16 November 2016

Elysée Tando, supervisor of MSF-supported health centre in Boguila. Photo: 
Giorgio Contessi/MSF

Testimony of a Central African MSF Nurse, Elysé, who works in Boguila. Boguila is a project that is staffed almost entirely by national staff since 19 people were killed in an armed robbery at the MSF base there in 2014. He describes the level of violence in Boguila, and the dire impact on patients when they are too fearful to leave their homes to get care.

I am from Boguila, in the northwest of the country. That's where I live and where I work as a nurse with MSF, as I have done for almost 10 years. The situation isn't great at the moment. To the point where I've started to think that I should leave.

There are many armed groups active in the area, including one that wants to use the town as its base. Obviously, the leaders in the community do not want that to happen, and they opposed the idea. Now the group is hunting them down, harassing them, even killing them systematically because of their opposition.

The people in that group loot homes and rob people when they need money, or whatever else. They lurk in the bush along the main roads and they surprise people that pass by, demanding everything they have. After they have taken all they can from the person, they beat them up or kill them.

We hear these kinds of stories all the time -- every 2 or 3 days! They don't stick around very long because the “self-defense” groups generally chase them away once they hear that they've been robbing people.

The consequence of all this is that people are afraid to travel to come to the hospital. MSF is the only organization that offers free care in the region - there is an MSF structure in Paoua, 80 km away, and another in Bossangoa, an 115-km drive.

Hanriette, 65, arrives at MSF’s hospital in Paoua after walked for four hours from her village to the MSF-supported health center in Boguila to get medical care. Photo: Giorgio Contessi/MSF

Sometimes we figure out that an armed group is active on a certain road because we notice that there haven't been any patients arriving from that direction. We don't know how many lives could have been saved if those people had been able to access our services on those days.

In June and July this year, a motorcycle taxi driver was killed on the road just outside Boguila. Apparently, he was robbed and when the bandits had finished with him they killed him. The motorcycle taxi drivers were scared to leave the city, they worried that the same thing would happen to them.

So it was impossible to find someone that could transport the patients that we needed to refer to another health structure for advanced healthcare. Two babies died of malaria-induced anemia during that time because we could not send them to get the care they needed.

Women bring their babies to be vaccinated at the MSF-supported health center in Boguila. Photo: 
Giorgio Contessi/MSF

Recently, one of our patients, a 21-year-old man, died of meningitis because he arrived too late. His family brought him to the hospital around 7 am when he had started to feel sick during the night.

They would not leave home when it was dark because of the insecurity. In their village, a man had been robbed and murdered and his body found in the bush near the same week. In the morning, they took a moto-taxi to the health center. Because so much time had passed, the young man arrived in a critical condition. He died as I was filling out his transfer slip.

The same problems of access to healthcare are affecting the people living with HIV in and around Boguila. They come to us to for their ARV drugs, and if they get sick with an opportunistic infection, we take care of them at the health center. I recently heard of 4 deaths in a town not far away in which an armed group has just established itself.

They could not pick up their meds or get themselves to a health center, and therefore died at home. What a terrible, terrible way to go.

The thing is, we have no way of knowing the actual cost of this violence. If there's insecurity on the roads, people can't move around -- either because they're afraid, or because they are physically stopped from doing so -- and we never get to see them.

When you talk with women who bring their children to a hospital too late, they say, “I prefer to stay and bury my child at home, rather than try to leave and get attacked on the road”. It's an impossible choice.

MSF provides support to Boguila hospital for external consultations, for treating HIV/AIDS, for reproductive health activities, the pharmacy, the laboratory, vaccination, and outpatient nutrition. An international team travels to Boguila once per week to support local staff. MSF reduced its activities and withdrew international staff from the hospital after an armed robbery suffered in April 2014, during which 19 people were killed, including three MSF staff.

Find out more about MSF's work in the Central African Republic.