“During the crisis, there were only three of us midwives here in the Anyama hospital,” says Viviane recalling the fighting that raged in Abidjan from late February to April. “There were no doctors and no nurses. Only two nurse-trainees came during the day.”Viviane and two colleagues took 48-hour shifts in order to assist women who managed to reach this hospital, located on the northern edge of Abidjan. Nearly all the health centres in this region of small villages had closed. Despite the midwives' tenacity and courage, many young mothers had to give birth at home because of the fighting and curfew that followed.
Viviane's work days are now returning to normal. A Médecins Sans Frontières/ Doctors Without Borders (MSF) team has been working at the Anyama hospital since April 18. The operating room is functioning again with a MSF surgical team treating emergencies, operating on fractures and performing caesareans.
In addition, post-surgical patients are being transferred to the Anyama facility to ease the pressure at the overworked Abobo Sud hospital, where MSF has been working since late February. The transfers involve orthopaedic patients who require long-term care. Their dressings are changed in the operating room, under anaesthesia.
Soumaïla, 37, is one of these patients. He was shot in both legs and is recovering slowly from his operation. His left foot was amputated because he arrived at the hospital too late, after his wound had become infected.
A total of 47 patients are hospitalised. The midwives assist with an average of 10 births daily. This would be a reasonable level of activity if scores of people were not waiting at the hospital doors every morning, starting at dawn.
“The patients arrive very early,” explains Dr. Hamidou. “In the beginning, they would get here around 05:00am. Now they come at 06:00am. We see the first patients at 07:30am, but we can't take everyone. We give priority to emergencies, then to children, pregnant women, the elderly and people with chronic illnesses.”
The MSF team sees an average of more than 120 patients every day, not including prenatal visits with pregnant women. While patient visits are now well-organised, everyone still remembers Monday, April 18, the day when MSF first came to the hospital.
“MSF didn't make any announcements but everyone was here waiting for us,” Dr. Hamidou says. The people living in Anyama knew that MSF was here and had heard on the radio that the government had decided to offer free medical care. Care had always been free in the locations where MSF had been working, but the policy had not been extended to the other hospitals. There wasn't enough medicine and all employees had not yet returned.
The health care system was paralysed for months however it is slowly coming back to life in Abidjan. Given the huge needs, and in an effort to decentralise primary health care, MSF is providing support to health centres in several neighbourhoods as the system resumes operations.
The sound of gunfire is now rare at the Anyama hospital and it is safe to travel through the outlying PK 18 neighbourhood, the former stronghold of the “Invisible Commando” force. The blockades have disappeared, as have the armed men however fighting did flare up in late April between the forces of President Ouattara and Ibrahim Coulibaly's commandos.
The MSF team is still living at the hospital, in order to be closer to patients and for their own security. Marie-Rose, the nurse-anaesthetist, lives in Yopougon and has not been able to go home since March 28. Violence continues in that Abidjan neighbourhood, where militias loyal to Laurent Gbagbo maintain their presence.