A Tale of Two Cities.

 That may not seem a very seasonal choice of Dickens titles, to which I am obliged to reply, ‘bah humbug’ and carry on regardless. So ‘A Tale of Two Cities.’

The first ‘city’ is really a hotel, it is as big as a village and exudes importance. Built in the style of a Roman palace it has a defensive wall, and huge gates with armed guards. Situated by the river it makes an impressive sight, and all the trappings of worldly splendour have been added, huge tastefully furnished entrance lobbies, an amazing swimming pool and gardens. See for yourself by clicking here 

The vast conference/ballroom can seat 500 at tables, has chandeliers, air conditioning, and offers a very fine selection of coffee and vienoisserie mid-morning, plus sumptuous buffet lunches from what are no doubt excellent kitchens. All this was less impressive than the very interesting well organised meeting organised by the Ministry of Health over 4 days in mid- December. It was a bit of a surprise to get a telephone call from the Regional Health Director in the Tibesti whilst driving in a rather battered looking yellow taxi to the Health Ministry building. The line was very poor, but I eventually understood I was to go to the Hilton straight away and represent him at the meeting. Once there I saw that a major theme was Maternal Mortality and so Andrea joined me the second battered taxi of the day to grace the otherwise impeccable fleet of 4X4 and limousines on the forecourt.
It was really a very informative set of meetings, with presentations and debates amongst the participants from the 23 regions of Chad, all the major hospitals, the various programs and agencies, malaria, TB, HIV, UNICEF, WHO, etc. The second day, having been directed to our seats amongst the Chadian Regional Health Directors, and feeling a bit conspicuous, someone spotted us and assuming that we were with a large NGO, thought we should be on the other side of the room, but then agreed we  were already in the right place.
In addition to the main theme, Important subjects such as rural health mutual assurance, the currently bankrupt national Central Pharmacy warehouse, immunisation programs and the National budget were discussed. Perhaps the most important for us was how to encourage government employees who are deployed to places such as Bardai to actually go to their postings rather than simply remaining in Ndjamena and drawing their centrally paid salary. It seems there may be a move towards decentralisation which may help.
 As well as gaining a better understanding of the health care system in Chad we renewed and made a number of new contacts, and even had a brief talk with the health minister, who had some words of encouragement for our work in Bardai.
We sensed that there was a genuine attempt to address the major problems and can only hope that in a years time we can hear of targets for immunisation being reached, more doctors and nurses working in the regions and a revitalised Central Pharmacy supplying low cost, good quality, generic drugs throughout the country.

Two days later just before Christmas we had a completely different experience, a journey from the centre of Chad to the margins took us to Teriturenne, a village about 8 hours drive north of Ndjamena. The second half of the route is across the same area of Sahel that had proved impassable due to rain at the start of our journey last August. Now it was bone dry and it was difficult to believe that the large herds of cattle and other animals that we saw will be able to survive until the next rains; passing from water hole to waterhole and eating the meagre ration of spontaneously dried hay that thinly covers the area. The rolling hills of sand and earth have scattered trees with occasional villages on the higher ground.
 It is said that ‘A city on a hill cannot be hidden’ but if the houses are spaced out single room mud brick buildings without electricity it can be very difficult to spot, especially as we arrived at Teriturenne after night fall. There are about 60 homes in the 2 halves of the village. Light is not the only thing that is lacking. The name of the village Teriturenne means ‘one water pail village’ and that water supply is 1-2 km away down a steep sandy hill to the low ground, where the water is close to the surface. Despite this there is a thriving school in the local language that is attracting about 150 young people and children from the surrounding area. This is a new concept to learn to read in Dazaga and then teach French later. The same project is now working to get a solar powered well into the heart of the village, and as we arrived a team of experienced Chadians were working to drill a well by hand 60m deep. It was night and they had been drilling since midday and they continued working by the lights of one of our vehicles. The bore was completed and lined with a plastic tube by midnight. It was a real community event with women gathered round , ululating and garlanding the most enthusiastic worker; three men rode up on horseback and pranced back and forth and then rode off with gusto. The joy was palpable and the next day the news on everybody’s’ lips was ‘the well was born’.On the next trips the water tower will be erected, and the solar water pump installed.

We were there to see whether there was any possibility of having a small health clinic in the same village. We spent most of the day travelling over 100 km around the local area looking at what clinics were already in place. Fortunately, we had talked with the Chief Medical officer for the region at the Hilton Hotel just 3 days before to get his permission for the visit. We were travelling with a Chadian who is now a teacher in the University having done a master’s in law in the UK and who is seeking to help his birth village.

Recurring themes in all the villages we visited were the lack of drugs in the clinics, the problem of getting women having difficulty in labour to hospital, absentee staff, and a total lack of even basic dental care. They seemed less concerned about the lack of a good complete vaccination program and seemed proud and content with the once a year anti polio campaign.

In the evening we learnt about the reality of rural healthcare, there may well be a small clinic about 10 km away,but there were two patients who were seriously unwell and had been for 2 or 3 days, and no one was making any effort to get help. (apart from asking the visiting doctors after dark). The first was a man who was severely dehydrated with a diarrhoeal illness and another a young girl with a severe infection of the face and a high fever. We had an emergency kit with us and were able to set up the necessary intravenous drugs in their homes, something which we never do elsewhere, but it was clearly a day to bend the rules. The young girl was improving by the next morning and after a second injection could continue with tablets. The man needed more care in a hospital or clinic, but refused to travel, so on our way home to Ndjamena we stopped off at the clinic 10 km away and spoke with the local informally trained nurse. We paid for the necessary medicines and he agreed to go and give them. He knows the village as his son is there staying with friends so that he can go to the school. We have since heard that both have done well. Later this month we can check on them when we go back to speak again with the local people, do some health education and treat any dental problems that are there.

And now a question to consider; in which city would you expect to see God at work, at the Hilton or in Teriturenne? The answer we are glad to say is that we have seen it in both. However, if you are wise enough to be looking for a baby, try the village, the stars are truly amazing.