First thoughts on re-entering a developed country

I am currently on a little holiday in South Africa!  It’s very exciting and there is a lot to look forward to, especially as my parents are arriving here on Thursday.

We left a hot, dry and dusty Chad on Friday lunchtime.

Take-off from N'Djamena

 

26 hours, 3 planes and 1 hotel room in Addis Ababa later, we arrived in Durban.

 

View from hotel in Durban

 

I’d been told that Addis was fairly developed compared with Chad, and my first thoughts as we descended into Addis in the dark was ‘wow, there are so many street lights!  Obviously no electricity problems here!’ 

On descending into Johannesburg (short stop before the last flight down to Durban) my first thought was ‘wow, it’s so green!’

On arrival into Durban our first port of call was the beach!  Yes the beach!  Coming from Torquay where I would see the sea on a daily basis, living in a land-locked country for the last 7.5 months has meant I’ve missed seeing that blue expanse and the white crested waves.  Although it was about 7pm we still paddled as the water was so lovely and warm.

Today has been my first full day here.  I am spending a few days as a lone traveller before my parents arrive and am loving it!  My hotel room has sea views which are amazing and I’ve enjoyed just being able to walk up and down the promenade, take in the views and experience the South African holiday vibe.  The weather is warm but humid and it rained today too.  I enjoyed sitting out in it as it wasn’t that heavy.  I’ve walked a little into the city and came across a supermarket.  The choice and range of stuff available was immense and slightly overwhelming.  I bought a random assortment of things – mince pies (Rebecca made some in Chad which were great but when I saw them for sale here I had to taste more!), a twix (you can get in Chad sometimes but usually melted and re-solidified, was nice to have one of factory quality!), a can of pepsi max (my favourite soft drink, can’t get it in Chad), two bananas (staple fruit for me in Chad, buying them is a habit now) and a bottle of water (I am so used to drinking litres and litres of water a day that I’m getting really thirsty here).

Having a holiday where your starting point was a developing country means what you do on holiday, and what you consider ‘holiday treats’, is going to be different than normal.  I am looking forward to hopefully getting my hair cut, buying new flip flops, buying new clothes, getting gifts from home via mum and dad and just being able to relax with no heat/sweat/dust getting in the way!  Oh and obviously doing the standard tourist stuff too, don’t get me wrong!

It’s been a strange 48 hours and I’ve definitely felt reverse culture shock having come from a fairly basic existence in Chad.  However though it all I’ve known that God is the same wherever I am in the world and that’s helped me a great deal :)

Medication ordering

Really boring title for this entry, but to be quite honest it’s difficult to dream up a witty title for a process that is slightly – vast understatement – very frustrating!  To be honest this post is probably only going to be vaguely interesting for those working in the pharmacy/medical world back home but I did promise a post on this subject in my last blog, so here it is! 

There’s an agreement that we will endeavour to source medication for the hospital within country, rather than import from abroad.  The latter would be more reliable in terms of knowing when we’d get the order and not much more expensive.  However, we live and work on the outskirts of the capital of Chad and so have easy access to the main wholesaler for the country.  Also in the capital is a slightly smaller wholesaler and numerous ‘depot pharmacies’ (even smaller wholesalers) and then retail pharmacies.  So we have access to a wide range of potential medication wholesalers and as such are in a far better position than those working in other towns around the country.

That’s probably where my positivity ends!!  I am in Chad and I must remember that. 

All of the above wholesalers only mainly stock generic medication which is good as they are more affordable for our patient population.  The retail pharmacies only stock branded medication and as such charge a premium for them.

Within the pharmacy here at Hopital de Guinebor II, all of our stock records are on paper in a big red file – the ‘classeur rouge’ is referred to and multiple times a day.  The regular use and dust in the atmosphere means this file looks rather tired and the pages within slightly brown!  Keeping on top of what medication or sundries have left the pharmacy is a challenge but we now have a good system that only falls down when one of us forgets to write in the notebook what we’ve issued.  There’s always going to be small element of human error when everything is done manually!!

 

