Chad Chat
The Christmas season starts early in the west. Here in Bebalem it is very different. I have yet to hear a Christmas Carol one week before Christmas. The groups in the church are organizing who will recite which verses and are practicing songs to sing. That is about as far as obvious preparations are seen. For Christmas Day we will have an early church service to celebrate the birth of our Saviour followed by a pot-luck meal together as a church. The menu on the day will be about the same as any day. Rice or millet ugali/boule and meat stew. There will certainly be little distraction from the real meaning of Christmas but a good time will be had nonetheless. Whatever you will be doing, I hope the same will be true for you.
The best laid plans of mice and men...
I have never known such a year for plans changing. MAF tournées (trips by plane to visit health centres), have been particularly difficult to set up. June's tournée was reduced from 2 weeks to 2 days because of staff reductions at MAF following the political insecurity in April. October's tournée was put off repeatedly until November. That one was cancelled. They managed enough fuel (doubtful initially) but had no registration for the plane. Finally there was fuel for a trip in early December but only just. I was grateful that Patrick the pilot worked hard to safeguard such as was available. That was nearly cancelled because rebels were said to be advancing quickly on N'djamena but that turned out to be a false alarm. However, the security situation is deemed by MAF uncertain enough that they are reducing their staff to a minimum and leaving their families overseas. Who knows what will happen for MAF tournées in 2007?
Tournées by car have also been reduced this year. Around the time of insecurity in April I was advised to stay put in Bebalem although finally there were few if any problems in the south. Another factor was that through funding from ECHO, I have been able to organise seminars for health centre staff. We have had 3: two for lab technicians of one week each and one of 3 days for administrative committees. They reduce the time for trips out but they seem very worthwhile as an encouragement spiritually and otherwise for staff while improving care and administration. My recent tournée emphasised again the need to give further training in management and planning. Another reason for the reduction in trips out was the long rainy season. Rains started late but lasted longer and were much heavier than last year. This made for some very "interesting" trips before I finally reluctantly admitted defeat and stayed in Bebalem. I have been very grateful for my landcruiser which does very well in water (many routes have deep water-filled holes the width of the road) although the costs of repairs have been very high and its fuel consumption is excessive - 5-6km/litre.
Poverty - a challenge for "rich" and poor
I was doing a ward round and questioned why a patient with a positive malaria slide had received no antimalarial medicine during her three days in hospital. She had no money to buy the medicine. As a widow she lived alone. Her children live far away and it was only because a kindly neighbour had given her £l.50 after she was sick 8 days at home that she was able to come to hospital. Two days later, I admitted a baby of 3 months very sick with anaemia caused by malaria. She has been sick at home for 8 days. Why had they not brought her before? No money. She needed a blood transfusion and anti malarial medicines if she was to have any hope of surviving. When asked to buy the necessary, the parents said they had no money. What to do? I arranged for the necessary to be done at my expense. The child died anyway two hours later.
These stories are sadly typical all year around although worse during the "famine season" - the rainy season when, each year, people run out of food from last years harvest before the new harvest is ready. They have no money for food and no money for health care. After Kenya, patient expectations in Chad seem very low. Many do not even think of coming to hospital but suffer and often die at home without care. Surely this must be avoidable but how? How cope with these demands as one of the "rich"? Who should one help, with how much and how often?
For the hospital this poverty is bad news also. Patients don't/can't pay but overheads remain. Personnel have need of money for paying people to work on their land but it was and is difficult to pay them. They also have the pressure of relatives coming to them for help with food, money, clothes and help with medicines to an extent that it is a real pressure for them. As a Christian, how respond in a loving way without depriving one's own family of food and clothing?
Christian Health Care in Chad
Is subsidy of such hospitals wrong7 In such a poor area how will it survive without help?. All the other Christian hospitals in Chad are subsidised regularly by European charities. Bebalem hospital has no regular help and it is therefore almost impossible to make the hospital viable. Health centre personnel face similar problems. People often ask to be treated free but the only source of revenue for the health centres is patient fees which are often too low for survival: In some areas patients pay about 10 pence (20 US cents) for a consultation in a health centre and complain bitterly if the price is increased. Thus many personnel effectively subsidise treatment - Another good reason for encouraging efficient financial management in the health centres. In towns a health centre can charge 75 pence and be considered cheap. Such town centres have a large population living very close with easy access. Understandably it is very easy for them to make a reasonable wage. Thus we have the paradoxical situation of health centres run by the same church in which the nurse's salary varies from less than £20 per month (not received regularly) to £125 per month. Could/would the richer centres subsidise the poorer ones? Could town churches subsidise poor rural health centres?
