La mia Africa: breve esperienza di lavoro in un ospedale del Ciad

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Perché la mia Africa: non è mia intenzione affrontare nel profondo problematiche socio-economiche che ci porterebbero lontano benché servirebbero a spiegare, almeno in parte, la realtà di quel continente. Qualche accenno è necessario farlo perché lì c’è la chiave di lettura della scelta mia e di molti che come me e molto più di me lo hanno visitato. Quando dico visitato puntualizzo la mia consapevolezza che andare in Africa non è come si è soliti dire “una goccia nel mare” ma molto, molto meno. Parti con l’intenzione di aiutare, di fare, di dare una svolta e poi ti arrendi, pur facendo quello che in quel momento la realtà del posto ti richiede.

Claudia Recine nella sala operatoria del piccolo ospedale in Ciad.

L’Africa è il paese delle grandi contraddizioni, prima tra tutte quella tra il passato remoto ed un passato più recente, intendendo per presente quello che inizia nel XV secolo. Un passato testimoniato da grandi civiltà, una per tutte le rovine di “the Great Zimbabwe”, scoperte nel 1868, che rappresentano un’evidente testimonianza della potenza della civiltà bantu all’inizio del secondo millennio. Né si può sottovalutare un altro esempio di lungimiranza che ci fornisce Tamsir Niane, guineano, uno dei maggiori storici africani, il quale ci racconta dell’Impero del Mali che nel 1236 scrisse una Carta costituzionale del-l’Impero.

Dal XV secolo i primi contatti con l’Europa. In precedenza regni e grandi imperi africani sostanzialmente multietnici portarono forme brillanti di civiltà. Seguirono i grandi mali: la tratta degli schiavi ed il colonialismo. La fine di quest’ultimo è solo una realtà formale e teorica; alla presenza massiccia degli europei si è sostituita la presenza incombente della Cina e di altri stati emergenti come India e Brasile, potenze in crescita alla spregiudicata ricerca di rapporti privilegiati verso materie prime e sbocchi commerciali per i propri prodotti.

Con la fine del colonialismo gli stati indipendenti dell’Africa furono tracciati su confini dettati dagli insediamenti coloniali, non tenendo in nessun conto divisioni imposte a popolazioni tradizionalmente unite o viceversa, costringendo alla convivenza popoli nemici. Venne imposto un modello europeo con l’intento di combattere le diversità etniche, favorendo i partiti unici allo scopo di cancellare l’eterogeneità e costruire uno spirito nazionale. Questo, purtroppo, ha portato al predominio di una etnia sull’altra identificata con quella del Presidente di turno. Da qui ribellioni e rivolte cui seguirono nella scelta politica i militari che non fecero meglio dei civili.

Sentirsi in parte responsabile di tutto ciò è forse la spiegazione dell’inte-resse personale a “visitare” questo paese.

Perché il Ciad? Si potrebbe dire che il Ciad ha scelto noi come Associazione Pole Pole… Piano Piano…Arezzo quando Monsignor Michele Russo ve-scovo di Doba, una delle regioni del Ciad, ha avuto notizia di un gruppo di volontari italiani impegnati in opere umanitarie in Tanzania. Ricordo ancora quella sera in cui lo incontrammo dandoci un quadro della situazione sanitaria della sua regione. Ci parlò dell’ospedale di Bébéjià, opera dio-cesana che aveva bisogno di aiuti di uomini e mezzi. Era il 2009… Dal 2010 nel periodo gennaio-marzo, sanitari medici ed infermieri che condividono con l’Asso-ciazione Pole Pole… Piano Piano… Arezzo l’inte-resse verso questa realtà si recano nell’ospedale a piccoli gruppi di 4-5 per un periodo di 15 giorni ciascuno.

Il Ciad, con capitale N’Djamena, conta 11,5 milioni di abitanti con una densità di popolazione che si aggira attorno a 9 abitanti/km². Paese estremamente composito, sia come etnie sia come lingue, con più di 200 gruppi etnici, il cui gruppo principale, il cristiano/animista (popolo Sara) vive nel sud. Le lingue ufficiali sono il francese e l’arabo, ma per la sua grande varietà si registrano più di 100 lingue tribali parlate. La religione più diffusa è quella musulmana, principalmente nel nord del territorio, poi seguono i cristiani nel centro sud.

La maggiore criticità è la scarsità di medici che è una emergenza di tutto il territorio ciadiano che conta 4 medici per 100.000 abitanti perlopiù lontani dalla vera attività assistenziale. Una metà di essi si trova all’estero, l’altra metà negli uffici o in cliniche private. Evidente altro paradosso con il quale ogni giorno convive la gente del Ciad.

