Chad bears the grim distinction of having the highest under-five mortality rate in the world. Médecins Sans Frontières (MSF) teams in the country focus on maternal and paediatric services, and respond to emergencies.
In Am Timan, eastern Chad, MSF supports a Ministry of Health district hospital and seven health centres. Staff cared for more than 3,700 children on the paediatric ward, held some 7,300 antenatal consultations and assisted 1,795 births. More than 5,300 children under five were treated for malnutrition.
In the southeast, in Kerfi health centre, MSF provided comprehensive healthcare including nutritional support, blood transfusions and hospital referral to both Chadians displaced by conflict and to the local community. Staff also offered reproductive healthcare and assistance for victims of sexual violence. The team treated more than 27,800 patients. Maternity staff held 3,500 antenatal consultations and assisted 188 births. As the displaced left the area, reducing pressure on health services, MSF withdrew from the health centre.
In Massakory, western Chad, MSF is mainly involved in treating malnutrition in under-fives and delivering emergency medical care to under-15s. During the time of year known as the ‘hunger gap’, when food scarcity is an acute problem, more than 170 beds in Massakory hospital are reserved for children in need of nutritional support or other vital medical care. In total, about 1,200 children were admitted for malnutrition in 2011. Another 750 children were admitted with malaria, meningitis, diarrhoea or respiratory infections. Around 3,200 severely malnourished children were treated in MSF’s outpatient feeding programme, and more than 6,400 children under three received supplementary food to prevent malnutrition.
Further north, in Nokou district, in Kanem, MSF extended its response to the nutrition crisis, treating 3,600 children.
An estimated two million women live with obstetric fistulas worldwide, most of them in Africa, in poor and remote areas with limited or no access to maternal healthcare. Obstetric fistulas are injuries to the birth canal that are mostly caused by prolonged or obstructed labour and they generally result in incontinence, which in turn can lead to women being rejected by their families and communities. In Abéché’s regional hospital, where MSF supports gynaecological and obstetric services, specially trained medical staff performed fistula repair surgery on 222 women, and assisted more than 2,980 births. Skilled obstetric care can prevent fistulas.
Despite efforts to contain the cholera outbreak that began in 2009, it continued through much of 2011. Inadequate sanitation was the main reason for the persistence of the disease: cholera is an infection spread by contaminated water or food. It causes profuse watery diarrhoea and vomiting that can lead to severe dehydration and death if not treated early. Treatment consists of administering rehydration solutions to replace fluids and salts. Some 325 MSF staff worked in 23 health centres throughout the country, caring for more than 12,700 patients.
MSF vaccinated approximately 575,000 people against measles, the majority of them children, in districts in the southern and southeastern regions of Logoné Occidental, Logoné Oriental, Moyen-Chari and Salamat. More than 2,800 people were treated for the disease, and the team donated drugs to the Ministry of Health to treat an additional 3,500. Measles is a contributing cause of malnutrition, and MSF staff treated almost 3,000 children in nutrition programmes in Logoné Occidental.
Southern Chad falls within the so-called meningitis belt, a huge strip across sub-Saharan Africa where the disease is particularly prevalent. Meningitis causes inflammation of the membranes surrounding the brain. In 2011, MSF staff vaccinated more than 900,000 people in campaigns that covered five regions. They treated close to 3,500 people for the disease and provided drugs to treat an additional 3,000. In Mandélia, Chari-Baguirmi region, the team introduced a new vaccine, used for the first time in Chad, which offers protection for 10 years – four times the protection of the old vaccine.
The malaria programme in Moissala, Mandoul region, includes treatment and prevention activities, and focuses on children under five and pregnant women, for whom malaria is particularly dangerous. In a region where every child may have an average of two bouts of malaria per year, and where some villages are a three-hour walk from the nearest health centre, bringing healthcare to the communities can make a crucial difference. MSF trains workers to go to villages to perform rapid diagnostic tests for malaria and provide treatment for simple cases. Children suffering complications are sent to the nearest health centre or transferred to a ward built by MSF at Moissala district hospital. More than 2,100 people were treated at Moissala hospital in 2011, and 17,000 mosquito nets were given to young children and pregnant women.
War in neighbouring Libya aggravated instability in Chad. In the eastern provinces, road ambushes, car jackings and robberies all increased. The risk of kidnapping also grew. As a consequence of the heightened security risk, some MSF teams had to reduce their activities. Despite these constraints, staff provided medical assistance to 1,850 Chadians fleeing political violence in Libya and vaccinated 3,000 against measles.
At the end of 2011, MSF had 977 staff in Chad. MSF has been working in the country since 1981.
Moussa*, 12 years old
”When I got to school I didn’t feel well. I had a backache. I had to take an exam that morning, but I lay on the bench. The teacher told me to get up, but I couldn’t.”
At home, Moussa’s pain worsened: his joints ached, especially his ankles, wrists and neck. He had a fever. His mother took him to the hospital, where he was diagnosed with meningitis.
Meningitis is treated with antibiotics. When treated early, the chances of cure are high. Without treatment, however, only 50 per cent of people survive the disease, often with serious after-effects such as deafness or a physical disability.
Moussa said the injections were quite painful but that the doctors were nice and careful. He stayed in hospital for the injections and treatment for dehydration, and to have his temperature monitored. A few days later, he returned home with his family.
* The patient’s name has been changed.