Bahai Beach 64

Bahai Beach 64

Oure Cassoni updates

May 27, 2007

The story of the prisoners escaping jail with the use of a spoon I will surely not forget. Yesterday I walked by the prison and found to my great surprise that the hole in the wall is still in place. Although I must add a big rock has been shoved into the hole so that escape is hard.

In the camp I visited the boy who was chained to a wall in very dire circumstances. As I visited his room now has a door and a roof so he is not exposed to sand and sun and he does not have to be attached by a rope. He also follows creative therapy twice a week and is improving week by week.

Hagar our old friend (4 years old) has returned from a stay in Sudan and is eating at our breakfast every morning again. He looks happy and talks a lot nowadays. Pointing out when we should go and eat (11.00), that he needs water to wash his hands and that we should be quit while eating.

In the village arms a plenty. Looking at the soldiers one wonders at times how old some of them are? They can look like 14 or 15. Small banditry may be less these days but now we have bored young guys running around time looking for a good time.

My chickens seem to have recovered from the loss of their brothers and sisters. I am still awaiting renewed production of eggs. But they whispered to me that 45 degrees is not a good temperature for them to be very active in that field. I am happy of late to be in contact with several other chicken farmers. So experiences can be exchanged. As I will be leaving soon I am making travel arrangements for the chicken as well. If I leave them here I am sure the will end up in the chicken soup. I like my chooks too much for seeing that happen.

In the market the old Mimi is happily limping around. When I call her she comes to be stroked. She looks well fed. Our two Mimi’s in the compound tend to spend copious amounts of time in my room. I sometimes wonder if they read my books there?

At times even in case of a medical emergency it is not possible to arrange an airplane. Luckily there is a hospital with a surgeon in Iriba, 100 kilometers and about a 4-hour drive away. A pregnant lady presented to the hospital with all signs of an extra uterine pregnancy and she was very pale. In Bahai two blood transfusions could be given and this morning at 05.00 Dr Ponce escorted the lady in an ambulance to Iriba. There with his colleagues he operated on the lady and despite losing more than 3 liters blood she pulled through the operation. She received another blood transfusion and is now stable

Tomorrow a weeklong campaign will start to register all the children born after October 2005. It is important for them and their families for several reasons. Receiving an official registration by the Chadian government is one reason and it will also lead to an addition on the ration cards. There are families where there are 5 children but rations are received for 3 only. It may seem simple to register an estimated 800-1000 children but witnesses need to be present at the registration. Most of the midwives and traditional birth attendants will be assisting.

Amongst other things we are preparing for the rainy season. A cholera contingency plan is being rolled out, constructions are being sped up, and materials are pre-positioned. And it seems we will have a generator in the health center next week.


Namaskar

Ashis

Bahai Beach 63

Bahai Beach 63

Gorilla escapes

May 22, 2007

My o my some antibiotics need to be praised like anything. After hobbling around, complaining and being ill for 10 days today all of a sudden I am starting to feel energetic again. It must have helped the afternoon was spent napping but praise to Cefixime.

What also must have helped is the fact that due to meetings I stayed back in Bahai for two days. Two days spent to pour over the budgets with the donors (UNHCR) and ourselves to see if there is any more money to squeeze out of the budget or all money has been spend all ready. It seems we are good in spending money. In a way it is not surprising at all. Considering the act that Chad is land locked and Bahai is amongst the points in Africa furthest away from a coast/port it becomes logic that items like a bag of cement are 4 times more expensive than in the capital N’Djamena. Also given the minuteness of Bahai no technicians (read mechanic, plumber, electrician can be found in the village) and if the come they ask for the moon to come to end of the world. Eleven months ago I was pretty ambitious about building structures in the camp. The reality is slow it goes.

Amongst the headaches for us in the next months will be rupture of drugs. Then again given the long time it takes for items to be delivered in Chad it is as it is. Even in the capital basic drugs cannot always be bought in large quantities or are sold for exorbitant prices. Also there is the raining season or rather lack of rainy season to worry us. The lake like last year is getting empty and anxiously clouds are being hoped and perhaps prayed for. Then the president of the Republic is presently in the East to discuss with the rebels all kind of peace agreements. In lieu of that there is a massive increase in troops in and around Bahai.

In the camp in the mean time we are de-worming all children between 6 months and 5 years. Also we are giving them vitamin A. Roughly 3000 children are supposed to receive treatment in this campaign and the refugee public health team mainly does this exercise. Tomorrow I will be back in the camp. There will be a lot of small improvements over the next 2 weeks. We are constructing 7 examination couches and 7 cupboards. Also 15 washing points (small water containers) will be put in place so the nurses do not have to walk to wash their hands.

