fact finding visit to chad 2005 - our first visit
In November 2005, two members of our group, Pippa Zintilis, senior nurse and midwife, and Angela Gorman, senior neonatal sister, visited the Hôpital Général de Référence for vital first-hand experience of the situation in Chad. Not only did they bring a range of vital supplies, but were also able to give some hands-on training in the resuscitating newborn babies and the use of hand-held electronic foetal heart monitors. They also spent time with senior hospital staff to establish the requirements and priorities of the unit and the women they treat, as it is vital that Hope for Grace Kodindo responds to real rather than presumed needs. Drugs and equipment were found to be in very short supply. Even basic resources, such as sterile gloves, sutures and IV equipment were not available to patients, unless they were paid for and sourced off-site. Those who needed a caesarean were allowed one dose of paracetamol post-operatively, if they could afford it. There was a lack of infection control equipment, and also of antibiotics. |
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Before the visit, Hope for Grace Kodindo was aware of one of the
maternity unit’s biggest killers – eclampsia. This condition was claiming
more than 20 women a month in this unit alone (in the entire UK it claims
two or three women a year). Because antenatal care is not generally available
in Chad, women are often not seen by a doctor until the condition is in
its final stages, at which point it is life-threatening to both mother
and baby. It is easily and cheaply treated with magnesium sulphate – however,
this drug was not available in Chad. This ‘wonder drug’ is a form of Epsom
salts.
Pippa Zintilis had scoured the entire UK for suppliers of magnesium sulphate,
and finally tracked down the manufacturer, who, with enormous generosity,
offered to supply hundreds of doses free of charge. These ampoules were
delivered to the hospital at the time of Pippa and Angela’s visit, and
they were there to see this life-saving drug in use almost immediately.
Just prior to their visit a German obstetrician had also made a very generous
donation of magnesium sulphate. With these two valuable sources of this
vital drug, the high mortality rate from eclampsia – in this hospital
at least – should be a thing of the past.
However it's not just drugs and equipment that save lives. Midwifery training
needs to be updated, and more hands-on, rather than theoretical. The midwives
are more than capable of managing straightforward deliveries, but need
further training to deal with complications. In some cases, midwives were
astonished to discover that some of the Western methods of delivery introduced
to Africa had now been superceded by woman-centred care that was much
more similar to the traditional methods their mothers and grandmothers
had used!
Added to the problems within the healthcare system, there is a lack of
basic infrastructure, such as roads. Women often cannot reach maternity
clinics – and when they do, they find that the clinics lack even basic
facilities, or may not even be staffed. Angela and Pippa visited a maternity
clinic at Chagoua, a crowded and poor area of N’Djamena. It had been without
electricity for many months – a single candle was the only light source.
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Angela
and Pippa also met with a UN representative (left),
who made it clear that there is systematic long and short term problems
in Chad. It is the belief of Hope for Grace Kodindo that
it is essential to keep the supply chain direct and close to ground
level, building relationships of mutual trust with those directly
responsible for the use of donated supplies for patient care.
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"The Truth about Maternity Care in Chad", a fly-on-the-wall account by Pippa Zintillis, and "From Cardiff To Chad", Angela Gorman’s account of the visit.