Category Archives: Côte d’Ivoire

Tabou, Côte d’Ivoire

In mid-October I was transferred from Daloa down to Tabou, a small town located on the Atlantic coast of Côte d’Ivoire, overlooking the Gulf of Guinea, just a few kilometres from the Liberian border. This is what Tabou looks like:

Tabou beach
Tabou beach
Tabou lighthouse
Tabou beach

On Sunday I sometimes play volleyball with our staff:

Volleyball in Tabou

As for our base, which serves as both home and office, this is part of the fleet of seven vehicles I manage:

MSF Tabou base

This is the office:

MSF Tabou base

It’s not always bright and blue here. This is what the house looks like in the rain, complete with a doctor’s vain attempt to not get completely soaked on her way there:

MSF Tabou base in the rain

Thinking outside the puddle

Have you ever got your car stuck in a big puddle, unable to dig the mud out from under the car to get moving again, because there’s so much water it just keeps filling the mud back in? Probably not. But, if it should ever happen to you, I suggest you think outside the puddle.

Our Mitsubishi L200 (a 4×4 pickup truck) entered a seemingly shallow puddle only to suddenly sink into a very deep part of the puddle. Within a second the rear differential was already sitting in the mud at the bottom of the puddle, so we were stuck.

Stuck in a puddle, you can't get out of

We got the shovel and hoe out, and tried to dig the mud out from underneath in order to get the vehicle moving again, but the puddle was too deep: water just kept pouring the mud back in under the car and making it sink further. Keeping the engine running to make sure water couldn’t get in and destroy it, we began waiting for people to walk by. Soon enough, we had 3 young men down to their boxer shorts trying to help us get unstuck, but still no success!

After about half an hour, a young man wearing a red sports jersey with Chinese lettering happened upon us. He took our hoe, and started walking off into the tall grass at the side of the road, forcing the grass down to the side to make a bit of a path, without explaining his strange actions.

Dude takes our hoe and walks off into the bush

After a minute or so, we began to understand: the young man first cleared some of the grass and then began loosening up the soil at the side of the road. He then began digging a trench about half a foot deep and two metres long, perpendicular to the road, leaving some soil at the edge of the puddle to keep the trench dry while working.

A trench starts to take shape at the side of the road

Once they judged the trench sufficiently awesome, my driver broke the dyke and the water began to flow out of the puddle.

Breaking the dyke

To speed up the flow of water out of the puddle, one guy continued lengthening the trench farther away from the road, and my driver and one other passer-by used their hands to push the water faster toward the trench.

Speeding up the flow of water into the trench to drain the puddle

Within ten minutes, the water level was low enough to dig out a bit of mud and for a dozen people (by this time, quite a crowd had gathered around) to stand only ankle-deep in the water. Together they rocked the vehicle side to side for about a minute while the driver revved the engine and pumped the clutch until the tires gripped well enough to drive out of the puddle and onto a dry part of the road. In total, the car had spent nearly an hour stuck in the puddle! Check out how happy my driver was afterwards:

Success!

The moral of the story: think outside the puddle. If you’re stuck, and the road is at the same or higher level than the surrounding area, put your civil engineering hat on and try emptying the puddle.

Measles

At the end of June, we learned of some reported cases of measles in a village 53km from Daloa, where I was based for the first four months of my time with Doctors Without Borders (MSF) in Côte d’Ivoire. While measles vaccination is a universal practice in places like Canada, the percentage of children vaccinated in developing countries is often low. Measles is a very unpleasant disease; it’s extremely contagious, painful and, for the unlucky ones, deadly. While measles is most commonly seen in children, teenagers and even adults can catch it too. When I visited my travel clinic in Canada in May, I was surprised to hear her advise me to get a second measles vaccination, as the childhood vaccination is no longer fully active now that I’ve grown up and the places I work have very high rates of measles.

So, when someone called us to tell us about several suspected measles cases, we didn’t waste much time in going to the village to see whether it was true or not. The nurse working in the local health centre spread the word so we could see the kids as soon as we arrived from the hour and a half drive. As soon as we pulled up, local kids started crowding around to see these strange white people.

In order for our nurses to check the supposedly sick kids for measles, they needed somewhere without dozens of healthy kids getting in the way. A house with a veranda was volunteered, but still the healthy children ran into the yard to see what was going on. Not only because of the distraction, but because measles is so highly contagious, we had to get rid of them despite how friendly and happy they were. Solution? Find a willing mother and assign her to crowd control, explaining that healthy kids hanging around might soon end up as very unhappy measles patients. This lady fit the bill perfectly and did a great job of keeping healthy kids at a distance:

Vaccination crowd control techniques in rural villages

Some kids were a bit more shy, preferring the safety on the other side of the fence, which posed no problems for us:

Curious neighbour in Gadouan, Côte d'Ivoire

Among the crowd of kids back out on the street, a helper selected those that appeared to have some measles symptoms and allowed them into the yard of the home. In the yard, a trained nurse did a quick check of each of these kids to see if they did really seem to have measles or not. The ones who seemed to have measles were then given a spot on the veranda to wait their turn for treatment. The puffy eyes of the small child in the middle show one of the symptoms seen in measles cases:

A father and some patients wait for their measles treatment

Each kid with measles then received a proper consultation from one or two nurses, who checked the severity of the symptoms, and whether the kid had any other health problems as well. Next, one of the nurses prepared a treatment for each child consisting of antibiotics, vitamin A, eye ointment, and special nutritional supplements. The exact dosages had to be calculated for each child, and a patient health card filled out for the child to keep. In Western countries, that would be the file at your local doctor’s office, but in developing countries it’s very common for patients to keep their own records and take them each time they visit a health centre.

Preparing measles treatment

Two months later when a number of measles cases were reported in some other villages, the authorities decided to run a vaccination campaign. With organisational, logistical, and some financial support from MSF, in September the Ministry of Health vaccinated over 15,000 kids in three areas around Daloa, one of which was the village we had visited at the end of June. It was a LOT of work, but it went relatively well, with excellent cooperation between MSF and the Ministry of Health.

Disclaimer: The postings and views expressed on this site are mine alone, and do not represent the position or values of Médecins Sans Frontières.

Beetlejuice!

One day in June I cut open a mango to feed my addiction, and noticed that the seed looked a bit different than usual. I imagined I’d seen something move slightly so I stared a little closer for a few seconds and, lo and behold, a little brown beetle slowly came to life and emerged from his camouflaged place among the woody brown of the seed, crawled groggily out of the hole, and headed for freedom.

Beetle inside a mango
Close-up: beetle inside a mango

The moral of the story: always check for bugs in your food. In Burma I found little white worms inside lychee nuts all the time, curled up hiding where the stem meets the seed. And every week I find at least one fly swimming in my coffee. Yum.