In addition to keeping the hospital and medical supply side of things ticking over I have also had the opportunity to go on outreach a few times since coming to Zemio. MSF supports four small health posts a couple of hours along the main roads leading into and away from Zemio and a larger one in Mboki a whole day’s drive away which necessitates a two car two expat team and a couple of overnight stays at a subbase to visit. The villages we support are small but isolated, malaria and diarrhoea are the main killers out here, and it would be a long walk to the hospital in Zemio without these centres.
Our day starts early, 6am, packing a car full of equipment and making sure we have all the necessary supplies to restock the health posts. By 7am we are on route out of Zemio, and the day is already beginning to get hot. My French has improved – somewhat – and day to day medical conversations no longer totally faze me, but outreach movements require regular contact by radio, and frankly, asking me to speak and understand French over a crackly HF radio is like handing Superman a piece of kryptonite and then pushing him off a cliff face. Just plain messy.
I make a couple of abortive attempts at doing the contact under the outreach nurse Julie’s tutelage, but wind up laughing hysterically at my inability to comprehend what is being said back to me by the unfortunate radio room operator at the other end, and thrust the handset back to her. Our driver rolls his eyes humorously at me and I writhe at my own incompetence.
We pass family groups of Peuhl – largely nomadic cattle herders who have migrated down into CAR of the last few decades from Chad and other Northern African countries. Their skin is paler, their features more Arabic, the dress of their women more colourful and gypsy-esque. We wave to them out of the vehicle windows as we pass. In fact the waving is more or less mandatory – it’s part of our security briefings, as well as being common sense to be entirely frank.
MSF both for information and safety purposes relies on maintaining close and friendly relations with the communities it serves, and you are far more likely to think kindly of a strange white face in a car as it passes you if it smiles and waves, than if it ignores you, although four hours per day of smiling and waving at everyone you pass gets a little monotonous, heaven only knows how the Queen does it day in and day out. But then I imagine it’s easier done from inside an air conditioned Rolls Royce. The equivalent four hours squished into a stuffy land cruiser tumbling and jolting over rough roads is not especially comfy on one’s derrière, which in turn tends to have something of a detrimental effect on one’s social skills.
The villages are in small clearings in the forest - no electricity here, no music, just the background noises of people quietly getting with life – pumping water, sorting grain, raising children. It’s gloriously calm after weeks spent at the hospital. Humid though, it rained heavily last night and the heat and resultant evaporation from the surrounding forest makes it feel like you are trying to breathe soup.
Julie takes the lead at the first health post, delivering a small refresher training on dehydration treatment to the staff and going through their statistics with them. I poke around in the small mud walled pharmacy, doing an inventory and reviewing prescribing with the local pharmacien. After a couple of hours we pile back into the car and rattle off to the next one where we repeat the performance and consult on a couple of complex and chronic cases. A certain hopeless frustration is shared by both of us at this point – MSF’s remit out here is acute and emergency care only, and we have little or no access to medications and treatment for things like arthritis and heart failure and the other common accoutrements of advancing age.
There is something deeply unjust about seeing the dignified older people of these communities – who have survived so much in their lifetimes somehow so neglected in their last days. One beautiful crumple faced old lady who has a chronic cough and bloated ankles is clearly suffering from some sort of congestive heart failure and has us both scratching our heads for a while and trying to come up with justifications to transfer and treat her – we finally plump for TB as a somewhat tenuous differential diagnosis for the cough and bundle her into the back of our car for ”investigation” back at the hospital (two days of IV diuretic later the cough and the swelling have both vanished as has any likelihood of TB. Hurrah on all counts).
As long and draining both physically and sometimes emotionally as the journeys are, they are also incredibly beautiful, the vibrant greens of the forest counterpart to the rich ochre of the dirt road, and in places in feeding on who-knows-what dizzyingly beautiful clouds of enormous butterflies scatter out from the undergrowth as we barrel past. I pass some of the long journey time between waving at people trying to remember what the collective noun for butterflies is, and when my memory fails me, decide that a “flirtation” of butterflies best fits. With an hour still to go I try next to come up with a collective noun for MSF workers. Given the usual sweat and dirt stained condition of me and my team a “shamble”, “scruff” or “embarrassment” of MSFers strikes me most appropriate.
Slowly the shadows lengthen and the car begins to slow down as we begin to pass through the outskirts of Zemio and the huts become more closely spaced together. Out of the corner of my eye a figure moves in the undergrowth and my shoulders sag slightly at the thought of more smiling and waving. I chide myself internally and remind myself that it is my own security and reputation I am responsible for here. So I push my facial muscles into a fixed semblance of a smile and lift a grubby hand at the direction of the moving grass just outside. As we bounce past, I stare out of the land cruiser window into the vacuous, cud-chewing face of a small brown and white goat, who seems indifferent to my herculean efforts at greeting him.
I glance over at the driver and really, really freaking hope he didn’t see. Bet the Queen never did that.