With a high proportion of women birthing at home, newborns in the Central African Republic (CAR) often miss out on the essential care that can avoid, or start to address, any complications such as prematurity, low birthweight, infection and lack of oxygen. In the rural areas of Bria, Carnot and Paoua, Médecins Sans Frontières teams can treat sick, small or pre-term babies as long as they are not too complex. Serious cases however need urgent airlift to the capital, Bangui. Paediatrics Advisor Dr Belen Caminoa shares the story of a critically ill newborn admitted to the newborn unit in Paoua.
“In Paoua we had a critically ill newborn who had been admitted with a severe infection, what we call sepsis. I had just arrived and gone straight to the neonatal unit. Just a few minutes after I reached his bedside the baby had a cardiac arrest. Only after we resuscitated him did the staff have time to explain his history. He had been brought in five days after being born, and had seemed to improve, but it was now obvious that he had started to deteriorate again. His infection had developed into necrotising enterocolitis, an acute and life-threatening inflammation of the abdomen, so he needed surgery. The team and I agreed that we needed to transfer him to Bangui via the next flight, if he managed to survive.” Although Médecins Sans Frontières no longer handles surgery in Paoua hospital, it looks after transfers to Bangui for all complicated surgical and trauma cases, adults and children combined. In Bangui responsibility is divided between Médecins Sans Frontières for the adults and the Italian non-governmental agency Emergency for the children.
“We explained to the mother that the transfer itself was risky, but that if her baby boy wasn’t transferred he could die. We had to wait from Thursday to Monday, keeping him stable with antibiotics, fluids and oxygen. We transferred him in his mother’s arms throughout the flight, while I monitored his breathing and the intravenous, or IV, infusion. In principle he needed oxygen but we don’t have oxygen in the plane. We half-jokingly asked the pilots to fly lower to increase the amount of oxygen. Next thing, we could see the ground more clearly than we normally would! Every 15 minutes they’d turn their heads to check, ‘Is he still OK?’ We had coordinated with the team in Bangui and an ambulance was already waiting on the airstrip. As soon as we arrived the baby was put on oxygen to help stabilise him. Once admitted to hospital he stabilised to the extent that they could plan surgery the next day. So that was satisfying for everyone who had been involved, that we were able to care for him and get him to surgery safely when he had been so gravely ill.”
In 2015, MSF ran 17 projects across Central African Republic, involving more than 2400 national and over 240 international staff. As one of a number of NGOs providing the majority of health services, our medical activities include paediatrics, vaccination, sexual violence care, trauma surgery, and HIV management.
Read Part 1 of Belen's visit here