Fieldset
Termite time: A day with a community outreach team

French logistician Antoine is in the Central African Republic, joining a Médecins Sans Frontières / Doctors Without Borders (MSF) community outreach team on a trip to a remote village health centre.

An MSF landcruiser driving through a river in CAR

As one of my colleagues, Joe, is away from the project on a break, the outreach team was searching for a second international team member to come with them and support the health centre in Benzembe, a village three hours northeast from Bossangoa.

I gladly accepted the invitation, allowing me to experience how all the items I help supply here are actually used on the ground.

Preparing for departure

Departure on these outreach assignments is always a great deal of organisation for the team.

They first need to ensure that there are no major security issues in the area by contacting all the relevant authorities in the region.

They need to prepare the supplies to bring to the health centre (soaps, medicines, therapeutic food for malnourished children, etc).

Several bridges can't be used and the roads are flooded at multiple points. Fortunately, the cars are made for it and the drivers are skilled.

Finally, they need to coordinate with the logistics, water and sanitation team to have the cars ready, as well as expert staff to undertake repair work at the health centre – this time including repairing the latrines, building a new hut to handle the patients, and installing a sterilisation machine (known as an autoclave) to clean medical equipment.

We then meet at 06:20 on the morning of the assignment for a briefing.

Andréanne, the head of the outreach department, presents us with the security briefing, defines the main objectives of the day and then gets the day started.

Relais Communautaire

We leave the compound at around 07:15 and start along the "road" which is quite bad and muddy due to the rain. Several bridges can't be used and the roads are flooded at multiple points. Fortunately, the cars are made for it and the drivers are skilled.

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The community health centre in Benzembe
The community health centre in Benzembe

We reach the village at around 10:00 and meet the team handling the health centres.

A team of "relais communautaires" are also here. These are people of the villages whose job is to spread health information among the community. They do a great deal of health education and help identify and refer malnourished and sick children to our clinic.

We start the day with a meeting explaining the purpose of our visit. We also raise awareness with the team about a hepatitis E outbreak that the Ministry of Health declared somewhere 200 kilometres northwest.

We remind everyone of the importance of washing their hands and tell them that they should insist that the community do the same. If no soap is available, people can use ashes with water as this will also kill bacteria.

Termite time

Once the meeting is over, the team start to do their routine jobs.

Some go to see the patients waiting outside and start assessments to determine the severity of each case: rapid tests for malaria are being performed; temperatures are being taken; children are weighed. Then the patients go to see one of the two nurses so they can be diagnosed and either receive a treatment or be referred to the main hospital in Bossangoa.

It is decided that, in order to ensure the child’s chances of survival, we will take both mother and baby back to the hospital in Bossangoa.

Today is unusually calm. We expect, on normal days, twice as many people to come to visit the health centre when MSF is here.

It seems that there are two reasons for the quiet today:

First, it rained quite heavily last night, preventing people from walking to the health centre from their villages - which are up to 50 kilometres away.

The second reason is that it is “termite time”. Some people explain to us that when it rains at this time of year, termites come out of their habitats. Here, termites are a fine and nourishing meal. So, when it’s “termite time”, people flock to the forest to catch the maximum number of termites, then cook them with chilli.

Methode, the nurse supervisor of the outreach team, promises me that he will cook some termites for me once we are back in Bossangoa. I am somehow looking forward to it...

Meeting the mayor

Once everything is up and running and the routine activities have started, Andréanne and myself go to meet the mayor of the town who is quietly sitting at home, healing his feet after he was injured in a bike accident.

We go to sit with him and discuss the security situation of the region, about the health centre, and if he has other concerns. We explain the hepatitis E outbreak and inform him that we will be organising a training session for the relais communautaires next week. We say he is more than welcome to join.

On the way back from the mayor’s home to the health centre, I take some time to look around the village. It is very green and everything is quite well organised. It seems that the village was quite big before the war and it is slowly growing again now.

Referrals

There’s only an hour left before we have to drive back to Bossangoa.

Andréanne sits together with the staff taking care of the malnourished children. She does a small training job, explaining some basic nutrition concepts – which foods contain proteins and why a mother should continue breastfeeding her child, even if she is pregnant again.

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Andreanne taking a look at a young patient in Benzembe
Andreanne taking a look at a young patient in Benzembe

One of the children that we see is severely sick. The mother has come from very far away to get treatment for her baby.

It is decided that, in order to ensure the child’s chances of survival, we will take both mother and baby back to the hospital in Bossangoa, where he will be able to get more extensive treatment.

It's now almost 13:00 and we’ve spent three hours in Benzembe. It's time to leave.

We give the last pieces of advice to the remaining team and walk back to the cars with the patients we are referring to the hospital.

After the three hours of bumpy road, I'm back to Bossangoa – with an empty stomach, but feeling richer with a brand new experience for me.

 
 

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