Bahai Beach 46

Bahai Beach 46

Visitors

February 26th, 2007

Scores of people want to come and hang out at our beloved Bahai Beach. Political activists, donors, observers, exploration teams, humanitarian workers, ambassadors, journalists, photographers, cameramen, movie stars and philosophers.

Amongst the quoted reasons for a visit to our beach resort:
Quality of the beach at lake Carriari, funky nightlife, exquisite gastronomy of the region, fine market, tons of sand for kids to play in, proximity to Sudan, proxy for Sudan and lastly the wild life. As Sudan or rather Darfur is impossible to visit nowadays the media visits the camp closest to the Sudanese border.

Our friends at UNHCR double as innkeepers at times with between 2-10 visitors. Some of the visitors have huge expectations of the Bahai experience and expect high maintenance care. After all they are big fish. And fish in a desert need good care.

Yet it also brings an opportunity for the refugees to present their story to the world. To assure that their present status remains an embarrassment to political leaders worldwide. How many years more of talks of intervention of UN troops? The refugees are very articulate in expressing their needs for protection and their hopes and expectations for a peaceful future. If only world leaders could some a similar passion and interest to do something about the shame beyond shame talking place presently.

Spates of visits, high profile or not also give the impression that something might happen. What I find admirable is that the refugee community does not give up despite hollow words a plenty and little action taken (by governments around the world in a concerted effort) to ameliorate their urgent problems.

Yet normal life continues and so the Bahai hospital received a patient from Bao. She had delivered her 7th baby but she did not deliver her entire placenta. When the family managed to come to our hospital after seven days she had a high-grade fever and signs of sepsis and shock. Despite maximal efforts of the team in the hospital the lady died.

Maternal deaths remain a huge problem in this part of the world for a plethora of reasons;

Lack of access to obstetric care (this lady traveled about 140 kilometers over non existent roads)
Lack of nutrition (many of the women are anemic due to lack of proper nutritional practice)
Frequent deliveries in short periods (No time for recuperation)
Female genital mutilation, in this part of the world many women have their vagina sutured so a delivery requires a cut always (risks of infection, bleeding, prolonged delivery, obstructed delivery).
Unsafe delivery practice with infection like tetanus as a consequence.

In the camp in the mean time we had a similar case. It was a lady with a retained placenta. Due to custom she preferred a delivery with an untrained traditional birth attendant. That is her personal choice. However when a complication developed things were less good. For hours out midwives had to argue and insist that the lady required further medical care. Her placenta was eventually removed manually but it was a not so easy scene for our midwife who got threatened in the process

There must have been something in the air because there were miscommunication and arguments all over the camp. At least it is not cooking hot with the sturdy wind to flow a steady flow of sand in your face. I am dreaming of snowy slopes. Perhaps I should go to Dharamsala this April. Hang out with the Dalai Lama.

On that note,

Om shanti

Ashis

Bahai Beach 45

Bahai Beach 45

Busy days

February 22nd, 2007

The heat strikes.

Mr Mathias had been presented with a precious gift. A minute gazelle. Left on it’s own the animal passed away. The sun has started to burn again. Winter is over!

The warm weather will make it able to sleep outside for all, but during the day there is no place to find shelter. Fikiri our new logistician was born on the lakeside so I will propose to him to open a swimming club at lake Carriari. It should be fun splashing around in the main water reservoir for the entire region.

Today the water collection truck broke down so we have been with out water since the morning. Solutions are rapidly found and one of the other trucks was dispatched to arrange the water situation.

Flies adore this heat and today visit to the market will likely end in a purchase of a flyswatter. Sometimes you see on television a lethargic kid too weak to swipe of the flies of his face. It is not a matter of lethargy the flies are just too persistent.

Oure Cassoni has received visitors from WHO to ascertain what skin diseases are causing mouth and head lesions in the camp. The doctor and the lab technician were well experienced in outbreak control and I realized again that one of the things I like most about medicine are our friendly parasites.

