Part of the experience of working with Médecins Sans Frontières (Doctors Without Borders) is not just work but also taking a break. The work in the project site is seven days a week most of the time, but then after two months or so, we get a break in the capital city. We call it "R and R" -- meaning, "rest and relaxation."
I can't quite say my R and R was what I had intended but it still was interesting. It was a definite change of scenery compared to my usual routine of being in one of three possible places -- the MSF house, the MSF office or the MSF hospital. For the past two months I have spent everyday in just these three places. It's meaningful, but my human spirit craves a bit more variety time to time.
Oliver, our German supply logistician, and I went together on R and R. I first did the morning rounds in the hospital, had a few meetings, tried to do as much email in the office as possible, and then we went to the "airport". The airport in Amtiman is a dusty patch of land where the International Committee of the Red Cross and Red Crescent (ICRC) plane can land. Our MSF cars wait on the side of the airstrip for the plane to land. Staff with flags ensure children playing soccer nearby stay well out of the way. Curious villagers line the runway at a safe distance.
When the plane landed, three of our patients with vesicovaginal fistulas (VVF) emerged. They had been treated in Abeche by the MSF-Switzerland team over the course of many weeks. VVF is a tragic medical problem where there is an abnormal connection between the bladder (or bowel) and vagina. This is often caused by an obstructed labour. Women are divorced, lose their families and are ostracized for this terrible problem. At the MSF-Switzerland "Village des femmes" this problem is surgically repaired and women can recover and gain their strength among other women with the same problem. I am not sure I have seen a more incredibly important and dignity-restoring intervention than MSF's VVF hospital in Abeche, Chad.
We currently have six women in Amtiman waiting to go to the VVF hospital. Sigrid, our German midwife, gives me the referrals. I scan them into the computer and send them to the capital for approval. We then fly them to and from Abeche. Sadly, three of these women have no one -- no relatives and no friends -- who will go with them to be their guarde de malade or accompaniment. A guarde de malade plays a critical role in health care in Chad; they are an advocate for the patient, help with personal hygiene, and most importantly provide the human support needed when one is ill.
It breaks my heart when someone has no guarde de malade, but the kindness of strangers is always inspiring. Like I have seen in Toronto, Canada, and all around the world, patients and their families band together with other patients and families and I have seen many cared for and aided by complete strangers. It's amazing to see the kindness of strangers around the world.
The plane flight to Abeche was very hot and bumpy. I wanted to kiss the ground when we finally landed. We got to the MSF Switzerland office then waited, and waited, for a connecting flight to the capital, N'djamena. The crisis in the Central African Republic meant planes were being diverted there to evacuate aid workers. We ended up waiting in Abeche for three days.
Making lemonade out of lemons, Oliver and I took the chance to visit the ICRC hospital and I got to see three patients I had transferred the week before following our mass causality incident. All were doing well. A woman I had referred with chest trauma had six broken ribs and bleeding around her lungs. She did not seem to mind the plastic tube coming out of her chest to drain the blood. The ICRC staff and myself agreed her fortitude was amazing. We shook hands and I wished her well. This has been one of my favorite "housecalls." We then visited the beautiful MSF-Switzerland VVF hospital. It made me proud to be an MSFer the way these women were housed and treated.
On our fourth trip to the airstrip, three days later, we finally got a plane to the capital. The turbulence and heat again really got to me. Oliver carried my bag and gave me his water to drink as we waited for the pink MSF car to pick us up (MSF cars here are painted pink to avoid car-theft which has been a problem). We then went shopping for our team. Essentials and a few comfort items like chocolate and cheese were on our list.
Realizing how short our break was -- we had 36 hours in the capital -- we were asked if we wanted to stay longer. Not wanting to strand our team in the field, Oliver and I opted to return by car, as scheduled, acknowledging that just being able to get out the project was a break enough.
The next day, I spent my morning with our communications officer, Laura from Switzerland, preparing for an interview with the BBC World Service. Admittedly, we did our meeting in nice café where the coffee and bread was a welcome change. We then went to the MSF office to meet the Producer for BBC Afrique. I was afraid my French would not impress her, but the producer was supportive and friendly. I talked about our patients and our work. To my surprise four days later, the nurses in the hospital in Amtiman were telling me they heard our interview on the BBC news. I was satisfied with the chance to talk about some of the struggles our patients and team faces.
The following day we woke early. The plan to return to Amtiman was by road, criss-crossing Chad from west to east. It would take two days by car. The long drive was eye-opening. Villages, trees, savanna, forest and mountains passed us. The air coming in the window was like a hair-drying blower on your face. I closed the window and listened to some music. My mind wandered to my dear fiancé Maeve in Canada who I miss so much, the work ahead and how nice it was to see some of Chad.
After a night at the Oxfam compound in Mongo, we kept going. About 80 kilometres from Amtiman however, our MSF car broke down. I called Eve and Luigi at the base and they organized a car to come get us. A car with the Ministry of Health pulled over to check on us. Their driver got out and together with our driver they worked under the hood of our Landcruiser. They did not have to stop like so many others that past us and left us in their dust. The kindness of strangers yet again.
It was really hot. I went to sit under a tree only to put my hand into a thorn bush and start bleeding everywhere. After a while, I got bored and Oliver and I went to go look at some camels, keeping close to our cars and team. Eventually our MSF "rescue" car arrived and we made it back to the base.
I must have looked horrible and I definitely felt harried. Our R and R had not at all been restful, but we got to criss-cross the country and break the routine of life in Amtiman. The best moment was seeing MSF's VVF project in Abeche -- something I wish the world could see and somewhere I wish every patient affected by VVF could be cured.
Farewell for now from the house-call....to Chad.
Raghu