It’s Wednesday morning in Bangui. My last few days in Paoua included the amputation of our burn patient’s arm (he decided to have surgery) on Saturday, treating a woman with bad open fractures of her forearm and hand from a motorcycle accident on Sunday, and performing a pair of after-hour emergency C-sections on Monday. The replacement surgeon’s flight was late getting into Bogila on Monday, too late to make the drive to Paoua before it got dark. When I left Paoua for Bangui at 6am yesterday, she was scheduled to arrive in another car coming from Bogila to Paoua around 8am. I ended up having to leave a written sign-out note for her, not optimal but sufficient.
Our transportation arrangements, including these last minute changes, are the responsibility of the MSF logistics crew. The 'logs' keep the entire project running, making sure that the hospital, clinics and the residential compounds have all our supplies, medications, transportation, food, fuel, water, electricity, etc….basically everything. Without the 'logs' and other non-medical personnel whose jobs include finance, HR, coordination with local and national governments and coordination with MSF headquarters, I wouldn’t have been able to do a single operation in Paoua this past month.
In the US, I show up everyday counting on finding a working hospital and OR. The same was true in Paoua. Keeping the generator running might not sound as exciting as doing surgery, but both are equally life-saving. The non-medical personnel deserve as much credit as anyone for the medical care provided here. Many people don’t realize how many non-medical people it takes to do what MSF does. Our log chief in Paoua, a 29-year-old American from Arizona, told me he had heard of MSF for a long time before ever applying with them, thinking that they only took on doctors and nurses. This is now his fourth mission with MSF.
My trip from Paoua to Bangui was indeed bumpy and 11 hours long, but it was also beautiful and educational. The green, rolling hills were reminiscent of driving through Virginia or the Carolinas though the 10 foot high grass on either side of the road seemed distinctly African. In Paoua, most of the trees look to be the same type, standing 40-60 feet tall with smooth bark and oblong, waxy leave. Halfway to Bangui, I noticed a gradual increase in the number and variety of trees including some eucalyptus (disclaimer here, I think they were eucalyptus but I’m no botanist) and palms. But even though we passed through towns larger than Paoua, the houses by the side of the road mostly remained identical until just a few kilometers outside of Bangui; one storey, clay block structures with either thatched or corrugated metal roofs, many with only a curtain or metal roofing panel for a door, many without a door and no visible furniture from the road. Bozoum was one exception. About 120 kilometers south of Paoua, Bozoum is a much larger town than Paoua, with a number of government buildings including a local hospital, situated in a small river valley. The houses here in the center of town appeared slightly more substantial from the road. We stopped at the market in Bozoum to stretch our legs and have a bite to eat at a roadside “diner” similar to the ones in Paoua; an open pit grill with family style seating at worn wooden benches where you can get servings of cooked meat accompanied by a small mound of salt and spice on a three inch diameter metal disc, plus steamed cassava wrapped up in a large, green leaf.
Our next stop was Bossentele where we met the MSF Land Cruiser from Bangui and I switched vehicles. Not as large as a town as Bozoum, there was still much more roadside commerce here, likely attributable to the fact that the road from here south to Bangui is more or less paved, as is the road going west from Bossentele toward Cameroon. From here on we were able to travel at near highway speeds. With better roads came more traffic and a different type of vehicle. Up until this point we had seen few other vehicles and all of them were either off-road four-wheel-drives comparable to our Land Cruiser or moto-cross style motorcycles. Now there were larger trucks carrying lumber and other cargo, medium sized stake-bed trucks filled with either people and their belongings or firewood and a handful of workers hanging precariously to the sides, minivans and sedans filled with people and also fitted out with roof racks carrying cargo and more people on top, motorcycles with four and five people riding together, even a moped with two people and a goat strapped onto the rear fender. But even with the increase in traffic, just like everywhere else in the country there were always many more people walking along the side of the road than vehicles, most of them carrying a load of wood or water or food on their head or pushing a cart.
About two hours later we passed through the town of Bossembele and could intermittently see the Mbali River to our east, more or less paralleling the road as it too traveled south toward Bangui to meet the Ubangui River. It is difficult to say for sure but it appeared to me to be at least half a mile wide in places. Even though it had only been a little over a month since I left the Puget Sound area, it was a nice feeling for me to see a large body of water again. About 75 kilometers north of Bangui, we entered the town of Boali and I was surprised by something else I hadn’t seen for a month. There were wooden power poles lining the street with lines feeding electricity down to the homes and businesses in the town. Roadside commerce was in abundance here. We stopped for a break and I was able to ask about the electricity. I was told that the waterfalls just east of the town center are used for a hydroelectric generator that supplies all the electricity for Bangui, the capital city. Because of this, everyone in Boali gets unlimited free electricity. But even though the power lines travel overhead along the road between Boali and Bangui, no one outside of those two cities has electricity, even if they live directly under the power lines.
Back on the road an hour south of Boali we began passing more vehicles, seeing more businesses and a few walled compounds. I didn’t notice a sign for the city limits but at some point it became obvious that we had entered Bangui. We passed some government buildings, a variety of schools, a hospital and some sort of transit center where green minivans were all lined up. It was some type of bus system but I couldn’t tell if it is municipal or private and I was too tired to try to think of how to ask the question in French. They were all painted the same green but each one had a customized name or saying across the rear quarter panel. One bus had “God is Great” written across the back, another said “Rock and Roll”. The ones that were leaving seemed to be filled with a dozen or more people each. By now the traffic had increased to an urban pace but again there were far, far more people walking along the road than riding in motorized vehicles. A few kilometers later we took a right at a traffic circle, the next left and a right a kilometer later and we were at the MSF office compound in Bangui.
Last night I slept at one of the residential compounds in a bed twice the size of my bed in Paoua, in a room three times the size of my room in Paoua, with a bathroom one door down the hall. I’ll spend the rest of this morning exploring Bangui. I have a debriefing at the office in the afternoon where I will pick up my plane ticket to Paris. The flight leaves early tomorrow morning at 6am. I’ll have another debriefing in Paris at MSF headquarters on Friday, then return home to Seattle on Sunday. This will be my last blog posting until my next MSF assignment (yes, I plan to go somewhere with MSF again and blog about it).
Thanks to everyone who spent time reading this blog. For me, the CAR has been an educational experience (a combination of Intro to Africa 101 and Conversational French) but also a fun and interesting adventure. I hope I have been able to share some of that with you.
If you have any questions for me or if you are Abe Ellenberg, you can email me at lauter@laparoscopyNW.com .