Paper stock records

We aim to use the main wholesaler for the bulk of our ordering as it’s by far the cheapest.  However we’re obviously not the only hospital ordering from them as they are basically the main wholesaler for the whole country.  As with all things in Chad, the order is done on paper – no internet connection to the wholesaler with same-day delivery here!!  I wish, it would make life much simpler!  I usually place an order that will last us about a month, based on consumption in the preceding few months.  Most tablets come in boxes of 1000 and injectables in boxes of 50.  So making exact orders can be tricky with these pack-sizes!  Even if you hardly use a certain tablet you have to buy 1000 of them!  We just try and ensure they’ve got a long expiry date!  Once I’ve figured out what to order, this gets printed twice, once for us and once to take to the wholesaler.  Once dropped off we have to go back a week later to pick up the ‘proforma’ – which is our order, plugged into their computer by hand and then printed out.  I then have to check the proforma against my original order and make any corrections (there’s always at least one).  It also gives me chance to see what they’ve not got in stock and make other arrangements to get those products from another wholesaler (more expensive).  We then take the proforma back to the wholesaler and wait....and wait.....and wait....and make numerous phone calls to check on progress....and wait a bit more and then in about a month after we dropped off the original order we can go and pick up the order.  The length of time from start to finish varies – the shortest has been 3 weeks and the longest 2 months!  Meanwhile, I am having to figure out orders on a weekly basis at the second largest wholesaler in town.  The big advantage of this place is that you get products the same day but they sell the exact same products as the main wholesaler but 20% more expensive.  So we’re not keen on making orders with them although they’re really convenient and when the main wholesaler is taken a-g-e-s to get our order ready and/or they’ve run out of something, we have to. 

These two wholesalers are where we get most of our products but we can’t get everything from them all the time as they often have stock-outs.  An example was two weeks ago – we received our large monthly order from the main wholesaler but with only 4000 paracetamol – this is enough to last us 2 days!  I’d ordered 40000 tablets but they’d run out, meaning we had to get the remaining 36000 from the more expensive wholesaler.  Slightly annoying!

There are numerous other smaller ‘depots’, one of which will deliver out to the hospital.  Given that it’s a good 30 minute drive into town, this is a great help.  Although he obviously sells at a slightly higher price.  I have been known to haggle with him over his prices!  As he’s a smaller private business, this is easier to do.  That was a weird experience at first, bartering over buying ampoules of ampicillin but it’s become strangely ‘normal’ now!!

So keeping on top of drug ordering here is a fairly busy task and a crazy juggling act – trying to get the most we can from the most cost-effective place, but having to deal with long lead times and frequent stock-outs of important drugs.  There’s usually a way around it though, we end up being fairly resourceful out here out of necessity!

Part of a monthly order waiting to be unpacked in pharmacy

 

A day in my Chadian life

I thought it would be good to outline a typical day for me here as I work in the pharmacy.  I’ve been finding my feet and a few different things have needed to be sorted out, hence why I’ve not blogged about my work until now.  

No two days are ever identical to be honest, but there is some kind of routine established now.

So my day starts with the dreaded alarm at 6.30am.  Closely followed by a cold shower – no hot water here but to be honest, after a night in the early 30s, a cool shower is just what you crave!  Despite the bright mornings – it’s lovely to wake up to blue sky and sunshine 90% of the time – I am still a zombie at that time in the morning!

At 7.30am I walk up to the hospital, about 100 metres away, for our morning prayer/devotion time.   This includes singing in French, with varying degrees of tunefulness (don’t be tricked into thinking that all African’s can sing well, as I once thought.....believe me, they can’t!!).  The songs tend to be fairly old and traditional.  Some I recognise as direct translations from old English hymns such as ‘To God be the Glory’ and ‘What a friend we have in Jesus’. 

8am is the official work start time for most staff.  It is the changeover time for the nurses and midwives and the start of the day for everyone else, apart from the two guys who work in triage who start at 6.30am and screen every outpatient.  At 8am all staff meet for a morning meeting, where any information pertinent to everyone is shared.  This usually lasts about 10-15 minutes

Outside la pharmacie - obviously not open at this point!!

I usually start in the pharmacy at about 8.15am and greet Elisabeth and Cleopas, my two fellow pharmacy workers.  Generally speaking, Cleopas is the dispenser for all drugs to outpatients and Elisabeth ensures all the stock records (on paper, no access to computer stock records here!) are up to date and goes into town to buy drugs from various sources.  Sourcing and buying of drugs is a blog topic all of its own, so watch out for that  update in the future!  Let’s just say there’s no broadband internet connection to the local wholesaler, who’ll deliver twice a day.......!  Ensuring we don’t run out of essential drugs is a time-consuming and sometimes frustrating task.  It is also one big juggling act.  At the moment we’re in the peak of malaria season, so making sure we’ve enough anti-malarial drugs has been a challenge.  So far we’ve managed to have a continuous supply but the drug supply chain as a whole in Chad is fairly precarious, with things in and out of stock nationally on a regular basis.

