Bahai Beach 6 - sand sand and heat - August 11, 2006

Bahai Beach 6

August 11, 2006

On Wednesday we were struck by a true tragedy. Behind the compound lies our septic tank. For reasons unknown to all the lid had been taken off the septic tank. At 1600 a group of children came to our gate crying that something had happened in the back of the compound. When the guard arrived a 5 year old girl was found inside the septic tank. She had fallen in and had drowned. The emotions running through the hearts and minds of the national staff ranged from disbelief, anger, sadness, shame, fear, sorrow. How could we have neglected such an important and basic practice? The police came to do an investigation where it was found that the incident was a tragic case but there had been no intent on our side. We pray for the family and the girl that has lost her life. All I can hope for is that we at our side at times reflect more on the procedures we have in our organization. It is near impossible to avoid accidents, but clearly we do not look good on this issue. As a consequence UNHCR needs to give all the NGOs in the area clearance to go to work for the rest of the week. Perhaps the host community does not take well to the loss of life of one of their children and all men in this community carry knives and possess guns in their houses. You may have read in the newspapers that across the border in Darfur but also in Sri Lanka humanitarian aid workers are becoming more and more a target to violence. Several projects across the border have been abandoned. Also the peace agreement between the Government of Sudan and Mini Minawi ( biggest Sudanese Liberation Armee ) is unraveling rapidly. Mini Minawi’s supporters form the majority of the people living in Oure Cassoni refugee camp. There is infighting in the SLA as well and several split ups are against the signing of the peace agreement. On top of all this the Chadian president Deby who hails from this region has been installed for a third term as president after changing the constitution to satisfy his needs. Many of his detractors come from his own family/clan the Zagawa. Again the population in our camp is also Zagawa but those that live across the border in Sudan.
On a lighter note I am currently the owner of 2 chickens. Two more are being brought today or Saturday. Friday it is Independence day in Chad so no work. I feed them with grains and rice and they are awaiting the completion of the villa I am building for them. As I tap Kutidai (Zagawa for hen) and Jedada Entai(Arab for hen) are pecking way at the grain I have purchased for them. Kokiak (Goran for hen) and the Sara term for hen are to follow suite soon. And somehow five sparrows find the neon lighting I have very interesting and sit on top of it every night. Mr mouse (zag zag) or desert rat also seems to like to hang out near my veranda.
With the holiday of our field coordinator the health coordinator will be acting field coordinator for three weeks and I shall be acting health coordinator for the same period. For the camp we have a monthly activity plan drawn up for all the different departments. Some of the things that we are doing this week include; paying the incentives to our refugee staff, filling holes (avoid mosquito breeding grounds), distribute bed nets to all pregnant women (about 300) and orphans (about 2000), have health campaigns about prevention of diarrhoeal disease, monthly stock inventory of the pharmacy, international drug order, prepare construction of a water basin in our health post and center, work on the quality of the drinking water (being trucked in form the dam), have an active malnutrition drive where the community health workers look for malnourished children, jobinterviews with laboratory technician and doctor, monthly report. One of the good things that did happen to us is the arrival of Charles a Congolese member of the Emergency Desk who will help us with drawing up of Memoranda of Understanding on different topics; agreement with Bahai Hospital as we have new funding there for a 6 month transitional period in which we try to hand over (again) the hospital to the authorities, reduction of refugee incentive staff members. I think I mentioned in the health department alone we had 108 when I came here, possibly around 70 would be a more effective figure. Also we are improving the pharmacy and storage of drugs in the camp and I can go on for a long time more.
Whenever Yoda Pancho and Dr ~Chewbaca get frustrated we get out our big football (look at http://www.flickr.com/) and kick the ball or end up discussing the lesser and greater Philosophers of the last 3000 years. I am blessed with such a neighbor. He keeps me sane in times like these. No visits to the market this week.
Does anybody have a good suggestion for a weblog site. I am considering opening one.

