Life & Death at Guereda Hospital

Spend a day at a hospital in eastern Chad and you quickly will witness the life and death implications when doctors have sophisticated equipment available, and when they do not.

Take International Medical Corps' hospital in Guereda, which serves the local Chadian population, as well as refugees from Darfur living in nearby camps. Guereda Hospital is one of three IMC facilities in eastern Chad that soon will be receiving desperately needed equipment donated by the GE Foundation: x-ray machines, ultrasounds, electrocardiographs, fetal monitors, etc. But until the equipment arrives, patients must go without the diagnostic care they really need – and the consequences are dire.

Eastern Chad is one of the most difficult and dangerous places in the world for delivering health care. IMC's medical director at Guereda Hospital is a South Carolinian named Florence, who just arrived in mid-January and has been at a full sprint ever since, treating patients while training IMC's local staff of nurses and health care workers at the hospital. Her first day on the job she saw around 50 new patients – not counting another 30 or so children being screened for malnutrition and receiving feedings – and the numbers keep rising. In particular she's inundated by female patients; Muslim women customarily prefer not to be examined by a male doctor and many of the women had been tended primarily by IMC's female nurses and mid-wives til Florence arrived.

In her consultation room, one patient, a woman in her 20s, explains that she has suffered abdominal pain on her right side for four years. Florence tells me that doctors in developing countries like Chad, faced with this sort of complaint from women, and without an ultrasound or ECG available, perform an appendectomy, the most common cause of pain in the area. In the case of this patient, she had her appendix removed but the pain never subsided. Florence suspects the woman has either uterine fibroids or multiple ovarian cysts. But without an ultrasound or ECG there is nothing that can be done for her beyond some temporary pain relief. This patient simply will have to wait, and come back when the equipment arrives.

Another woman in her 20s suffered a compound fracture to her tibia and fibula in a fall. Doctors had tried to remove bone fragments, but after two months her leg has become dangerously infected and may have to be amputated. Florence needs to be able to view the damage, but without an x-ray, she must perform surgery under general anesthesia to explore the bones and see if there's any possibility of healing or if a bone graft is necessary.

Yet another woman, in her 40s, lifts her shirt to reveal her right breast, gnarled and bloody from a very advanced tumor. Her treatments have consisted primarily of seeing a traditional healer who, as is often done, rubbed mud and straw into the open wound. This, sadly, has made it much worse. No modern equipment or chemo can save her now. Florence says there is nothing she can do for her. Had the cancer been caught earlier, things might be different.

With each patient I ask myself, will we be able to help? And will we be able to help in time? Fortunately, most of the patients Florence examines she is able to provide at least the band-aid that will hold in the interim with a minimal amount of suffering.

For the woman with the infected leg, the bone graft was successful. Her leg will heal, but given the severity of the damage, it will take a long time. Time is exactly the luxury that some patients can afford, while others cannot.

Once a Teacher...

I spent yesterday in a place called Gaga Camp, in eastern Chad, near the border with Sudan. For the 20,500 Darfurian refugees who live in this camp, International Medical Corps is the only health care available, providing primary and maternal/child care, mental health and nutrition services, and HIV and hygiene education.

I brought with me a special package for one of the camp’s residents, care of the Washington Post’s Nairobi bureau chief, Stephanie McCrummen.

About a year ago, Stephanie wrote a terrific profile of a man named Azhari Ali. Before fleeing Darfur and settling at Gaga three years ago, Azhari had been a professor with master’s degrees in economics and political science. He spoke with Stephanie eloquently about the difficulty of trying to find purpose and intellectual stimulation in a camp with few resources – much less books. His only reading materials were what he was able to carry with him, including “Macbeth” and two-year old copies of Time and The Economist, which he had re-read countless times.

You can see Stephanie’s story here:
http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007092102286_pf.html

Soon after that piece appeared about a year ago, IMC received calls from people wanting to send books to Azhari - the parents of one IMC staff member even paid to send them. Stephanie too heard from numerous readers moved by the story. Compelled herself to help him in some way, she put together a package of books, magazines, notebooks, pens, batteries for me to take to him.

Azhari had been working as a translator for IMC when Stephanie met him. As a way to keep his mind sharp, he was attending relief agency meetings and educating himself on various health campaigns. He is now a community educator for IMC, helping with HIV, nutrition and hygiene education campaigns in the camp.

When I first arrive at Gaga camp and step into the tent to meet him, he is finishing up a training of other community educators. He is a quiet, dignified, solicitous man of 45 – just a few years from the average life expectancy in Sudan. I explain that I have something for him. When I pull out the materials he seems a bit confused, perhaps surprised that anyone would do this for him.

We chat a bit – he is taciturn but his English is excellent. He expresses his gratitude for Stephanie’s gift, and says he is happy once again to be working and productive.

One of IMC’s doctors in the camp, Ibrahim Cisse, says to me: “IMC is lucky to have found someone with such a high level of education to help organize the health community. We cannot succeed here without strong community participation and without health workers like him.”

Refugee camps are filled with people like Azhari - people who had lives, loved ones, professions and aspirations before chaos ensued. All of them are trying to recover what they once had.

Azhari tells me it’s the education and training of others that is so crucial. “This is the most important thing, for our future, wherever we are.”

Arrival in Chad, and Other Musings

I'm sitting in the living room of IMC's compound in N'Djamena, the capital of Chad, feeling blessed with a surprisingly strong internet connection, and a bottle of wine I brought from Nairobi.

I had been warned beforehand of the heat, sand and dust here - it's formidable. I arrived about 1am at the airport. An hour later, as I put my head down to finally sleep, I could feel and smell the dust surrounding me - like a car had just driven by on a deserted dirt road.

Our lovely cleaning staff here has left on the tv for me - I've got the Michael Douglas masterpiece, "The Game," to keep me company now that they've all left for the evening.

I am a jumble of emotions here. I have just come from the displacement camps in eastern DRC, which are swollen with a couple hundred thousand people, all desperately needing food, medical care, clean water. The poverty and suffering is immense.

I'm also feeling a deep sadness about a close friend battling cancer far away from here. The latest news is not good and so I treasure any updates I'm able to get on her condition. I fear the worst and fear it will come soon, and yet know there is absolutely nothing I can do.

Amid all this, it is hard not to notice the optimism in the air here about our new president. Traveling through Kenya, Rwanda, DRC, Chad, I continue to be struck by the impact Barack Obama is having on this continent. Everyone is atwitter with the pending inaugural. Nairobi radio promotes "Obama's iPod, all day, every day". The TV stations are promising non-stop coverage of the event. Cab drivers opine about Obama's style of leadership, how he will handle the economy, the war in Iraq, aid to Africa, Congress, and how America's position in the world might shift next.

An IMC finance officer here in Chad told me Obama becoming president has had a major impact on him. When I asked how, he replied: "He is a brother to me." This is a time of great possibility. I just hope Obama doesn't "screw the pooch," as Gus Grissom famously warns in "The Right Stuff."

Early tomorrow morning I fly to Guereda, on the other side of the country, where IMC is working in camps serving about 275,000 refugees from neighboring Darfur, Sudan and the Central African Republic, as well as about 180,000 displaced Chadians.

I am delivering a special package to someone in one of the camps, which I will write about next time.

Until then...