Fieldset
“War isn’t just about gunshot wounds”: Maternity care in Bangui

Welcome to Castors maternity hospital, the “first and last line of defence” for mothers and newborns in Bangui, capital of the Central African Republic. Finnish anaesthetist Kariantti, just back from his second assignment with Médecins Sans Frontières / Doctors Without Borders (MSF), shares his experience of arriving at the lifesaving hospital.

Working in the Central African Republic has always been my “professional dream”.

Since some years ago, I have wanted to come here to help and hopefully make a difference, even in the tiniest way. When the opportunity arose, I was more than happy to volunteer to go to this country – a place that is suffering from a brutal conflict.

Some 570,000 Central Africans are now living as refugees in neighbouring countries and almost 690,000 people are internally displaced - forced to leave their homes and livelihoods to escape the violence. Half of the population of 4.5 million is totally dependent on humanitarian aid for their survival.

Adjusting to life in Bangui

If I wanted to help women and children, the MSF maternity hospital Castors, in the capital Bangui, was the perfect fit. In many ways, the hospital is the first and last line of defence when it comes to maternal and newborn care in the area.

The entrance to Castors Maternity Hospital. Photo: Elisa Fourt/MSF

It has taken me a bit of time to adjust to the hospital and my new assignment, since this time it's more specifically about maternal and newborn healthcare. On my last MSF assignment, in Yemen, we performed more general surgery with patients with a variety of medical and surgical needs.

Despite the air conditioning and enough staff, within minutes you are drowning in your own sweat. The smell of blood, sweat and placenta hangs thick and syrupy in the air."

And I still feel that I’m struggling with my French every minute. Let’s face it: a few years ago, I didn’t really speak French. I had always hoped to learn the language but never seemed to find the time.

After joining MSF, I was able to improve my French. And, after a few intensive courses with MSF Sweden in Stockholm and countless hours of self-study, here I am in francophone Africa doing my best.

Thankfully both the international and national staff are very forgiving.

As for the security situation here in Bangui, it can be somewhat different between neighbourhoods because of the ongoing tensions. The most notorious of them (though not the only one) is the district PK5, the scene of a lot of the violence. This has had an effect on the population in various ways, for example making access to healthcare even more difficult than it already is throughout the whole of the country.

Welcome to Castors

We handle a large part of the city's childbirths and childbirth-related complications here in Castors. The hospital also provides services on family-planning and helping female victims of sexual violence.

Together with international and Central African colleagues, I provide anaesthesia and post-operative care during caesarean sections and other obstetric operations. My work also includes responding to different emergencies in the hospital… and there is no lack of difficult and rapidly developing situations, to put it mildly.

The entrance to Castors Maternity Hospital

The entrance to Castors Maternity Hospital
The entrance to Castors Maternity Hospital

The operating theatre in Castors is small, given the huge number of patients, labours and operations. There are two operating rooms and a small recovery room with space for four patients, which sometimes acts as a sort of intensive care unit if a patient needs to be observed for longer.

Sure, it’s very basic and we’re constantly struggling with broken monitors and worn-out batteries, but at the end of the day, most of the equipment is very similar to what I’m used to. There is only less of everything.

The war isn’t just about gunshot wounds. It’s a crippled infrastructure, stripped from many of its basic functions, including the lack of proper healthcare."

Despite the air conditioning and enough staff, within minutes you are drowning in your own sweat. The smell of blood, sweat and placenta hangs thick and syrupy in the air.

First patients

On my first day, we were already running out of beds in the recovery room because of the patient flow.

Normally we have between three and ten operations per day. One of my first patients had a massive uterine rupture and had been bleeding heavily before the operation. Luckily, the gynaecologist was able to stop the bleeding, and, after some units of blood, the patient was already recovering from the operation and the blood loss. The baby, unfortunately, had already died in the womb.

There was little time to mourn the life lost, since the day continued with many more operations, including an ectopic pregnancy. This patient was another reminder of the current situation in the country. Since it is hard to get proper pre-natal care for pregnant mothers, ectopic pregnancies with severe complications are not uncommon.

The war isn’t just about gunshot wounds. It’s a crippled infrastructure, stripped from many of its basic functions, including the lack of proper healthcare. Women and children are the first to suffer since they often can’t reach health facilities –  if there even is a facility to be reached.