I recently made a field support visit to the MSF project in the Central African Republic (CAR), a landlocked country in the middle of the continent with a history of recent and ongoing conflict. As a result, a significant proportion of the 4.5 million inhabitants have become displaced and there is widespread food insecurity.
Life expectancy in CAR is now amongst the lowest in the world and characterized by excess mortality, including among children and women. Human resources for health are scarce (e.g. one doctor for 10,000 people) and only about one-half of CAR’s health facilities are functioning, due to the chronic conflict.
CAR has a high burden of HIV, with at least 5% of pregnant women testing positive at prenatal clinics. Out of a total of ~110,000 people living with HIV in CAR, only ~14,000 were on antiretroviral therapy (ART) in 2014. Not only does this represent poor ‘coverage’, since it means that only ~17.5% of the ~80,000 eligible are on ART, but this number has actually shrunk from a total of ~18,500 in 2011!
In some settings, the detection rate for TB is only ~40% (objective = 70%) and the success rate is ~70% (objective = 85%). About 1/3 of TB patients have been found to be co-infected with HIV. For those TB patients with drug-resistant strains, appropriate treatment is largely available only in the capital city (Bangui).
In addition to a setting in the eastern part of the country (Bangassou), MSF-OCB is supporting medical activities at 3 sites in Bangui: Hôpital Communautaire, a Maternity Centre (Maternité des Castors) and an unofficial camp of internally displaced persons (IDPs) at the M’poko airport in Bangui. Mother and child health care, HIV and TB (including DR-TB) continue to be priorities.
Ousseni Wendlassida TIEMTORE
Southern Africa Medical Unit (SAMU)