Take care,
Namaskar,

Ashis

On Thursday all of a sudden 40 trucks with military rolled into the wadi. One kilometer from our base. Straight away we rushed to the compound. UNHCR found out it was Chadian Government troups. In the same night a soldier and a civilian got into a brawl over a women and the soldier shot the civilian in the abdomen. This morning we spent arranging a flight for the man as well as for a second case a young girl who had fallen in a hole. It is hot and the conflict in Darfur is getting more and more hot

Bahai Beach 5, 05-08-2006

Bahai Beach 5
05-08-2006

Mission chicken is about to succeed. I have decided to start up a chicken farm. After searching the local markets and considering the prices of an egg (about one $) calculations showed that it would be more fun to keep some hens. Sunday I am building a little house for them and Monday they shall move in. Names are being assessed and high on the list are the following: Jedada (Arabic for chicken) and the Sara, Goran and Zagawa names for a hen. Some people tell me I need a rooster as well otherwise there shall be no eggs. Well we shall see. In case it is required I shall distribute earplugs to the other expats before they strangle my rooster. The market is my place to chill out. And I have found jawafa, a sweet local fruit, which is then made into a fruit shake. Also the sheesha (waterpipe) is still one of my favourites. Slowly slowly my Arabic skills are improving and even some Zagawa words are picked up left and right. Zagawa is the tribe that has been chased out of Sudan by the Government of Sudan and the Janjaweed. On the othe side of the border things are heating up. There are more and more attacks on the local populations and humanitarian aid workers. Here in Chad there are always rumours of what may or may not happen. To illustrate the unpredictability of the Darfur conflict: Mini Minawi (Zagawa Sudanese Liberation Army) is now the third vice president of Sudan and is supported by George Bush et al as well. He was in Washington last week and until 1 month ago he was fighting GoS. Now the other rebel groups have turned on him. Our refugee community are mainly Mini Minawi followers. The camp I have visited 5 out of 6 days this week. And as I said last week it gives me energy to struggle through administrative battles as health incentive staff for 96 people and monthly reports (due Monday) about 16 pages. Luckily Sylvie the new health coordinator has arrived and she is great. Finally I have time to plan ahead instead of always be in the troubleshooting mode. Also our reproductive health doctor Joaquim (Burundian) has returned. But work has a natural tendency to be heaped upon our shoulders. UNHCR expects us (Sylvie, Joaquim or me) to chair the taskforce on HIV/AIDS for the region and camp. A brilliant challenge yet it has to fit in with all other ongoing business as cholera preparedness, clinical care, transfers to the hospital in Bahai, or by airplane to Abeche and N Djamena, clinical supervision, public health programs, teaching sessions, meetings, reporting, security awareness and all. In short a great way to learn how to multitask, prioritize, delegate and hand over. Fresh blood is coming into the program and it gives it a real boost. Also there is more of a work hard play hard atmosphere in the camp. Dr J likes his beers, dancing and music. And Sylvie is taking over the responsibilities I was covering as Acting Health Coordinator. Some good and some sad stories to tell as well. The sad story is a refugee arriving in Bahai hospital (25 kilometer from the camp) on Wednesday. Bravo Golf Julliet 39, my call sign went off and I was requested to come to the hospital immediately. A lady in labor had obstructed labor because her placenta was in the way of the delivery channel. While I was busy to arrange an evacuation by airplane she vomited once and collapsed. She died. If only she would have come two hours earlier she and her baby would have survived or if we had a surgeon (we = actually the Chadian Ministry of Health Bahai Hospital) on call. The good doctor however is now not on his post for 37 days. What ifs do not help. All I can wish for is that the job interviews we have next week will bring as a dedicated surgeon with a caring heart. It is well to be understood that living on the fringes of a desert are not first choice for many medical people. I am sure we will find one. Several applications have been sent as well for a laboratory technician. Both will increase the functionability of the hospital as well as save lives. The beautiful story was a 5 year old boy who drank pesticide. He was brought in respiratory failure and with brusque intervention we managed to pull him back. He left the clinic two days ago smiling and that just makes my week. And to top it all I had the good fortune to do a normal delivery a healthy baby girl in the new maternity clinic today. O yes it is raining I shall send some photos so you can see how urgent it was. The lake is empty and we truck water from the dam now (10 kilometers from the camp).

Let me stop here. I am still happy here and Yoda Pancho, my loggie mate is snoring to loud so I will have to take some of his ear plugs. He gave me a nick name as well: Dr Chewbaca. Me a Don Quixote to him or vice versa is unknown. Enigmatic paradox.

