So what did I actually do in my first term at IMC?!

Disclaimer: this blog post is based on, with their permission, an original blog post by my friends and fellow mission trainees Simon and Wendy.  Their original post is available here.

BMS International Mission Centre, Selly Oak, Birmingham

Studying at BMS's training centre, IMC, is a fantastic experience.  A lot of people have been asking me 'what do you actually do there?!'.  In response to that question, here is a short summary of each course we did in our first term (September - December 2014) and the associated assignments.

Paul's mission journey - This course follows Paul, the original pioneer missionary.  I was struck by the importance that Paul placed on his equivalent of Home Assignment!  Making sure he 'returned to base' in order to 'refuel' and share how things are going with his supporters back home.
Assignment - An essay exploring the concept of 'Maturity as the goal of mission'.

Theology in a global context - Exploring theology through the lens of mission and practical life.
Assignment - To research the spiritual atmosphere of the countries to which we're being sent.

History and practice of mission - It all begins with Missio Dei. 'Mission is thereby seen as a movement from God to the world; the church is viewed as an instrument for that mission'.
Assignment - To prepare a mission statement and presentation summarising my understanding of how my life and work might co-operate with God's mission in Chad.

Mission in the community - An opportunity to leave IMC and interact in the real world!  I have been going along to help with the practical setting up of the hall for Taekwondo classes being run at a church in an ethnically diverse area of Birmingham.  Certainly a different experience and I've enjoyed interacting with some of the students and the Taekwondo instructor!

Intercultural studies - This examines the process of cross-cultural living, contextualising the gospel and communicating in culturally relevant forms.
Assignment - A study into 'Honour and Shame' cultures and how they are similar and different from our Western individualistic 'Guilt and Justice' culture.

Character in community - mainly a practical course involving being helpful at IMC - in most cases through gardening and washing the dishes.
Assignment - to read and discuss the book 'Cross-cultural servanthood: serving the world in Christlike humility' by Duane Elmer. An excellent read and really useful stuff to bear in mind once we're living and working overseas in another culture.

Country project - a chance to research and present one area about the country we are going to.  My country project looked at the political history of Chad since independence.


Mission life and work - a course aimed at making our expectations of life, hardships and joys in our overseas work realistic.
Assignment - to interview a mission worker and to read a mission biography.  I read 'Chasing the dragon' by Jackie Pullinger.

Rediscovering the Bible - An overview of the Biblical meta-narrative
No specific assignment except to read more of the Bible.

Trinity and spiritual formation - this course helped me understand in greater depth the wonder of the Trinity and that Father, Son and Holy Spirit are not just three distinct 'beings' but equally each being a manifestation or expression of our One God.
Assignment - to write a Trinitarian prayer.

Attitudes, Characteristics and Temperament - An examination of our own characters and those of others, exploring who we are in Christ and how to get on together.
Assignment - to complete a Myers-Briggs-type personality test and discuss how this might affect how we work and interact overseas.

Development week - we learnt all about log frames and how to work effectively, building sustainability, and in partnership as we seek to improve, in any way, the countries to which we are going.
Assignment - to write a project proposal aimed at reducing the high child mortality rate near Lake Chad.

Communications week - in the light of the increased number of blogs and prayer letters that we will be writing, this was an opportunity to get some tips from the pros.
Assignment - to follow some blogs and opinion columnists closely and critically examine their style and content.

Reports on BMS history and current work around the world - it's pretty amazing to think that BMS was established in 1792 and that it is still working in more than 20 countries today.  Through these sessions we got a better understanding of the personality and character of the organisation through which we are going overseas.  

And finally, there have been a whole host of practical and safety trainings, as well as trips to Catalyst Live and BMS's Council of Reference.

Overall it was a great first term at IMC.  It's been good to have the space and opportunity to reflect on my previous time in Chad and to prepare for the future work I'll be doing, as well as make some fab new friends!

As for what I'm up to now - this week I have started an fairly intensive period of French language lessons, whilst some of the other trainees are doing placements in various community projects in the area.  For the next few weeks I'll be doing 8 hours a week of French lessons, the rest of the time I am trying to do as much listening to French radio and TV as possible.  This is all with the aim of trying to get my language skills as progressed as possible before I go to France in the summer for intense language training.

We start the next term's classes and assignments at the beginning of February.

Hopefully this has given you a good picture of exactly what I've been up to since September!   

Feed the world? Reflections on Christmas at home and abroad

This year I’m in the UK for Christmas.  Last year I was in Chad.  There are so many differences between these two places in the way that Christmas is prepared for and celebrated.  So sit back and let me take you on a short journey of my ponderings and reflections.

