October 2013 archive

D58, Friday 27th September, Abeche to El Geneina, West Darfur

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My day started bright and early, traipsing around town in a tuk-tuk looking for cash. I was beginning to feel like my life was really defined by the accessibility, or more likely inaccessibility, of cash points. We needed cash to leave Chad!

Given eventual success our departure planning started in earnest. My task was window cleaning:

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Low level flying seems to increase the number of ‘dead window flies’ exponentially!

A UN World Food Programme aeroplane arrived. The passengers seemed unable to walk to the aircraft, each seemingly driven onto the apron in their private vehicle…

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And we were off! Very hot temperatures already by 9am, but a light aircraft as refuelling was still to happen in our next destination of El-Genina, West Darfur.

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We soon passed the border between Chad and West Darfur, marked by a dry riverbed:

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As we turned onto finals for the El-Genina dirt strip, several pedestrians scurried away!

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We taxied to the apron and came across 5 large UN helicopters.

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These were so interesting a sight that I initially failed to spot the large gathering of people that, it turned out, had come to welcome us!

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These student midwives were immaculately presented and started singing as we approached:

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I shook hands with each in turn as I walked down the line with the deputy minister of health:

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There were so many officials and dignitaries too that I couldn’t quite take it all in! Overwhelming in many senses!

The UNFPA would be hosting us in their compound for the next 2 days. We travelled there in an armed vehicle and rested a while before being taken for a traditional dinner with the medical team from the hospital. We had a barbecue on a reed mat under a mango tree:

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I have never tasted such good lamb!

Fromt there we visited the sandy ‘Wadi’ (dry river bed) and the chief’s house (now in a state of unfortunate disrepair following ransacking):

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The sun was setting over the city and it was time for foreign visitors to honour the curfew:

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D57, Thursday 26th September, Sarh to Abeche

Our kind new friend (whose hotel, well house, we were staying in) drove us to the ‘Hopital Regional Sarh,’ in the centre of town, after breakfast. It seems he knew everyone in town so a visit wasn’t difficult to arrange!

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It was a cold-looking, grey-brown building over 3 floors with attempted high security at the entrance – an armed guard presence and strict ‘no weapon’ enforcement. We seemed to wander through quite easily, perhaps because of who we were with!

We met with the hospital administration. Discussions revolved around payment for services: acute services, including Obstetrics, were free to the local community.

The FEM donations were gratefully received:

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The labour ward seemed functional, with individual cubicles:

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And so we left, just as quickly and efficiently as we arrived; no time for teaching today.

As we drove to the airport we passed a monstrosity of a building, unfinished, in support of women. It had been unfinished for many decades.

There was a long negotiation over the parking and security bill at Sarh. Overinflated and very clearly inaccurate. Anyway we fumbled our way through successfully!

Take off from the dirt strip was unremarkable:

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We were heading for Abeche in the far East of the country, to enable to short flight the following day to Darfur.

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Wet, swampy areas gave way to dry, dusty Nomadic communities:

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We flew low level to take in as much of the changing scenery as possible. Unfortunately this led to very high cockpit temperatures, turbulence and a degree of nausea. Wetwipes with cool air blowing onto my forehead just about kept me in reasonable condition!

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I was so pleased to see the airport of Abeche!

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And felt immediately better when on the ground!

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We tied down the plane and accepted a lift from the airport bus service! In the end they drove us out of the airport and a short distance to a serviced room where we would stay.

After dinner at a restaurant opposite the WHO we settled down for the night. No lights but brilliant wifi! And an entire bottle of Amarula to try and get through before our entry into Sudan the following day!

D56, Wednesday 25th September. Moundou to Sarh

The training session went well. I think it was my most confident (language-wise) French session to date! A good feeling!