As I write this many of the protocols have been translated in Arabic and have been transformed in to poster so the staff can peep on them incase they forget the fine details of a treatment/diagnosis. Our laboratory is in full swing now, remains to find a refugee laboratory assistant so the services can be provided 6 days a week instead of three days.

Despite all constraints over the last 11 months they has been a clear improvement in quality and quantity of services. Our national staff team has increased in depth and strength and so have the refugees. Now with the health committee in place we hope that even on a management level the refugees can take over the services.

For all of you not living in the Netherlands. A 180-kilo Gorilla has escaped from his cage in a zoo in Rotterdam, leaving 4 people wounded. That in itself is sad. What surprises me is that it is still first page news 5 days after the event. Any way it is as it is. As the Beatles sang Let it be, let it be.

Namaskar

Ashis

Bahai Beach 62

Bahai Beach 62

Cows eat books

May 17th

The ice chilly waters of Ma Ganga are still pristine at Rishikesh a vibrant village with a healthy quota of spiritual seekers from with in and outside India. I like the place because it is right mix of nice people, spirituality, yoga light, lost travelers, waterfalls and peaceful monkeys.

In the morning I take my dip in the river feeling my pulse drop to 30 beats a minute a tranquil awareness and yet much better than last time when I visited around January and the water was truly ice cold. While I was reading a book on tantrism a cow came up and started munching away at my book. Blessed the book I thought and I let the four legged bovine happily munch away. Monkeys also seemed to be after my books. Whispering ‘Ashis forget about knowledge from books find wisdom.’ Well the dear monkeys were happily awarded with a bag of bananas and naturally a book on the history of India.

Birds aplenty in the valley swooping over or casually hopping around looking for dazed spiritual seekers to feed them breadcrumbs, Everyday at sun down an aarti (fire sacrifice) is held for Shiva. About 100 saffron clad orphans with 3-5 musicians chanting Sanskrit hymns for Krishna, Vishnu and Shiva. A robbed long bearded priest leads the ceremony. Every time I go to Rishikesh this is where I find inner peace. Children chant their devotion to Universal love. Little basket filled with flowers, candles, and incense float away on the river and in the middle of the ceremony tens of fire holders passed around to cleanse the sins. The peacefulness of the ceremony is hard to describe and should be experienced by all.

In the village a man walks around dressed up as hanuman, the mythical monkey king and servant to Rama. The faithful ever reliable friend how plays a major role in India’s most known story the Ramayana. He grunts with such a mischievous glint in his eyes and poses beautifully with his attire and mace, rupees flock to his pockets easily.

Anywhere in India where there is a spiritual site beggars and handicapped people flock. Yet this is not the bustling and scamming of the big cities but a more serene facet of the religion. While on a pilgrimage people tend to be more generous. Also the spaced out new converts to yoga or the old school adepts from all over the world chip in. And there are the sadhu’s. This being where the Beatles came to meet Shri Maharishi for a long long time the Shaivite monks are found here. Some phony, many funny, some dealing bhang, some doing severe penance (think about holding your hand up in the air for 17 years, or standing on your head for 8 years. You can meet generation next young Indians coming to combine parasailing, hiking, a religious dip and grandmothers who have always wanted to visited this sacred place. Rishikesh lies smack in the beginning of Char Dam. The four springs of the most spiritual river in India. In fact a goddess called Ganga who was forced to leave her celestial Milky Way to make the parched earth fertile again. As she did not enjoy leaving her peaceful abode she crashed into the earth with such force that the entire planet was about to drown. It was then that Shiva; Lord of destruction was asked by all the Gods and humans in earth to save the planet. By using his Rastafarian dreadlocks he tamed the river. Ever since Shiva and Ma Ganga are in cosmic union.

I missed out on the visit of the sources as they are opened only late in April when I had moved on for Mumbai and Goa of which in a later Bahai Beach perhaps more.

Bahai Beach 61

Bahai Beach 60

Tomorrow some time

May 17, 2007

Snotty nose, coughing out my lungs, fever a splitting headache has doused the inspiration by my muse. Even as I type away now one of the Mimi’s is trying to curl her way up the keyboard. And then I was more or less obliged to sacrifice my rooster for the sake of extended sleeping hours of my felloe workers. The chicken soup did not taste that well on that day.

