When I signed up to work with Medecins Sans Frontieres/Doctors Without Borders, I never imagined I would manage a bunch of horses and dromedaries. But I knew the work would be different from my nursing duties back home in the Yukon.
MSF is a humanitarian organization that responds to medical emergencies in about 70 countries. I was offered a chance to work in Chad for six months. There was no big earthquake and no recent armed conflict that triggered the emergency I was responding to. Malnutrition is one of the many humanitarian emergencies that rarely make it to the headline news.
Many children in the Kanem region in Chad are chronically malnourished. Their lives are affected by the desertification of the Sahel belt in northern Africa, a process that has been noted for the last four decades. Climate change is in action – slow and steady. Lack of development and infrastructure are also factors in this vast and sparsely populated region on the margins of the Sahara. Kanem is as far from the capital N’Djamena as is the Yukon from Ottawa.
In 2010, every third child under five in Kanem was suffering from acute malnutrition: some of them severely and with many medical complications. Of those, every second child risks death without treatment. The few functioning health centres were overwhelmed with the treatment. I was part of a therapeutic nutrition program that MSF set up in response to the nutrition emergency. No other international nongovernmental organization was daring to intervene in this remote region with difficult access.
It is not as easy as setting up a soup kitchen that will attract the hungry. Our program had two inpatient units with intensive care capacities and initially a network of nine ambulatory feeding centres in an area the size of Switzerland. The mothers from Massaforty travel by donkey with their malnourished children to seek help at the centre in Kournah. They told me they leave their village in a convoy the day before and sleep along the way in the desert to cover the 40 kilometres. It was a three-day journey each week to receive treatment. If they came for assessment and did not qualify for the feeding program, they returned empty-handed.
MSF had a fleet of Toyota Land Cruisers to serve the ambulatory clinics once a week. I spent many hours travelling on sand tracks in 50-degree Celsius weather to support and supervise the mobile clinic teams. I couldn’t imagine doing the same on a donkey like the moms did with their sick and vulnerable children. That is why MSF hired local community health workers who would go out to the small and isolated villages and nomad camps. They would actively screen the children to detect cases of severe acute malnutrition early, to inform the villagers about the MSF program and to deliver health-education messages.
The community health workers had no vehicles. Vehicles would be useless most of the time in this region without roads. So MSF helped the health workers to secure horses or dromedaries (one hump camel) for travel. They go about twice as fast as the donkeys.
Abakar Ali, a community health worker from Mordinga was very happy with this initiative: he saw a spike of new admissions into the program, children that would have been kept at home – with a high chance of dying – due to the remoteness of their location. Abakar was also happy to avoid unnecessary travel for many children because he was trained to recognize the children who needed to be referred. He acquired the knowledge to educate the villagers about preventing severe acute malnutrition. Knowing that the work of Abakar and other health-community workers had this kind of impact, I didn’t mind managing horses as part of my nursing duties!
We also opened four new clinic sites to extend the reach of the MSF program to other parts of the Kanem and to help more people. But there were still many small villages too remote to reach with traditional means. Eventually, we noticed the newly acquired fondness of the desert people for cellphones. Not all families have a cellphone, but most political and religious dignitaries do. All of a sudden, it was possible to follow-up on a child that missed a clinic day or to give health advice to a family that was moving with their livestock herd, even in remote areas of the Sahel too far for the health workers on horseback.
In the end, it was a combination of ancient social networking and cellphone technology that allowed us to maximize our reach and provide assistance to as many people as possible.
Most tribal chiefs and village leaders have attended MSF orientation sessions and were well aware of the malnutrition situation in their area. They also had the phones and the resourcefulness to use them. Like the teenage boy who would sit in the shade of a lone tree on a sand dune with a pocket full of phones from his village. It was likely the only spot in the region with a signal. He would answer any call, jump on the horse and ride back to the village; the chief would then ride to the dune and call back. From there, any message was spread along the ancient, informal network established among the desert people.
I am happy to have expanded my clinical skill set with some knowledge about horses and dromedaries. Without their deployment, MSF Chadian and international staff would not have been as successful in treating more than 4,000 children with severe acute malnutrition. Many of the children would have died or suffered from medical complications without the intervention. As nurses, we are mandated to use appropriate technology in practice. Sometimes it is hard to imagine in advance what that will mean!
Othmar F. Arnold is an advanced practice nurse and peace worker from Carmacks, Yukon. He has lived and worked with aboriginal populations in Canada’s North since 1993. He has experience in humanitarian service from Uganda, Rwanda, and Pakistan. The nutrition project in Chad was his first mission with MSF.