Augustine recently returned from his fifth assignment with MSF in the Central African Republic (CAR) for a six month assignment. He was in CAR from April to October this year. Augustine has been to South Sudan, Niger, Mauritania and CAR twice for other assignments. He is a nurse by profession.
Where were you based in CAR and what was your position?
MSF has four projects in CAR, so I was working at the one at Kabo Hospital which is about 62km from the Chadian border as a Medical Focal Person.
What were some of your duties and responsibilities?
- I was basically in charge of the entire medical team and or activities / oversaw all medical activities at Kabo Hospital and three other health posts which are 62Km, 23Km and 27 Km respectively away from Kabo Hospital where I was stationed.
- I was responsible for reporting medical activities to the co-ordination team in Bangui
- I compiled epidemiological statistics / responsible for epidemiological research
How big was the team you were overseeing?
In total there were 109 staff (79 nurses, doctors and 18 health promoters as well as 12 staff from the three health posts who consisted of a matron, consultant, pharmacist and someone responsible for malnutrition)
Can you describe what a typical day was like for you?
My day started at 6am when I woke up to bath and have breakfast before heading off to the office at 07.30am.
- When I got to the office, the first thing was to check if there were any requests or emails from the co-ordination team in Bangui.
- After responding to co-ordination emails and requests, I would go to the hospital to assess the situation, visit all the wards and all service areas so as to have an idea of what was happening i.e. how many patients were being attended to, the kinds of medical problems that needed attention.
- I would also visit our two outpatient departments (for adults and children) – to see if they were running well.
- I would then go back to the office to follow up on co-ordination’s requests or queries until lunch time.
- After lunch, depending on the day, from Monday – Wednesday, I would go through the epidemiological study and on Thursdays and Fridays, we would have a medical meeting and on Saturdays, we would have a health promoters meeting until 1pm. We only rested much on Sundays.
What were your impressions of the area/context?
In Kabo, there was no fighting like in the capital Bangui where fighting between Christians and Muslims ensued recently. The humanitarian situation however is generally bad in CAR. The infrastructure including roads, hospitals, clinics, schools etc have been destroyed. The roads are extremely bad and the only mode of transport especially for those who are referred to the main hospital are motorbikes and these are expensive.
People have no money for transport to get them to the hospital, so MSF pays for a round trip for any patients that are referred to Kabo from the different villages around the different villages. In Kabo the biggest problem has been armed robberies targeting NGO premises and staff. Just before I arrived in Kabo on the 15th of April, MSF staff were robbed at their house on the 1st of April. Such occurrences are common and we are always prepared for them.
Really you cannot resist the attack because you might get killed. Also usually after Ramadan, people would want to have a party to celebrate the end of Ramadan, but because they don’t have money, they tend to rob NGO staff to finance their parties – that’s how bad it is in Kabo.
What are the majority of cases you were seeing on a daily basis at the hospital?
Since it was the rain season, we received a lot of malaria cases, respiratory infections, skin diseases and injuries sustained due to sexual violence. During this period, many people go to their farms that are a few kilometres away from their homes to farm and most of the times, they sleep on open fields and mosquitoes bite them, hence a rise in malaria cases.
How many people did you treat per month?
We received an average of between 9 000 to 10 000 per month, which is an average of about 300 patients per day.
What were some of the challenges you faced while on your assignment?
- Since it was the rain season, it meant it was peak malaria period too (June to November), children were dying from malaria which meant as MSF, we had to fight hard to keep the death rate at 5% or below.
- Most people in CAR believe so much in traditional healers and medicine, so their first port of call before coming to the hospital are traditional healers. Malaria can be treated easily, but many people prefer to consult traditional healers first and will only come to the hospital when it is too late or when the situation worsens – making it difficult for us to save lives. MSF has really tried to work with health promoters to raise awareness in villages because it’s sad to see so many children from dying from a treatable disease like malaria.
- The HIV rate in Kabo is quite high because there is a lot of movement around that area between the Chadian border and CAR. You find a man marrying four wives and have many children, so if he is HIV positive it means all of his wives are likely to be infected and so are some of their children. The situation is really terrible and it affected me a lot to see children suffering and dying. I have seen 11 year old girls getting married. We really should do something about this, off course we have our different traditions, but there are things we should throw away because just so many things are wrong.
- During my assignment, I suffered from malaria a month before I came back. It was really bad, but I had to fight. Such things happen, as healthcare workers we are not immune to illnesses. My team needed me, so I didn’t allow malaria to take me down. I rested whenever I could and took some medication, but had to work at the same time.
What did you enjoy most during your assignment or what struck you most?
I really enjoyed treating children and whenever they recovered, I really felt good. When they died I really felt bad and wished I could have done more to save their lives. In general I enjoyed every bit of my stay at Kabo, we managed to control and keep the mortality rate low and worked with a wonderful team.
What was one of the worst experiences during your assignment?
We received a pregnant woman at the hospital who had eclampsia. When we examined her, she had high blood pressure and oedema, so we immediately operated her and removed the baby. She was feeling much better and was full of life after the operation and was recovering well and we were all happy to have saved two lives.
Four days later, she just died and we were all shocked and could not establish the cause of death. This really affected me and it’s still haunting me severely because I keep asking myself, what more could we have done to save her. I still see her fighting for her life on that hospital bed – this is really haunting me!!
What was your memorable moment?
The whole time was memorable, but implementing the Treatment Prevention Presumptive of Malaria programme for the first time was really a great experience for me. This programme was targeted at preventing malaria to children under the age of 5 years. Since the start of malaria peak period in June, we gave a tablet per day for 3 days to children.
This tablet would protect them against malaria for 4 weeks and we repeated the dosage twice. A lot of people brought their children. This was such a good and new experience for me because I had never implemented such a programme. The tablets are quite effective and many children did not register any side effects. Initially our target was to reach 4000 children, but we went up to 8000 in Kabo only.
What kept you going while on your assignment?
Just that care for people / humanity really drove me and kept me going. I think that’s what I do best.
What are your plans now that you are back from this assignment?
For now, I just want to rest for a while probably up to December and will see if I will be sent on another assignment thereafter. I really would like to go on another assignment.
Find out more about MSF's work in Central African Republic