Don't count your chickens...
In 2005 Samaritan's purse, an American charity, agreed to donate some medical equipment to Bebalem hospital and the health centres. The container finally left USA late June and we rejoiced when it arrived in good time in Cameroon all set to be in Chad the 9th Sept. We are still waiting. As I write, Valentin the hospital director is in Douala trying to resolve the problems and organise its transport to Chad. The contents include a portable X-ray machine and a new ultrasound machine. We have had no X-ray for several years and no ultrasound since August. The lack of this equipment has a negative impact on our care at Bebalem hospital and in particular reduces the likelihood of attracting patients with money to pay.
Who is the boss?
The medical work of the Evangelical Church of Chad (EET) was, until January 2004, under "CODESEET" - the board of the health department of EET. CODESEET resigned and was replaced by a transitional committee with a 6 month mandate to help revive the hospital at Bebalem and to choose two board of governors - one for the nursing school at Bebalem and one for the hospital to oversee also the health centres and community health department (my "bosses"). COTRANSEET did their work but the new boards never met and so we had little support for almost one year. The central office of the church (BGEET) tried to fill this vacuum but, with all their other responsibilities, they didn't succeed. Hence issues which needed to be sorted out - like lack of staff, discipline of personnel, looking for donor support and organising an agreement with the government for support were dealt with slowly if at all. At the third attempt the church were successful in finding people prepared to serve the two institutions. They were officially "installed" by the church on 14th October. The first real board meeting for the hospital took place on 1st and 2nd December. Some important decisions were made for the hospital. We pray that they will be put into practice. For the health centres the main decision was to organise a forum to discuss the many issues in detail. I am to organise this with Valentin. Hopefully it will take place in January or February 2007.
Vacancy: - Who will do the job?
In the hospital there is a power vacuum. Valentin is the hospital director but as an administrator he has no medical knowledge. Elisabeth decided in September that she wished to concentrate more on her work as director of the nursing school and could no longer be interim médecin chef of the hospital. (Médecin chef is charged with ensuring good medical practice, relating to government authorities on medical matters and helping with medical issues in administration. Helshe would also see patients). The church wanted me to take over; the mission refused to Let me accept. I had mixed feelings wanting to be able to support the church and particularly to improve the quality of training of nurses by improving the care in the hospital. I believe this would help me to work from the inside in promoting a broad vision for medical mission in the church. But I recognise that I would only be able to do the job in a relatively superficial manner if I am to continue effectively working with the health centres as I wish to do. Meanwhile we have no-one. So who is responsible? Where will we find a doctor? BGEET did find one interested enough to come and visit Bebalem to see if she might work here. Sadly she wanted too much money. So we remain with only Dr. Elisabeth and me with our multiple other tasks. Although one might have thought it possible in the 20 months since my arrival to find a doctor to help in the hospital one has to acknowledge that there is a great shortage of doctors here in Chad - one doctor per 27000 population. The medical school trains 10 per year. We pray that the government will Let us have a doctor paid by them (as we did at Kapsowar) but they do not have enough.
What strategy?
This vacuum means that patients suffer, the hospital work and witness suffers, the personnel suffer and the nursing school training suffers. But is it our business as a mission to help? I have been asked to prepare a strategy for the medical mission work of AIM in Chad and hope to answer this and other questions about the best way to reach out to the unreached and build up a maturing church through medical work. This will require careful research and thinking. How glad I am that I did the MA at ALL Nations including the teaching modules and the research which I did into Christian Hospitals in Kenya. It is quite a large task which I will enjoy - but I have quite a lot of other things to do ... !
All Change!
During the board meeting we were able to agree to a series of 16 changes of post for health centre personnel. We hope these changes will improve the efficiency of some centres and will help personnel who have had difficulties - of lack of salary andlor problems with the community. Now it remains to organise them. Please give thanks that I recently heard of money given by a church near Hull which will hopefully cover all the costs). Pray for the hospital lorry which should act as removal van - it is often broken down. Pray also for staff as they settle in to new situations especially for those who didn't want to go where they have been placed. Owing to nurses leaving the health centres (including two during the last two weeks) we have to leave 6 centres without nurses in charge. 2 have midwives. One will be closed. The others will be run by lab technicians. PLEASE pray! Life is hectic and a challenge but good. Please pray that God will use me for his glory, helping me to see the priorities He has for my life amongst the many needs. Many thanks for your support. I pray that God will bless you richly in the New Year.
With love, Ann
EET-COCOAM. B.P.127, N'djamena, Chad annfurdson@stratos.net AIM International, Halifax place, Nottingham, NG1 1QN UK |
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