Why are we there?
- Armed conflict
- Endemic/epidemic disease
- Health care exclusion
This is an excerpt from MSF-USA's 2013 Annual Report:.
Although the Chadian government has promised to increase investment in healthcare, the quality of care and health indicators are still poor, particularly for rural communities, children, and refugees.
The mortality rate for children under five is high, and routine vaccination coverage is low. People often die from malnutrition and preventable diseases such as malaria and cholera, and disease epidemics are recurrent. Instability in the surrounding countries also means Chad is host to a high influx of refugees. In 2013, some 60,000 new refugees arrived in the country, with urgent needs for basic and specialist medical care.
Focusing on malaria
Malaria, a mosquito-borne disease, is one of the main causes of death for children under five, but deaths can be prevented with simple measures such as the use of mosquito nets, preventive medicine and early detection and treatment.
For the past few years, teams from MSF have worked on preventing and treating malaria in the Moissala and Bouna districts, Mandoul region. Teams focused on children with severe and complicated cases of the illness in Moissala hospital‘s malaria unit. MSF also supported health centers and community health workers in rural areas with drug supplies and staff. Seasonal Malaria Chemoprevention—the distribution of antimalarials as a prevention strategy—was organized for children under five and pregnant women during the high season (July to October). The strategy had previously proven effective in reducing the number of people developing severe malaria. In 2013, prophylaxis was distributed to 53,000 children and teams recorded an overall reduction in malaria of 60 percent in Moissala when compared to the previous year.
At Massakory hospital, Hadjer Lamis region, where MSF provided support in pediatric care, teams treated 36,600 patients during an acute peak in malaria cases between July and December. Children also received treatment for malnutrition in the hospital and surrounding health zones. A large water sanitation campaign for people’s homes was launched to help prevent outbreaks of diarrhea. This activity currently reaches 900 families in 20 villages.
From August to October there was an emergency intervention in response to high levels of malaria in the Salamat region. Based at Am Timan hospital, outreach activities expanded to ensure people in remote areas of the district could get the medical care they needed. An MSF team in Am Timan hospital also continued to provide basic and specialist care with a focus on women and children. Reproductive healthcare, emergency obstetric care, and treatment for tuberculosis (TB) and HIV, including prevention of mother-to-child transmission of the virus, was offered. Teams carried out 5,280 outpatient consultations, assisted 1,895 births and tested 2,050 people for HIV. A pediatric nutrition program based at the hospital and in nine outreach sites admitted 9,990 children for treatment. Six of these outreach sites were handed over to the Ministry of Health at the end of the year.
Providing assistance to Sudanese refugees
Renewed clashes in Darfur, Sudan, led to an influx of refugees in the Tissi area of Chad early in the year. MSF launched activities in Tissi town, establishing an emergency room to treat victims of violence, a health center in Ab Gadam camp, and a health post in Um Doukhum. People were suffering mainly from malaria, respiratory tract infections, diarrheal and skin diseases, and malnutrition. The team carried out 52,820 outpatient consultations and treated 10,400 people for malaria. MSF provided clean drinking water and built latrines to improve basic hygiene in Ab Gadam camp. In Goz Beida, a team carried out basic healthcare consultations, provided access to drinking water and distributed relief supplies such as blankets and washing kits to improve living conditions.
Extensive vaccination campaigns
Without routine vaccinations, children are at greater risk of infection, and the consequences can be fatal if they are also malnourished. MSF has been involved in expanding routine vaccination coverage in collaboration with the Ministry of Health, and organizes vaccination campaigns for displaced people and in response to outbreaks of disease. There were three measles vaccination campaigns in 2013, reaching 257,000 children in Ouaddai region in May, and 102,000 children in Guéréda and 68,100 children in Iriba in September.
Beginning in February, a vaccination campaign was carried out in Goz Beida for an outbreak of yellow fever, a mosquito-borne viral disease that can cause severe liver disease and death. A total of 161,300 people were vaccinated. In Salamat region, outbreaks led MSF to vaccinate 12,250 people against measles and 26,800 against meningitis.
Responding to emergencies
Following flooding in Maro, Moyen-Chari region, MSF provided assistance to refugees from Central African Republic living in Yaroungou and Moula camps, carrying out 12,200 basic health consultations, and offering nutritional support to 2,630 children, as well as immunizations. In August, assistance was also provided to refugees in Koldaga and Moissala.
An MSF program started in 2008 in Abéché provided medical, rehabilitative, and psychosocial care to women with obstetric fistulas. Fistulas, a consequence of birth complications, cause not only pain but incontinence, which in turn often leads to social exclusion and sometimes rejection by friends and family. The program handover to the Ministry of Health began at the end of 2013. The 45-bed village des femmes had welcomed around 850 women in total, and patients had benefited from rehabilitative surgery and post-operative care.
An emergency nutrition program in Bokoro, Hadjer Lamis, was handed over to the health ministry in February.
At the end of 2013, MSF had 1,039 staff in Chad. MSF has worked in the country since 1981.
Hawa Youssef, 18-years-old, received surgery for an obstetric fistula
"I was in labor for two days and was transported from my hospital to N’Djamena, but it was too late; I had a bad delivery. Soon, I began to lose urine without being able to prevent it. I underwent two operations but continued to lose urine.
My parents were angry because the operations were so costly. An acquaintance recommended the women’s village in Abéché and after two attempts, my leaks have ceased. I’m happy to lead a normal life once again."