Take care,

Love and peace,

Ashis

Bahai Beach 4- sand sand sand - 30-07-2006

Bahai Beach 4
30-07-2006

The Libyans are the main suppliers of goods in the souk (market). They travel in huge Mercedes Benz trucks convoys loaded so full that they are twice as broad as usual. You rarely meet more friendly people. In a mixture of French, English, Arabic and Hindi We exchange stories and share foods and teas in copious amounts. One can not leave without having a full belly. The bring to this isolated community: clothes (buying a FZ Barzalona Shirt), food items, but also satellites, television and other goodies. The souk provides opportunities to starta proper chicken farm in the compound. Need to haggle hard because as a khawadja (white man) the price for items is twice the local price. Also me being a leading expert on chicken they may sell me infertile, blind or mentally retarded chicken defeating my vision of an egg emporium in Chad with little outlets all over the country. If this plan is succesful however the camel breeding project is second on my list.
Water is becoming a major issue. Although it has rained it is not yet in the amounts we long for. Trucking is our second options from a dam about 10 kilometers from the camp. This body of water should suffice for about 3 months. In any scenario it needs to rain across the border in Sudan so with the gravity and aquifers it can fill up our Lake Cassoni and I can have a massive swimming pool to my disposition. Sancho Yoda, our midget logisticians is back in the project and we spend our nights exchanging list of most senseless movies- innuendo – mischief and other projects two 35 year old with the mindset of a 12 year would engage in. And new staff is about to be rolled in the project a new health coordinator and a member of the emergency response team. Charles (ERT) is here to reduce staff numbers in the health departments and work out a proper memorandum of understanding with the Ministry of Health Hospital at Bahai. And Sylvie will be here to coordinate the different departments: Reproductive, Clinical, Public and Hospital Health. I hear we are recruiting for a Hospital Manager as well. Let us wait and see what time brings us.
The most impressive story of this week was the prolonged labor and delivery of a child in the maternity ward in the camp. After an episiotomy (cut) and lots and lots of help the mother managed to push out a baby boy. No cry, no heartbeat, floppy, bluish immediately neonatal resussitation was started but after 15 minutes of mouth to nose mouth breathing, medication and heart massage the baby boy had to be declared as a stillborn. On seeing the sadness in my eyes the traditional birth attendants responded in a touching way. Dr Ashis do not worry, the mother is still alive and inshallah she will deliver again in a years time. No need to further express the survival mechanisms the Sudanese people in the camp are used to. Another boy took some traditional medicine or improperly prescribed drugs in the camp and developed a severe fixed drug skin eruption. He had blisters all over his body. Yet after nursing him properly he is improving day by day. As in all countries I have worked in the danger of HIV/AIDS is eminent. In our wards are two patients who have all the signs and symptoms of this lethal disease. The MoH hospital is understaffed however. The doctor is on a sick leave/strike/holiday and the lab technician has left them as well. And well we are at the end of the world in semi dessert how can you blame them ? I am getting to know the health staff better and better and overall I am very happy about their motivation and skills sets. They love teaching session and traditional birth attendants, nurses and community health workers each have 2 sessions a week on those topics that are relevant given the season or because they are basic skills for their work. Last week we discussed malaria, malaria in pregnancy, diarrhoea and prevention thereof. Also we have started a bed net distribution program for pregnant women and intermittent treatment of all pregnant women with an anti malarial drug in the second and third trimester. Malaria cases are expected to shoot up in the next two weeks. Every week a new challenge is up so the learning curve is still steep and is what I like. The final words for this week will be that although we have a total rupture of vaccines since 1 week, a case of acute flaccid paralysis is in the camp (possibly polio), incentives for the 96 health staff need be prepared, drug order for hospital and health centre are being arranged, weekly and monthly reports are due, rupture of water delivery may be on the way and many many more things going to the Oure Cassoni camp six days a week is like filling up my tank brimfull of asha (hope) and energy for the next weeks and months to come.

Namaskar,

Ashis

Thank you for all you for writing your tidings I really enjoy it.

For those of you who wish to see some pictures: try http://www.flickr.com/ and search for polio or ashis_brahma.

In due time a myspace photolog will bein place as well. But having difficulty uploading pictures there.

