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CAR: My tenth assignment with MSF

25 May 2016

More than 70 per cent of health facilities in Central Africa Republic (CAR) have been damaged or destroyed by civil war since the end of 2013. People have become reliant on Médecins Sans Frontières as one of the main health providers in the country. A world away from his career as a 3D printing expert in Sydney, Don McCallum shares experiences from his seven months as a project coordinator in CAR’s third largest city, Berbérati.

What is the situation in Berbérati?

I would describe Berbérati’s health system as being almost at the point of complete failure. There is a shortage of trained doctors, nurses and skilled support staff, and those who do work endure irregular salary payments and poor conditions – resulting in low motivation and frequent strikes. On top of this, medical supplies often don’t arrive, health education in the communities is extremely low, the lack of infrastructure and a harsh rainy season make transportation extremely difficult, thefts occur...the list goes on. The instability that cripples the country is exasperated by multiple factors...historical, religious and ethnic. The extreme violence that overran the country in late 2013 and 2014 resulted in nearly half a million refugees from CAR seeking sanctuary in neighbouring countries, with another half a million or so internally displaced according to United Nations data. 

"I would describe Berbérati’s health system as being almost at the point of complete failure"

What is Médecins Sans Frontières doing in Berbérati?

Our teams support a large regional hospital in the city, as well as four rural health centres – providing health care to approximately 250,000 people. We also employ around 2,500 national staff in CAR, making Médecins Sans Frontières one of the biggest contributors to the local economy. Jobs with Médecins Sans Frontières as doctors, nurses, technicians, drivers, cleaners and other support staff are highly sought after.


What are the primary health needs?

Although we treat many cases of malnutrition, diarrhoea, respiratory tract infections and measles, around 80 per cent of consultations are related to malaria. Malaria is the leading cause of death among children under five – a sad and preventable statistic. Médecins Sans Frontières planned to hire an additional 60 community health workers in 2016 to help fight malaria in the region. We will train them to test patients in local communities and remote villages, treat mild cases and refer severe cases to the health centres. A massive mosquito net distribution will work in parallel, as this is still one of the simplest and most effective forms of prevention. The vaccination programme in the country is very weak. It is beyond frustrating to see children dying from easily preventable afflictions such as tetanus and measles. When I was there, MSF had vaccinated more than 60,000 children around Berbérati against measles, polio, diphtheria, tetanus, whooping cough, hepatitis B, influenza, pneumococcal diseases and more.

What were your main responsibilities in the field?

I’m a mechanical engineer, so I have a knack for problem solving. This puts me in good stead to work as a logistician (or ‘log’ as we say in the field). It’s the logs who coordinate the infrastructure and supplies that enable the medical teams to do their work. My role with Médecins Sans Frontières has taken me to many places: from unstable Afghanistan, to the Syrian refugee crisis in Lebanon or the Ebola emergency in Liberia. Médecins Sans Frontières gave me the experiences and training to develop into a project coordinator; not just supporting the medical activities, but managing them as well. As project coordinator in Berbérati I was responsible for 250 staff. Many of our national staff have stories from the time when CAR’s crisis escalated in late 2013. Some showed me bullet wounds, or told me about friends and relatives they had lost. From time to time, national staff would show signs of emotional trauma, and I would do what I could to support them. 

"From time to time, national staff would show signs of emotional trauma, and I would do what I could to support them."

Can you share a particularly memorable patient story?

Around 500 people from one of the threatened minorities had been given protection in the grounds of a local cathedral since 2014. In August 2015 we oversaw the transfer of these people back to their suburbs. We provided food and medical care to help them rebuild their shattered lives. While life can be difficult, there is a lot of laughter and dancing, football games, conversations over cups of tea, and long, serious discussions in the backs of off-road vehicles as we journey deep into remote villages in the jungle. And every day we see patients leaving the hospital, cured and heading home on foot or on the backs of motorcycles. We see children getting fatter by the day, and mothers with their new babies.