Chad is a predominantly Muslim country (53% ish) but about a third of the population would call themselves Christian.  Therefore all Muslim and Christian festivals are celebrated with a day off from work and gatherings that involve food, family and friends.  This means a fair few public holidays!  So Christmas Day is a public holiday, but there’s no such thing as Boxing Day and so it’s back to work on 26^th December.  Have to say it was a bit strange working on 26^th December last year!

Another thing that was strange last year was the temperature!  This picture was taken at around midday on Christmas Day last year – the thermometer reads 30C (86F).

One thing I’ve enjoyed this year and that I acutely missed last year is the ‘pre-Christmas build-up’.  Catching up with friends, singing carols and generally getting into the festive spirit!  Feeling the coolness on my face, seeing frost and wrapping up in my thick winter coat that’s been hiding in my Mum’s wardrobe for the past two years.

However, one thing I’m not relishing so much is the commercialism of Christmas and the incessant loop-playing of Christmas ‘songs’ in the shops.  I don’t know whether it’s the fact that I didn’t experience it last year or whether it’s getting worse in some way, but the materialism surrounding this time of year in the UK is at fever pitch.  I’ve had to ask the same question: ‘did this happen here last Christmas, as it didn’t in 2012?’ about a fair few things this year, one of which was the craziness surrounding ‘Black Friday’ and people fighting over TVs and the like in supermarkets.  What was that all about?!  

I mentioned Christmas songs.  There’s one in particular that I’ve thought a lot about.  The title of this blog post gives a big clue as to which one.  I listened to the earlier versions in Chad (i.e. not the version released this year, which has had some of the words changed - personally think that was a good idea).  Next time you hear this song, try to imagine listening to it whilst living and working in Africa.  It definitely puts a different perspective on the lyrics.  If you want to know my thoughts, ask me!

The saddest thing about being in the UK at this time of year is the dawning of the realisation that Jesus’ birth is apparently little recognised by many people.  It’s all about shopping, food, Father Christmas/Santa, presents, Christmas parties and days off from work.  I’m not intending to be bah-humbug here!  Of course it’s great to celebrate this time of year with people.  It’s just not great to see how materialism and commercialism can drown out the real reason for why we’re celebrating.  The birth of Jesus was, and still is, great news!

Wishing you joy and peace as we celebrate the birth of our Saviour, Jesus Christ.

Christmas dinner on the Hotchkin's veranda,
Christmas Day evening 2013

Whirlwind life changes

What a difference 203 days make.  Six-and-a-half months to be precise.  Having spent 10 months in Chad during 2013/14 I am heading back!  Let me tell you about my last 29 weeks and bring you up to date with the life of Claire. 

I landed back in the UK on 19^th March 2014.  Back to the land of green, spoken English, tarred roads without (a lot of) potholes and cool weather.  Cue catching up with friends, keeping up with friends in Chad, debrief at the BMS head office and eating the foods I missed the most:  strawberries and cheese (not together!).  This was swiftly followed by more interviews at BMS headquarters, as I had felt God calling me to longer term mission work whilst I was in Chad.  By the time my career break officially ended and I resumed my job in Torquay on 14^th April, I had had a second interview for long term mission work with BMS, medical and psychological checks to make sure I was fit-for-purpose and the final BMS interview for long term work was in the pipeline.

Resuming work was strange.  Having been out of the NHS for a year, there was a lot to catch up on.  I regaled colleagues with tales of different pharmacy practices in Chad, helping us all realise that some things we concern ourselves with here in the UK pale into insignificance, when compared with the challenges of practising pharmacy in a developing country.  I threw myself back into my job and enjoyed working with my colleagues again.  However I always knew that I wouldn’t be back there very long.

At the beginning of May I had my final interview with BMS and was accepted for training as a long term mission worker.  The aim would be to return to the hospital at Guinebor II in Chad after nine months of training.

So, after having been back at work for a month, I gave in my resignation.  I had only just moved back into my flat in Torquay and was enjoying having ‘my space’ back again.  However it was only temporary and I am learning to be able to adapt to the nomadic lifestyle that long term mission work entails.

So, in the space of 6.5 months / 29 weeks / 203 days, I have

• landed in the UK
• been through 4 interviews
• restarted my job
• moved back into my flat
• resigned from my job
• moved out of my flat

.......and now find myself living the furthest north I ever have lived in the world – Birmingham!

My training as a long term mission worker at BMS’s International Mission Centre (IMC) in Birmingham started on 8^th September and continues until mid May 2015. 