Bahai Beach 3, Yippie - 21-07-2006

Bahai Beach 3

21-07-2006

Matthias picks up his shoe and smacks it on the floor. Bang another cockroach less in this world. But no it is a scorpion size about 8 centimeters. Both John and Matthias will be sleeping inside both have been bitten before and have felt the excruciating pain in the past. Frankly there is no treatment for a scorpion sting in our pharmacy. Luckily I have gone to the local uruk (traditional healer) and he has made a leather amulet to ward of scorpion stings, snake bites, knive stabbings and bullet wounds. Comes in handy these amulets.
Two days ago a young chap arrived who had been attacked with an axe like weapon. Part of his skull has crushed. All we could do here was stabilize him and get him evacuated to Abeche where there is a surgeon. By the way our Ministry of Health doctor has self evacuated and we pray that he may return here. Presently I am the only doctor in an area with 30000 refugees and 40000 host population and surgery is not my cup of tea. Challenges, challenges, John the Kenyan male midwife is traveling on Monday for a new mission in Liberia leaving me in charge of the Clinical – Public – Hospital – Mental -Reproductive Health for two weeks. The good news is we are recruiting a Chadian doctor and a new Health Coordinator shall be arriving Inshallah first week of August. As these interviews have to be done in Abeche I will probably fly up there next week to conduct them. The score for cancelled flights this week was 3/5 however. Mechanical failure.. Always good to hear when you are flying. We are encountering some sensitive political issues. The sultan is more or less demanding that we recruit local people only. It is hard to deny him many things as he is the brother of the Chadian president. Yet the illiteracy rate in this region is very high and trained doctors or labtechnicians are not available in the region. We have tried recruiting local nurses but there are just none. Some posts therefore stay open even if the budget is there because Chadians from outside the region are not always accepted.
The first party since I have arrived was in the UNHCR compound. Main guests were the staff member of UNHCR (security man) who was leaving, a gazelle (male), 2 ladies and about 40 men. Yet when the African music hit the speakers hips were churned a great mélange of dances from Benin, Burundi, Ethiopia and Holland were shown off. The cleg dance went down very well indeed. Since about a week I go to the souk (market) regularly to work on my Arabic and Zagawa, drink tea, gossip and get to know the people living in Bahai. In the camp nowadays we share breakfast with the Sudanese nurses. Either lentils, or beans or camel with bread.
An attempt is being made to contact the foci (healers by scriptures from the Koran) and bada (trained to remove djinn through there own two devils) yet it is culturally unacceptable for them to talk with a khawadja (foreigner). Overall besides the security the program is up and running with potential for improvement. Our expatriate staff numbers are low however and will not be replenished very past so although we are consolidating better to say we are trying to float.
Since the cock awoke me at 0430 and otherwise the pigeons at 0500 I am closing my eyes and want to thank all of you for writing it makes my day. Will attach a photo of the lake. Or what remains of it

Bahai Beach 2 - 17th July 2006

Bahai Beach 2
17th July 2006

Dear friends,

Another week at the job and it has been mildly eventful.
Attending a leaders meeting is fun. After explanation of the activities of the main actors in the camp the leaders get the chance to put in their questions. Instantly the sea of white turbans releases snapping fingers. Elaborate introductions- blessing of all present and Allah and then sweet itinerary. Could UNHCR replace all 10000 tents before the rainy season (due now), can IRC take care of the roaming donkeys, we need 3 new traditional birth attendants as the Blacksmiths have different birthing customs than the Goran and Zaghawa, can you provide the rain to fall. When you are about to answer any of the above questions men and women will add on to the previous requests. Yet hearing all the dynamics-politics-clans-testing the NGO’s makes me realize I need to learn to be very prudent.
Traditional birth attendants were very happy this week as the new maternity ward had opened. A fresh 4-roomed white washed building (teaching room, 2 delivery rooms, 1 examination/storage room) Dr John gave an interactive teaching session on the delicate issues surrounding sexual transmitted diseases. In a role play two midwives demonstrated the difficulties of needing to address not only the one patient but also the partner and possible other 2 to 3 wives. Rich men in the refugee camp may have up to 4 wives and 20 children. Well what remains of it, when the janjaweed came some ran with only the clothes they had on. Some were more fortunate and crossed the border with up to 300 camels.
Outright sad was the news that our team leader of vaccinators younger brother had been killed fighting in Darfur (Sudan side). The medical team visited the ceremony to pay our respect to the mourning family.
On a lighter note this week: the gazelle (male) Ruby living in the UNHCR shall be mated with a female gazelle living in an adjoining refugee camp. An 85 year old lady was admitted with a snakebite. It took me a while to wrestle the snake off the lady and I ended up getting entangled (see attached photo for proof)
The market (souk) has finally been explored today: The Libyan market (truckers drive straight through the Sahel/Sahara) has sheeshas, tea stalls, plenty of Bibsi, shoes from China, phunky Football shirts (bartering hard for a Barceloona shirt), blankets, cup. All you need to be happy in a desert cum beach resort as Bahai Beach. One of the Libyan drivers actually had lived in Pakistan so I was able to exchange some Urdu with him. We ended up discussing who was the greatest Indian actor Shah Rukh Khan or Hritik Roshan.
We are awaiting the rains… No rain will put the camp and entire region in severe danger. All depends on one wadi (lake) photo will follow. If not tomorrow I shall perform a rain dance to ensure thunderstorms and driplets.
It was good to hear from all you wish you all the best and until the next week or for the lucky skypers : ashisbrahma