My role here is to try and exert some sort of control over what medications and sundries (urinary catheters, cannulas, bandages, scalpels, NG tubes, syringes, needles, plaster of paris, IV infusions etc etc) are released from the pharmacy.  Previously, nurses and midwives would come to pharmacy and write an order for what they required.  It was often quite a random list with random quantities – this is a culture where you don’t forward-plan and you crisis manage.  So the concept of thinking ahead as to what drugs etc you may need over the next day or so is not one that comes readily to your average Chadian.  That’s just the way they are and it isn’t anything against our staff, it’s how Chadians ‘tick’.  A kind of ‘live for the day’ mentality – often borne out of extreme poverty – they often don’t have money to forward plan, they only have enough to live on day-to-day and hope that something comes along after that.  So my role is to devise stock lists and ensure that each area of the hospital – maternity, emergency room, operating theatre, adult wards and paediatric ward – have their allocated stock level each day.  So far maternity, emergency room and the operating theatre are up and running and I’m in the process of sorting out the inpatient wards.  The storage of drugs on the inpatient wards is ok at present but could be vastly improved.  I’ve just designed a drug trolley which we are going to ask a local carpenter to make.  A drug trolley will reduce the potential risks of medication error that are currently a possibility with the existing system of drug storage on the wards.  In the interim Sue (nurse here) and I have found a cabinet on wheels that will suffice as a drug trolley until my prototype is made.  Drugs here come like they used to in the UK – either loose in tubs of 1000 or as strips of ten in boxes of 1000.  So no individual patient packs to neatly sit in a drug trolley!  We have to be pretty inventive with storage solutions here in order to segregate drugs on the wards and stop them being mixed up (which is what can currently happen).

So, each morning I go to each area, count the drugs they’ve got and then top them up to the allocated level.  Pretty straightforward stuff, although you try doing it in rooms of around 40°C!  Another of my roles is to work with Elisabeth on the drug orders she needs to collect from town.  As I said, that’s a blog entry all of its own and is a very time consuming process.  I also give Mark (doctor here) monthly statistics on drug availability and, at the moment, the level of anti-malarial usage.  I also ensure we always have a spare gas cylinder for the pharmacy fridge (gas powered, and I’m getting good at predicting when it’s going to run out!  There’s no way of telling exactly when the bottle will run out, which can be tricky in this heat if we miss it and the fridge is off for a few hours).  I also help Cleopas at the outpatient counter when it’s really busy, getting medication ready for him to dispense.  Unless the patient speaks French, I can’t dispense drugs to them as I can’t explain how to take what they’ve been prescribed.  Most patients at our hospital speak Arabic and I can’t!  So that stops me being able to have any patient contact in terms of dispensing drugs to them.

Talking of languages, the official language of the hospital is French.  So I am immersed in French all day, which doesn’t tire me out as much now as it did at the beginning!  I can make myself understood and can run the pharmacy on a day-to-day basis so my French is bearing up and we’ve had no major miscommunications yet!  I’ve had to learn the French words for loads of what I consider basic medical and pharmaceutical words, such as tablet, cream, syrup, gloves, water for injections, hydrogen peroxide, scalpel, crepe bandage etc etc.  The most confusing thing to me is that IV cannulas are ‘catheter IV’ in French and urinary catheters are ‘sonde urinaire’.  That took a lot of getting used to and remembering because as a British primary care pharmacist, a catheter is usually referring to a urinary catheter.  Simple things can be really confusing!

Another role I have is ensuring the lab have enough reagents, test strips and so on.  As I had in my last blog entry, you have to learn to step outside of the ‘usual’ pharmacist’s remit here and help out where you can.  Fortunately for me, the head lab technician is on the ball and lets me know when they’re getting low.  I just have to check the quantities he’s ordering sound reasonable and sign off his order.  One test we have had to buy lots of at the moment are the malaria finger-prink tests.

Our day officially ends at 3.45pm, and we usually get a break at lunchtime.  However if there are a lot of outpatients, we sometimes end up staying until 4-4.30pm to enable them to get their prescriptions before they leave the hospital.  As well as bringing in revenue for the hospital, our prices for drugs are a lot less than if they took their prescription into town to a pharmacy there.  So it’s a win-win situation!  There’s no NHS-equivalent here, all patients have to pay a fee to consult a nurse or doctor, a fee for lab tests and a fee for their prescribed medication.  If they are hospitalised, then flat-rates per night are paid depending on whether they’re medical or a surgical case.  This covers all their care and their drugs given on discharge.   We are fortunate that kind individuals from the West often send money to the hospital which we put into a benevolent fund, so that if a person really can’t pay, we can subsidise their hospital costs.  We endeavour to keep our prices as low as we can and just ensure we cover our running costs.