With all our fine-tuned planning most of the health staff in the camp is out at the same time. It actually leads me to do more hands on work again. Checking out the babies, seeing the more difficult cases in the clinic and today’s delivery. A 15 year old with female genital mutilation presented while in labor. I asked Zahara to step behind and to let one of the other midwives do the delivery. The young girl did not flinch and the progress of the labor was steady. In the final stages of such a delivery a cut (episiotomy) needs to be done. The head came out slowly and as I had asked to check for the umbilical cord the midwife found that it was wrapped around the neck. She rapidly clamped the cord with two clamps and then cut it after which the baby girl could be born. Like the mother it was a strong child so it started to cry instantly. Observing deliveries like today’s gives a very good feeling. When a danger symptom/sign presents the midwives know how to act rapidly.

As I walked out of the delivery room after checking the baby I walked into the meeting of our Health Committee. The theme of their meeting was neonatal mortality. In an attempt to understand the problem they had to write down root causes and most of the essential causes were mentioned. Next week they will work on solutions for each and every cause. Step by step responsibility in the camp is being handed back to the refugees.

It is also seen at other levels. My community health supervisor is the first teacher for the community health workers. Yet not all is love and peace. The monthly meeting with the refugee community leaders turned out to be a three and half hour blood fest, where accusations flew left and right and tempers flared.

Perhaps it is due to the heat. This month is supposed to be the month for early rains. All we have had so far is some splatters of drops. Next month will be the hottest month with historically no rain until the July/August rains arrive.

I realize every day I go to the camp the completion of a cycle is nearing. As my mind wanders I try to frame my thoughts about the progress over the last year. Given the nature of the last 11 months, the dynamics, the obstructions, the obstacles maintaining a status quo should be perceived as a success yet clearly at points there is an increase in strength of the program. It is a joyful thought I will cherish while l put my drowsy head to rest.

For those of you awaiting stories of India. I am sure the muse will return soon-ish. After all I cannot be in mourning for my rooster too long there are other chooks to take care of.

Just a final little story I managed to buy a digital video camera and I was in full conviction that I had a tape as well. Yet on an arrival the tape was a head cleaning tape. O well. I hope I can find somebody to find me a Panasonic tape in N’Djamena

Namaskar,

Ashis

Bahai Beach 60

Bahai Beach 60

Back to Chad

May 6, 2007

A long break in India has done a world of good. Time for reflection. Visit of family and friends and lots of loitering. Bahai Beach 61 or 62 will be devoted to parts of my trip in India.

Here in April a lot of positive changes. Our translator is back in Bahai. We have a new female and male nurse. Three verandas and a shower have been built and more constructions are underway. Nowadays > 85% of the mothers in the camp deliver in the maternity ward, supplementary food is being distributed to over 400 breastfeeding mothers and pregnant women.

The weather varies from hot to cooking hot. In the afternoons one sees the refugee, national and international staff huddle in the shadow trying to ward off the swarms of flies and escape from heatstroke. Today luckily the sky was clouded and a mild breeze has been blowing all day. Unlike N’djamena or Abeche nights here are generally very tolerable. Food distribution has been going on since Tuesday and long lines of donkeys and people are making a great panorama of vivid colors and movement.

Not all-good news from Chad. While the house constructed for the major pump at the Chateau was effectively crashed into by a water tanker a full three days after completion of the building. The whole building has to be rebuilt from scratch delaying the introduction of the gravity based water distribution system. It is similar callousness that has caused our fence to be smashed by another water tanker. Then we have armed boys in town from different denomination and the old adagio guns lead to trouble holds true. Shots can be heard on a regular basis, most is not target practice. Our Congolese loggie managed to tango with a motorbike in Rwanda leading to a bad fracture of his foot. Wishing him a speedy recovery from here. The saddest news by far however is the departure of my Jedi knight buddy Mr. Sancho Yoda. He has rejoined Princess Adriana. May the force be forever with him. Hope to see you sooner in LA!

In the camp despite our efforts a mother decided that the traditional way of healing was better for her child. She there fore left the hospital with her dehydrated and malnourished baby and had a traditional healer carve the little one with more than 50 incisions by razorblade. It is clear that these avoidable deaths are hard to accept yet there lays the challenge of the work. When to act and when to accept other choices, other treatment modalities. We hope to find out this week what made the mother take this path. As per the story the child was born outside of wedlock and is a big problem in the camp.

Since several months we have a health committee in place, which will ultimately manage the health care infrastructure, the committee consists of male and female refugees only and there are advisory members from IRC. The issue of scarification is definitely one of the issues that need to be addressed. Even if the practice is much less common than 4 years ago. Preventable death is an issue that with the help of the leaders and the health committee can be addressed.

My end of contract is rapidly nearing. There are so many things I would still like to do. But for now I will focus on a limited amount of things. Drug Management System, preparedness for the rainy season (yes even in the desert we can have torrential floods) cutting off access to the camp for days to weeks.

For today this will do.

Tomorrow a parable from India or more about Chad

Namaskar,

Ashis