Worm, virus, protozoa, bacteria bring em on. I will have them for breakfast. The interaction between them and us. The mediating immune system I find it inspiring. Spent a large portion of last night reading up on obscure disease like bejel. As I wrote in the last post I am thinking about different paths for after this mission. I feel an urge to absorb some more knowledge; epidemiology, healing, medical anthropology. I will see what appeals most and how I can combine it with work or perhaps be a full time student again.

In the camp in the mean time there are some health practices deleterious to the health of babies. Consider cutting the uvula (the thing dangling from your palate as one. Common believe is that when a baby vomits it is because of that thing dangling and irritating him/her. One might as well have it cut with a razorblade. A young baby is now admitted in the hospital trying to deal with this problem. The WHO doctor told me that in the regions he had worked this was the prime cause for malnutrition of babies.

On Monday we will have a superstar visitor (John I guess you know) I shall happily write about the visit on Monday. It seems the Timster, Marckie Mark and myself are all geared up. It far outshines the visit of the American ambassador yesterday. He came by plane to see what the situation is like for the refugees, local community and humanitarian aid workers.

My chooks are on the way to have offspring I hope. It has been a while since the two of them are hatching eggs and it seems the cats have become accustomed to the chickens.

Our weekly meeting should start now and afterwards I am sure to visit the market. I have money in my pocket for the first time since 3 weeks and I will go on a mango spree. Yahoo.

Catch you later,

ashis brahma

Mango’s not available but I had BBQ meat and a guava drink.

Bahai Beach 44

Bahai Beach 44

Busy days

February 17th, 2007

For the last week both the Health Coordinator Sylvie as well as Dr Ponce are out of Bahai. It means that the responsibilities of their jobs come to be shared amongst the other members of the health staff.

Luckily the hospital has been calm for the last few days. Dr Ponce is in meetings with the Ministry of Health to assure the deployment of a doctor, an administrator, several nurses, a lab technician and a pharmacist. After all it is a Government District Hospital and to be honest it would be a shame if the equipment, the medication and the infrastructure cannot be utilized in the near future. Our Ngo has been trying to hand over the responsibility back to the authorities for quite some time now. Today I took the new head of office of UNHCR for a visit to the hospital and as he said compared to many other hospitals this was a well-organized place. With a functional operation theatre, a laboratory, a generator, a pharmacy and a new kitchen under construction.

A stroll in the market today and a guava drink made life very agreeable on Sunday. A nice sandy wind and a light sun made the temperature agreeable. And then there was the Saturday night film night. A silly Jennifer Lopez was so bad it became good again. More important hanging out at the UNHCR once in a while gives a different and pleasant perspective.

We are moving up our staff numbers to 27. Unfortunately we only have 2 vehicles and that does not make life easy for planning the programs. It means at times people have to stay back in the office because there is no place in the cars. And that indeed means the office is up and functional again. For those of you who have not seen try www.flickr.com (ashisbrahma). After the massive rains in August 2006 and the increased security threats of November we have worked a lot from the compound. But with so many people around and a new logistician in place (Fikiri) our beloved office compound is back in full swing. It makes it easier in some ways to separate work from leisure. Read not being at work 24/7. Yet giving all the back log due to reduced access, reduced staffing we all need to work hard to improve again the services

The last months have no cakewalk. And the next few will not be either. The security situation has not improved much. It is hard to see that hoped for improvements in the health department have been delayed. Examples are planned constructions (on hold for 5 months), introduction of training programs, proper drug management systems, yet with the return of key staff I have the feeling we might see rapid improvement of several components of the program.

First and foremost as I wrote before in the reproductive health care department. It is where by the help of traditional birth attendants we can increase visits to the Maternity ward before and after delivery. But also supply supplementary feeding to breastfeeding and pregnant women. The hope is to prevent women from becoming anemic and malnourished and assuring the increase of the average birth weight of the children born in the camp.

