Date: Thu, 11 Apr 2019 05:29:58 +0200
By Amaury HAUCHARD

AdrĂ©, Chad, April 11, 2019 (AFP) - Dinar Tchere is fighting time and the sun, and he fears he may be losing.   This morning, the health worker is expected in a remote village of eastern Chad, where he will administer the measles, mumps and rubella vaccine to poor children.   But he's behind schedule -- and there is limited time before his enemy, the blistering Sahelian heat, will destroy his precious drugs.  Tchere takes his gear and the ice-packed cooler that shields the vaccines, puts them in an NGO pickup and heads out from his clinic in Hilouta, in Ouaddai province, on the dusty untarmacked road.

Twenty minutes later he is in Agang, a village of 400 people, and there, another private dread has turned to reality. No-one is there to be vaccinated.   "It's just what I feared -- most of the mums have gone off to the market to do their shopping," groans Tchere, a stocky, shaven-headed man in his fifties.    There is nothing to do but hope that the mothers and their children will return. He stretches out a mat on the soil, under a mango tree.   His luck starts to turn. One by one, mothers with their children make their way to the spot, and soon there is no room on his mat for youngsters waiting for their jab.

- Cold chain -
Always worried by the heat -- the thermometer now reads 40 degrees Celsius (104 degrees Fahrenheit) -- Tchere dips his finger into the cooler to check that the ice has not melted, and starts the vaccination.   "Our biggest headache is ensuring that the vaccines are always kept cold," says Tchere, who heads one of 21 health centres in the region.   "Since the troubles of 2007, we no longer have a solar panel or fridge."   The "troubles" refer to years-long violence by armed groups on the tense border between Sudan and Chad.   Hilouta, which lies less than two kilometres (one mile) from the border, became a combat zone.   With no power, how does Tchere keep his vaccines cool?   "I stock them in Sudan, in a clinic on the other side of the border. They've got a fridge," he explains.

But there's a problem: because of security concerns, Sudan refuses to let people cross the border by motorbike -- Tchere's only form of transport when he cannot use the pickup.   So on the eve of every immunisation session, Tchere walks into Sudan, carrying his cooler, fills it up with vaccines, and walks back into Chad.   His clinic administers to about 60 villages. He says e does four vaccination sessions per month -- two in the clinic, and two in the villages.   Most often, he does the outside trips on his motorbike, always taking care never to take the same route back home, in order to avoid holdups.

The state no longer pays the running costs of his health centre -- a French NGO, Premiere Urgence Internationale (PUI), has stepped in, using financial help provided by the European Union.   In Arkoum, about 50 kilometres (30 miles) from Hilouta, Felix Djembonoudji, a nurse who runs the health centre, says that the stockpile of vaccines -- held in the district's main town of Adre, several hours away by road -- has run out.   "The people (in Adre) sometimes don't receive any -- we've been without MMR (vaccine) for five days," he says.

- Measles threat -
Measles is often dismissed by so-called anti-vaxxers who oppose immunisation as a disease of the past or non-threatening.   Experts say that it is neither -- measles is on the comeback trail.    And out of every 20 children who catch measles, as many as one will suffer from pneumonia, according to the US Centers of Disease Control (CDC). Blindness, encephalitis and severe diarrhoea are also serious complications.   Only one child in five in Chad is fully vaccinated against measles, according to a 2017 survey.   "Measles can also cause malnutrition in non-vaccinated children, which in itself is a cause of premature death," said PUI's mission chief in Chad, Fabienne Mially.

According to UN figures, more than one child in 10 in Chad will die before their fifth birthday.   In Agang, the measles vaccination session comes to an end, and Tchere is packing up his gear when a horse appears on the horizon, its hooves kicking up dust, bearing a man and his six-month-old baby.   The infant needs his second MMR vaccine. "It's important!" pleads the father. The child will get his jab.   Tchere returns to his clinic in Hilouta. There is no water or electricity. Two local people are awaiting him in the gloom, desperate for a medical consultation.    "The working day is long," he sighs, as he welcomes them in.
Date: Tue, 9 Apr 2019 04:47:15 +0200
By Amaury HAUCHARD

Hadjer Hadid, Chad, April 9, 2019 (AFP) - "I've already earmarked a customer for this drum -- I need to get a move on!"   Ali Ahmat,12, flicks his whip to persuade a hard-driven horse to press on with his cart, laden with 200 litres (44 imperial gallons) of freshly-fetched water.   The young entrepreneur is one of the informal but indispensable links in a chain to supply people in Ouaddai, eastern Chad, with water, the stuff of life.