So there we have it, an account of what I get up to out here!  Elisabeth and Cleopas both have a good sense of humour which means we often have a lot of laughs in the pharmacy.  One such example was the other week.  It was really hot in the pharmacy (I know, the drugs, there’s not a lot we can do as we’re not on city-power so have no means to run air-con – we have the fridge for items that must remain cool).  I was feeling the heat after a morning of walking around the hospital checking on stock levels and distributing drugs and other sundries.  We had a lull and no patients were at the counter for prescriptions, so I was sat by the fridge, longing to get in it!!  I then had a little brainwave – I explained to Elisabeth and Cleopas that in the UK when it’s cold, we have something called a hot water bottle to warm us up.  So I thought to myself, I need a cold water bottle at the moment!  In the freezer compartment of the fridge we keep ice packs, so that if drugs are taken out of the pharmacy in cool bags, we can add an ice pack to keep them cool.  I took one of the ice packs out of the freezer and hugged it like a hot water bottle!!  It was sooooooo good!  Below is a photo of me in the pharmacy hugging my ice pack J

In la pharmacie with my ice pack!

 

Carry on crutches!

I am currently preparing a blog entry that will outline a typical day for me here working in the pharmacy.  However, when working in a situation such as this, I am fast learning that I can’t just stick to medicines in my day-to-day work.  It’s all hands to the pump with whatever needs to be done.  If it’s possible for you to assist and carry out a task safely, then you do it, even if it’s not what a pharmacist usually does!

One such example happened a couple of Fridays ago.  Fridays here are half-days for most of the staff, as the afternoons tend to be quieter - most people are at the mosque for Friday prayers and so don’t come to the hospital unless really ill.  This particular Friday, a Chadian patient (who happened to be known to us expats) had been to see Doctor Mark because of a painful knee.  After she had finished seeing him, one of the things she required was a pair of crutches.  Crutches are stored in the pharmacy, as are a lot of other things you wouldn’t see in a hospital pharmacy in the UK, for example cannulas, needles, syringes, plaster of paris bandages, scalpels, sutures!  So I was called to open up the pharmacy and provide the lady with her crutches.  We can only source wooden under-the-arm crutches here (physio’s hold those gasps!) and so they are better than nothing at all.  They are hand-made to the specifications of an expat physio who works here a couple days a week.  They are fully height-adjustable and so I asked Doctor Mark for guidance on how high they should be made for the patient, both in terms of the hand-bars and the whole height of the crutches.  Typically, they weren’t the right height for the patient.  The screws required removing, the pieces of wood moving up and then the screws replacing.  Sound straightforward?  It wasn’t!  It was now 4.30pm.  The hospital handy-man who was my first port of call to do the adjustments had already gone home.  Cue a 10 minute search for a screwdriver and pair of pliers.  Then cue a search for people to help me.  Fortunately Malc was still in his office finalising the week’s figures and he agreed to help, as did Alain the local Chadian interpreter (who also happens to teach me French).  The crutches had been carefully made to a good standard, and then varnished.  However, the guy who’d made them had varnished *over* the screw heads.  Removing the screws proved to be a time-consuming task anyway but we had the added task of getting through the varnish before removal could begin.  We took the crutches to the consulting room where the patient was patiently waiting.  It took ages to remove all the screws, washers and nuts, with a few rolling onto the floor – good job the patient was alert and could tell us where they’d gone!  It then took three attempts to replace them all at the right height.  Darkness was fast approaching which didn’t help (no lights in the consulting room as they’re only used by day....normally.... and our solar energy is better conserved for use on the wards at night).  Other patients kept knocking on the door asking to be seen – I draw the line at extending my duties to consulting patients and making diagnoses!  Finally, after an hour-and-a-half, lots of laughter at our ineptitude at adjusting crutches and a comment in jest from the patient (‘je veux rentrer aujourd’hui - I want to go home today!), we had finished!! 

So that’s another string to all of our bows, should the need ever arise again!!

Things I miss and things I like!

I thought I’d document what I miss from home and things that I like here in Chad J

Things I miss:

·         Sleeping under a duvet

·         Fast broadband internet

·        Going to a shop and being able to get change - coins are in short supply here and most times at the shops they ask if you’ve got coins.  Which can be a bit annoying if you’re trying to save them to buy smaller value items such as bread or fruit from road-side vendors

·         Being able to easily buy meat that’s ready to cook

·         A more comfortable climate – although see below too!!

·         Looking like ‘me’ – I don’t normally have my hair tied up and under a headscarf for the majority of the day, nor do I always wear ankle-length skirts

·         Being able to converse freely and accurately in the native language

Things I like about Chad:

·         Blue skies and sunshine 95% of the time

·         Bananas that taste like banana – trust me, the ones in the UK are tasteless in comparison!

·         Colourful and busy markets

·         Fresh baguettes for the equivalent of 15p

·         Vibrant Church services

·         Meeting people from a wide variety of countries and backgrounds

·         Working alongside other expats and Chadians at the hospital

Cool water?

When it’s hot weather in the UK, we think nothing of taking a glass, turning on the cold tap and pouring ourselves a nice drink of cool water. 

