Dr. Polycarpe Takou - Caring for Darfurian Mothers and Children in Chad's Refugee Camps
Dr. Polycarpe Takou, an obstetrician and gynecologist, arrived in Chad last December to coordinate reproductive health services in Oure Cassoni and other border camps. He shared his experiences with IRC health writer Leilani Gallardo.
Coming to Chad gives me the opportunity to provide relief to the Sudanese refugees living here. By resolving reproductive health problems, we resolve at least 80 percent of all health problems in the communities where I work.
Because my job is to coordinate reproductive health activities in all 13 refugee camps in eastern Chad, I spend 40 percent of my time visiting the camps and the refugees. I always meet with refugees themselves so that I have complete information, appreciate the quality of the services they receive and take their opinions and suggestions into consideration.
I have to reach the camps early in the morning to maximize my time if I don’t want my field visit to be just a tour. Because of security issues, I have to leave some camps before 2 P.M., which significantly reduces the time I have to interact with refugees and staff. Sometimes, as a safety precaution, travel has to be by convoy—even if I am the only one who has to reach the camp.
Overcoming Cultural Barriers
There are numerous reproductive health issues in the camps. Family planning services are very limited, when they exist at all. The high frequency of sexually transmitted infections is also a concern. Ignorance about HIV/AIDS—even outright denial—as well as a general cultural adversity to the use of condoms, are also troubling issues.
I am particularly concerned about the large number of women giving birth outside health facilities. More than 60 percent of childbirths in the camps are conducted by traditional birth attendants in the tents. The risk of death greatly increases for both mother and baby when a woman does not deliver in a health facility, assisted by clinically trained medical staff.
Why are health services in the camps so underused? Taboo and cultural perception and the poor quality of some services partially explain it. One pregnant woman in the Gaga refugee camp told me that she doesn’t intend to go the health facility because she had heard that, “One has to expose her nudity on a table, while at home I deliver squatting.”
It can also be difficult for refugees to get to the health facilities. Nongovernmental aid organizations (NGOs) help patients reach the clinics during daytime, but at night, patients have to make transportation arrangements themselves. This delays arrival to the health center and is the principal factor associated with neonatal and maternal deaths. One camp in Iriba, close to the Chad-Darfur border, recorded two neonatal deaths and one maternal death during my field visit.
I don’t mean to say that it is always like this, but it shows that, despite exceptional work by international NGOs with very devoted personnel, we must always seek to improve services. Refugee communities are not yet organized enough to respond efficiently to health problems on their own.
Setting Short- and Long-term Goals
The challenges are numerous for improving reproductive health in the camps. We have set up a coordination mechanism for reproductive health activities in the eastern Chad, for example.
We have also set up a family planning service in each camp and improved the referral system for survivors of sexual violence. Two voluntary counseling and testing centers for HIV/AIDS have been put in place while a peer education program for young people has been developed. Our aim is to implement an entire reproductive health package within two years after refugees settle in.
By the end of this year, I would like to have programs in at least three camps focusing on the prevention of mother-to-child transmission of HIV and to have all maternal and neonatal deaths in every camp thoroughly investigated and the results discussed with the communities to raise their awareness about how to avoid these tragedies.
Dr. Polycarpe Takou, from Cameroon, is the IRC’s reproductive health and MISP coordinator in eastern Chad. He advises and trains health staff and local health ministry officials who are assisting 200,000 Sudanese refugees living in camps near the Sudan/Chad border. Dr. Polycarpe is also a specialist in the management of maternal and child health programs and, before joining the IRC, served for 4 years as a UNICEF health officer in Cameroon. He is married, with three sons.