A REPORT ON THE VISIT TO THE NATIONAL REFERENCE HOSPITAL IN N’DJAMENA FROM 20TH FEBRUARY – 5TH MARCH 2007
Following an episode of BBC’s PANORAMA in June 2005, a number of viewers contacted the producer offering help. The programme gave a harrowing account of how one doctor was struggling to manage the unmanageable in a country where the maternal mortality rate is 1:11. At least one woman a day was dying from eclampsia and/or infections. This terrible statistic is due to a lack of basic drugs and equipment, which are readily available in the West and cost just pennies. In the UK the maternal mortality rate is >1:5200 .... |
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... Money
was raised, the drugs were sourced and sent and 2005 ended with a very
successful visit to Chad by four of the supporters
including the author of this report. Three were clinicians and the fourth
accompanied us as our interpreter. Chad is a former French colony with
French being the main language spoken.
It was always our intention to return to Chad, despite the volatile nature
of the politics in that country.
Objectives For Return Visit:
For many years, there
has been an awareness that financial accountability and governance has
been lacking in large parts of the African culture. We in the charity
were acutely aware that sending items would not necessarily ensure that
those who needed the drugs etc. would receive them as we intended, free
of charge. Whilst we had every confidence in Dr Grace Kodindo, the doctor
at the centre of the BBC programme, we knew that she could not be present
at all times. We also knew that Dr Kodindo had been offered the opportunity
to work with Columbia University in New York as an Advisor on Maternal
Health in large parts of Sub-Saharan Africa, South America and Asia. So
our main contact would be leaving N’djamena for 5yrs. We therefore
felt it important to forge new links with individuals within the hospital
in order to achieve as great a level of transparency and accountability
as possible given the distances involved.
The main objectives therefore, were as follows:
1. To create significant lines of communication with one or more individuals within the hospital.
2. To evaluate
the usefulness of what has already been sent and to assess future needs.
3. To provide
training in midwifery care, plus basic neonatal care and resuscitation,
within the confines of the resources available.
4. To provide
first-hand feedback to those groups and individuals who have supported
our efforts in saving the lives of the women and babies.
Communication
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We attended several meetings with the Hospital Director, the
Head of Obstetrics & Gynaecology and her Deputy, Dr Grace Kodindo,
the Senior person in Finance and the Chief Pharmacist.
At each meeting,
we laid out our expectations in relation to accountability and transparency
and after much discussion, it was jointly decided that an Agreement would
be drawn up and signed by both parties involved. We explained that the
greater and more accurate the level of accountability, the more funding
would flow to the hospital and therefore to the women and babies. Over
the following days and several drafts, agreement was reached on what was
proposed. (A copy is enclosed within this report.) Unfortunately over
the first few days of our visit, it became apparent that some of the items
which we had already sent, were not available to the clinical staff and
at one point, we actually searched rooms looking for those items. At a
subsequent meeting it became apparent that our concerns had been taken
very seriously and senior named individuals have now been identified as
being responsible for whatever is sent. Much to our relief, those individuals
are well known to Dr Grace Kodindo and she has expressed great confidence
in their integrity and commitment.
To
Evaluate, Present & Future Aid -
A major part of the aid which we have sent to the hospital is in the form
of medications, predominantly Magnesium Sulphate which was unavailable
in Chad and other African countries and is used to treat eclampsia. Antibiotics
to treat infections, which often occur as a result of illegal abortions,
have also succeeded in saving lives. We have also sent contraceptives
in the form of injections. The current statistic related to the success
of the medications is undeniable and more than justifies our involvement
with this cause. Since November 2005, over 1,100 women have been treated
for eclampsia, are alive, well and returned to their families. Since 2005
when the aid began, we have ensured that the hospital has never been without
Magnesium Sulphate.
The Chief Pharmacist is now in direct contact with us and we will be informed
in plenty of time when the supplies require “topping up.”
All supplies are channelled through the pharmacy and an account is being
set up which will show what is available. We discovered through the meetings,
that some of the items which we have been sending are actually available
through the hospital. What some of the patients and their families do
not have is the money to purchase them, so we have left money in an account
which we are assured will be used appropriately. This will save the unnecessary
sourcing and shipping of the medications.
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Training
In Midwifery & Neonatal Care & Resuscitation -
A
meeting was set up for us to meet with the midwifery staff on our second
day in Chad. Several had met us on our previous visit and we were acutely
aware that the response could have been either one of resentment that
we were back again “to tell them what to do” or that the welcome
would be warm and emotional. Luckily our fears were put to rest as we
were hugged by one after the other of the midwives. As Grace put it “It
was as if you were their family members!”
Over the coming days, many made the effort to come in for the teaching
sessions, some stayed after working night shifts. Of concern to us were
some of the practices related to the care of infants immediately following
delivery. Currently, babies are washed under a cold tap, then wrapped
in a thin sheet brought in by the mother and placed on a cold tile surface,
sometimes for considerable lengths of time. They are not given to their
mothers to feed as the mothers and midwives believe that the colostrum
(the first milk) is “dirty” because it is not the traditional
white colour of milk. Babies are given water for the first 24-48hrs until
the mothers milk comes in. I explained the risks involved in placing the
babies on the cold surface and the even greater risk of not feeding the
infants. I added that the tiny premature babies I care for back in the
UK are given even the smallest amounts of the precious colostrum as it
helps to protect the babies against infections. The implications of not
keeping the babies warm was explained in great detail, even though the
outside temperature was 38-40degs, the heat loss of a wet baby on a cold
surface could be catastrophic in relation to their ability to maintain
temperature and blood sugars. They looked shocked when I explained that
these practices could cause a baby to die. By the time we left Chad, we
noticed that there were fewer babies on the cold tiles, so the message
was getting through. I also produced protocols for the administration
of antibiotics whilst there and have promised to produce and send more
over the coming weeks.
My midwife colleague spent several hours teaching on birth complications. There seems to be reluctance by midwives to call for medical assistance, which has undoubtedly cost lives. The view from my colleague is that the midwives manage normal deliveries very skilfully, but lack the confidence and insight to recognise the limitations of their skills.
We were pleased
to see that overall, the appearance of the Maternity Unit has improved
significantly due in part to funding from the United Nations. The buildings
have been painted inside and out and new bright pink mosquito nets are
visible over every bed. There is now a library housing two computers with
internet connection and a librarian who speaks English.
To
Provide Feedback To The Charity Supporters -
A report has
been prepared by Pippa Zintilis, my midwife colleague who accompanied
me to Chad which will be placed on our website. Simon Granville our interpreter
was determined to come with us and prepared to take a financial risk in
order to accompany us to Chad. He had been very disappointed when our
planned visit last April had to be cancelled because of the civil unrest
and fighting in N’djamena. The funding made available through the
“Wales for Africa” initiative made a huge difference to his
ability to fully appreciate the enormity of the problem we face at this
hospital. He, like me has been changed forever by the experience and wishes,
through me to express his thanks for the funding. I am enclosing a copy
of the Agreement between our charity and the hospital in Chad. The discussions
were difficult at times and pushed Simon’s sensitivity and ability
to choose and translate the correct words, to its limit!
ANGELA GORMAN.