It has been nearly 8 months since I am in Bahai. A holiday is looming soon and I am looking forward to that. Time to ponder on the route to be taken in the near future. Time to meet some old friends and family to reflect and discuss. Time to eat and meander, read and listen to music. Dance and travel freely without being locked up in a compound.
Time to breath in and out!

Until the next Bahai Beach

Namaskar,

Ashis

Bahai Beach 43

Bahai Beach 43

Car Crashes.

February 15th, 2007

Our third car (for 27 staffs) has been taken back to Abeche. There is some mechanical defect. En route yesterday the replacement vehicle had a car accident. Luckily our driver is ok and the car is more or less intact, but for some days more we are half stranded. Security limits are movements by foot and absence of cars the driving to and fro to the camp.

A sharp reminder that car accidents are dangerous here was when a vehicle toppled yesterday near the camp. It is said that one man died.

In the camp as every day there is good news and bad news. Amongst the good news is the arrival of treatment for the ringworm. The quality will allow us to start treating the severe cases. The less severe cases will have to be treated with a lotion. Our health center is flooded with cases.

The sad news was the death of a 1-month old child in the health center. Upon arrival it was clear that conventional treatment had taken place. With a knife about 50 small carvings were scratched into the baby. On arrival the child was in a very bad shape and despite or firm efforts it died nearly immediately of the blood infection. I talked about this practice with Adam and Zahara. In the past they said cases like this were very common but nowadays they were becoming more rare. Yet today proved that the health message about scarification may well be repeated as to avoid other needless loss of life.

Over the last days the wind has picked up again and it is freezing cold again at night. In the camp a distribution of blankets is taking place for the vulnerable. Just imagine how cold it must be in the more or less open desert. Even the cats are crawling back indoors every night after a period of sleeping outdoors. As always at night they have found the one person who is tapping away in the middle of the night to share some heat.

My chickens are getting fed up with their diet of rice and spaghetti. I have requested a chef cook for them from N’Djamena but unfortunately we are bound to a maximum number of people in the compound. The next two days will be long hard days of work, but on Sunday I go in hiding again. Time to ponder, relax and, well not visit the market after all after the bombardment it has been off limit. Perhaps we can challenge the boys from UNHCR or ACTED for a game of footy. We shall see….

My buddy Sancho Pancho is booked to come to Bahai for about three weeks and I am happy about that. Wise cracking at night time. A smile in the desert.

In a way it is a sad week as well. Sospeter the logistician is moving on. Soon he wil be in Congo looking for diamonds with another NGO. I wish him all the best. I am sure we will do very well.

For now my mind is void.

More later in the week,

Namaskar,

Ashis

Bahai Beach 42

Bahai Beach 42

Calmness prevails?

February 11, 2007

Two of my chickens have understood the message. Their role is to make sure I become Lord of the Chicken. Grandmaster of the Eggs. Number One Chicken farmer in Chad. One is having 2 and the other 7 eggs stuffed under their wing.

The weather is becoming warmer and the nights less cool. The kittens enjoy their sunbaths and play in the sand. I can sleep outdoors and gaze at the stars again at night. It is a great season just before the heat strikes and the fierce winds are over.

In the camp 3 children were born in the health center over night on Friday. Since the arrival of Melel our reproductive health assistant manager, an experienced midwife, services are picking up rapidly. More and more women come to the antenatal clinics and we hope that more pregnant ladies will decide to deliver in the health center. To assure that at the grassroots people are aware of our new enhanced services 10 traditional birth attendants have been taken in to service. The core duties of TBA’s include finding those women that are pregnant and promoting the utilization of the health services.

A lady popped up at the clinic. For three years she had been walking around with a bullet in her shoulder and it has become too painful for her to handle further. Monday she will be on the ambulance to have the bullet removed. At the same clinic our new doctor Remi is finding his work cut out for him. The nurses in the camp have always said that children below let us say 3 years are difficult to examine and diagnose. One of Dr Remi main tasks will be to supervise the nurses so they increase their skills and also to give a boost to the quality of the consultations.

