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Central African Republic: a day in the MSF hospital, Paoua
MSF manages the only hospital in the Paoua area, which has a population of approximately 120,000.
Our teams work with the Ministry of Health in all departments – pediatrics, surgery, maternity, emergency, outpatient care, treatment of tuberculosis and HIV – in this 155 bed hospital.
Our reporter takes you into the wards on a typical day...
Inside the hospital
It is 7.30am at the MSF hospital in Paoua. This is the time when the night shift updates the day team on the night's developments.
The doctor on duty explains the cases of the patients hospitalised during the night in the different units.
He asks his colleagues' advice and opinion regarding any problems.
Later, around 8am, Dr Frédérique Eygonnet heads to the pediatrics department, which she oversees.
"Paoua is the only hospital in the region," she explains.
"Patients come from the city, but also from health centers located on the outskirts, about two hours away. On average, we receive four to five patients every day who have been transferred by motorbike from our health centers."
The hospital has approximately 155 beds. It includes several buildings that house the medicine, surgery, maternity, malnutrition and pediatrics departments.
One wing has been designated as the 'TB village' and is reserved for patients with tuberculosis. Another building is dedicated to patients living with HIV.
A dozen motorcycles are parked in the central courtyard under a tree. They transport the patients arriving from the clinics that MSF manages in the bush.
Together with Neema Kaseje, the surgeon, Frédérique visits the patients who have had or are awaiting surgery.
Neema tells her colleague that she was called twice the previous night: "Around 11pm, I was called in to see a patient who suffered a skull fracture in a fall. I came back later that night to perform a caesarean.
"But that's pretty standard. I don't have anything special to report today."
Children in danger
Next, accompanied by the nurse and the nurse's aid, Frédérique visits the pediatric intensive care unit and the neonatology unit. She asks about each patient, speaking to the mother and the night nurse.
She is particularly concerned about a newborn in the neonatology unit. The little girl was born three days earlier and suffers from respiratory insufficiency. Frédérique asks the nurse to do an X-ray exam.
"The visits take a long time," she says. "The department is very crowded and there are often two children to a bed. My visits are regularly interrupted by emergencies. Most of the time they involve children with severe malaria anemia, who must be transfused very quickly."
A bit further off, two newborns lie in bed under the worried, watchful eye of their mother. They are ill with malaria and have become anemic. They need a blood transfusion.
Malaria is one of the leading causes of hospitalisation. When it’s not treated, it causes many deaths among children under five years.
Gaspard, a two-year-old boy, is lying in another bed on the ward. He was admitted for severe malaria anemia. The child also presented with marasmus, a severe form of malnutrition. He needs a transfusion right away and also requires treatment for malaria.
"In certain cases of severe malaria – the neurological form, for example – children have convulsions or sometimes fall into a coma," Frédérique says.
"When I started my mission, everything was very intimidating and stressful. It felt like we couldn't manage anything, that we were courting catastrophe.
"And then, very soon, we realised that we were developing automatic responses and we would perform cardiac massage on infants, calmly, without even breaking a sweat."
It's almost 3pm and time to return to the MSF base, located not far from the hospital. Frédérique is on duty tonight. She is making preparations to return to the hospital in case of emergencies – but she'll drive there because you don't go out at night on foot.
155 beds (total)
18 maternity beds
55 pediatric beds
10-15 new HIV/TB patients admitted monthly