Here in Chad there’s a slightly longer process we have to go through before we can pour ourselves a glass of cool water!   In the hottest weather we drink on average about 4-5 litres of water a day.  Mainly just plain water but we can get a sugary powder in a myriad of artificial flavours, which we can add to the water if we want to.  There are other ideas too for flavouring water, such as adding a peppermint or lemon teabag to a jug of water and letting it soak overnight.  When you’re drinking so much cold water you need a bit of variation!

This blog outlines the process us expats go through on a daily basis in order to ensure a constant supply of cool water is available:

1.  Fill bowl with tap water

 

 



2.  Pour tap water into water filter

3.   Once water has filtered through to the bottom chamber (a very slow process), fill bottle or jug with the filtered water

 

 4.   Place bottle of water in fridge and leave for a couple of hours to cool

Once all that is done, there is a supply of cool water in the fridge!

Just for a bit more background, I thought I’d explain where the tap water comes from.  There’s no piped water provided by a national company here.  The tap water in our houses and also for use at the hospital is pumped from an underground source, using a generator, into a water tower on site.  It takes about 30 minutes for the generator to pump enough water to fill the tower.  Below is a picture of yours truly posing by the water tower!

The water in the tower doesn’t last the compound very long and so water is pumped into it about 3 or 4 times a day.  We often turn on a tap and find no water and then go and find a guard to put the generator on.

Sometimes the generator is out of action, although thankfully this hasn’t happened yet since I’ve been here!  Alongside the generator-driven water pump, there is also a hand water pump that can be used.  This sources water from underground, there’s natural water not far below the surface.  So if the generator is out of action, we use the hand pump to pump water into buckets, bowls (anything really!), to be used in the houses or on the hospital wards.  Below is a photo of me at the hand pump!

So there we have it, a brief description of water here!

Wimbledon: Arabic style!

Last Saturday a few of us expats went to our friend’s house.....cos she has cable TV and invited us to watch some Wimbledon!  So three of us from the compound here at Guinebor II Hospital went into town, armed with home-made scones and chocolate brownies.  After everyone had arrived there were three Brits, two Americans, a Dutch girl and a Swiss girl (who was very despondent that Federer had already gone out!!).  We enjoyed some lovely food that people had brought and sat down to watch a match.  Our friend’s cable TV is Arabic and so the commentary was in Arabic.  It was a bit strange not having the usually John McEnroe, Tim Henman and Sue Barker trio giving us the lowdown.  What was even more strange was the fact that the studio presenter on the cable channel was in full Arabic dress.  I suppose it’s not that strange that Arabic TV presenters wear Arabic clothing, but it was strange to see as a Westerner.  A few times they cut over to a correspondent at Wimbledon and had both presenters on the screen at the same time.  See picture below.  This is Wimbledon Arabic style!

We had a fun afternoon chilling out and watching a game.  Us Brits were sooooo excited when a shot of Sue Barker came on screen.....although she was muted!  So this was another slightly different experience here in Chad!

Au frigo

So I thought I would show you an interesting sight of Chad......the inside of our fridge!!  (frigo is the French word for fridge).  Just thought it would be interesting to compare and contrast to the inside of a fridge at home and give you an insight into my ‘Chad life’.

So we have a gas powered fridge, the gas bottle isn’t in the picture.  One bottle of gas last about 2 weeks.  There’s no warning as to when it’s going to run out, so you have to keep an eye on the flame at the bottom of the fridge to ensure it’s lit and the fridge is still working.  As you can imagine, if the gas runs out it’s only a matter of hours until all the food is ruined because of the heat.  Another thing you can’t really see in the picture are the two towels we have draped around the outside and which we keep wet all the time – this helps to keep the fridge cool.  We have to wet the towels with water about three times a day as they dry out really quickly.

Ok, so the main thing you’ll see in the fridge is water!  We can’t drink the water from the tap and even if we did, it’s luke-warm at best anyway.  All our water is filtered and the water that comes out of the filter is room temperature (i.e. about 35 degrees centigrade).  We therefore always ensure we have a continuous supply of water in the fridge.  I probably drink about 5-6 litres of water/squash/cold tea (bottom left of pic in jug) a day.  In the bottom right of the fridge is a bottle of d’jino, which I stumbled across in a shop the other day and was very excited about!  It’s made in Cameroon and I drank loads of it there, it’s kind of like Lilt.  I bought myself a bottle as a birthday treat!!