With our team nearly reaching full strength (only missing 2 nurses and 2 translator and one expatriate Reproductive Health Manager) it seems business is back to usual. Yet there are only 3 cars in the project (usually 8) and only 27 people in Bahai (usually around 50) you can imagine not all services are back to full strength. The health department has been in ways lucky.

Yesterday for the first time since I am here a football match between UNHCR staff, IRC staff and random passer-byes. It ended in a thrashing. My team lost 4-0. More luck next time and at least I tackled several opponents in the process hurting myself more than anybody else. Such a relaxing day!

To make the day even better I went over to UNHCR. Two new satellites were installed and I was force fed with a round of 220+ canals (Most of which Arabic) by Audrey the Big Fish of UNHCR in Bahai. So I dozed off at 22.00 after I had rambled on for about an hour that I would collapse after being put through more punishment.
Dog-tired but happy as a little bird.
I said: “Calmness prevails?”

Why?

This morning we heard two loud explosions in the distance and a little bit after we felt the trembling of the earth, the windows/doors shaking and an even louder noise. The most likely explanation is that an airplane dropped bombs. I do not know about wounded or structures hit but so far it seems Bahai was not hit

Always when you are lulled into a false sense of security in this place instantly you are brusquely awoken. The consequences for today are:

No movements outside the compounds until further order.

At the end of the day of tomorrow we will find out more. The local authorities and UNHCR are investigating as I type this story.

To me it gives a feeling of awareness of where I am. Only last week two nights in row I heard gunfire. Anne asked what the noises were and all 4 people present who had calmly continued with what they were doing (watching TV, chatting, working online) responded that it were guns being fired. Some how you get used to it.

Aware and accommodated to it, making an assessment as to:

1. Hit the deck
2. Go to your room and lock the door
3. Continue as usual
4. Inform the security focal point to follow up
5. Await security briefing
6. Go on with what you are doing

Today I am sure that the church service continued for our national staff. Several people have just returned.

Well to all of you,

I am fine.

Dr Ponce will leave for N’Djamena for meetings with people from the Ministry of Health. But with Dr Remi around that does not mean that the responsibility for the hospital will fall completely on my shoulders.

So calmness does prevail

Namaskar,
Ashis

Bahai Beach 41

Bahai Beach 41

Sun is shining

06-02-2007

He was standing in a round mud hut. His leg tied to the wall. On the floor lies a bowl with the remains of a meal. A snotty nose but there was a smile on his face. While I squeezed into the minute room he looked up to me and put the free dangling stethoscope in his mouth. The boy was seven years old and could not speak a word. As his mother explained he got lost during the attack of the janjaweed on their village. Our friend got separated from his family and was found back after a day.

Ever since he has not talked.

I wondered looking into his dark brown eyes what would be going on in his mind. To be tied to the wall and having very few ways to express yourself. What had he gone through and what is going through today.

There is a NGO called SOS-Kinderdorp run by Jolanda in the camp focusing on psychosocial care. Whenever I feel less happy I go their center to watch children have therapeutic playing session. Surely he should be on the list for playing therapy and his family should receive support as well to help them out.

And then on Monday a 15 month boy was presented with an acute flaccid paralysis of his left arm. In medical terms that can mean many things but in a refugee setting in Chad one has to consider poliomyelitis. If that is the case mass vaccination campaigns need to be rolled out. But we are not there yet. It can be a host of other reasons. The boy was not so lucky in many aspects. At 15 months he still could not sit up, walk, talk. It seem she is partially blind. It looks like he has a heart rhythm problem. In all milestones of development he is behind. His young father and mother care for him passionately.

Bold heads, or patchy loss of hair. Many children in the camp were found to be suffering from a fungal infection. This will involve a major operation to treat all these children (estimate 3000) for the duration of 1 month at least. Such a large quantity of drugs we do not have in stock so I t needs to be bought locally. Chad being Chad (in other words landlocked) it is proving to be an expensive exercise.

