Honeymoon in Chad

Written by Grant…

Old Story with a New Twist

Did you know that some girls here in Chad are expected to be married and out of their father’s home by the time they have their first period!?  Imagine.  Actually, it isn’t something I can even come close to imagining – and I see it every day.   So don’t feel bad if it seems a distant story to you, unrelated to your world of Boxing Day shopping and family ski trips.

Plus it is usually an arranged marriage.  Plus it is often to a much older man.  Plus it is likely that this man already has a wife or two.  That often puts them pregnant with child number one before they are 15 years old.

One of our community health workers is 23 and has 7 children.  You do the math.

While I am caught up in the social and psychological consequences of this all, our doctors and midwives see the medical consequences of young pregnancies.  The girls’ bodies are not fully developed and are not ready for pregnancy, let alone delivery. This puts them at higher risks of complications, including obstructed labour, fistulas, and ultimately, miscarriage.  There was a recent delivery of twins at the hospital.  It was the mother’s 11^th pregnancy, of which 6 were stillborn….

…but the real kicker is that, according to our midwife who actually delivers their babies, THEY ARE HAPPY!  The girls seem thrilled to be having their first child at 14 and to officially become a real women.  Wouldn’t want anything else.  Somehow they don’t seem to mind the fact that they go from child to women and miss the whole being a girl part.

In my mind, I have this picture of Muslim men making their wives cover up, keeping them from going out, forcing them to have more children.  Yet it is a whole, complex social system that somehow makes it not only OK, but truly the norm.  And, in the end, it is not the men but the WOMEN who directly enforce this strict code.  The grandmothers and mothers and sisters.  It seems it is not only accepted by the women themselves, but also DESIRED by them.

Too young to be mothers?? Depends on your perspective…

So while I always thought those other things were so appalling – the older man, the arranged marriage, that they are so so young – it is the fact that, for the most part, these girls seem to be HAPPY to be having this first child at 14 that is so hard for me to swallow.

How can I even comment on the situation, or pretend that “my” way is better, or to even start to understand how things work in this context when it is so far from my ability to grasp this one thought?

Meanwhile….Dancing in Am Timan

Yesterday, we held a party to mark the departure of two of our expats.  There was a Medics vs. Logistics soccer match, followed by a dinner of roasted lamb, dates and your choice of orange Fanta or beer.  Of course there were a few speeches and a bit of music, but mostly people just come for the free food and any change from the ordinary.

Being new to this Muslim context, I had no idea how things would work but definitely didn’t expect there to be much dancing.  Wrong again.  Our cook, the quietest and reserved female staff member that we have, led a charge to the dance floor with some high-pitched yelping, 10 seconds into the first song.  Suddenly that awkward pause where the dance floor is huge and no one is willing to be the first was no more.

Our cook, hard at work in the expat kitchen.

Later in the evening, an Indian-type song came on and another of our female Chadian staff jumped into action.  Although she dresses well, every time I’ve seen her she has always been completely covered – everything but hands, feet and face.  Yet there she was, alone in the middle of the dance floor in a tight-fitted pink top, her wrap left discarded on her chair, her hands high in the air and her chest pumping in and out in a frantic rush to keep up to the beat.

Two and Two Together

The 23 year old community health worker with 7 children wants 5 more.  That makes 12 in total.  She is one of the best from our team of twenty…loud, outspoken, intelligent.  She knows how to laugh and has bright eyes that always seem to shine.  Nothing at all seems wrong in her world.

…and I am left asking myself just how does it all fit together!?!?

So, two months into my 5^th mission with MSF and you have a glimpse into what is bouncing around my head these days.  It is only once I am able to rationalize these ideas that I will be able to properly coach the other expats and guide the programs here in Am Timan.  Not there yet, but working on it.

While Chantelle has been busy exploring the world of Cholera in the southwestern corner of Chad, I have immersed myself in the increasingly complex project of Am Timan.  It has been intense, to say the least, and after 7 weeks in country I am only today enjoying my second full day off!

