Supply logistics in the Central African Republic: First week of work

In Bossangoa, in the west of the Central African Republic, Antoine has joined the Medecines Sans Frontieres/Doctors without Borders team during the peak season for malaria. He blogs…

The emergency room at the Bossangoa hospital

Here I am, in the middle of the Central African Republic, surrounded with colleagues from all over the world: Canada; Sweden; Rwanda; Congo; Germany; Netherlands; Cameroon as well as a few hundred locally hired staff. All motivated to do well around us and trying to bring some basic health care to people living in the region who have literally nothing.

My first tours in the hospital plus my discussions with the nurses and the doctors was really interesting in that regards. Most of the patients that come to the hospital are severely ill or wounded; they usually come to us when the local medicine did not work.


The emergency room at the Bossangoa hospital
The emergency room in the quiet of the morning

Lots of the patients are kids, mostly malnourished and with several life-threatening diseases: malaria, meningitis, hepatitis...

A lot of pregnant women come too. People travel hundred kilometres on a moto-taxi or by foot through the forest to come to the hospital.

On top of this I got the opportunity to discuss with the outreach team going around the region to meet directly people in the villages. Their role is crucial because they are in direct contact with the population. So, on top of providing health care free of charge, they are the eyes of MSF assessing the situation in the countryside. They also have an important pedagogic role to teach the population some important hygiene and health guidelines. I hope to have the chance to join them at some point to see how they work and understand better their need.


The operating theatre at the MSF hospital in Bossangoa
The well-equiped operating theatre

The hospital itself doesn't have the resources of a European hospital, but still provides really good care; the buildings are quite old and could use a layer of paint; there is little privacy for the patients and there are no paved paths between the buildings, making it challenging to transport patients from one building to another.

We are currently in "pic palu" season; meaning that because of the rainy season, the number of patients affected by malaria is higher than usual. The rainy season means puddles and pools, which mosquitos breed in. It’s the mosquitos which carry the parasite which causes malaria. 115 000 patients with the disease have already been treated in 2018.


The new intensive care unit at the Bossangoa hospital
The intensive care unit tent by the hospital

In this season it is also more difficult to find food, which means the malnutrition cases among young children are higher in number and more severe. During this period the nutrition ward is overcrowded (around 80 patients for 45 beds), especially because usually the kids do not come alone to the hospital, but arrive with their parents and siblings.

To ensure that all the patients who need to be are admitted and get the care they need, several patients can be assigned to one bed. MSF is currently building an additional tent ward that will allow several additional beds in the service: decongesting the building and allowing us to treat the patients even better.

On my side, working on supply, I'm not working directly with the patients; my role is to ensure the supply and the delivery of everything in the hospital.  Literally everything:  food, oil, coal, medicine, stationeries, biomedical instruments...

The challenges I’ll have to deal with are numerous: getting transparency on the level of stock we have, dealing with and preventing “rupture” of medicine supplies (i.e. running out) because of overconsumption; dealing with the transport challenges from Bangui, the capital city where all non-medical items are purchased. Transport is done by plane or trucks and are regularly cancelled or delayed because of the rainy season or security reasons.