CENTRAL AFRICAN REPUBLIC
10 years of activities, more than 400,000 children treated, and a strengthened health system: our work in the Central African Republic.
According to data from the United Nations Development Programme, the Central African Republic has been ranked last in the Human Development Index for several years now, with a life expectancy at birth of only 51 years. The under-five mortality rate is 130 deaths per every 1,000 live births and easily treatable diseases are among the main causes of death.
At the start of the civil war, which broke out in 2013, only two paediatricians and two paediatric surgeons were working in the Complexe Pédiatrique (CPB), the only paediatric hospital in the country, where 50% of the population are under-18. Even today, the lack of qualified personnel represents one of the biggest gaps in the national health system: there are only 250 doctors in the entire Central African Republic.
EMERGENCY’s Paediatric Centre
In March 2009, we inaugurated our first project in the country – the Paediatric Centre in Bangui, the capital city. Created to be a ‘satellite clinic’ for the Salam Centre for Cardiac Surgery in Sudan – the first hospital in the African Network of Medical Excellence, completely dedicated to treating congenital or acquired cardiac illnesses – the Centre soon became a reference facility in the country’s health system for free, 24-hour assistance for children and their mothers, and for the training of local staff.
Malaria, respiratory infections and gastrointestinal diseases: these are some of the most common diseases we found among the 260,000 or more children treated. Throughout our time here, we also took care of pregnant women, providing prenatal assistance, advice on family planning methods, and a vaccination programme for mothers and children. More than 50,000 women visited our facility since it opened.
Commitment to the Complexe Pédiatrique in Bangui
Following a coup d’état in 2013, the entire country descended into chaos, characterised by a whirlwind of insecurity and unprecedented violence.
In these circumstances, the Minister of Health asked for EMERGENCY’s help to be able to ensure surgical operations in Bangui and provide assistance to war victims. We moved there immediately and pinpointed the Complexe Pédiatrique de Bangui (CPB), where we reopened two operating theatres and restructured the operating block, transforming the hospital into a reference facility nationally.
Over the years, we widened our involvement here, also taking control of the Complexe’s paediatric wards: the emergency room, intensive and sub-intensive care units, triage area, pharmacy, logistics and ancillary services, such as laundry and laboratory, up to and including supporting the remaining recovery wards.
Since our work began, more than 12,000 surgical operations were carried out and over 85,000 children received treatment.
Collaboration with the National Blood Bank
Following damage inflicted by the civil war, we began our collaboration with the Centre National de Transfusino Sanguigne (CNTS), the National Blood Transfusion Centre in Bangui, in 2014. Careful and continuous training of local staff, and support with supplies and technical help, have ensured a gradual increase in the number of blood bags collected over the years, used for life-saving treatment. Since the collaboration began, more than 106,000 blood bags have been collected by the Centre and consequently analysed. Of those, over 85,000 have been distributed to facilities.
To achieve these results, we used biomedical equipment capable of carrying out high-quality analysis in line with international standards and organised periodic campaigns to raise awareness among the population about the importance of donating blood, and monitoring and preventing diseases, including sexually transmitted ones.
This process, based on safety, quality and widespread awareness, has allowed a substantial expansion of the network for the collection and distribution of blood bags. In 2018, 22 healthcare facilities linked to the CNTS received blood, while in 2019 that number has already risen to 31.
Training local staff
As in all our projects, training local doctors and nurses was one of our primary objectives in the Central African Republic. In time, we even implemented a new, integrated system involving both the university and hospital.
Many of the Central African colleagues trained by EMERGENCY at the Paediatric Centre have now been integrated into the Ministry of Health to work in the country’s hospitals or within ministerial institutions.
150 nursing students and over 40 medical students have been trained over a decade of activities.
Right from the start of our intervention at the Complexe Pédiatrique, we immediately placed the training of local staff at the centre of our work there as well. In addition to the daily on-the-job training, we began a collaboration with the Faculté de Sciences de la Santé at the University of Bangui in 2015. 14 paediatric specialists have been trained, and since February 2016 90 nursing science students and more than 70 medical students participate in hospital shifts in local facilities every month.
The gradual withdrawal from the country
In October 2017, with a view to relieving the overload of work at the Complexe Pédiatrique in Bangui and ensuring constant treatment for patients suffering from chronic illnesses, we decided to adjust the mandate of our Paediatric Centre, concentrating on free high-quality healthcare for patients under-15 suffering from chronic illnesses: asthma, nephrotic syndrome, diabetes, epilepsy and sickle cell disease.
After 5 years of intense work, we concluded our commitment at the Complexe Pédiatrique, Bangui. The hospital had acquired sufficient autonomy on both a management and a clinical level that we agreed a gradual handover with the local authorities, which concluded in June 2018.
In the following month, local health authorities inaugurated a new centre for the research and treatment of sickle cell disease (CRTD), a hereditary disease which affected 80% of the patients we cared for at our Paediatric Centre. In order to avoid duplicating services, and in light of our gradual withdrawal from the country, we prepared a simultaneous handover of control with the CRTD. In addition to redirecting patients to the CRTD, EMERGENCY staff supported and trained the healthcare and management teams at the Centre, guaranteeing the quality of care provided. The Centre is fully equipped and supplied with drugs and materials to ensure continued care for patients.
On 31 October 2019, we ended our collaboration with the National Blood Bank.
Over the years, our intervention guaranteed the right to free, high-quality healthcare, triggering a process of reconstruction within the national health system, with the active participation of local and international institutions.
We will continue to collaborate with the country’s healthcare authorities through the cardiac screening missions, connected to the Regional Cardiac Surgery Programme that is active across Africa, which has our Salam Centre for Cardiac Surgery in Sudan as its reference point for the treatment of cardiac patients.