Regardless, I am learning…learning lots and fast and continuously!  Learning about my staff, the programs we are running or hope to start, the history of MSF in the area, the Muslim religion, local politics, security management.  Although questions often lead to more questions and answers can be somewhat conflicting, I am slowly getting a feel for how things work around here.

Nice and Easy

Take, for example, our nutrition program.  When we opened in February of 2010, we used nutrition as our entry point with the ministry of health.  This is one service that was not being provided by the ministry of health and we showed up in their hospital with the idea to treat whatever small number of malnourished children could be found in the area.  From there, we would get a better idea of the current condition of the local population and the capacity of the ministry of health in their provision of care…and we could go from there.

The first month, with all of the staffing and supply problems common during a project startup, we admitted 34 malnourished children under 5 years old into the program. 149 in March. 211 in April.  By the end of May we had 401…and it just kept growing and growing!  To date, we have treated over 3000 children for malnutrition and still have more than 500 kids coming each week to receive their bag full of PlumpyNut or what can best be described as a high energy, nutrient enriched peanut butter paste.

In Am Timan, we go through 60,000 sachets of PlumpyNut each and every month!

Receiving Care at our treatment center.

What’s Going On?

We were shocked by the numbers!!  Remember that Am Timan is located in what is called the “Granary of Chad” and is known for its consistent and plentiful production of millet, sorghum, corn and beans.  Yet we kept finding huge numbers of malnourished children and we weren’t even really looking.  So much for a quick and easy entry point with the ministry of health, as suddenly we were running a full blown nutrition program!

Mothers waiting to have their children’s weight and height taken, as part of their weekly trip to the MSF nutrition center.

In the end, it seems that even this rich agricultural area was not spared by the lack of rains consistent across the Sahel region of Africa over the past 2 years.  In Am Timan, these drought-like conditions reduced harvests and farmers had to dip into savings to plant for next season and to feed their families.  While the rains improved and things were looking up for 2010, there was huge and unprecedented rains in September that led to widespread flooding and practically wiped out what was looking to be a very promising harvest.  Less food, more debt and definitely more skinny and hungry kids.

The list goes on.   A general lack of hygiene, zero latrines outside of Am Timan and very limited clean drinking water leads to what could be considered endemic diarrhea.  And, as you can only imagine, it only takes so many days of constantly running to the bush to shit before malnutrition sets in.  Men also have to pay a significant dowry to get married (roughly 9 head of cattle per wife!) and this is often only managed by borrowing money.  With the September crops all but destroyed, farmers will have a hard time making good on their pre-sold grain contracts this year as well.

It’s pretty simple.  Bad harvest = less money = more debt = less food = more malnutrition.

Fish Season Brings Temporary Reprise

During each rainy season, torrential rains fill the otherwise dry and sandy ‘ouadis’ and, in this granary of Chad, they always overflow to cover vast flood plains with live-giving water.  The rains normally end in September and the waters recede, leaving behind enormous fields of nutrient rich soils that are rapidly and completely planted with millet for next February’s harvest.

As these gigantic ‘rivers’ shrink (some can grow to more than 50 km across!!!), bottom feeding sucker fish become concentrated in smaller and smaller areas and it is literally like fishing for trout in a stocked pond.  Fish flood the market – cheap, meaty and delicious – and it really is “la grande fête”.   Boxes of fish are sent to relatives in N’djamena.  There is a real buzz in the market and around tea stands.  Even the expat team got our fair share!

Deep Fried Goodness

Unfortunately, this “fish season” only lasts 1 month as the ouadis are bone dry once again and will remain that way until the rains start again next June.  For now, this short burst of protein has led to a slight decrease in the number of patients in our feeding programs.  However, with the September harvest largely destroyed by floods this year, we are expecting our numbers to peak in January as people hungrily await the harvest of their recently planted crops.

…and so we ramp up our nutrition programs accordingly and help then wait it out.