LOCATION- Eastern Chad-bordering Darfur

Introduction

I am working in Eastern Chad in subsaharan Africa providing medical care for refugees and internally displaced people (IDPs)

Chad is probably the least infra-structured country in the world. During the French colonial reign only one high school and only 200km of potholed tarmac was constructed. It occupies 167th position out of 176 countries in the UN Human Development Report.

We are based 70 km from the border of South West Sudan i.e. 70 km from the border of Darfur. The political situations in Chad, Darfur and Central African Republic are inextricably linked.

Since February 2003 armed conflict in Darfur has escalated dramatically. The Darfur conflict has displaced about half a million people (UN estimate 2006) and has created a refugee crisis in our area. 220, 000 Sudanese refugees are scattered over an area of 600km and are hosted in about 12 refugee camps. In addition the UNHCR estimates that there are over 90 000 Internally Displaced Chadians (IDPs) in our region.

Insecurity has hampered relief efforts. From December 2006 many aid agencies including the UN have evacuated non essential staff. There is a curfew for expatriates and we all have to be in the MSF compound by nightfall (6pm).

The MSF compound is quite well arranged (now known as 'Hotel Mille Etoiles') featuring individual tukuls, dining area and social terrace. It has become quite attractive to the friendly expats of other NGOs such as the Red Cross, UNICEF, Oxfam and Save the Children. There is a significant risk of armed carjacking  and so we always travel in a convoy of at least 2 vehicles.

The Project

Our project is run by MSF Holland and is based in Ouaddai province. MSF Holland employ 125 contracted National (Chadian) staff and 220 non-contracted refugees in this region..

The Adre Health District has a population of over 200 000 of whom about 65 000 are refugees from Sudan/Darfur. Infrastructure in the region is very poor. Most villages have no running water, sewerage systems, electricity or mobile phone networks. Villages are mostly comprised of grass hut tukuls.

Qualified national (Chadian) staff are French speaking and are hired from outside the region. They are  nurses, teachers, Community Health Workers (CHWs) psychologists etc. The staff are continually supervised by expatriate staff. The role of Community Health Workers is to offer health education, assist in vaccination campaigns, trace patients for follow-up, encourage pregnant women to attend clinics and screen for malnourished children.

My Work

My role as a doctor has several different components to it. The focus of my work is primary care and nutrition. But referral facilities are sparse and almost non-existent so inevitably I provide as much secondary care as I can.

A lot of my work involves teaching and training the Chadian National staff. In addition I am responsible for implementing clinical guidelines and protocols. I also spend a lot of time seeing and treating patients - generally those clinical cases that are too sick or too complicated for the national staff to manage safely. The most common diseases I see are malaria, gastroenteritis, malnutrition , measles, pneumonia, meningitis, TB and HIV. Some time is spent treating children in the Therapeutic Feeding Centres (TFCs)

I am also responsible for publishing mortality data and reports, ensuring that the Pharmacy is well stocked and ordering medical supplies etc from Amsterdam. (All drugs and resources are transported from Europe and are subject to European quality control standards.)