Central African Republic: A new future

by Gabriella Grea, MSF anaesthetist

24 May 2023

France walks out of the MSF’s SICA hospital on 22 January 2021 after completing her inpatient treatment. She will continue to receive outpatient care and come back regularly to the MSF SICA’s Hospital for wound dressing, physiotherapy sessions and more.

We are lying down, each on their own sofa, lost in their own metropolitan world of origin: someone updates their diary, someone studies a video of a new surgical technique, and someone entertains his far-away child with a video call.

The trill of a notification bursts into our three phones simultaneously and brings us back to the present.

The alert

We are in Bangui, the capital of Central African Republic: an orthopaedist, a general surgeon and an anaesthetist, here for six weeks to contribute to an MSF project. We work in a trauma centre managed by MSF, in agreement with the state government, which sees local doctors and nurses side by side with the international staff.

The message that reached us is an update on an arrival that was announced yesterday: the MSF plane will land with a young man, victim of a road accident in the previous 72 hours, attached the photos of the traumatized right upper limb.

The plan

The images flow fast, we each look up in the hope of reading a little less horror in the others’ faces. We all know: that limb will be amputated, without wasting any more precious time, otherwise the boy's life will be in danger. Assuming it's not already too late.

Complex fractures, resulting from road accidents or bullet or knives wound, usually require at least a cast, often an external fixator, and sometimes amputation.

“Ça va aller – it will be fine, we will overcome this too”: we learned that here. When you're about to be overwhelmed by discouragement, when you're losing hope, there's always someone who puts a hand on your shoulder and reassures you. So, we gather around the table, study together and organize the surgical plan for this young man, with the pros and cons of each possibility.

“Ça va aller – it will be fine, we will overcome this too: we learned that here.”

GABRIELLA GREA

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MSF ANAESTHETIST

The next day, he arrives. He is very young, and can't even speak for long, he is so weak and exhausted.

The accident

Three days earlier he was driving in the distant provinces. He climbed onto the roof of his truck to better secure the transported goods. He fell.

His right arm hurts badly, it was bleeding. He managed to get back on the truck and reach a village. From here he is accompanied to the nearest medical aid centre, which is 150 km away. It is the rainy season, so the bumpy roads are in even worst condition.

MSF medical staff do wound dressing around France's injured hand after her wound was stitched on 19 January 2021, at MSF's SICA Hospital.

At the medical centre the exposed fracture is stabilized and the wounds are treated, but the picture is dramatic and clear to all: by now the boy has lost feeling in almost the whole limb and he can no longer move it, he has a high fever and is frightened.

This is a medical emergency.

Trust

There is a chance to save his life: the Sica Trauma Centre in the capital, the MSF hospital. Thanks to the coordination network between the various NGOs and the local government, it is possible to organize the air transfer.

Now that he's here with us, we have to give it our all.

“Their final glance before unconsciousness is always for the anaesthetist and the anaesthesia nurse... How much courage can we try to instil in those few seconds?”

GABRIELLA GREA

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MSF ANAESTHETIST

When the patient is on the operating table, their final glance before unconsciousness is always for the anaesthetist and the anaesthesia nurse... How much courage can we try to instil in those few seconds?

France is brought to the recovery room after a surgical procedure to get her wound stitched on 19 January 2021, at MSF's SICA Hospital.

From his eyes I sense that the young man trusts us completely, even though he knows that he may not wake up, and at best, he will wake up but without his right arm.

You, who's 22 and drives trucks for a living.

You

After the surgery, your fever and pain are gone but so is your dominant arm and, I worry, a secure future in a country ever-poorer in possibilities.

Instead, a surprise…

Thanks to your youth and grit, and the support of psychologists and physiotherapists, you get better.

Two weeks after the surgery, you chase me through the corridors and call me into the courtyard to show me your progress. You are learning to write with your left hand and you want to study. You ask me about books, especially history books, but in reality, anything goes.

Early physiotherapy care is essential to allow the patient the best recovery possible after trauma and surgery and to mitigate long-term consequences. Rehabilitation often takes month, even years.

You tell me that you want to study to become a teacher. Because you can be a teacher even with one arm. You say that you’ll learn to write on the blackboard with your left hand, and then it’s just reading and speaking.

Soon I must leave you to your new future. I’m coming to the end of my assignment and preparing to return home, to Italy.

“Ça va aller Gabi,” you tell me. “It will be fine, have a good trip”.

Gabriella Grea is an anaesthetist with Médecins Sans Frontières/Doctors Without Borders (MSF).