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During our discussions, I was sad to hear that misoprostol, a very good drug widely used for the management of post partum haemorrhage, was not widely available in Moundou. There was, for the patients, an unaffordable cost associated with it. I promised to put the department in touch with Angela from Life For African Mothers (http://lifeforafricanmothers.org/) who sends misoprostol as well as magnesium sulphate, another life saving maternity drug, overseas to less developed countries. A way forward, I hope.

During this trip, I have often found myself linking people together, whether it be for resource opportunities like the misoprostol, for training opportunities like bringing the Liverpool School of Tropical Medicine’s Emergency Obstetric care course to new parts of Nigeria, or career progression opportunities like the logistics of how to do a Masters degree via the UK if you live in rural Cameroon!

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And so I left Sarh with my Mama Natalie resuscitation model on my back and jumped on a motorbike taxi to the airport. Not before saying goodbye to Bintou. She had been amazing!

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We had a big argument in the airport when paying our fees. Was I a doctor, or a pilot? I certainly couldn’t be both ESPECIALLY because I am a woman. But of course if I was a doctor then I was a passenger and not crew. It’s hard to argue your point in French, but we succeeded! The air traffic controller was on our side!

We had a good flight. I was mesmerised by the number of footpaths coming from each small village to the farmed fields.

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The landing at Sarh would be our first onto a dirt runway.

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It wasn’t a secure runway or airport.

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And so we jumped on two motor taxis and headed for the only hotel we knew of. The kindness of the owner blew us away: wait here have a drink, I’ve no space but’ll take you somewhere where there is a room, I’ll pick you up for dinner, take you to the hospital…. we couldn’t believe our luck. And do you know he was, as proved the following day, just being kind. Not something that is very common without a request, albeit it often polite, for a reward of some description. Very refreshing.

D55, Tuesday 24th September. Moundou, Chad.

It was a long wait at breakfast to see if our passports would actually appear from the passport officer who had kept them the day before to finalise our visas! But appear they did!

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I took my chances and opportunistically visited the ‘Hopital Regional de Moundou’ to make some donations of blood pressure cuffs, pregnancy tests and midwifery packs. I was lucky to receive an enthusiastic reception including a tour of the maternity department.

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A new labour ward had been opened within the last 3 months:

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None of the staff knew how if had been funded, just that it was a vast improvement on the previous labour ward:

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Each cubicle was well equipped and private and, to be honest, would rival many a UK labour ward!

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I did notice 2 unopened vacuum extractor boxes. Does anyone know how to do instrumental deliveries, I asked? No-one was really sure!

But the best news of the day by far was that a training session the following morning was welcomed! Time to practice my French again….

D54, Monday 23rd September. Flight to Moundou.

So it was goodbye to Dreamland, and goodbye to Cameroon. One of our longer country stops!

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Our flight took us East to Moundou – a small town in South Western Chad.

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Our ‘entertainment’ started after landing: first of all the negotiation of the exorbitant taxi-fare proposal, secondly finding the visa office (not in the airport but in an out-of-the-way office in town!) Then a hotel…wifi? Not a chance!

D53, Sunday 22nd September. Flight to Garoua.

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Our leaving Bamenda created quite some local interest! Scores of photos were taken with mobile phones and there were lots of requests for whiskey and painkillers!!! Ross donated a half-eaten packet of Pringles. I think he regretted that later when we were yet again delayed with our evening meal!

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By this time, we had been able to check the fuel tanks for volume remaining and realised we would not be able to reach our planned destination of Garoua. Frustrating as there was no option for refuelling at Bamenda. Back to Douala it would be!

Take off was uneventful with a left turn over the city after take off.

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It was a straightforward journey back, save some weather concerns voiced by the tower at Douala that in the end weren’t an issue.

We managed to refuel, file our flight plan to Garoua and pay our various landing fees fairly efficiently given our prior experience of Douala airport (this had been the deciding factor in going back to Douala rather than Yaounde).

