Tissi is a very small place in the very big country of Chad. If you look Tissi up on google maps you won't find it. However if you take a map of Chad and look right down in the bottom East hand corner of this huge country that is where Tissi lies, approximately seven km from the border with conflict-ravaged Darfur (Sudan), and less than one km from the Central African Republic (CAR), also ravaged by conflict.
It is a very volatile region and currently hosts Sudanese refugees affected by the fighting in Darfur and Chadian returnees from CAR..
MSF has set up a health facility here offering healthcare to tens of thousands of people.
We see many different kinds of patients: women with complicated labours; people with gunshot wounds; malnourished children; children damaged by mines they found while playing in the sand; women with postpartum infections; people with malaria and the list goes on.
It is a remote little village and it can take a very long time to get here – and a very long time to get out if it is rainy season.
Looking at Tissi from above there does not appear to be much movement. However, once in the town there are sad little donkeys being loaded up with all sorts of goods, children playing together in the sand, people buying and selling at the local market on Mondays and Fridays, men riding horses, women carrying water on their heads with babies on their backs.
At the moment it is the rainy season and there will be rain almost every day for the next three months.
It is raining now as I write and little drips are starting to fall into my tukul. Tukuls are the quaint little huts we live in made of cement with a straw roof. Everything is quite basic where we live but I rather like it. We don't have much lighting around the compound we live in but we get to see the stars very clearly. We have outdoor showers and latrines. I never liked the idea of latrines, the thought of falling into that Big Black Hole was not very appealing, however they are not too bad.
There are seven expatriate team members, all of different nationalities which is something I have always loved about working with MSF. We have a very dedicated national staff team and it is a pleasure to work together. I am not a big football fan but we did watch Italy playing against Uruguay in the World Cup. I felt a little nostalgic for home, for my family and friends, and all the national staff supported Italy because I am half Italian. It was a nice moment despite the fact Italy lost.
The maternity unit © Natalie Giorgi Alberti
I am the midwife of the team and I work together with three lovely dedicated Chadian midwives. As happens in obstetrics sometimes the delivery room is quiet but then all of a sudden it will get very busy. Since being here we have had some complicated cases coming to the maternity.
Last week we received a woman in premature labour. She had a gunshot wound to the abdomen. We delivered the premature twins she was carrying, both of whom were no longer alive within the womb. I will never forget the woman, she never complained as she delivered. We managed to transfer her to Abeche where MSF has a surgical program, however she did not make it. Twenty-four hours after delivery she died.
Not all endings are as sad as this one. Fortunately many end well.
Seven days ago Mariam was brought to the hospital by ambulance. She had a very high fever and was seriously unwell. She had given birth at home four days before to a healthy little boy, however she then developed a serious postpartum infection. She was unable to eat and was hardly able to talk. Yesterday she left the hospital smiling, with little Adam in her arms. She had received the necessary care and antibiotic treatment and was ready to go home.
Kaltouma, in her fifth month of pregnancy, also came into the hospital by ambulance. Her mother had taken her to the nearest basic health care center as she was unwell. When we admitted her she was extremely pale, very weak and had no appetite. We tested her iron levels which were dangerously low, it was amazing she was still alive.
Tissi maternity ward: Kaltouma recovering from severe anemia in pregnancy, with support from her mother © Natalie Giorgi Alberti/MSF
Kaltouma received three blood transfusions and treatment for severe anaemia. Her iron levels went up and she started to feel much better. We wanted to keep her in a little longer, however she really wanted to go home to her family. We can't force someone to stay, so she went home on a donkey promising she would come back for a checkup.
Kaltouma's little niece. It is not uncommon to find little children visiting family in Tissi maternity ward © Natalie Giorgi Alberti/MSF
I still haven’t managed to stroke a sad little donkey yet, perhaps soon.
Another busy week has gone by. Tomorrow another busy week starts but before I know it it will be the weekend again.
Time goes by very quickly when you have a lot to do, when you enjoy what you are doing and when you feel that what you are doing has a beneficial impact on the population you are serving.