The long road to recovery for CAR's weakened health clinics

The long road to recovery for CAR's weakened health clinics

I woke in the middle of the night to the chilling cries of a mother in a neighbouring house. I didn’t understand what she was shouting in Sango, the national language of the Central African Republic. But what I did know was that she was in mourning. Her wailing, a ritual lament, was a way of expressing profound grief at the loss of someone precious.

At dawn, we learned that her young daughter had died. She had been weak and sick, and because her family lived in a rural village far from Bossembele town, they had travelled to stay with relatives beside us and across the road from the hospital. Unfortunately, the child had arrived too late for treatment – and passed away in the darkness.

It is a sad situation that happens all too frequently in the Central African Republic, where one child in eight will die before the age of five. A lack of access to nutritious food because of conflict and insecurity has left many children dangerously hungry and susceptible to other life-threatening illnesses such as malaria and pneumonia. Growing up in the world’s hungriest country is full of challenges. A third of all children in CAR suffer from severe malnutrition – and in some places, overall acute malnutrition rates among under-fives have reached emergency levels.

Hope that help will one day arrive

In the remote village of Pama, about 100 kilometres from Bossembele town, we meet Augustine. She has walked for hours on foot to reach the village health facility with her youngest child, three-month-old Passi. She tells us that she has already lost one of her children to ill health and is now deeply concerned about Passi. “I worry that the same thing might happen to him,” she says.

32-year-old Augustine is among 30 women who have gathered at the health facility this morning, desperate to have their children assessed and treated.

A Concern team member discovers a child who is severely malnourished after an impromptu health screening at Pama Health Facility. Photographer: Chris de Bode/Panos for Concern
A Concern team member discovers a child who is severely malnourished. Photo: Chris de Bode

Screenings are carried out every week. However, the clinic, which serves almost 7,500 people, is struggling. Resources are few. The rooms are eerily empty. The pharmacy is almost bare. The only medication that remains is a cardboard box of malaria treatment tablets that expired more than a year ago. The director of the facility, Faustin, is on his own – there are no qualified nurses to support him.

The sole piece of equipment in the clinic is to be found in the delivery room. It is a shockingly austere-looking metal birthing table with paint flaking from its rusted surface. Women who are about to give birth choose to deliver at home – for them, that is a more favourable option. The absence of a female midwife does not help.

Faustin in the delivery room at Pama Health Facility, where he is director. Photographer: Chris de Bode/Panos for Concern
Faustin in the delivery room at Pama Health Facility. Photo: Chris de Bode

Faustin shows us the records for the clinic. In one of the months during rainy season, when hunger rates were at their peak, 38 children under five received treatment for acute malnutrition – many more were on the limit. The response put immense pressure on the already strained health facility.

The last name written in the register is from three months ago, when supplies of ready-to-use therapeutic and supplementary food, and medication were exhausted. Despite that, anxious mums continue to flock regularly to the clinic with their children – in the hope that help will soon arrive.

Mum Augustine and her three-month-old son Passi. Photographer: Chris de Bode/Panos for Concern
Mum Augustine and her three-month-old son Passi. Photo: Chris de Bode

For fragile Passi, the indications are that he is severely malnourished. His upper arm circumference measures only 85mm – slightly more than the thickness of my thumb. He is weak and listless in his mother’s arms, but thankfully, still able to feed.

It is heartbreaking to know that Augustine and the other mums will have to seek help elsewhere if their children are to survive. They have few other options.

I feel really bad because there is nothing here for my child. My children continue suffering because of a lack of medicine and a good hospital.

Augustine

Hundreds of thousands critically vulnerable

The crisis in CAR has severely weakened the healthcare system, leaving hundreds of thousands of people like Augustine and Passi critically vulnerable. Many clinics and hospitals have been destroyed in the violence or are now languishing, empty and neglected.

In the Bossembele area, where Concern is working, more than a third of health facilities are not functional. They struggle to support their local communities despite the efforts of local staff. At their best, the services they provide are unreliable - they are often temporarily closed, regularly run out of stocks of essential medicines, and lack qualified staff, equipment or monitoring tools.

'We have many more things now'

Rufin (29) has been nutritional health officer at Gbadengue Clinic for just over four years, when Concern started to support the facility. It is one of more than a dozen clinics in the Bossembele area to receive help from Concern.

Rufin has been nutritional health officer at Gbadengue clinic since Concern started to support the facility. Photo: Chris de Bode/Panos for Concern
Rufin has been a health officer since Concern started to support the facility. Photo: Chris de Bode

Rufin tells us that before Concern’s presence the surrounding area “was overgrown with weeds” making the clinic hard to access. The building lacked even the most basic of facilities. “When someone got sick, they couldn’t stay. The pharmacy was empty,” he says.

Now, the upgraded health facility has become a hub for the community of around 6,000 people. “We have beds, we have medicine, we have a matron - we have many things now,” says Rufin.

The clinic’s pharmacy is well-stocked and orderly, thanks to pharmacist Marcelin. He has meticulously labelled and packed each shelf. A tall fridge in another room is used to house live vaccines for infectious childhood diseases like polio. Besides that, a store containing boxes of high-energy emergency food.

Concern-supported Gbadengue Health Facility has a well-stocked pharmacy. Photographer: Darren Vaughan/Concern Worldwide
Concern-supported Gbadengue Health Facility has a well-stocked pharmacy. Photo: Darren Vaughan

Next door, is a delivery room, complete with a padded birthing table, and adjacent to that, a small maternity ward with a few beds. Matron Micheline, who lives right beside the clinic, is on hand day and night to provide much-needed maternity care. She proudly shows us her midwifery certificate that she obtained two years ago. Now, an estimated five in every six pregnant women in Gbadengue choose to give birth in the safety of the facility.

When it comes to childhood health and nutrition, Rufin and a team of well-trained health volunteers carry out daily screenings at the facility and organise a mobile clinic every fortnight in a village 15 kilometres away. They use the resources available to them to spot the signs of malnutrition - scales and a wooden measuring board to record weight and height, and prescribe emergency therapeutic food, malaria medication, hydration salts, worming tablets and vitamins, where necessary.

One of Concern’s mobile maternal and childhood health units that provides a vital lifeline for pregnant mums and children under five.  Photographer: Chris de Bode/Panos for Concern
One of Concern’s mobile health units that provides a vital lifeline for many. Photo: Chris de Bode

They also provide training for mothers on how to prepare nutritious food for their children, while community health workers give advice on good hygiene practices, and encourage mums to exclusively breastfeed for the first six months of their child’s life.

'She might have died'

The impact of the team’s efforts to improve access to healthcare for the 1,025 under-fives who live in Gbadengue is hugely positive.

For 30-year-old Alpha, it has been nothing less than a lifesaver.

Two weeks ago, Concern health workers diagnosed Alpha’s 17-month-old daughter Nicoles as severely malnourished. Photographer: Chris de Bode/Panos for Concern
Two weeks ago Concern diagnosed Alpha’s 17-month-old daughter as malnourished. Photo: Chris de Bode

She lost her husband in the conflict, and has often struggled to provide for her children. Two weeks ago, she brought her 17-month-old daughter, Nicoles, to the clinic after becoming increasingly worried about her. Rufin and the team discovered that the child was severely malnourished and treated her with medication and a supply of ready-to-use emergency therapeutic food. Alpha was also given advice to follow carefully.

A fortnight later and back at the health facility, it is a moment of relief to discover that Nicoles has put on half a kilo. Alpha is thankful that her youngest child is on the road to recovery:

I appreciate the support I get from the health centre for my child, otherwise, things would be different – and she might have died.

Alpha

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