Over the past few years the barren plains around Lake Chad in West Africa have become temporary home to tens of thousands of families fleeing violence and disruption in surrounding countries. In this most challenging of environments Concern has had to adapt to respond to their needs.
Out where the buses don't run
The first thing that you might notice as you drive through this part of Chad … is that there really aren’t any roads. It’s mostly just an endless vista of sand, scrub, and thorn trees. Tiny mud and thatch settlements blend with the scenery, rendering them almost invisible to the outside eye. Herds of camels and goats wander the landscape, seeking out whatever sustenance they can find.
This place is hot, dusty, and vast.
Of course, it’s fairly unlikely that you’ll be driving around the Lake Chad Basin at all anytime soon. It’s very remote and insecure — various armed groups roam these lands and violence is never too far away. But for many who have ended up here as refugees, it’s better than where they came from.
"At least here we feel safe"
Mohammad says he and his family fled across the border from Nigeria after an attack by militants in which he was shot and lost one of his legs. “We are reliant on the local community for support, but at least here we feel safe,“ he says.
The problems here are many, not just for the displaced, but also those who call this home — the "host community." The health system is shockingly under-resourced and overburdened, leaving hundreds of thousands of people outside the reach of basic services. Child malnutrition is a big problem.
Problems need solutions
“Most people here live quite a long distance from a health clinic and the terrain is very difficult. Even if they do manage to reach a clinic, the level of service available can be quite low,” according to Christian Olodo, Concern’s Emergency Program Coordinator.
Essentially, many of the rural health posts in the Lake Region provide little more than low level diagnosis and perhaps basic medication. Some of them are community-run and the absence of refrigeration makes providing something as fundamental as a vaccination service very challenging. Nutrition programs for young children are few and far between. The influx of refugees has put increased pressure on facilities.
Concern's solution? To mount up and move out.
Hit the road Jack
“We do this every day, five days a week,” says Christian, as his team loads the last of the supplies needed for the day ahead and climbs aboard a pair of Concern Land Cruisers. It will be a long day. No roads and no navigational aids make life tricky, but the Concern drivers use some sort of sixth sense to negotiate their way across the drylands. Punctures are a daily occurrence and every car carries two spares. Getting two punctures sucks.
Some of the villages where Concern has established its network of mobile clinics are upwards of three hours distant from the base, which doesn’t leave much room for error — there are strict curfews. But this is quite literally an essential service. People die out here every day from untreated conditions, with young children and pregnant women most at risk.
Today, one team peels off to set up at a village about 90 minutes out. The others carry on, reaching a wide river about 10 miles further on. There’s no bridge, and the only way across in a vehicle is via a human-powered raft, made from barrels lashed together with rope and rough timber. It’s nothing fancy, but it does the job, and 30 minutes later we’re setting up a tarpaulin and plastic tables under the shade of some desert date trees.
An essential service, off-road
Mothers and children are already here, over a hundred of them, mobilized by the Concern-trained community volunteers who live amongst them. They are a mix of locals and refugees. Many of the kids have had preliminary screening for malnutrition at home. The team here will do a thorough check, talk to the mom, and if it’s needed, give them a supply of high nutrient therapeutic food with some simple training on how to use it at home.
Doctor Altiga Romaric explains some of the other services provided, “Children with basic medical conditions such as malaria and diarrheal diseases are diagnosed and prescribed appropriate courses of treatment, while those with complications are referred to the nearest health center.” Concern has upgraded health facilities at Tchoukoutalia and Ngouboua, training staff, installing medical equipment, and ensuring a regular supply of pharmaceuticals. Other smaller centers are also being renovated and upgraded. The mobile team carries out a range of immunizations, transporting vaccines in specially insulated containers.
Nearby, there’s a small thatched hut set aside for pregnant women, to allow them privacy during their examination. Mayadang, the team’s resident midwife, says that when she first started working at the district hospital she noticed that many women were consulting health services very late in their pregnancy. That could be a big problem if there are complications. “I decided to join the mobile clinic team, to provide prenatal consultations in villages where women are unable to reach health facilities for a variety of reasons.”
"I feel like I am saving lives”
Christian Olodo looks at his watch, indicates that the time is up, and the team starts to disassemble the clinic. They need to get back on the road — figuratively speaking — if they’re to reach the office before dusk. This has been a productive day, and as our mobile medics bounce and rattle their way back to base, the vehicle is filled with cheerful banter and raucous laughter. I ask Mayadang if the discomfort and long periods of time away from her family are worth it. She smiles. “Of course. I feel like I am saving lives.”
Tomorrow, they’ll do it all over again.