Hepatitis E Emergency Response Project Update:
In the past three months, in Am Timan, MSF has seen 270 patients with Acute Jaundice Symptoms (AJS). AJS, which commonly causes the yellowing of the skin and eyes, can indicate a person has Hepatitis E. 42 of these people have confirmed cases of Hepatitis E (HEV RDT+) while 36 have been hospitalised and 8 have died.
The red markers above indicate the new AJS cases found just last week. Even through the virus is primarily transmitted through contaminated water, there is no indication that the virus is coming from a specific water source. As I write this, new cases are being identified all over Am Timan.
I feel truly privileged to have been a part of everything the Hepatitis E Emergency Response Project (HERP) team has accomplished these past six weeks. I’ve experienced the recruitment of over 400 national staff, helped implement a bucket chlorination and hygiene promotion program, and water jet two wells in the wadis (water channels) that run through Am Timan.
A close friend reminded me the other day that we work to live, and not live to work. Coming from Canada, I feel that the social norm is to go to school so you can get a decent job that will enable you to buy a house and support a family. You live to work.
Even in Chad I’ve noticed that I’m struggling to enjoy the moment. Some days I get so caught up with trying to check off activity items and complete objectives that I forget to appreciate and savour the bonds and friendships I have made with my colleagues.
The reality is that there will always be work. For the last half of my mission I am going to really focus on finding balance between work-and-play and living in the moment!
My WATSAN Life: Week 6
In the Muslim culture, water is an essential element in the Islamic ritual as a means of purification. Prayer is performed five times each day and the purification ritual is required before each prayer. It is required that water used for the ritual must be without color, taste and smell, as any of those would indicate the presence of impurities. As chlorinated water sometimes leaves a distinct smell and taste, it is understandable how it could viewed as impure.
During last Friday’s prayer at the Grand Mosque, the topic of chlorinated water was raised with the congregation. Immediately after the prayer, we noticed a significant increase in refusal rates for chlorinated water at a third of all water points, especially those concentrated around the Grand Mosque.
On Thursday, 176 people refused chlorine at all 72 water points covered in our chlorination program; approximately 2.44 refusals per water point. The day after Friday’s prayer, 1,608 people refused chlorine; a refusal rate increase of 900%!
We have been meeting with the various high-ranking religious leaders, the mayor and governor, to reinforce our project objectives and to clarify any uncertainties about chlorinated water.
On Thursday we water jetted two wells in series in the dried up sandy riverbed! This location was chosen because it is upstream from the city (meaning upstream from any city pollution and waste water) and in a neighbourhood where the main source of water is from the river.
Water is pumped from the river through a plastic hose down a string of steel pipes with a sand screen and one-way valve at the end of the string. As pressurized water jets through the screen and valve, the watery sand mixture gets washed away and a hole starts to form.
As the circulation of the water down the pipe string and up the annulus continues, the string is hand-rotated and lowered down into the water table. Despite jetting almost a dozen wells on each side of the riverbank and many in the middle, we always hit clay around 3m deep.
We decided on two final locations based on the coarse sand composition found in the water table. The sand screen assembly and pipe string are left in the ground to serve as the permanent casing and screen. The two wells are approximately 10 meters apart and will be tied-in to a pump and two bladders next week. They are currently each pumping 60 liters of water per minute!
Reverse-pumping the well to see if we have reached the water table. First customers getting access to free water from our wells.
Having a background in drilling for conventional oil and gas, I was really excited to water jet! However there were some pretty big differences between drilling a well in Canada and jetting a well in Chad. For instance, before operations in Canada, we have a geologist or team of geologists who tell us the depth of the target formation and the types of formations we are most likely to encounter while drilling. In Chad, there are no logs, no geological information, and we didn’t know the depth of the desired water table prior to jetting. We jetted by trial and error. Also, the six inexperienced daily workers had a quick 60-second training session prior to us turning on the pump and starting operations. And did you notice their personal protective equipment (PPE)?
Two jetted wells in the wadis being fenced in to prevent children and animals from damaging the wellheads.