IMC

I live and study at IMC, learning about a wide range of topics that will prepare me for my future life overseas that starts mid May 2015.  It’s definitely a challenge to learn and discuss theology (amongst other things), when I’m so used the slightly more black-and-white, structured nature of scientific learning, but I’m enjoying it!

Ten months later

I leave Chad on Tuesday evening and I can’t quite believe where time has gone to be honest.  It’s a weird feeling.  In some ways the time seems to have passed quickly and in other ways it feels ages ago that I was last in the UK.  It’s been an interesting ten months and a steep learning curve in many areas.  I thought it would be good to document the highlights before I leave and everything comes a bit more distant in my memory.

The hospital site, taken December 2013
(the 'grass' you can see is now no longer there as it hasn't rained here since October 2013)

Regarding the work at the hospital, all the staff have been good to work with and it’s been good to learn the systems already established here and help to develop the pharmacy related ones.

Recruiting and training new Chadian pharmacist – the Chadian pharmacist here when I arrived wasn’t really up to the job so we didn’t renew her contract and so I went through the recruitment process with our hospital administrator.  We interviewed three candidates – in French obviously, interesting experience – and I knew straight away who I felt would be the best candidate.  I’ve been proved right as he’s been really keen to learn from me and work hard to continue to maintain and develop pharmacy services here.  I’m hoping he’ll continue to ensure that the hospital is stocked with sufficient quantities of vital medicines, despite the sometimes inconsistent nature of the drug supply chain here.

My three Chadian pharmacy colleagues – in addition to the pharmacist there are two assistants in the pharmacy.  It’s been a pleasure to get to know them.   I’ve enjoyed working alongside them, especially as they’ve all got a good sense of humour (once you’re on the Chadian humour wavelength!).  They’ve also all be very patient with my slightly dodgy French which I’ve appreciated.  As mentioned in a previous blog post, they’ve also enables me to taste various Chadian delicacies.  As well as the crickets, savonier and bouille previously mentioned, I’ve also had the delight to taste a fair bit of mutton (staple meat here, I politely declined the stomach lining), boiled eggs (from the children who walk around the village selling them), Chadian ‘sandwich’ (baguette filled with either meat or egg), bananas, the list goes on.

Improved drug supply to the main wards – one task asked of me was to improve the system used by the nurses to dispense drugs to inpatients.  With the help of my parent’s Church in the UK I have been able to design, commission and install a drug trolley!  This has enabled better segregation of each strip of tablets so that the nurses can easily find the drug they’re looking for on their drug rounds.  Previously the system was a bit more chaotic and not very easy to use.

A road in N'Djamena

Living where you work, in the desert, means you need to make as much of an outside life as reasonably possible.  The hospital is located on the edge of N’Djamena, the capital of Chad.  It takes about 20 minutes to drive there (longer in rainy season!).

Friends in town – it’s been good to get to know other expatriates in who live and work in town.  They are mainly other mission workers with other agencies and it’s been great to have them to socialise with when there’s some down time.  There’s not a lot of variation in the things you can do for leisure here.  There’s one good outdoor pool, a lovely café and various restaurants.  So those are the things we tend to do, other than that we just hang out at a friend’s house and watch films.

The pool – being able to go to the good outdoor pool here more-or-less all year round has been a highlight and was a definite treat.  The only months we didn’t go were December and January because the high temperatures were ‘only’ in the twenties and the water wasn’t warm enough!

Grande marché (central market) – you have to be in the right frame of mind to go but I have enjoyed the busyness, craziness, hustle and bustle of the central market.  There are people *everywhere*. And motorbikes.  And the odd crazy driver who decides to drive his car through the narrow streets.  You’ve got to keep your wits about you.  Add in the high temperatures and you can begin to understand why you need to be in a certain frame of mind to go!  At the beginning are ladies selling fruit and veg by the side of the road.  Further in are the meat sellers and men selling cloth and headscarves.  The list of what’s for sale at central market is endless, it’s a cavern of stalls and boutiques selling a wide range of stuff.  It’s amazing what you can get there sometimes!

Chadian family – Rebecca, my colleague and housemate here at the hospital, introduced me to her Chadian friends who she met when she lived in town at the start of her time here in Chad.  I’ve enjoyed visiting them with her, seeing where and how they live and experiencing their typically generous Chadian hospitality.

L’amandine – no expat visit to N’Djamena is complete without becoming acquainted with L’amandine!  I mentioned it in one of my first blog posts and predicted I’d spend a fair bit of time there….which I have!  It’s a lovely, air-conditioned café selling coffee and yummy pastries amongst other things.  A definite treat and break from the heat and dust of living here.

