Last week we closed our medical clinic at the refugee camp. The local hospital will now serve Danamadja and its refugees/returnees (whereas before our clinic served as a triage location and we’d only refer patients to the hospital if needed). Since the hospital is 5 km away and our clinic provided free care in the heart of the camp, much talk arose with our departure. My project coordinator handled the intricacies of our exit strategy with the local community, authorities, and organizations, and the rest of the team (Burkinabe logistician, Ivorian doctor, French nurse and me) took care of making it happen. Within ten days we had evaluated our staff, performed inventories, disassembled hospital beds and tents to pack, donate, and/or ship back to Ndjamena to our central warehouse. Sadly and necessarily, my contribution involved the layoff of 10 staff, some talent management to “save” 4 nurses for other projects, and hearing out all staff’s apprehensions and fears as we clearly diminish our involvement in the area. My office became the grimmest over the two days I handled closed door appointments with each staff to lay off. Unlike similar experiences in the U.S. in my previous job, unemployment benefits don’t exist in Chad. Aside from the financial benefits employees accrue with an end of contract, the only instrument that I have to ease the process of letting employees go is their performance evaluation to add them to a pool of ex-employees for future engagements; truthfully, not much a question of whether there will be one, but rather when.
The clinic site
We remain present at Danamadja camp with our water sanitation site, especially since the new Kobiteye camp does not have operating wells yet. Our mobile clinics continue at border towns far away from hospitals and clinics and we bring back severe cases for hospitalization. Last Monday I finally had an opportunity to tag along with our nurse and her team for a taste of the trip. After a 3 hour trip (merely 90 km but unruly roads and flooding make the jungle crossing interesting every time) we set up shop under a tree as a dozen mothers with their kids awaited our arrival. The goal is to treat malaria and malnutrition in infants, and primary healthcare to others. Upon arrival the 8 person team of Chadian nurses, techs, and community-recruited aids instantly take over assembling the site as a small production line to first triage patients, second vitals, third consultations, and lastly fill prescriptions. An almost seamless orchestrated production line - except for wandering goats and a dog crashing the site, patients cutting in line, and the sudden rainfall and impromptu shelter set up. The long drive did not disappoint with the wide range of talk from Chadian Olympic athletes (allegedly diving and kayaking?), growing up in the Scout movement and merit badge bragging, Pope Francis and his improviso speeches, guessing crops we drove by, and the hour-long affair to free our truck from the river. Later that evening our French nurse told me about the strangest and most painful patient encounters out in the bush and throughout her previous MSF missions in South Sudan and CAR. I’ll need to consider a future mission as a logistician to be closer to the medical staff for similar stories.
The truck, shortly before the river incident
On house matters, this week I began my term as kitchen manager. Similar to college communal living, it’s a volunteer position that rotates among expats to handle grocery shopping and menu planning with our cook. Since products are scarce in Goré I tagged along for an airport drop off up to Moundou (115 Km north and 4 hours in the rain – PIC) for supplies including copious amounts of nutella and computer speakers to play music at home. One of our last visitors left behind a projector and fortunately my Ivorian and French colleagues travelled with loaded hard drives. My birthday celebration became an all-day marathon of Game of Thrones indulging on freshly sent peanut butter from my friends in LA.
Wrestling for a spoonful of peanut butter with our nurse and visiting medical coordinator.