Nell’ultimo decennio il Ciad ha sperimentato un processo di trasformazione politica interna ed estera che lo ha portato a giocare un ruolo militare e diplomatico incisivo. Il Presidente Idriss Deby, al potere dal 1990, ha partecipato attivamente ad operazioni internazionali sotto l’egida delle Nazioni Unite, dell’Unione Africana o in appoggio ai contingenti francesi impegnati nel nord del Mali e nella Repubblica Centroafricana. Ciò ha favorito le relazioni con quei Paesi Occidentali impegnati nella lotta al terrorismo in Africa, soprattutto Francia e Stati Uniti.

Nonostante queste velleità di mediazione internazionale, il Ciad deve affrontare notevoli problematiche domestiche, prima fra tutte la resistenza al potere centrale della UFR (Union des forces de la Résistance) che ha l’obiettivo di rovesciare il governo di Deby accusato di favorire l’etnia Zagawa che, pur rappresentando il 3% della popolazione, occupa posizioni privilegiate e partecipa, essa sola, alla redistribuzione dei proventi dell’e-strazione del petrolio.

Il petrolio. Già nel 2008 una nota della Misna (Missionary Service News Agency) dichiarava che ogni giorno si scavava un nuovo pozzo di petrolio, per un totale di almeno 3000. Negli ultimi anni la capacità produttiva nel settore estrattivo ha subito svariate fluttuazioni dovute all’andamento altalenante dei prezzi e della domanda mondiale, ma, dopo aver raggiunto la quota record di 173.000 barili al giorno nel 2005, la produzione si è ormai attestata a 120.000.

Il petrolio gioca un ruolo fondamentale e determinante per le ambizioni di politica estera e per la stabilizzazione del fronte interno a scapito della popolazione locale che non si è giovata di una sola briciola del benessere promesso. I campi petroliferi sono la rappresentazione visiva più concreta ed evidente delle enormi contraddizioni di questo paese. Grazie ai buoni rapporti con l’ospedale, instaurati per ovvie necessità sanitarie, abbiamo a-vuto la possibilità di addentrarci allo interno di questa estesa area che ci è apparsa come un corpo estraneo, un pezzo di Occidente dotato di tecnologie avanzatissime che rimarca la sua estraneità alla realtà africana in modo evidente anche al più distratto visitatore. L’area petrolifera frutto di e-spropri a centinaia di contadini cui è stata sottratta l’unica forma di sostentamento, si estende per ca. 750 Km2 è circondata da filo spinato invalicabile e provvista di un aeroporto privato e completamente autosufficiente, salvo, come dicevo, alcune necessità sanitarie di primo soccorso. Uno dei pochi contatti con l’esterno al di fuori del filo spinato è una bidonville dove alloggiano ragazze che si prostituiscono e quella parte della popolazione che è impiegata nei lavori più umili.

C:\Users\Paolo\Desktop\BOLLETTINO N. 114\4-RELAZIONI\la mia africa\foto\giovani genitori 32 anni in tre.JPG

Il reparto pediatrico dell’ospedale Saint Joseph.

Ospedale Saint Joseph di Bébédjià

Con un volo da Parigi si arriva a N’Djamena in tarda serata e la mattina successiva si parte per Bébédjia che si raggiunge dopo 600 Km. Durante il viaggio si ha modo di prendere coscienza e fare conoscenza di un altro mondo e le prime reazioni di sconcerto anticipano le ben più stridenti diversità che si osservano in quella realtà ospedaliera venendo naturale fare paragoni. L’Ospedale è situato nella regione del Logone o-rientale a ca. 30 Km da Doba. Il villaggio di Bébédjià conta circa 20.000 abitanti e l’ospedale diocesano è l’ unico punto di riferimento sanitario per un’area ben più estesa ed una popolazione molto più numerosa. In verità, con i proventi del petrolio il governo ha edificato una struttura ospedaliera che è al momento una sorta di cattedrale nel deserto; completata la parte muraria, i lavori si sono interrotti e tutta l’area versa in un evidente stato di abbandono.

L’Ospedale di Saint Joseph, opera esclusivamente diocesana, iniziamente era un semplice dispensario ma nel 1994 fu riconosciuto come ospedale dal governo ciadiano. Tutta la struttura, completamente delimitata da mura e sorvegliata da guardiani, comprende l’ospedale con reparti di ostetricia e ginecologia, pediatria, medicina e chirurgia per un totale di circa 120 posti letto, le servitù ad esso annesse, laboratorio, farmacia, consultorio per la gravidanza, la residenza delle Suore, strutture recettive per i volontari o visitatori che a vario titolo vi soggiornano. L’area propriamente o-spedaliera, anch’essa recintata, a cui si accede da un ingresso anch’esso sorvegliato, durante il giorno ospita in spazi aperti, corti sterrate, i familiari dei pazienti che provvedono all’ assistenza dei malati e alla preparazione del cibo. A questo scopo, al di fuori dell’area ospedaliera sono stati creati spazi con fuochi, prese d’acqua, lavatoi, servizi igienici. Chi provvede all’assistenza dei malati sono le donne di famiglia, madri, nonne, sorelle che portano con sé i propri figli e/o i figli di coloro che assistono.