Next shelf up on the left is some left-over rice which we ate at luchtime, and on top of it in the bowl is some home-made crème fraiche type stuff, which my housemate made from gone-off home-made yoghurt (she’s very entrepreneurial!).  Behind that is a bottle of ‘chilly willys tomato ketchup’ – grerat name!!  Haven’t braved any of that yet...... On the plate to the right, with the pretty red doily is the remains of my birthday cake that Andrea made (it’s very yummy).   Ah, next shelf up is eggs, mayo, some salad dressing, in the bowl is a local lemon (the yellow/green thing, it’s kind of a cross between a lemon and an orange), also in the bowl are tomatoes, then some watermelon and behind that a mango.  Top shelf on the left is some cheddar cheese (yep, another treat, not always available so I buy it when I can!), in the blue food bag is lettuce, duly washed in disinfectant last night, then there’s a jar of home-made mango jam which we made a few weeks ago, then in the brown bag is my chocolate stash, given to me by the girls here for my birthday!  On top of the paper bag is half a cabbage. 

So there we have it, an insight into my Chadian fridge!!  This has got me thinking about what I miss from my UK fridge and the first few things that spring to mind are – proper milk (we only have powdered milk or UHT), sausages and bacon!!  I guess my Chadian fridge is more healthy, apart from the chocolate!

My new surroundings

OK so I thought I would try and describe my new surroundings as best I can. I am living in the Guinebor II area of N’Djamena, at the hospital there. The hospital has a 10 foot (ish) wall around the perimeter, with barbed wire running around the top of it. There are two entrances, one for vehicles and one for pedestrians. People coming to the hospital to consult a doctor or nurse usually arrive by taxi or motorbike which drop them off outside the pedestrian entrance. It’s usually just us missionaries going in and out of the vehicular entrance and trades-people such as the builders or the solar-panel engineers.

The hospital is situated in a very dry and dusty, fairly barren landscape (although I am told that most of the sand/dust turns to mud in the rainy season, which should be interesting!).Since the hospital was built, more and more private houses have been built in the area. These are typically one room mud-brick buildings with galvanised iron roofs.There are also a few small shops (boutiques in French, although they’re nothing like you would expect a ‘boutique’ to look like!).These shops sell basics like bread (fab baguettes, a hang-over from French colonisation) and milk powder (the only way to have milk here apart from UHT that doesn’t last long).Oh and also Coca-Cola!Oh and mobile phone credit, which is really useful as else it’s a 20 minute trip into town. There’s a mosque about 500 metres away from the compound and we often hear the call to prayer.Below are 2 photos.  One is of the main hospital entrance and the other is of the area outside the hospital compound. The second one was taken at 5.30am one Saturday a few weeks ago! It was fab to see the sunrise and it was so lovely and cool at that time of the day – about the same temperature as at midday on a sunny summer’s day in the UK!


Main entrance to hospital



Area outside hospital (compound wall is on the right of the pic)
 

Inside the compound is a carpet of sand. To the right-hand side are the houses us expats live in. Single storey houses with tiled floors. All have solar panels and we generate enough electricity to mean that that is our sole source of power. We have gas-powered fridges and cookers. To the left of the compound is the pedestrian entrance to the hospital and triage area. Then there are gates through to the admin office, payment desk and pharmacy and a waiting area for the outpatient consultation rooms and the laboratory. Behind the pharmacy are the maternity rooms and operating theatre (called the ‘bloc operatoire’ in French, it took me ages to work out what people meant when they said ‘they’re in the bloc’!!). Via a link pathway are the 4 hospital wards – around 8 beds in each – and 3 private inpatient rooms. Just outside the compound is a covered area where the carers of the patients stay and prepare meals for their relative who is an inpatient.

So there we have it, a brief overview of my new surroundings! Add the daily temperatures that are still around 40 degrees by day and 30-35 degrees by night and you have a bit of a picture of where I’m currently living!



Chad life one week in!

