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Redefining remote

Trish Newport Special to the News Massakory, Chad I generally thrive in discomfort, but even I was dutifully impressed by the living conditions in Massakory when I arrived to work for Medecins Sans Frontieres.


I generally thrive in discomfort, but even I was dutifully impressed by the living conditions in Massakory when I arrived to work for Medecins Sans Frontieres.

Access to clean water is considered a privilege. Fare at the local market often consists of roasted grasshoppers, onions and rice.

The weather is either too hot (between 40 and 50 degrees), or too dry. Powerful sand and wind storms burn the eyes and skin.

Most people live in straw and mud huts. The living area for the medical team consists of a dormitory made of straw mats, which do not block out the heat or the sand storms.

There’s no space for privacy. To have a moment to yourself, you need to go to the outhouse.

Our only place to clean, the bucket-bath area, is only cordoned off by straw mats, so cleaning often simply entails rubbing sand from the current sand storm into your skin and hair.

For the next three months, from March until June, I would be working with the community health side of MSF’s ambitious malnutrition project in Massakory. While there are the classic ambulatory programs for malnutrition set up outside of health centres, MSF is also trying a new approach to treating severe malnutrition in the remote communities.

Community members in designated distant villages have been trained to screen for malnutrition. The children screened as malnourished are directed to the local ambulatory program for a consultation.

If they don’t have complications, they return home and receive their weekly ration of Plumpy Nut, which is the treatment for uncomplicated malnutrition, in their village. It is distributed by a trained community member who is reimbursed by his or her own community, either through money, food, or some other means.

In March, I toured some of the villages that are involved in the new initiative. In the past four years I have had the great opportunity to work in some of the most dire and remote places in this world. I remember my first time heading into the bush in Niger - I was blown away by the new definition of dire that was created in my mind. My experiences in Chad were similar - not so much dire, but removed and remote.

We travelled by Land Cruiser on sandy paths through the desert for one and a half hours from the already small town of Massakory to arrive in a smaller village with a health centre which has an MSF-supported ambulatory malnutrition program. From there we drove another hour, on an extremely uncertain path, through the most enchanting desert forest I have ever experienced.

We saw beautiful green birds, various type of raptors, hopping camels (their legs are tied together so they can’t run off), endless mules and slightly emaciated cattle. Elephants are said to pass through this forest, and to my great chagrin none were seen, but not for lack of incessant trying.

After one hour we arrived at a tiny village consisting of a few mud huts with straw roofs. Upon our arrival, an impressive quantity of children tumbled out of the huts as clowns do out of tiny circus cars.

There were no signs of motorized vehicles in this village. I asked the village chief how they usually travel to the health centre, and how long it takes. He explained that usually one must either take a donkey and cart, which takes a number of hours, or walk - which takes an even greater number of hours.

In most cases only people with medical emergencies head to the health centre. Women give birth at home with hope that all goes well. Standing in this tiny village, the importance of MSF’s new approach to treating malnutrition was beyond evident.

From our first stop, we travelled to a number of other villages involved in the malnutrition program - each one equally small and remote. Village chiefs continually thanked us for making the treatment of malnutrition more accessible to them, and they told countless stories of the hardships involved in living so far from a health centre.

In the last month, the number of malnourished children in the entire MSF Massakory project has increased exponentially, even though the seasonal “hunger gap”- the months in which food insecurity levels and malnutrition rates rise in unison while waiting for the harvest - is theoretically still several months away.

Throughout the world, the causes of malnutrition are extremely varied, but lack of early medical treatment for basic childhood illnesses is one of the major causes. Seeing firsthand the distance so many families have to travel in order to seek basic treatment here, I worry about what the months of the hunger gap will bring when the effects of food insecurity and lack of access to early medical treatment are intertwined.

While the villages I visited could easily fit into the stereotype of “quaint African villages,” it was clear their way of life involves endless challenges and difficulties.

After an extremely long drive, I returned home, to the luxury of my tiny bedroom, which is part of a long row of bedrooms made of straw mat walls and a straw mat roof. I lay down on my bed, where in the night I can hear every movement and breath of every other person in the straw mat row.

I listened to the chickens squawk in the henhouse, which was closer to my room than the latrines or the outside showers. I turned on my fan, which circulates the hot air, the chicken smell and the sand throughout my room, and I was grateful for it all.

Tricia Newport is a nurse who lives in Whitehorse. This is part of a series of dispatches from Chad.