Tissi is a very small place in the very big country of Chad. If you look Tissi up on google maps you won't find it. However, it lies right down in the bottom East hand corner of Chad, approximately 7 km from the border with conflict-ravaged Darfur (Sudan), and less than 1 km from the also conflict-ravaged Central African Republic (CAR). It is a very volatile region and currently hosts Sudanese refugees affected by the fighting in Darfur and Chadian returnees from CAR.
Médecins Sans Frontières
Médecins Sans Frontières (MSF) has set up a health facility in Tissi offering health care to tens of thousands of people. We see many different kinds of patients: women with complicated labours; people with gunshot wounds; malnourished children; children damaged by mines they found while playing in the sand; women with postpartum infections; people with malaria. It is a remote little village and it can take a very long time to get here—and a very long time to get out if it is rainy season.
Looking at Tissi from above there does not appear to be much movement. However, once in the town you can see donkeys loaded up with all sorts of goods, children playing together in the sand, people buying and selling at the local market on Mondays and Fridays, men riding horses, women carrying water on their heads with babies on their backs.
At the moment it is rainy season and there will be rain almost every day for the next 3 months. It is raining now as I write and little drips are starting to fall into my tukul. Tukuls are the small huts we live in made of cement with a straw roof. Everything is quite basic but I rather like it. We don't have much lighting around the compound but we get to see the stars very clearly. We have outdoor showers and latrines. I never liked the idea of latrines, the thought of falling into that big black hole was not very appealing, however they are not too bad.
There are seven expatriate team members, all of different nationalities—something I have always loved about working with MSF. We have a very dedicated national staff team and it is a pleasure to work with them.
I am the midwife of the team working together with three lovely dedicated Chadian midwives.
Maternity care in Tissi
As often happens in obstetrics, the delivery room can go from quiet to busy in moments. Since being here we have had some complicated and heart rendering cases coming to the maternity unit.
Last week we received a woman in premature labour. She had a gunshot wound to the abdomen. We delivered the premature twins she was carrying, both of whom were no longer alive. I will never forget the woman, she never complained. We managed to transfer her to Abeche where MSF has a surgical programme, however she did not make it. Twenty four hours after delivery, she died. Not all endings are as sad as this one. Fortunately many end well.
Seven days ago Mariam* was brought to the hospital by ambulance. She had a very high fever and was seriously unwell. She had given birth at home 4 days before to a healthy little boy; however, she developed a serious postpartum infection. She was unable to eat and was hardly able to talk. Yesterday she left the hospital smiling, with little Adam* in her arms. She had received the necessary care and antibiotic treatment and was ready to go home.
Kaltouma*, in her fifth month of pregnancy, also came into the hospital by ambulance. Her mother had taken her to the nearest basic health care centre as she was unwell. When we admitted her she was extremely pale, very weak and had no appetite. We tested her iron levels which were dangerously low, it was amazing she was still alive. Kaltouma received three blood transfusions and treatment for severe anaemia. Her iron levels went up and she started to feel much better. We wanted to keep her in a little longer, but she really wanted to go home to her family. We can't force someone to stay, so she went home on a donkey promising she would come back for a checkup.
Another busy week has gone by. Tomorrow another busy week starts but before I know it will be the weekend again. Time goes by very quickly when you have a lot to do, when you enjoy what you are doing and when you feel that what you are doing has a beneficial impact on the population you are serving.
The benefits of working abroad
Working abroad provides lots of challenges and makes one more resourceful, which positively impacts on one's practice at home. MSF recruits trained, experienced midwives for their work in the field; for more information on what it takes to do this work and how to apply, visit www.msf.org.uk/job-profiles/midwife.