Scorching temperatures, an open sky, a shortage of deep wells and lack of water purification system make this a thirsty part of the world indeed.   "After the rainy season, water becomes scarce," says Mahamat Adoum Doutoum, chief of the Guerri region, where only two deep wells exist for 86,000 inhabitants. "So people go to look for water in the wadi."   Wadis -- "riverbeds" in Arabic -- are watercourses that run strong and fast during the rains and are often dangerous to cross, but largely dry up for the rest of the year. When there is no more rain, people dig wells in the wadis and install pumps to extract groundwater.

Ali and dozens of other water carriers flock to the pumps to collect supplies they plan to sell to people who have no access to the source, often in dusty settlements.   Each refill of his 200-litre drum costs Ali 100 CFA francs (0.15 euros / $0.17), but he can sell the water for five times as much in town. "We do between seven or eight return trips each day, roughly," he says.     Towards the end of a hot Sunday, the blazing sun has set and Ali's cart is heading towards Hadjer Hadid.

The town harbours a refugee camp for people who fled conflict and mass killings in the Darfur region of western Sudan, the far side of the border.   Pascal, a Sudanese refugee and father of five in his 50s, is also used to the return trips between the town, the bed of the wadi and the muddy wells.    He first came to Chad about 15 years ago and says that he "suffered" to be able to buy his own donkey.   The beast of burden was an investment that has paid off, however, enabling Pascal to deliver water to the townsfolk over the past two years and bring a small sum home to his family.

- Add bleach -
But he remains concerned about the quality of the water.   "To drink the water, you also have to add bleach," Pascal says.   While water has become as rare as it is valuable, the kind to be found around wadis is unsafe. Traditional wells dug into the earth at the wadis provide water that is often the same colour as the soil.   "The water can be contaminated at various points, either at the source, which may be unprotected, or during transport, using receptacles which are inappropriate, dirty or uncovered, and during storage and distribution," says Fabienne Mially, mission chief in Chad for the French aid group Premiere Urgence Internationale (PUI).

The NGO supports 11 health centres in the Ouaddai region, where awareness sessions on the importance of proper drinking water are regularly organised.   In Borota, a village several hours' drive from Hadjer Hadid, the head of the local health centre has no illusions. Of the six standpipes in the village, none is working any more.   "They were installed by NGOs," says the official, Koditog Bokassa, who says that wadi water is the only available source of water locally.   He hands out sachets of bleach to dilute in untreated water.   But Bokassa lacks the means to satisfy everybody and PUI has become the sole supplier of bleach in central parts.    The state used to deliver some, but has not done so for more than a year, he says. It is quite common to see young people at the wadis drink directly from their cans.

- 'Barely enough' -
The town has holding basins and water towers designed to retain water during the rainy season.   "But the holding basins are insufficient and the two water towers broke down several years ago," says local resident Hassan.   One trader has bought two barrels of 200 litres apiece, which he leaves in the courtyard of his house. "It's barely enough for the children, but it's better than nothing."   The water deliverer Pascal does not have the money to buy a drum of such munificence. For the seven members of his household, there are seven 20-litre cans on the stoop.    "I haul water every day, but I have the same problem as everyone else," he said.
Date: Sun, 7 Apr 2019 06:19:43 +0200
By Amaury HAUCHARD

Abeche, Chad, April 7, 2019 (AFP) - The chief medical officer at Adre hospital takes a routine phone call: a patient has been admitted with gunshot wounds and needs emergency surgery.   A dusty town in eastern Chad, once part of the proud Ouaddai empire, Adre is caught up in a mounting conflict between local farmers and nomadic camel herders from the north of the sprawling country.   Last year, the hospital treated more than 100 patients with bullet wounds.

In a territory where almost everyone seems to have a gun -- a legacy of rebellions launched from eastern Chad and of the brutal conflict in Sudan's Darfur -- squabbles over grazing land and trampled crops swiftly lead to violence.   Such disputes are tragically familiar in many parts of Africa.    But in arid eastern Chad, near the border with Sudan, the bloodshed is particularly acute, rooted in a bitter drought and population pressure sharpening rivalry over access to land.   The vicious circle of attack and retribution is running full tilt.

- Seasonal -
Admissions in Adre rise sharply during "times of tension", a source at the local hospital said.   Those times mirror the seasons. At the end of the rainy season, in December and January, herders drive their beasts northwards into the Sahel. When water sources start running low, they return south, from about the end of June.   Local chief Abderahim Dahab, who supervises 136 villages in his traditional leadership role, said the modern-day bloodshed contrasted with long-established cohabitation.   "Movement of livestock has always happened peacefully, for decades," he said.   Migratory herders benefit from pasture on which to feed their animals, and farmers benefit from the animals, whose droppings fertilise the soil. And farmers and herders mutually benefit from trading with each other for food.