Le patologie che si incontrano sono quelle che affliggono le popolazioni dell’Africa sub-sahariana, malattie infettive come tubercolosi, malaria, HIV, infezioni batteriche e parassitarie, gastroenteriti oltre la endemica malnutrizione che affligge soprattutto le popolazioni nomadi provenienti dai paesi limitrofi in fuga per ragioni belliche.

In verità l’ospedale di Bébédjià, per la realtà africana, è quanto di meglio la sanità locale possa offrire. Il male peggiore è la resistenza della popolazione a rivolgersi in tempi utili alla struttura ospedaliera che è ancora l’ul-tima risorsa dopo aver provveduto personalmente alla cura con il fai da te e/o dopo l’intervento dello stregone o sciamano. Capita anche che durante la notte in ospedale venga fatto entrare lo stregone di turno, all’ insaputa dei controlli, che “segna” la parte dolente con delle piccole incisioni sulla cute. Da questi comportamenti deriva un’alta mortalità perinatale ed infantile che è del 10% a cui si associa una mortalità materna dell’1%. La paternità assurge a simbolo di orgoglio maschile, come una sorta di prestigio sociale che segna la vita della donna relegata, mi si passi il termine, a ruolo di “fattrice”. Come definire altrimenti quella donna conosciuta il nostro primo giorno nel reparto di ostetricia e lì ricoverata per problemi nella gravidanza in corso, che aveva già avuto 18 gravidanze?

C’è un solo medico, Suor Elisabetta Raule, religiosa italiana, che provvede ai bisogni dell’ospedale coadiuvata da 2 consorelle infermiere. Il personale infermieristico è locale e svolge una funzione di raccordo fondamentale tra la medicina occidentale e quella tribale. Suor Elisabetta è un chirurgo e-sperto, che per l’ esperienza maturata ha raggiunto livelli ragguardevoli nell’affrontare le patologie che affliggono la popolazione. Durante la mia permanenza ho prestato la mia attività di anestesista in 42 interventi chirurgici e gli altri componenti del gruppo, un’infermiera, un giovane medico e una ginecologa, hanno partecipato alle attività ambulatoriali e di reparto.

C:\Users\Paolo\Desktop\BOLLETTINO N. 114\4-RELAZIONI\la mia africa\foto\mentre la mamma è ricoverata io aspetto fuori con la nonna....JPG

Abbiamo avuto poche possibilità di visitare il villaggio ma non è mancata l’esperienza del mercato dove le donne portano i frutti del loro orto e i loro manufatti, che consistono in recipienti di legno “boule” a forma emisferica che si utilizzano per contenere i cereali cotti che si insaporiscono con erbe varie e più raramente con carne di pollo. Inutile sottolineare abitudini igieniche tanto diverse, ma una nota di colore singolare ci è stata offerta dalle rivendite di farmaci vari e materiali per medicazioni evidentemente sottratti all’ospedale.

La scuola secondaria ai margini dell’ospedale.

C:\Users\Paolo\Desktop\BOLLETTINO N. 114\4-RELAZIONI\la mia africa\foto\la scuola.JPG

Una esperienza interessante e rassicurante ci è stata offerta dalla visita di una scuola secondaria che si trova ai margini dell’area ospedaliera. E’ un’opera promossa dai Fratelli del Sacro Cuore canadesi, gestita localmente da personale ciadiano che ospita circa 450 ragazzi. La struttura è all’avanguardia, ampie aule luminose e ben arredate, biblioteca, laboratorio, servizi, spazi aperti all’esterno per lo sport, parcheggi destinati alle biciclette, molte, degli studenti, insomma, tutto quanto occorre di corredo per una scuola di ottimo livello. Gli studenti con le loro divise impeccabili , dopo la ritrosia per timidezza o diffidenza iniziale, sono esplosi in sorrisi ed esclamazioni di sorpresa vedendosi riprodotti nelle foto che abbiamo scattato a loro e con loro, non senza aver chiesto prima il permesso di farlo. L’atmosfera è stata quella gioiosa e spensierata di una scuola qualunque del mondo occidentale nel momento della ricreazione, ma abbiamo visto in alcuni una luce, quella luce di spe- ranza e riscatto che è la fiducia nel futuro attraverso l’istruzione. E’ quella e solo quella la chiave per entrare in un mondo migliore (il nostro?) ma, senza strafare, fermandosi al momento giusto, senza eccedere, senza incorrere nei nostri errori… ma questa è un’altra storia.

I familiari vivono nei cortili per portare assistenza ai malati.

Riunione tenuta il 05.06.2014

Come testimonia un banner appeso sui corridoi dell’ospedale, il programma Polio Plus è stato vicino anche alle popolazioni del Ciad.

*Claudia Recine, socia del Club

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