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This next take off over Douala to head North was rather more scenic than the previous time. In particular, we had this great view of the bridge we had crossed everyday from our accommodation to the city and to the hospital the previous week:

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Thunderstorms remained on our mind throughout the journey, aided by our strike finder. Luckily they were all behind us!

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Finally after 3 hours flying over very remote and mountainous territory, including one of the early tributaries of the River Niger, we approached Garoua:

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Welcome to the Dreamland Hotel (our best hotel yet!)

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Day 51, Friday 20th September. Bamenda, Cameroon

Although I was up and out in good time for this morning’s teaching session, I forgot my posters and hand-outs and the quickest way back to my hotel room was by moto-taxi! (Don’t mind the lack of helmet – there were none on offer!)

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I picked up Mbu from his office and we headed to the meeting hall:

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We had a great attendance, but I was asked to be quick so that staff could get back to their clinical duties!

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As I demonstrated the condom-balloon tamponade method for massive Obstetric haemorrhage, Dr Etienne Belinga, the head of department, described how he had attempted the same method the night before for a patient bleeding heavily but who unfortunately also had a coagulopathy (clotting disorder because of huge volume blood loss). The patient had ended up with a hysterectomy following failure of such conservative measures and was still critically ill. Really what was needed to keep her safe were blood products such as fresh frozen plasma and platelets to correct the coagulopathy; they were not available in Bamenda.

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(Apologies for the closed eyes!!)

There was much excitement about the haemorrhage drill; infact it stimulated much discussion about the importance of regular simulation training and remembering the basics in dealing with emergencies. Certainly this was a department re-energised!

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Dr Belinga was very pleased with my donation of an episiotomy surgical set:

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He also wondered how funding might be found to use the MEOWS charts (Maternity Emergency Obstetric Warning Score charts) – the cost is in the colour printing, and each maternity patient would require one chart per admission. Not for the first time, my thirst for a more long-term partnership with a unit I had visited was there.

I was invited for a labour ward tour by some of the midwives I had been teaching:

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They deliver between 150 and 200 babies per month, with one set of duty midwives 7am – 5.30pm and a second set overnight. Most of their women do present for antenatal care, albeit late in pregnancy, because this is necessary in order to be allowed to deliver in the unit.

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In the afternoon, I made a visit to Nkwen Subdivisional Hospital, situated on the outskirts of Bamenda. They have only one qualified Obstetrician/Gynaecologist – Dr Orock – working with 3 medical officers, and, using July as an example, 165 deliveries per month with a caesarean section rate of 3.6%. Dr Orock is one very hard working man!

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Day 50, Thursday 19th September. Flight to Bamenda.

Now that we had worked out the process the previous day, our departure at Douala was both early and efficient!

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North of Douala, dense, green forests were below us with very little signs of human habitation:

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We approached Bamenda after about an hour:

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There were people on the runway but fortunately we overflew first and so they had the opportunity to dissipate before we landed:

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Dr Mbu and Ray picked us up and we headed directly for the office of the regional public health representative who would help us plan our stay in Bamenda. There was a great deal of interest in Flight For Every Mother and an immediate understanding by the regional representative of what we were trying to achieve – not always something that is easy to convey at first interaction. We would try and visit 4 different health facilities over the days to follow to develop an understanding of the delivery of maternity care in the region.

First stop – the Regional Hospital, Bamenda:

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This hospital is the referral hospital for Bamenda and the surrounding villages, and also has a large HIV department.

We would come back tomorrow for training (the midwife in charge of the labour ward that afternoon promised to phone around her colleagues to encourage a good attendance at 8am the next day!)

Day 49, Wednesday 18th September. Unable to leave Douala!

We spent all day trying to get ready for departure from Douala to fly North. The number of different payments and the convoluted method of submitting our flight plan meant that by the time we were ready, afternoon thunderstorms had built up along our route to Bamenda and we postponed to the following day!

Not before we took a picture with our friend Ignacious, though:

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Finding a hotel for the night was a whole other story!

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