I have been here in the Central African Republic (CAR) for about a week now and will try and write blogs about daily life here and the work we are doing at the Boguila Hospital. For the last week I have been travelling, sleeping off jet lag, and in mission briefings/handover between Boguila, Bangui and Berlin with both national and expatriate staff in either English or in French. I think I’m starting to grasp what a massive task I am fixing to take on. My French comprehension as best is at 60% of what is said and so I'm needless to say lost at times.
My job here in Boguila the North-west of CAR is Outreach Nurse. This means I will be working with the outpatient department (OPD), the outreach team, vaccinations, and therapeutic feeding programs (ITFC/ATFC). There will be no lack of abbreviations in this blog, sorry for this, however we have more abbreviations in MSF than most American bureaucratic offices combined.
As outreach nurse one of my main tasks is travelling with the team to the health outposts and remote areas to provide mobile clinics, vaccinations, and follow up on treatment of malnourished children in the ATFC. This being said, I am arriving in the CAR at a time of a great deal of instability and uncertainty due to the political climate. Therefore, our outreach team is a bit touch and go in regard to travelling and at times, isn’t able to “reach out.”
We are on a pause, regrouping, troubleshooting how to move forward. One of the seemingly most pressing situations to navigate is how we can continue to provide care to the malnourished children who do not live with in a safe walking distance to our hospital. These are children who do not need to stay inpatient, but if not treated could lose more weight and suffer from further complications (developmental delays, electrolyte imbalance, and increased risk of infections). The one thing that is evident to every member of the outreach team, is that there are families who expect us to come as scheduled, there supply of treatment is running low and we need to attempt to reach them. My predecessor set up rotating schedule for visiting all 7 health posts monthly or bimonthly.
When we learned that our clinics would need to be cancelled this week, work began on preparing therapeutic foods to send out. This is not merely food like rice or hamburger helper, but a prescribed regimen of what is called PlumpyNut. (PlumpyNut is similar to your aunt’s Christmas peanut butter balls packaged in a granola bar wrapper but minus chocolate topping and plus vitamins). The plan is to send a motorcycle taxi with the PlumpyNut on its back tire rack. Motorcycles are frequently used for transporting goods and people (enroute to Boguila, I saw one motorcycle with at least 5 adults on it, not counting the children to boot).
So today with Bertrand, a nurse on the outreach team, I learned how to make our ambulatory therapeutic feeding center (ATFC) a “to go” service. Each dose of PlumpyNut was counted and packed, a list of the children prepared, and a letter to the president of the community organization written (COGES). By the time this was done, it was too late to send anyone on the road due to security and sunset. The town intended for the PlumpyNut sits on a dirty road about 4-5 hours away. So arrangements were made to send the moto-taxi first thing tomorrow morning.
The moto-taxi arrived, MSF scotch tape and makeshift bungee cords were used to secure the boxes of PlumpyNut to the back, and our valiant moto-taxi drove on to glory. The taxi driver left at 7:30am and didn’t make it back till after 4pm. He came back with a handwritten official letter from the president of the COGES, proof that our PlumpyNut had arrived in good hands and that was that for today.
There is still uncertainty if our outreach team will move in the coming days as the security is tense. After one week here, it is evident that the lack of stability in CAR has caused ongoing gaps in medical care and vulnerable children often bear the brunt of the consequence.