Namaskar Ashis

Bahai, July 9, 2006

Bahai, july 9, 2006


Dear friends,

One week in the country and what a week it has been !
A calm start with a flight from Amsterdam to N’Djamena, the capital of Chad. The local club scene has potential with one or two discos and open air restaurants/ drinking holes. The one I visited (Carnivore) has live music, a local band and plenty a singers and dancers. Mustapha the driver and I chitchatted about the IRC and Chad. Sunday I spent visiting the market and eating at a Lebanese restaurant. Early next morning with a World Food Program airplane to Abeche which is a city in the south east of the county. It has a population of 72000 and many many NGO’s, UNHCR and the French military. It is the nerve centre for all the refugee camps in Eastern Chad. Due to the conflict in Darfur about 200000 refugees have spilled over from Sudan into Chad. There are about 12 refugee camps run by different NGO’s. The international rescue committee runs the most northern one near Bahai beach. It is called Oure Cassoni and has about 29000 beneficiaries. After one night in Abeche I flew with a teenie weenie aircraft to Bahai. From the air one sees sand, wadis (dry rock formations which from time to time contain water) tiny settlements and Acacia like trees. At the airport I was picked up by Pascal the logistician in one of the Toyota landcruisers. He is an American chap with a wicked sense of humor.
Whisked to the lovely compound (photos will follow) were the first surprise was awaiting me. I got the George Clooney suite! (try http://www.theirc.org/ or google Bahai+IRC) Any hair I find shall be sold on E-bay soon) At present our team is in transition but in Bahai we have about 7 male expats (from Kenya-Eritrea-Tanzania-Italy-USA-Burundi) After about 2 days shit hit the fan. About 35 local youths (including sons of the Sultan) came into the office armed with sticks and demanded jobs. It took the local gendarmerie and UNHCR 2 hours to get them out of our office and free our national and expat staff. Another common crime here is carjacking one car a month gets stolen from the different fleets available here. For now part of the program will be shut down and talks are being held at all levels to sort out the issues. The camp I have seen but once due these security issues but it looks ok. Two years and some permanent structures are up amongst a health post, health centre, maternity wards, schools. My job responsibilities have been adjusted as well: I am now the Public Health and Clinical Health Manager. In the team there are about 2 translators, two assistant managers, 4 Chadian nurses and in the camp; 39 Community Health Workers, 3 Team Leaders, 1 Supervisor and 6 Sudanese refugee nurses. John Kwenda, the present Health coordinator is giving me a two week handover to explain budgets, the program, the context etcetera. As some may have noticed there is internet facility when we have the generator on i.e. working hours in the office and perhaps after working hours in the compound. Therefore I can skype-msn messenger-yahoo. Our non local national staff (about 40) are staying in our compound for security reasons since the incident. Yesterday we watched Germany thrash Portugal as we have Camerounian tv reception. The food is ok to good – only thing missing is fresh fruit but what to expect in the desert. At night one can gaze at the stars. And during the day play with refugee children. The health status of the camp is not at all bad but always on the look out for outbreaks as there have been in the past: thypoid fever – mumps. Well it is 0700 in the morning now I am off for breakfast. Wish you all the best around the world and do drop a line when you find the time my yahoo-hotmail-gmail may all be used. The IRC e-mail address I shall keep for work only

Love and Truth---Namaskar Ashis