I still remember my first visit to Babalme in July 2011. The MSF vehicle had to use a local guide to point at indistinguishable features on the horizon, a lone tree or a sand dune, to direct us more than twelve kilometers off the last known track in the desert sand. It was a bleak picture. The area was drier than the rest of the Sahel, not a single mud brick building, no school, no health centre – just people living a pastoralist life in a forgotten corner of Chad and close to the border with Niger.
Our team was warmly received. In a bush shelter, we sat on oriental rugs in the shade from the relentlessly burning sun and drank tea. The first meeting with the local tribal chiefs and village elders went as expected. On one side the representatives of a powerful NGO, on the other side the local authorities of a poor and neglected region: The expectation was that Doctors without Borders/MSF would have the wonder cure for all the medical ills and the neglect by the state government.
All we came to offer was to open an ambulatory therapeutic feeding centre to treat the many severely malnourished children under five in the area. Once a week, a mobile medical team would arrive to assess, diagnose, and treat in the shade of a tree in the centre of the village. Mothers with their sick children would have to ride on donkeys from the surrounding villages.
I was impressed by the reaction of the men in Babalme to our very limited offering to their expansive unmet community needs. When MSF nurses and community health workers addressed the waiting mothers to inform them about the nutrition program, all political and religious authorities stood behind us to show the strongest possible endorsement for MSF’s intentions.
A village chief offered to train and work as a community health worker. He would be riding a horse from village to village to do community mobilization, health education, to screen the children for malnutrition, and to refer them if necessary for treatment at the ambulatory clinic. He dedicated four days a week to do outreach and was also helping out on clinic days. His 92-year old father, a former chief, and his deputy carried on his political functions.
And what a response we got from the community. Within two weeks, we had almost 100 children enrolled in the program: some of them needed to be transferred to intensive care in the regional centre. They were too sick and too weak to be treated in the community. Within a month, we discharged the first children as cured and the number of new admissions started to decrease. Inversely, the number of requests from the community started to increase.
Of course, it was hard for the medical teams to refer all requests for basic health and medical care to the nearest government health centre – a four-day camel ride away. MSF’s mandate allowed only treating life-saving emergencies. But then we also received a request for two bags of cement: The community decided to build the first ever latrine as a demonstration project near the tree that served as our clinic site. Next, the community leaders asked MSF to establish a permanent health centre to meet the needs of the people. As an international humanitarian organization that responds to medical emergencies, MSF does not have the capacities to sustain development work. We lobbied the Ministry of Health to consider such a request.
By the time MSF announced the withdrawal from the nutrition project in late October because the number of severely malnourished children was drastically reduced, there were rumors that the dream of local health services could come true for the chief and his people. In November, we organized a workshop for continuing education in nutrition care for all government nurse practitioners in the region. A nurse appointed for Babalme participated. At the same time, the community recruited volunteers to a nearby oasis to fabricate several hundred mud bricks for a future health centre.
It was so rewarding to see how a community and its leaders could be inspired by the dedication of our mobile medical teams to drive to this outpost of simple civilization in the desert on a weekly basis and demonstrate that change is possible. With simple means, we turned around the fate of several hundred malnourished children. The community decided not to wait for a distant government to take action any longer. It took the initiative to build their own health centre to meet its needs and to reduce the suffering that was for centuries considered as God-given. This made Babalme look so much greener than on my first visit.
For more content on my experiences in Chad, go to the With MSF in Chad page. From there you can see the above story as a video presentation in English and German, as well as access the MSF magazine Dispatches online in English and French. The new version of the short film is also posted on this blog post: Hope on the Horizon – the Movie.
OFRADIX 
Othmar, great post. My favorite essayist, Albert Jay Nock, would have called this ‘social power’. If the government had built the health center using ‘political power’ it would have been at the expense of social power and the community would have been spiritually poorer as a result.
Malcolm, thank you for your reply. It was indeed social power at work, despite the clear political structures that exist in the tribal societies in the Sahel; those are often also interconnected with religious authorities. But from my observations, the traditional “chef de village”, a hereditary title and position, is deeply embedded into the daily life of the community. On the other hand, the “sous-préfet”, installed through the former colonial system, is a modern-day political entity, and seems clearly more separate from the life in the village.
In Babalmé, the grassroots initiative (- is that even an appropriate term for a community on the edge of the desert?) luckily found support from the political system. But as you say, the strength of the initiative comes from the people involved. They start to believe that marginalization and suffering do not need to be and remain God-given! Indeed a spiritual awakening.