“We are happy for every pound gained”

Dr. Cordula Barthe reports from the hospital in Am Timan in Chad:

Picture: Doctors without Borders
Picture: Doctors without Borders

I have been working for three months with Doctors without Borders in the district hospital in Am Timan. I have been a doctor for more than 30 years, the last 25 years as a general practitioner and psychotherapist with my own practice in Germany. I would have never dreamt how helpful my past experience over those years would be here. All of the know-how that I learned with my hands, ears and eyes, I can and must use here.

Doctors without Borders supports the children’s station in Am Timan which has up to 50 beds and an intensive care room. Furthermore, our teams have supported obstetrics since 2010. In addition to safe inpatient deliveries, our staff performs caesarean sections in emergencies and is thus able to save many lives. If there are complications, there are enough beds available for inpatient care. Together with my two colleagues from Doctors without Borders we provide around the clock on-call service for all of the departments. Although I am an experienced practitioner, every night I am confronted by a host of problems in obstetrics and pediatrics which I master thanks to the support of my African colleagues and due to reliable treatment protocols.

Improvement of the laboratory facilities

Throughout the year in 2011 Doctors without Borders has expanded the laboratory facilities. Our teams are now able to provide safe blood transfusions, measure kidney and liver values as well as complete the cost-effective CD4 measurement for an early detection and treatment of HIV patients. Furthermore a doctor, this is my function, and three nursing assistants, as well as an advisor to the treatment team, support the inpatient and outpatient treatment of HIV patients and tuberculosis patients.

Program for the prevention of HIV for mother and child

In addition in 2011, we began a program for the prevention of HIV transfer from the mother to the unborn child with a lot of commitment and dedication. In the hospital and the health centers in and around the city, as well as the mobile clinics in the country, we see more expectant mothers who come for prenatal care and now have the opportunity to get tested for HIV. Our teams advise and treat the patients so that they know their status early and are able to protect their unborn child. This offer has been well-accepted by the women; a prerequisite is that we sensitize them to the illness through clarification and health education. In this way we hope that also in the Chad in the future not so many women and children have to die of AIDS.

Early treatment of HIV/AIDS

In particular it is the women who often first find out about their illness when it is already in an advanced stage and they must be admitted to inpatient care. Often it is a long diarrhea illness or tuberculosis that discloses the underlying HIV infection. In my experience the tuberculosis patients are especially grateful for the opportunity to become healthy again here in our hospital. They are always emaciated when they come to us. Adult women sometimes weigh only 20 kg, or men who only weigh 40 kg, such that they can no longer stand alone and were bedridden at home for a long period of time.

I am touched by each individual person because I witness how badly they were doing at the beginning; they cough, have difficulties breathing, are in extreme pain and are hardly able to eat. We have to hold on together for many weeks because often they have a severe anemia and diarrhea or other infection with many complications. And then one day I see a smile for the first time when I come for my visit and my handshake is returned; for the first time their strength is back again. And a few days later this man or this woman is able to stand on the scales alone and we are happy together for each additional pound gained each day!

Most of the people here in the back areas of Chad have such a hard life that they can only think about surviving each day and are not able to think about tomorrow. This is something that I had to get used to because our target-oriented thinking is taken for granted. Unfortunately there are still too many patients who come too late; especially those people in the advanced stages of Aids who we can’t always help anymore.

Learning from each other in an international team

I have a good team together with my national MSF nursing staff here in the HIV/TB department: we can depend on each other. Even though I struggled with the language in the beginning, they noticed that I put my heart and soul into my work; I never lose my temper and try to always do what is best for the patients. My colleagues share their way of looking at life and their thoughts and in our work together I try to share with them the things that have helped me through the years of my practice. We learn from each other. For example, we have set up a daily problem discussion meeting in which we talk about how we can improve our work. My colleagues are grateful for the additional training and together we celebrate the success of our hard work when we see each patient whose health is improved.

Cooperation with the government nursing staff

In the last year we have also begun to work together with the government nursing staff so that the quality of our work could improve. They are the executors of the government’s tuberculosis protocol. At first they tentatively accepted our support of the fulltime care of the inpatient HIV and TB patients, through further education and shared visits. Now they accept it gratefully such that they will be able to continue with good quality medical and nursing care when this project comes to an end.

Am Timan, November 27 2011, Dr. Cordula Barthe (Translated by Tereska-Foundation)