Malnourished children and displaced people

As the dry season drags on, Raghu and the team in Am Timan in southern Chad must work together to respond...

We all knew that late in the dry season, malnutrition would peak. But this week it hit us hard. Our outreach teams had difficulty coping. The hospital was temporarily over-run. Dr. Johanna, our MSF doctor from Sweden, told me the hospital “looked like a refugee camp”. The team and myself surveyed the hospital grounds. Two patients shared a bed in some circumstances; the area we use for children’s play was covered with mattresses on the ground and patients; and our tent used for epidemic infectious disease was filled with malnourished children.

I quickly emailed our nutritional epidemiological data to our medical coordinator, Cristina, from Spain – she coordinates our medical operations from the capital and has many assignments of MSF experience.  She quickly produced some graphs for our team and provided medical direction. The increase in our malnutrition curve had never been so steep in the past four years. The following graph can give you a sense of the spike in cases we are seeking now and the seasonal rise in malnutrition in 2012 (TFP stands for therapeutic feeding program).

Quickly, we started making plans to deal with the increased numbers. Stefano, our Italian MSF head of mission, and Luigi, our Italian MSF project coordinator quickly met with me in front of an erasable whiteboard.  I outlined the mobile clinic situation. We quickly agreed on an action plan based on the data and our team’s input. We would immediately add five staff to our mobile clinic outreach team. Andrea, our Swedish mobile clinic expat nurse, sat down with her Chadian team and made a plan to support the hardest hit health centers. Our Chadian hospital supervisors shifted nurses to the malnutrition wards to aid with the increased numbers. Gardy, our construction logistician from the United States, started constructing new beds and putting up a new patient tent. Oliver, our supply logistician from Germany, starting having new mattresses made.

The same day the mattresses were delivered to the hospital and the next day the bed frames were ready. Within one to two days the extra outreach team members were hired and deployed. At some point we had 50 children in the malnutrition service and 43 in the pediatrics service. The doctors, nurses and nutritional assistants worked extra hard this week. The intensive care was completely full. But at the end of the week, the situation was stabilizing. A new reality was settling in – the malnutrition season was here in force.

At the same time, violence to our east had erupted. In the Tissi region just east of Amtiman, tens of thousands of displaced civilians poured into eastern Chad from Sudan and the Central African Republic. Internal to Chad as well, the population was displaced in this area with a tri-border between Chad, the Central African Republic and Sudan. Violent clashes in neighboring Darfur had lead to about 50,000 people fleeing. Our MSF mission responded swiftly. Lead by our MSF Chad Emergency Response Unit (CERU), our team was providing vaccination against measles, primary health care, emergency medical care and clean water.

Our Amtiman project pitched in to help the emergency response in Tissi. Our site became a strategic operational base where staff and logistics could be funneled to Tissi. MSF emergency response staff came in, got ready for Tissi, and shipped out by Land Cruiser or plane. We made a decision to deploy our Congolese doctor, Guy, to Tissi. I knew conditions there must have been difficult. He texted me after he got there – asking me to send a towel, soap and toilet paper. He got it the next day with Claudia, an MSF nurse from Germany, here on her eighth assignment. Claudia had recently been evacuated by MSF from the Central African Republic, to our south, after their own violent change in regime. She had quickly agreed to come be part of our mission in Chad.

Soon, our Amtiman physician, Dr. Johanna from Sweden, will head to Tissi. It will make our work here harder losing her temporarily – but we all have to dig a little deeper when an emergency strikes. Everyone in our team is being flexible. That is a watchword in MSF work – flexible. We need to be flexible and nimble at all times – able to shift and adapt to the ever-changing local circumstances. While we have our ethics, our founding Charter and our operational plans as a backbone of our operations, everyday here I learn that our role shifts and evolves all the time.

Otherwise, the last week for me has been tricky. I’m covering for our international staff hospital nurse who is on vacation and also Dr. Guy’s usual responsibilities in the HIV/TB service. Our international staff member in the laboratory is also on vacation, so I cover her position as well. One has to be flexible. We’re also entering a major planning phase for the rest of the year with our medical data for the past four months. It’s very busy.

To our surprise last night, a huge sand storm was followed by rains for a few hours. The usual searing heat fell. The team and I sat outside last night savoring the cool weather of about 26 degrees Celsius. When the rains started to fall, I was skyping with Maeve, my dear fiancé in Canada. We miss each other so much. I said good-bye and ran back to our house to move my bed inside because of the falling rain. Lately with the heat, I was sleeping outside. Last night however, the whole team slept inside our tukuls – or little huts – and slept royally because of the cool breeze. After the heat, it will soon cool with the rainy season coming. The rainy season – though welcome – will bring new perils for the people here. Inaccessible roads, malaria and cholera are on the horizon. But we will be here. And we will be flexible.

Farewell for now from the house-call….to Chad.


Image shows mobile clinic and outreach program in Al Alak for the MSF hospital in Am Timan, Chad.