed an extra staff member.  She was trained mainly by Audrey and the others.  These four are effectively my 'Chadian family' in a lot of ways.  We get on well, work well together and often eat together on the floor of the pharmacy at lunchtime (off a tray, not the floor!).  We know a lot of what’s going on in each other’s families.

It was a joy to learn at the end of last year that Audrey was getting married!  His fiancée lived in the south of Chad at the time (where Audrey’s originally from) and so he got married down there.  This meant that unfortunately the rest of us couldn’t go because of the distance and some security issues (for me).  Cleopas went to represent us at Audrey’s wedding and took a typed greeting from the rest of us in the pharmacy – which he told me I needed to type for him to take about 10 minutes before he was leaving.  Those who know me well know I like lots of notice of things, but you just have to roll with these things here!

Ever since Audrey got married to Priscilla at the end of November 2017, we’ve been saying in the pharmacy that we needed to meet her and have a small celebration here in N’Djamena.  Priscilla and their daughter Angela moved to N’Djamena at the end of January 2018 once things were arranged for them to move.  Cue another four months of staff holidays, sickness, travel and we found ourselves at the start of May still not having done our celebration!  Finally though, last Friday afternoon after work (work on a Friday finishes early afternoon here in Chad), we made it! 

Elisabeth, Missi and I had bought Audrey’s ‘wedding fabric’ – the couple choose a fabric for their friends to wear and once made into clothes at the tailor’s, those clothes are then known as the clothes from that couple’s wedding.  We’d had the fabric turned into skirts and tops and headscarves but hadn’t yet had opportunity to wear them!  Now was our chance.

We piled into my car and headed across N’Djamena to Audrey and Priscilla’s house.  We were greeted by Priscilla and took photos of the team together.  Audrey and Priscilla also showed us their wedding photos which were lovely to see. 

Pharmacy team (L-R):
Me - if you'd not guessed ;) Cleopas,
Missi, Audrey, Elisabeth
With Missi (L) and Elisabeth (R)

With Cleopas (L) and Audrey (R)

The pharmacy team had all clubbed together to buy them a wedding gift, which was presented to Priscilla by Elisabeth and Missi.

Handing over our wedding gift
of thermal food storage containers, tray and fabric cover

While we were all busy at work, Priscilla had been busy cooking up a storm for us!  She served us fish, plantains and vegetables, washed down by the obligatory coca cola.  It was so good!

Yummy Chadian food :)
I kindly left the head of my fish for my colleagues,
cos I'm nice like that ;)  The Chadians consider the
fish's head the best, most nutritious part.  I'm always
very happy to leave them that part!

It was good to finally meet Audrey’s wife and daughter who we’d heard so much about but who we’d never met!  It was also good to celebrate their marriage as a team and hang out together outside of the pharmacy as this is a rarity!  I’m so grateful to work alongside these four hard-working, kind and hospitable people.