Lydia Cordier is project assistant in Bangui, Central African Republic. Here she describes a recent trip to Dissikou health centre with Merlin medical supervisor Olga.
Olga is looking at me with the exercised patience that comes from introducing too many visitors to health care in CAR.
I have accompanied her to Dissikou health centre - one of the eleven Merlin-supported health facilities in Nana Gribizi.
Olga is our medical supervisor with chief responsibility for training the health workers to better diagnose illnesses and prescribe the right drugs for the right things.
Noella
We have spent the last half hour with a ten-year-old girl called Noella. Olga has talked the Head of the Clinic and his assistant through the diagnosis process, checked their pulse-taking techniques and asked questions to prompt their analysis of Noella’s symptoms.
She is clearly distressed: frightened and embarrassed, lying half naked on the bed, sobbing quietly. Noella’s mother has a baby strapped to her back and is standing close by.
The diagnosis is slowly agreed upon. Noella’s ribs arc above an abdomen that is covered with wrinkles of loose skin. Her thighs look impossibly thin as they poke out from the material she is trying to cover herself with. She is severely malnourished with a skin infection on her legs that requires antibiotics; she is anaemic and dehydrated from the diarrhoea caused by a parasite infection.
I am most concerned to hear that her erratic pulse suggests a problem with her heart – something that potentially requires sophisticated treatment the likes of which are not to be found in Nana Gribizi.
There is a hospital in Kaga Bandoro town - 60 kilometres away - which is the point of referral for complex cases identified at Merlin-supported clinics. Unfortunately the only way to get there is Merlin’s one pickup truck, which - if in the right place at the right time - can take patients to Kaga Bandoro on the way back to the base.
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There’s no ambulance here. No buses. The very sick are often forced to walk the 60 kilometres into town, otherwise they may be pushed on a cart, or simply left to wait by the roadside on the off-chance that a vehicle passes that day.
“Pas d’argent”
Olga confirms my suspicion that Noella needs to get to hospital as soon as possible. I reached to shake the hand of the ‘chef de poste’ in anticipation of our departure for the hospital, but Olga has stepped closer to tell me that Noella’s mother has refused to consent. “Pas d’argent,” Olga explains. Despite the health care and journey costing nothing the mother cannot afford to travel to Kaga Bandoro.
It could be that she simply can’t afford to abandon her farming for fear that the whole family won’t have enough to eat. Or, more likely, she doesn’t have the money to stay and feed herself and her daughter once they reach Kaga Bandoro. Hospitals in CAR don’t stretch to meals on wheels – patients must feed themselves.
I follow Olga’s lead and force myself to push on with business, moving to the next consultation. This is the reality of life here. When I turn back to see the small family waiting for the pharmacist, Noella, on spindly legs, is scarcely visible. Her eyes - seemingly too big for their head - poke out from behind her mother’s back and quickly retreat again.
Olga tells me that Noella’s infection and parasites can be treated with antibiotics provided at the clinic. The health workers can rehydrate her with an IV drip and oral rehydration sachets. Her heart is not mentioned. What can be done, will be done.
Merlin has been working closely with the Ministry of Health to save lives here since 2007, but the lack of interest from international donors is both frustrating and heartbreaking. For the health workers here accepting the unacceptable has become a necessary part of their routine; they see cases like Noella’s every day.
Find out more about our work in CAR