Well I have arrived in Chad and have now been here a week!  The journey from the UK was uneventful thankfully, apart from my debit card taking a massive bashing whilst in transit at Paris Charles de Gaulle airport.  What was I buying I hear you cry?!  Some expensive perfume or a haute couture piece of clothing?!  Nope......lunch!  Expensive was an understatement.  Suppose it contributes to the free 15 minutes of internet I got!  I’d never been to Charles de Gaulle airport before and I have to say it was a large, rambling, pretty soul-less place.  I spent the 4 hours of transit eating; reading a newspaper and watching the same piece of newsreel on the TV go round and round.  Time seemed to pass quite quickly though and I was soon on the slightly delayed plane to N’Djamena.  Have to say I was impressed with Air France on both legs of the journey.....even if the air hostess on the way to N’Djamena spoke to me in English, obviously knowing from my attempt to order jus de pomme that I wasn’t a French national.....hey ho.....still some way to go on the old Français I guess!  The flight was good, had loads of films and TV series to watch albeit mostly quite old, plus lots of different genres of music to listen to.  Those of you from Torbay will be slightly astounded to know that a Metronomy album was available to listen to and so, in tribute to my homeland, I listened to ‘The Bay’ as we touched down in N’Djamena!!  Slightly surreal!  I loitered on the plane for as long as I could to enjoy the air con and then wandered out of the door to be hit by the wall of heat I was expecting (mid 30s centigrade at 9pm).  However it wasn’t anywhere near as humid as Cameroon was so I was glad not to get the ‘wet blanket’ sensation we always got in Cameroon.  The airport was efficient (we were the only plane in sight so I guess that wasn’t too difficult to achieve).  A bus took us the whole 100 yard to the arrivals room where they had air con!!  I was so pleased!!  After what seemed like ages.....my queue was definitely the slowest, although I didn’t care as I was stood by the air conditioner.....I was called up to present my passport and landing card.  I was expecting a barrage of questions in French that I couldn’t answer however I was not subjected to anything other than where I was staying (easily answered) and directed to put my fingers and the thumb on the electronic fingerprint-taker.  All very smart looking, even had a digital camera/webcam thingy taking a photo at the same time!  As soon as I was through immigration (two stamps later....only two stamps?!  Not a lot for Africa I’d say!) I was informed by another official to register at the police station within 3 days and then I was in the baggage reclaim area.  Cases were already going around and there were mine.  Yes both of them!  A porter helped me – they both had ‘heavy’ labels on them, there’s a first time for everything – we passed the girl checking the baggage labels against the stubs I’d received way back in Heathrow and then both were chucked (literally) through anther x-ray scanner and then that was it, I was outside!  All very quick and easy, I was very fortunate.  I walked out into the African night and felt strangely at home.  I wasn’t the least bothered by numerous blokes trying to flog me mobile SIM cards, tissues, sweets, the usual African street-sold stuff.  Have to say they are very polite here, one ‘non merci’ and they leave you alone.  Quite refreshing!  Found Mark and then we were on our way out to Guinebor II and the hospital compound that will be my home for the next year.

It only took about 20 minutes to drive to the hospital.  We drove on paved roads around the perimeter wall of the airport – not a pothole in sight on the paved roads, very impressive – and then we turned left onto a dirt road.  Good job they have 4x4 here that’s all I can say!  Another 10 minutes or so, after a few ‘hmmm I’m not exactly sure where I am’ comments from Mark (really difficult to get your bearings in the dark on a dirt road dotted with houses and the odd tree and obviously no signposts) we arrived at the hospital compound.  Cue a blow on the car horn from Mark and the guard duly opened the gates with a greeting of bonsoir. 

I’ll explain the layout of the compound and the surrounding area in another blog. However I am staying in the ‘guest house’ which is where those who are only here for a relatively short time stay. It is a comfortable place to stay, my room is fairly big actually and –get this – I have an ensuite bathroom!! Yup, I’ve arrived!

Guest house where I'm staying

The heat here is unimaginable.  I cannot even begin to explain how it feels.  Imagine yourself in your house on a hot summer’s day with the doors and windows closed and the radiators on max.  That’s kinda how it is, although there is usually a bit of a breeze especially in the mornings.

Ah mornings, my new favourite time of day (those of you who know me well can pick yourselves up off the floor now!).  It is the only time in the day that I feel semi-cool and comfortable.  I’m there wishing the temperature would stay as it is at 7.30am but alas, that doesn’t happen and it regularly hits 40 degrees plus around midday at the moment.  Consequently by the evening I’m shattered from just ‘being’ in the heat.  I’m in bed around 9.30-10pm and sleep for a good 8 or 9 hours (again, people who know me well should pick themselves up off the floor!).   

At the moment I’m spending most of my days adjusting to the heat, learning how the hospital functions on a day-to-day basis, getting to know the other missionaries here (Mark & Andrea and their two daughters Ruth & Rebecca, Malc & Sue, Rebecca and a Swiss medical student called Salome who's here until July) and continuing to learn French.  Not many Chadians speak English however there are a couple of interpreters here at the hospital who work alongside the medical staff as they consult patients who may not speak French but who speak Arabic or another local language.  One of these interpreters also speaks English and so he is my new French teacher, taking over from the lovely Justine who taught me in the UK!  I have lessons most mornings with him, mainly conversation so that I build up my confidence in speaking French.  We had a 3 hour lesson this morning which was really useful but quite draining!

I can’t believe I’ve been here a week already.  I’ve been into N’Djamena about three times so far and been introduced to all the sights.  There’s a really impressive public space opposite the president’s palace called ‘la place de la nation’ (see if there’s a picture on Google images!) which even boasts grass – very unusual here and it has its own sprinkler system.  That’s the main sight of N’Djamena really apart from some impressive sculptures on a few roundabouts about town.  I’ve been to the central market, really big compared to the one I was used to in Cameroon but similar layout.  Most of the fruit and vegetables here are imported from Cameroon as they don’t have a great climate for food growing unfortunately.  This importation means prices are higher than I was used to in Cameroon.  Also been to the craft market and also L’Amandines.  More about L'Amandines in another blog but something tells me I may spend quite a lot of time in there......!!

