Medical notebook of Ungrumbe Sita´s children in the Nzacko health center. Central African Republic, July, 2021 © MSF
The only tools that the Nzacko nurse has to assist deliveries at the Nzacko health center. Sylvie Grengbo, the local midwife, says that during the last conflict, the center was looted. The market was also empty, so there was no soap left. She sanitized her tools with lemon so she could treat patients. Central African Republic, July 2021 © MSF
"During the delivery, there was only lemon to disinfect"
Rose*, 44, knows this all too well. Like other people from Nzacko, she has experienced the consequences of the collapse of her village and her country.
In 2013, our lives were turned upside down. Because of violence and massacres, we had to flee and hide for months. We didn't have much to eat and my daughter started to get very sick. When we finally got back home, there was no food in town. My daughter suffered from malnutrition. We went to the health centre, but there was nothing there, and the nurses had fled to Bangassou. She died that night. With the help of our neighbours, we buried her a few metres from the house.Rose*, 44
The delivery room of the Nzacko health center. Central African Republic, July 2021 © MSF
Three years after this tragedy, Rose was about to give birth when massive clashes resumed in the village, resulting in the destruction of more than 10,000 homes and a new cycle of misery for the inhabitants.
I obviously couldn't flee, and the health post was abandoned again. The only midwife left in Nzacko came to my house to help me. She just had a plastic tarp and lemon to disinfect her scissors. There was not even any soap left. I gave birth on that tarp... But when my daughter was born, we didn't hear her scream. We didn’t her cry. She died a few hours later. We buried her alongside her sister.Rose*, 44
This double tragedy haunts Rose and her family, who had to flee again in January when the clashes resumed, as they did everywhere else in the country following the presidential elections at the end of 2020.
"We were in the forest for four months," says Jean-Marie*, Rose's husband. "Once again, we struggled to find food. We were all very weak, especially the children.”
July is the rainy season, when malaria becomes more deadly than ever and the access to the communities becomes more difficult for the outreach teams and the medical referrals. Central African Republic, July 2021 © MSF
A village cut off from vital support
Like Jean-Marie and Rose, most of the people of Nzacko fled the village, living in very precarious conditions, unable to access humanitarian assistance because of the insecurity.
It is a critical situation, which has actually been going on for years.
With the exception of Doctors Without Borders, few organisations have had access to the village since 2017 even though the situation there is worrying for things such as malnutrition and water-borne diseases. Even if our trips were short, we managed to get there. But with the resumption of fighting earlier this year, access has been made impossible.Pelé Kotho-Gawe, nurse supervisor
Pelé Hubert Kotho-Gawe, from the Doctors Without Borders outreach team, conducts a training for the local staff at the Nzacko health about the priority diseases in the area. Central African Republic, July 2021 © MSF
As clashes eventually ended, Rose, Jean-Marie and the rest of the population gradually started to return to Nzacko. In July, Doctors Without Borders was the first humanitarian organisation able to return to the village in order to assess needs and support the only existing health centre.
"When we arrived, we found out a health centre in shambles" says Pelé, who led the first Doctors Without Borders trip a few days earlier. "The pharmacy was empty. Equipment was non-existent or inadequate, and the staff were not sufficiently trained to provide adequate care to the population while needs were enormous. In the forest, malaria and malnutrition had taken their toll."
Massounga Delacroix, 48, is in charge of the pharmacy at the Nzacko health center. He says that the pharmacy had been empty for several months, until Doctors Without Borders arrived and made drug donations. Central African Republic, July 2021 © MSF
The Doctors Without Borders team entering the village on this late July evening left early this morning from Bangassou, 190 kilometres to the south. It took more than 10 hours for the vehicles to reach their destination. In this rainy season, the road is muddy and crossing the river was not easy. Because of the storm, a tree fell on the road, forcing the team to get out the saws in the pouring rain and break down the tree to allow the vehicles to pass.
The Doctors Without Borders team arrived safely. The plan is to stay here for four days. Four days to restock the pharmacy shelves, conduct training for health staff and community health workers, manage medical consultations, install solar panels to provide the electricity needed to cool the vaccines. It is all part of a race against time given the number of patients squeezed into two poorly equipped wards, with cracked walls and narrow beds.
"She's in good hands"
Lying on one of them, Octavia Braza, 33, is about to give birth to her seventh child. The contractions started more than three hours ago and she feels weak.
"She hasn't eaten all day because she has nothing left and has to feed her children," explains Sylvie Grengbo, the midwife at the centre. Sylvia is the midwife who helped Rose give birth in 2017. "This is going to be difficult."
Octavie Braza, 33, waits in the delivery room of the Nzacko health center to give birth to her seventh child. The contractions have already started, but she feels very weak. Central African Republic, July, 2021 © MSF
Such situations of exhaustion and malnutrition can be life-threatening for both the mother and the child. In recent months, there has been a marked increase in maternal mortality in the area. Fortunately for Octavia, the arrival of Doctors Without Borders with glucose and misoprostol - a drug that helps induce labour - will provide support. Regaining some strength, Octavia can finally take her son in her arms after five hours of effort. It's 5:30 p.m., the baby is out of danger. So is she.
The sun is slowly setting over the village. Tomorrow morning, Doctors Without Borders staff will head back to Bangassou before coming back here next week. Malaria, malnutrition, respiratory infections... There is a lot to do to meet people’s health needs.
Veronique Napese is being referred from Nzacko to the hospital of Bangassou, supported by Doctors Without Borders. She is in her seventh month of pregnancy and has an intense pain in the lower back. Her youngest daughter is accompanying her. Central African Republic, July 2021 © MSF
As they leave, inhabitants thank the team and ask them to return as soon as possible. In the crowd, a woman steps forward, supported by her sister and accompanied by her daughter. Her name is Veronique and she is seven months pregnant. The young woman is in great pain. The team examines her and the conclusion is immediate: she must be taken to Bangassou. This time, the journey will only take eight hours.
Once arrived at the hospital that Doctors Without Borders has been supporting since 2014, Pelé Kotho-Gawe takes her to the emergency room.
"We will keep her in observation for a few days," he says. "If the pain continues, she will deliver here. In her condition, staying in Nzacko was not an option. I am reassured. She is in good hands."
Delise Iansole, 23, is frequently hospitalized in the health center of Nzacko. Central African Republic, July, 2021 © MSF
Good hands are most needed in Nzacko too, as in so many villages in CAR, where years of war and violence have fueled a catastrophic situation for people.
Many Central Africans are deprived of the most basic essential services. According to the UN, more than half of the population is considered to be in need of humanitarian assistance. Nearly 1.4 million people are displaced or refugees, and CAR continues to be one of the countries with the most critical situations in terms of life expectancy, maternal mortality, malnutrition and lack of access to healthcare.
* names have been changed for privacy reasons
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