Historian Mahamat Saleh Yacoub said two factors explained the breakdown between the two communities.   The first is a drought that has gripped the Sahel since the 1970s and seems to be worsening. Everyone who spoke to AFP agreed that the key issue is a lack of water.   "The herders are now coming earlier in the year and going back later. The established ways have broken down," said another district chief.   Saleh Yacoub, who is head of the ENS college of higher education in Abeche, near Adre, said the second cause was a population increase -- "as much among people as among livestock".   Herds are getting larger, straining the fragile ecological resources of the Ouaddai.

- Ethnic friction -
The rivalry has "become intertwined with ethnic problems", added Yacoub.   "The herds all belong to the same people: colonels, generals, people in politics," explained a village elder sitting on his mat with a glass of tea.   "We have had meetings, we write letters to the deputy prefect (district administrator), the prefect himself, but get nothing back," he protested. "The population has no power against them."

Many cattlemen are members of the Zaghawa ethnic group, who come from the northeast of the giant country.    The Zaghawa include President Idriss Deby Itno, who came to power in 1990.    Members of their ethnicity have entered every rank of the Chadian state, although Ouaddai's governor, Ramadan Erdebou, dismisses any suggestion that tribalism is to blame for the region's problems.   "This ethnic question is a false debate. There are Chadian women and Chadian men and one single unity, Chad," said Erdebou, who was formerly the chief of the regime's powerful intelligence services.

- Disarmament -
Erdebou's predecessor was sacked after an explosion of communal violence last October claimed eight lives.   One of his first moves in office was to announce a massive disarmament campaign among the population.   He also warned that a mission would be coming from the capital N'Djamena to chase away "those farmers who have cultivated crops along the corridors (set aside) for livestock movement."

These designated corridors were established by law in 1959, to give nomads and their herds passage of up to one kilometre (more than half a mile) wide for their seasonal migrations.   "But Zaghawa herders feel they can do what they like and don't respect them," said a farmer, who maintains he lost his entire peanut crop in 2016 when hundreds of dromedaries trampled his field.   "How do you expect Ouaddians to agree to be disarmed when you see that the herdsmen have more and more weapons?" asked a local official.

In 2015, the National Assembly in the distant western capital passed a Pastoral Code that led to an outcry from people who found it heavily biased in favour of the cattle breeders. Deby overturned the law.   "It's hard to want national unity when those in power only favour their own," said the local official, who asked not to be named, saying he feared reprisals.   But, Saleh Yacoub observed, when quarrels turn violent, "the Zaghawa become the target for all the grievances, regardless of whether they are legitimate or not."   In a visit to Abeche in February, Deby named no names but acknowledged there was a "serious problem."   He vowed to "take matters in hand".   "The hour for vendettas is past," he declared.
Date: Mon 18 Jun 2018
Source: The New York Times [edited]
<https://www.nytimes.com/2018/06/18/health/guinea-worms-dogs-chad.html>

In this arid central African country [Chad], the long global struggle to eliminate a horrifying human parasite has encountered a serious setback: dogs. They are being infected with Guinea worms [dracunculiasis], and no one knows how.

Scientists are desperate to solve the puzzle. If the answer isn't found soon, or if the worms begin to spread widely into other species -- a handful already have been found in cats and even baboons -- then 32 years of work to end the scourge may crumble, said Mark L Eberhard, a parasitologist at the Centers for Disease Control and Prevention.

In 1986, when the Carter Center -- the global health philanthropy in Atlanta founded by President Jimmy Carter -- launched the eradication drive, an estimated 3.5 million people in 21 countries had worms.

Last year [2017], only 30 human cases were found: half in Chad and half in Ethiopia.

But 6 years ago, here on the hot, dusty banks of the Chari River, the worms mysteriously began emerging from dogs. Last year [2017], over 800 Chadian dogs had them.

Dogs cannot infect people directly, but they may carry the worms into ponds from which people drink, which is how humans are normally infected.

"They haven't caused a big human outbreak yet, knock wood, but that's my nightmare," said Ernesto Ruiz-Tiben, who directs the Carter Center's campaign.

To prevent that, Chad is paying villagers to tether dogs until all their worms wriggle out. The reward is $20 cash, plus a stout chain with 2 locks. (Dogs chew through ropes or are freed by children who take pity on them.)

The reward is $100 to humans with worms. To generate publicity, the cash is handed out at ceremonies held in the weekly roadside markets where villagers gather to barter meager fish hauls for goods like plastic buckets or quart bottles of gasoline.

