La Brosse

Logistician Kim travels out to visit remote health centres in Chad

I ventured out to the health centers today.  I am settling in here in my role as Project Logistician in a nine-month posting, and three weeks in I finally had my first opportunity to visit the rural health centers.  MSF supports 18 of the 24 regional health centers in the district.  Right now, in the dry season, we are pretty quiet, since the aim of this project is mostly to focus on fighting malaria in addition to supporting vaccination.  There’s not much malaria right now since it’s so dry, so we get to rest and recuperate, collectively.
Rest and recuperation for the project means maintenance, expat changeover (like myself), construction projects, trainings, annual leave, and, with the current situation, going to help the emergency teams nearby in Sido and Bitoyé where MSF is providing assistance to refugees from the Central African Republic.  For logistics, there are many small works to do in the health centers, which is the main reason for my visit.  I’m surveying, first-hand, the situation in each health center.  The surveys have been done and the results compiled into reports, which is what helped us get our budget approved and our scope of work nailed down, but I can’t internalize all that data from looking at scores of spreadsheets and reading dozens of pages of information (in French).  So I’m off to see the health centers.
I’m tagging along on a movement on our Western Axis, to the five health centers there.  The director of the Epicentre study on parasite resistance to our seasonal malaria prophylaxis distribution is checking on the health workers who started collecting samples for the study on Monday.
At each health center, we formally sit down and introduce ourselves to the manager.  The health centers range in size from a single-room building partitioned into different spaces for exams, deliveries, and offices, all the way to a multi-building compound with staff buzzing back and forth and patients lined up in waiting areas.  All of the health centers are admirably clean and neat.
After the formal meeting of the manager, I slip off to check out the four things on my list: water, latrines, cold chain to keep vaccines cool, and the waste area.  There’s work to be done, but things are in good repair.  I take notes on wooden covers annihilated by termites, well pumps with rusted handles, and the need for a shaded waiting area.  Everyone I meet is helpful and enthusiastic.  I’m impressed.
We finish at a new health center, which doesn’t have a waste area (a waste area includes an organic pit for placentas and an enclosed pit for ash from burned medical waste with accompanying incinerator).  That’s high on the list to build, for us, but more pressingly, there’s nowhere to put the current waste.  I’ll send shovels, picks, and a supervisor out next week to dig a hole to temporarily give them a place to burn the waste.  This is a stop-gap measure that will only last for six months, or less when the rains come, but it will give the health workers another option than hauling the waste half a kilometer through the village to an old well, where they throw the waste, unburned.
I wonder what they do with the placentas now.  I don’t ask, but instead promise to send the supervisor and hire some local labor to dig the hole.  ASAP.

Top image is an archive photo of Takawa health centre in Moïssala, 2011.