Monday, March 10, 2008

My first day out in the bush

Maitekolou, Central African Republic

After a trip from Boguila to Markounda with a “Kiss” (where two cars meet up to exchange passengers and their bumpers kiss) at a town called Tale, I met the Markounda team. The first day I spent in their very small compound next to their inpatient department of about 25 beds with five expats. They have a small cat and a vegetable garden.

We spend the day in meetings and at 7am the next morning headed off with two cars packed to the gills with 31 people (including patients being transferred home) and all the supplies that they need to carry out two mobile clinics, supply several malaria testing field sites, and food for the expats. We took off down a long dirt road with mango trees on either side and miles and miles of brush and fields of straw as far as the eye could see. It was quite deserted. From time to time, we would see birds or once or twice a civet cat dart out in the road but there were very few people. We arrived in a small town to find the local staff waiting for us. The coupeurs de route or highway bandits that plague this area had struck.

Because of the low intensity war between the government of the Central African Republic (FACA) and the Armee de Populaire Resistance pour Democracie (APRD), there is absolutely no law and order in this area. Deep in rebel territory, former mercenaries from Chad and Sudan who were hired by the current president to aid him in seizing power along with renegade Chadian army and local thugs prowl the area stealing everything they can get their hands on. IN this case, they stole all the malaria test kits, paracetomol (Tylenol) and cotton swabs that we had left behind and terrorized the population. They’ve killed 8 people this week along this road, we learned. After restocking them and offering them solace, we took off again for a town called Silambi that is on the border with Southern Chad and at the junction of two rivers. The town is frequently the scene of fighting between local farmers defending their sorghum, manioc, and cotton crops from the Peuhl, the ethnic cattle herders. The Peuhl call in the Chadian military to help them and the villagers call in the rebels to help them. People die in the meantime. (Note: about four days after I wrote this, Silambi was attacked and burned down. Stay tuned for more info).

I interviewed two groups of people who told me about hiding in the bush from the frequent clashes as well as from the Couepeurs de Route. While in the bush, they are eaten alive by mosquitos and tsetse flies which cause huge amounts of malaria and sleeping sickness. In fact, 30 percent of all the illnesses we see in our clinics are malaria. There was a malaria bed net distribution in June of 2007 but by August, the bandits had stolen almost all of the mosquito nets and the population was vulnerable again. Pregnant women and children are particularly susceptible to malaria so MSF attempts to distribute bed nets to them but most probably, they end up with the man of the household or traded in the market for food. The other thing missing is soap. We see huge amounts of scabies, eye infections, and other signs of people living without the bare necessities of life. They try to bathe in the river but soap costs more than they can afford and takes a 2 day walk into Chad past hostile border guards to buy. So they live withtout.

After our interviews, we had to return to Maitekolou, the site of our big mobile clinic. We had about 200 people lined up under a tree to see our four nurses. The expat doctor does triage, supervises, and pops in for difficult cases, such as an epileptic boy who fell into a fire during a seizure and burned almost all the skin of his buttocks. Because its too unsafe to travel after dark, the team spends the night every week in the health clinic. We brought out mattresses, mosquito nets (a necessity for delicate expat flesh!), and tables and chairs.

By 6pm, the sun was down and the national staff were gathered around to eat their communal meal of a big steamed boule of manioc and a stew of the three unfortunate chickens that I had met earlier in the day. The expats ate boxed rice and chili con carne. We all drank warm sterilized water toted from Markounda in old plastic liter seven up bottles that had baked in the sun all day. DELICIOUS!

By 7pm, most people were exhausted and had hit the hay. I sat up with a few of the national staff and the expat doctor practicing my French and quizzing each other on African geography. By 8pm, we crawled into our mosquito nets.

“Oh! We can’t shut the door to the room!” said one of the expat nurses I was bunking with… “since you are by the door, just be careful of snakes and scorpions when you wake up in the morning” she said, “I’m sure the guard will keep any wild dogs out.”

Nighty Night.

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