Cameroon: Community-based care is a lifeline for people affected by violence 

Mr. Esua Ettiene, a community health worker, consults with a patient at his home in a village in Cameroon's South-West region.
Cameroon 2020 © Fanwi Antoinette Buinda/MSF
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UPDATE: MSF nurse shot in attack on ambulance in South-West region

On Thursday morning, February 4, armed men shot at a Doctors Without Borders/Médecins Sans Frontières (MSF) ambulance that was responding to a call in Muyuka, in the South-West region of Cameroon. An MSF nurse was injured in the attack and is now receiving medical care. The vehicle was clearly identified as an MSF ambulance. MSF condemns this attack and reiterates that ambulances, health care facilities, health staff, and civilians are not targets.

A second ambulance was later dispatched to respond to the initial call for emergency medical aid in Muyuka. That patient is now in critical condition.

MSF medical teams have been responding to the severe and ongoing effects of the crisis in North-West and South-West Cameroon since 2018. Our teams provide neutral and impartial medical humanitarian assistance through our emergency ambulance referrals, secondary level care, and a decentralized model of community-based health care.

Reaching people displaced by violence

For four years, Cameroon's North-West and South-West regions have been convulsed by armed violence between government forces and non-state armed groups, which has displaced more than 700,000 people. The humanitarian needs are enormous and displaced communities face difficulties accessing basic services, including health care.

The crisis has severely affected the public health system and many health centers have closed or are unable to function. Both medical workers and facilities are directly targeted by violence, and insecurity is disrupting the supply of drugs and medical equipment.

Traveling from remote villages to health facilities is a major challenge for many people, due to insecurity, bad road conditions, and lack of transport. MSF offers a free, 24-hour ambulance service that operates seven days a week, collects eligible patients at designated pick-up points and takes them to MSF-supported health centers and hospitals. If MSF cannot reach an area, we provide money for public transport so that patients can reach health structures or make their way to pick-up-points.

“Our community volunteers are sometimes harassed by armed men,” says Paulo Milanesio, MSF emergency coordinator for the South-West region. “We are in constant dialogue with different stakeholders to guarantee their safety. We need everyone to understand that community volunteers and ambulances provide a much-needed lifeline for vulnerable communities who would otherwise be deprived of medical care.”

Due to the high level of insecurity, humanitarian organizations, including MSF, face many obstacles in order to reach displaced communities who often hide in the bush for safety. To continue providing medical aid in these challenging conditions, MSF has adapted the way we work. The model of care is focused on delivering care directly to the community, by the community.

Community care

Around a dozen adults and children are waiting patiently for their check-ups on the veranda of a house in a village in the South-West region of Cameroon. Sitting behind a small table, Etienne Esua listens to patients, dresses wounds, and pricks fingers to perform rapid malaria tests.

“When a test shows that a person has malaria but the symptoms are not severe, I treat the patients with drugs,” says Esua, a community volunteer trained by MSF to provide primary health care to some of the region's most vulnerable and hard-to-reach communities.

MSF relies on volunteers like Esua. “Community health volunteers are the bridge between the health facilities that we support and the vulnerable communities that don't have access to health centers,” says Yilma Werkagegnehu, MSF field coordinator. “Either because they are displaced, because health structures are closed, or because they can't afford to pay for medical services.”

MSF currently works with 106 community volunteers in several health districts near the towns of Mamfe and Kumba in the South-West region. MSF conducted similar activities in the North-West until they were put on hold in December 2020 following a decision from the authorities to suspend MSF’s activities there until further notice.

Prevention and treatment

Community health volunteers are recommended and selected by community leaders and trained by MSF to detect and treat simple diseases like uncomplicated cases of malaria, respiratory tract infections, malnutrition, and diarrhea. They also learn how to carry out health promotion activities aimed at preventing illness and advising people on how to recognize signs of sexual abuse and psychological distress. While they might not be medical professionals, community volunteers are trained to adhere to medical ethics and MSF’s principles—to treat those in need, regardless of their background.

In 2020, community volunteers provided more than 150,000 free medical consultations in the South-West and North-West regions of Cameroon.

The community health volunteers are paid incentives for their work and receive backpacks filled with medicines. They meet regularly with MSF supervisors to discuss their work, get advice, and share medical data. Their medical aid backpacks are refilled before they return to visit remote communities, often walking for several hours a day.

For serious cases, community volunteers can refer patients to MSF-supported health facilities where they receive free treatment. Examples include children with severe malaria, women with complicated pregnancies, survivors of sexual violence, and patients with intentional injuries.

A lifeline for vulnerable communities

Seven-year-old Dorcas was referred to the MSF-supported Presbyterian General Hospital in Kumba, in the South-West region for extra care. Her left leg is in a cast.

“[Dorcas] was injured in a traffic accident and was referred to the hospital by one of our community volunteers,” says Dr. Guisilla Dedino. “She was assessed in the emergency room and was diagnosed as having an open fracture of the left leg. A surgeon operated on her. She is making progress, with the fracture showing good signs of healing.”