We breakfast on hot sugary tea and fried dough balls (a bit like beignets but without the sugar). I completely associate these with Chad. Just like the barbequed meat (cow? goat?) from the roadside grills that you dip into a paste made out of a local curry powder and lemon juice. Yum!
I’ve resigned myself to the mosquito onslaught. No matter how much deet I spray on myself, the mosquitos find a gap. I even have bites on the soles of my feet! Every day I’m taking a concoction of malaria tablets, vitamin pills and antihistamines (for the mosquito bites). All washed down with Castle beer. I’m probably a physician’s nightmare.
The only respite is when I’m under my bed net. In fact, we would all rush to our rooms after dinner to sit under the protection of the nets. I’d like to invent one that I can walk around in, protecting me 24-7. Eating and drinking might be a problem, but I’m working on it!
Waiting for health care © Ruby Siddiqui
Bed nets are very effective at protecting against mosquito bites, especially now that they’re impregnated with long-lasting insecticide. This means that even if the net develops a few holes, the insecticide will still protect you from the mosquitos. And the insecticide lasts for at least three years as long as the net is not washed too frequently.
So bed net distributions are one of the main intervention strategies used in the fight against malaria. The Millenium Development Goal is to achieve universal coverage – one bed net per two people – in malaria-affected countries by 2015. We want to find out what the current bed net coverage is in Am Timan so we’re going to carry out a survey in the coming weeks with our Ministry of Health (MoH) partners. The results will help guide bed net distributions.
Abdul Aziz (MoH) and Jean-Claude (outreach-nurse) © Ruby Siddiqui
The long drive is made bearable by the tunes spilling out of the car radio. Wherever you are in Africa, you’ll hear Congolese music. It’s loud, fun and makes you want to dance. Our driver is clearly a fan. But he also has some Ethiopian shoulder-shaking tunes and Indian bhangra beats and the odd European classic like ‘Barbie Girl’. It’s an eclectic mix!
The long drive © Ruby Siddiqu
We finally arrive in N’Djamena. I already know that my chances of making it to Tissi are slim. The plane can’t land due to the rains and the replacement helicopter is being repaired. There are a number of people waiting to get out and in! But the team seem to be coping with the large number of malaria cases in the refugee camp (more than 500 per week).
Besides I might be needed elsewhere. I’ve analysed the latest data coming from SW Chad. We’re seeing a huge rise in malaria and alarming mortality rates in Kelo. We propose to send a small team (a doctor, a nurse, a logistician and me) to Kelo hospital to support the staff with drugs, tests and training. It seems to take an age to hear the decision. Everyone has an opinion. The medics generally support the idea and the non-medics don’t. It’s the traditional tussle you see in the field. And rightly so. The medics see the need and want to respond. The non-medics see all the potential problems, logistic difficulties and security issues. We have to find a balance.
Roger (CERU-nurse) and Marie Claire (Deputy-medical-coordinator) © Ruby Siddiqui
In the end the decision is to send Roger, our emergency nurse extraordinaire. He is part of the Chad Emergency Response Unit (CERU) and has vast experience in responding to sporadic outbreaks all over the country. He knows exactly what to do and has proved effective time and again. I’m disappointed but it’s the right decision. I’m the least useful person on the team. It’s time for the medics to take over and do their thing, diagnosing, treating and caring. They get all the action.