Time to 'get out of the boat'

Well the visa, my passport and yellow fever certificate have arrived!  Here's the proof :)

 

So the time has come.  I've been reading the John Ortberg book 'If you want to walk on water, you've got to get out of the boat' - actually it's been on the 'currently reading' pile for a few months...make that six (I'm not the most avid or quick reader!!).  Those of you who have read it will know what I mean when I say today, and tomorrow, is getting out of the boat time.  I am leaving behind all I know as 'normality', to enter a culture I have relatively little knowledge of.  It's upsetting, it's scary, but it's also the start of an adventure, one which, looking back, I've been craving for about 3 years.  I haven't really got much of an idea of what I will be doing day-to-day yet, which for someone who likes to know what's happening in great detail isn't easy!  However I will soon find out :)

 

Tomorrow evening I will travel to Heathrow with my parents and will then fly to N'Djamena, via Paris, on Tuesday morning.

 

So my next blog entry, internet access permitting, will be from Chad!  Here's to the adventure, thanks for sharing it with me :)

 

 

Original departure day

Today has been a bit strange.  I was meant to be leaving for Chad today and over the last few months everything was geared towards 30th April.  Now it's here, and I'm still in Torquay!  I've kept thinking 'I would've been at Heathrow now'....'I'd have been in transit at Paris Charles de Gaulle now' and right at this moment, as I type, I'm thinking 'I'd have been an hour away from landing in Chad now'.  It's strange to think that rather than sitting in my friend's house in Torquay typing this post, I'd have been an hour away from landing in a different culture and all that that would bring with it.

However, I am now preparing myself for a new departure date of 14th May and in the meantime I am making the most of still being in the UK.  I am enjoying the sunshine but the relative cool of the UK compared with Chad (where it's around 40 degrees centigrade at 9pm).  I am enjoying seeing friends over coffee.  I am enjoying still being by the sea.

Today I met a dear friend at Meadfoot Beach and spent a lovely couple of hours chatting and looking out at this fantastic view:

Meadfoot

I am so going to miss the sea!

I am also making the most of still being near my fab french teacher Justine and doing a bit more practice of my français.

I am also going to see more of my family too.  I wouldn't have been able to do any of this if I had gone to Chad today.  So I am making to the most of the delay in departure.  However I am also keen to get there now and do what I've been preparing myself for months to do!

Small change of plan

I've now been on career break from work for two weeks.  It's been surreal not going to work every day but it's also been great, as it's meant I can concentrate on seeing people before I go, buying supplies for my trip and generally just get my head around the fact that I'm going to Chad.  Soon.  More on that in a moment!

The 'to-do' list has been long and as soon as I have crossed something off, two things have been added, so there was a time last week where it just felt never-ending.  The tasks have been varied which was good!  Here's a sample of the things I've been having to think about before I go

- making a will (weird experience but had to be done)
- sorting my work indemnity insurance
- buying ankle-length skirts
- writing thank you cards
- letting people know I've put them down as emergency contacts (thank you, you know who you are!)
- buying mosi-net treatment
- buying a spare laptop battery
- syncing my ipod nano
- buying an abundant supply of AA batteries
- going to the dentist
- handing over Girls Brigade
- having French lessons
- buying a travel fan
- learning how my solar-powered battery charger works
- taking oral cholera vaccine
- giving mum details so she can apply for a new driving license for me when mine expires June 2013
- sorting direct debits out
- etc etc etc the list just goes on and on!

I've also been meeting up with friends for coffee, going out for meals and just generally enjoying being with the people I know well.  That's been fantastic but also difficult, knowing that it'll be the last time for a while.

Putting your life on hold for a year and preparing for life in a different culture is one major all-consuming task.  However it'll be worth it!

You'll notice there's a lot of mention of batteries in the 'to-do' list!  This is because the hospital is not on the grid and is mainly reliant on solar power.  Therefore I won't have a lot of electricity at my disposal, so I'm going armed with as much alternative means of power as I can!

So, the title of this post is 'small change of plan'.  Due to circumstances beyond anyones control, I've not yet got my visa through to enter the country.  I've known there was a potential issue with this for a few weeks now.  It has now meant that my departure to Chad will now be delayed by a couple of weeks and my flights have been rescheduled to 14th May.  I'm sad that I won't be going on my originally planned date.  However I will get to Chad when I'm meant to get there :)  In the meantime, the extra couple of weeks will allow me to enjoy being in the UK for a bit longer and see a few more people.  I'm especially excited that I get to see my dear friends Bex and Andy get their 'handshake' at the Baptist Assembly in Blackpool next weekend :) 

'Every cloud.....' :)