 

I hope this has given a flavour of some of my time here!  It’s been a hot, dusty experience with difficult times, but an experience that I have enjoyed overall.  It’s been great living and working with the other Brits here at the hospital and being part of a team of expats and Chadians that is endeavouring to bring high quality and affordable healthcare to the people of North N’Djamena and beyond.

I fly back to the UK on Tuesday evening and will begin to adjust back to my home culture, with all that that entails.  Thanks for journeying with me through my blog.  Hopefully I’ll get to see some of you in person soon!

Signing off from an increasingly-hot Chad x

Extraordinary pharmacy

Now that I’ve been here for a few months, things that once were a bit weird are now oddly beginning to feel almost ‘normal’!  I thought it would be good to document four things that have happened whilst I’ve been at work in the pharmacy here, that would never happen at home in UK.

A stitch up?!

This week Dr Mark needed a fresh batch of sutures for a specific operation scheduled for the next day.  He’d already done a bit of a search at the pharmaceutical depot in town (who also sell some surgical bits and bobs) but really needed these sutures to be purchased.  As it’s the pharmaceutical depot that sells them, and I work in the pharmacy, it was down to my Chadian co-worker Elisabeth and I to source them.  Another example of having to work outside a pharmacist’s usual remit!  Yours truly has absolutely no clue about sutures – it’s just a bit of nylon thread isn’t it, to sew someone up after their operation?!?!  After a crash course from Dr Mark about suture material & size, and the different needle sizes & points, we were ready to try and find the correct boxes from the depot!  Fortunately we came back with the right ones after a bit of searching and a twenty minute debate with the secretary about which product they should charge us with on the computer system!

Haggling

Who knew I’d take my haggling skills from the market and take them into the pharmacy?!  Apart from going to the two main medical suppliers in town (see previous blog entry) we also use a couple of salesmen who come us at the hospital with certain medicines.  They are independent businessmen and their prices are a bit higher, but also flexible.  So I’ve bartered on the price of such things as antibiotic injections, gloves, antimalarial tablets, infusion fluids!!  I honestly didn’t think it would work but thought it was worth a try to save the hospital a bit of money and he dropped the price quickly.  So now I barter with him every time he visits!  It was a bit surreal at first standing in the pharmacy with a box of medicines, haggling over the price but now it’s a semi-frequent occurrence!

Small visitors

On Friday we had a little visitor into the stock room.  Our usual visitors are small spiders and that’s about it, it’s fairly secure so we don’t have problems with larger animal visitors, which is a blessing.  Anyway on Friday a small lizard decided to have a little siesta amongst the boxes of tablets! 



Our little visitor!

Treats and snacks
 

In most workplaces in the UK, people bring in treats every now and then for the rest of the staff.  Biscuits & cakes are often the order of the day.  Not in Chad!  Sometimes it is something like bananas or a baguette, but one day Elisabeth brought in crickets!  Yep, fried crickets are a regular snack here and so I was invited to try them.  I can’t say I was relishing the thought but ‘when in Chad’ and all that!  Below is a picture of the crickets carefully arranged on the plate to make them look appealing.  I actually ended up eating two as I wanted a photo taken as evidence and I forgot on the first one!



Crickets

They didn’t actually taste of anything much I have to say, just crunchy.  Anyway at least I can now say I’ve tried them!

Other things that appear in the pharmacy are ‘savonier’, which are a strange nut-looking food. You take the shell off and inside is a stone covered with a sweet-ish thick substance. You suck the stone until none of the thick substance is left and throw the stone away. It tastes kind of sweet, it’s an odd taste really. Elisabeth told me that if you eat too many ‘ils sont comme bisacodyl’ – ‘they are like bisacodyl’ (a laxative!). Useful to know!!!


Savonier

Outside of the hospital several people have set up little stalls selling drinks and snacks.  It appears that two of the pharmacy staff have commissioned one of these ladies to bring them ‘bouille’, as two large beakers of it arrive at the hatch each morning!  I tasted it the other day; it’s a thick white liquid, apparently made from a random collection of things but mainly flour, peanut butter and heads of wheat.  It’s a really odd taste, fairly bland and thick given that it’s effectively liquid flour, but it does have a kind-of sweet after taste.  There’s probably sugar in it too, Chadian’s like to add sugar to a lot of dishes.

Bouille

It’s good to document these now-seemingly normal occurrences, as it’s not until I think about them that I realise exactly how different life can be here sometimes.  When you’re living it day-to-day it becomes standard!

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