At one such ceremony in Dangabol, in southeast Chad, Dr Hubert Zirimwabagabo, who heads the Carter Center's work in the country, played a quiz game with the audience, handing out bars of soap as prizes. Asked what caused worms, one winner shouted, to general laughter: "Drinking bad water -- and speaking ill of others."

Then Dr Zirimwabagabo asked local officials to present $100 to each of 3 women who had worms, reported them, and kept them away from drinking water. The officials obliged with grand ceremony, to loud ululations. People here may not see that much cash in a year.  [Byline: Donald G McNeil Jr]
=======================
[HealthMap/ProMED-mail map of Chad:
<http://healthmap.org/promed/p/57>

The reservoir in dogs in Chad was discussed by the WHO in the 2014: "Dracunculiasis eradication: global surveillance summary, 2014" (Weekly Epid Rec. 2015; no. 19, (May 2015, pp. 201-15. <http://apps.who.int/iris/bitstream/handle/10665/242354/WER9019_201-215.PDF>), which wrote "the unusually high number of dogs with confirmed Guinea-worm infections in Chad, which poses epidemiologic and biologic questions."

The situation was also described in a 2014 paper, Eberhard ML et al. The peculiar epidemiology of dracunculiasis in Chad. Am J Trop Med Hyg. 2014; 90(1): 61-70. doi: 10.4269/ajtmh.13-0554; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886430/>).

The contribution by the canine reservoir to maintaining infections in humans and whether they actually transmit the infection to humans by contaminating the water reservoirs is not known. A zoonotic reservoir is a potential complication to the attempts to eradicate dracunculiasis. - ProMED Mod.EP]

[In the majority of cases, under unhygienic conditions, both people and animals are affected by dracunculiasis.

Exceptionally, Guinea worm may occur as a purely animal infection. This was demonstrated during the last century, when 11 percent of stray dogs were found infected in Kizylorda (Kazakhstan), where no human infection was known.

In Uzbekistan and Turkmenistan, _Dracunculus medinensis_ has been identified in golden jackals (_Canis aureus_), which potentially can infect water sources.

According to WHO 2017 data, 817 dogs in Chad, 11 dogs in Ethiopia, and 9 dogs in Mali were reported to be infected with Guinea-worm (see at <http://apps.who.int/iris/bitstream/handle/10665/272648/WER9321-305-320.pdf>).

_D. medinensis_ infection in dogs remains a challenge to global eradication, particularly in Chad and to a lesser extent in Ethiopia and Mali. - ProMED Mod.AS]
Date: Tue, 29 May 2018 04:39:34 +0200

N'Djamena, May 29, 2018 (AFP) - Hospitals and schools were shut in Chad Monday as civil servants went on strike over pay cuts imposed by the cash-strapped government which is under pressure to cut public funding to meet the demands of international donors.   Public sector workers are demanding payment of their "full salary" after bonuses and allowances were slashed by 50 percent in January as part of a package of austerity measures to improve state finances. They had already seen a similar 50 percent cut in 2016.   President Idriss Deby, who has been in power since 1990, had asked them to wait until the end of the year to regularise their salaries.   The unions on Saturday refused his request and called for an indefinite strike.   Primary and secondary schools in the capital and the University of N'Djamena were closed on Monday while the main ministries were functioning at a slow pace, with many offices shut.   "This strike is jeopardising thefuture of our children who are in exam class," said parent Joseph Issa.   Schools in other major cities were also closed.

At the general hospital in N'Djamena, staff nurse Ali Soumaine said they were providing "a minimal service for surgery, resuscitation and other sensitive services".   The government was "surprised" at the strike call, spokeswoman Madeleine Alinque said in a statement.   "We question the headlong rush of unions that do not honour our country or workers," she said.   "The government is inviting all workers to go about their daily business normally, and efforts are under way for a sustainable recovery of the social situation," she added.   Magistrates on Monday also began a three-day strike in protest at a police attack on lawyers in Doba last week.   According to trade union leader Michel Barka, the situation of civil servants "is more and more unacceptable, and it gives the workers no pleasure every time they have to close the schools, the hospitals, the public administration".   Barka accused the government of not "making an effort" to deal with the situation.

Chad, a poverty-stricken landlocked country of nearly 15 million people, has about 92,000 civil servants.   The austerity measures imposed in January led to a seven-week strike by civil servants. The government and trade unions in March reached an agreement to end the paralysis of the public sector.   The government proposed ending the cuts to bonuses and allowances at the end of May.   N'Djamena obtained a three-year $312 million (254 million euro) credit line from the International Monetary Fund last June. It has received two tranches of $99.8 million but has to make progress on improving state finances to access further funds.   The economy of Chad, where 40 percent of the population live in poverty, has been badly hit by a downturn in the price of oil exports since 2015.
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