The health team has been growing rapidly over the last month. A new doctor, Remi a mid wife Melel, two nurses coming in 2 weeks, a new expatriate midwife coming in March and the lab technician has been around for at least a month. In the hospital more or less the same story despite the absence of the Ministry of Health Staff our midwife, pharmacist, 2 nurses have returned. Finally it feels like there can be improvement again in the program. Giving time to reflect, plan ahead instead of panting all day and doing crisis management day in day out.

Today I spent explaining the new staff the principles of IRC. I managed to do one verbal autopsy of the death of a four-day-old baby and to visit the Health Post. This last visit was clearly due. We found a dirty Health Post, with examination rooms doubling as storage rooms. And to top it all of for the first time in 3 months we had a weekly regular meeting with the health staff.

The outbreak of skin disease is a serious concern and we are still scrambling to buy enough medication.

Well as I gaze at the moonlit night I wish you all a beautiful day.

Namaskar,

Ashis

Bahai Beach 40

Bahai Beach 40

The caps are on

February 1st, 2007

And the afternoon sun gives a mighty smile yet my colleagues are walking around with monkey caps, skiing coats, boots, shawls and skiing glasses. Me I say cold is mental and I walk around in a flimsy kurta pyama. The winds have come down the last couple of days and it makes a lot of difference. Sleeping outside is on the agenda again. The stars are just waiting to be gazed at. Is it full moon?

The cats have found there way in and out of my room. We struggle to share the minute bed. Just as I type this both of the cats come over to play. They like the apple sign on the back of my lap top. But how could I forget the most important news?

The eggs – omelet or future chooks – are back in production. One of my latest visits I found 8 eggs. I have left 4 with mother chook to be bred. Awaiting the stipulated 4 weeks to see the result. In the camp they have warned me that the winter is not over at all. It could still hit hard. I however tend to follow my chooks wisdom and weather information.

I started to tell you about the outbreak of skin disease in the camp. There are over 1500 cases of ringworm. This requires a major intervention based on:
1. Treatment
2. Health Promotion campaign
3. Active case finding and surveying

You can imagine that we have nowhere enough medication to treat such a vast quantity of kids. Normally a drug order will take more than 3 months to arrive in to our land locked `Chad. So exceptionally drugs need to be bought locally.

I spent the day today out of the camp piling up work on the logistician Fikiri. About 17 different structures need to either repaired or build in the camp. Things ranging from wooden/plastic structures for vaccinators, to an incinerator, shower for the delivering ladies and a latrine in the health post. Also I had to chase him about the urgent request to buy the necessary drugs. He took it in his stride with a bit Congolese smile.

Only a few months ago we were with 6-7 people in the compound. The team is getting bigger on a daily basis and on the last head count we reached 22. It would have been much more were it not for the lack of airplanes. One of the constraints here is that the over land road is dangerous and that there is limited capacity through the air. If an airplane is needed in another region more urgently or maintenance is taking place immediately it leads to a backlog of people flying in and out. Only our organization has 15 people waitlisted. A huge dysrupture to services and a major impact on planning.

Our Public Health Assistant Manager Ben left today for a 2 day seminar, but given the erratic flights he may be out for quite sometime because of it. With him went our other lab technician as well. Well at least they get a break from the isolation. I wonder at times however if Abeche is such a good place for a break..

If you recall well Abeche was taken by rebels two months ago and I am sad to say that fighting has increased again in the South of Chad. This around a village called Adre near the Sudanese border.

Over the last 1 month two reports have come out reflecting the situation in Chad

1. Human Right Watch
http://hrw.org/reports/2007/chad0107/

2. Amnesty International http://www.amnestyusa.org/news/document.do?id=ENGAFR200012007reflect

They give a clear reflection of what is taking place in this part of the world with vivid description of people who have suffered this vicious violence. It may not be a bed-side read but it does spell out why there is need for protection of the victims, persecution of the criminals and peace making.

Let nobody be able to say ich habe es nicht gewusst!

Namaskar,

Ashis