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Central African Republic
MSF in Central African Republic, 2011
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In the Central African Republic, mortality rates are consistently above the emergency threshold countrywide, indicating an urgent need for large-scale medical assistance. Recorded death rates were particularly high in 2011, caused by a high prevalence of preventable, and treatable, diseases, a failed health system and years of conflict.
Despite this, funding for health is declining. In the report State of Silent Crisis, published in 2011, Doctors Without Borders/Médecins Sans Frontières (MSF) called for greater medical assistance in the Central African Republic.
MSF works in five of the country’s 17 prefectures, supporting nine hospitals and 36 health centers, mainly in the more unstable border areas, where it can be very difficult for people to access healthcare.
In 2010, MSF’s team in Mambéré-Kadeï opened a new program in the district of Carnot, providing pediatric healthcare and integrated tuberculosis (TB) and HIV treatment in the district hospital and four health posts. In 2011, MSF registered almost 520 new HIV patients and conducted 5,500 consultations.
Although Carnot is neither affected by conflict nor host to large numbers of displaced people, mortality surveys carried out in 2011 revealed death rates to be at least three times above the emergency threshold.
The emergency assistance program in the town of Gadzi was handed over to authorities in October.
In Zémio, on the border with the Democratic Republic of the Congo (DRC), MSF continued to assist people fleeing violence in the DRC, carrying out close to 31,000 medical consultations. Towards the end of the year, MSF started offering antiretroviral (ARV) treatment to people with HIV.
Supporting basic and specialist health services
In the town of Paoua, in Ouham-Pendé, an area recovering from conflict, an MSF team provides pediatric, surgical, maternal, emergency and outpatient services. As well as conducting 18,900 outpatient consultations and admitting more than 2,700 patients to the hospital, staff carried out consultations at seven health centers in the surrounding area.
Teams provide similar services in places still beset by insecurity and violence. In the neighboring prefecture of Ouham, at Batangafo, Boguila and Kabo hospitals, staff carried out some 16,700 consultations, admitted 940 inpatients and assisted more than 180 births every month. At Boguila, MSF regularly organizes ‘surgical camps’, in which a team visits for a limited period to perform specialist surgery that would not otherwise be available in the area. Staff also work in 14 health posts around the hospitals.
MSF confirmed that sleeping sickness (human African trypanosomiasis) has been brought under control in the Maitikoulou area. Sleeping sickness is a parasitic infection transmitted by the tsetse fly, and it is usually fatal without treatment. MSF showed that prevalence had fallen to below 0.5 per cent. The team carried out more than 56,000 general medical consultations and 35,000 antenatal consultations, before closing some health posts and handing management of Maitikoulou hospital over to the Ministry of Health.
In Ndele, the capital of Bamingui-Bangoran prefecture, an MSF team is providing medical assistance to both displaced people and local residents. Surgeons performed an average of 14 operations per month at the hospital. Teams also ran mobile clinics and worked in five health centers.
Combating three killers: malaria, HIV and TB
Malaria remains a major threat to public health and the principal cause of death and illness among children in the Central African Republic. In total, MSF treated more than 212,000 patients for the disease in 2011. By July 2011, 998 HIV patients were receiving ARV treatment at MSF clinics, a large increase over the previous year.
However, the National Centre for the Struggle against AIDS has estimated that 45,000 people, including 14,000 children, currently need ARV treatment. At present, only one-third, or some 15,000 people, have started treatment.
The prevalence of TB has increased significantly among both HIV-positive and HIV-negative people, and is estimated to have at least doubled between 1990 and 2009. MSF provides TB diagnosis and care at its hospitals in Batangafo, Kabo and Ndele.
At the end of 2011, MSF had 1,341 staff in the Central African Republic. MSF has worked in the country since 1996.