Miracles and Tragedies in Central African Republic

My natural alarm clock woke me this morning, as usual, at 5.15: a bird warbling in a mango tree outside my room. That sounds idyllic, a far cry from the horrors that are still occurring regularly just a kilometre or so from our house/office here. As I sit writing this, on my day off (in spite of the emergency, we try to have a day off each week, to recoup our strength for the week ahead) the birds are still singing, but their sweet sound is interspersed by the rattle of gun-fire.

It’s surprising how quickly you get used to an abnormal situation. As well as the background of gunshots and shelling, I’m getting used to the strong military presence, with heavily armoured cars rolling down the main streets heading to the flash points. I was fairly alarmed, on leaving the hospital one afternoon, to find the perimeter wall surrounded by crouching soldiers, machine-guns at the ready. For a brief second I thought we were being attacked – but quickly realised they were protecting a journalist who was interviewing someone for television.

I’m also getting used to different classifications for the MSF statistics. Normally I’m filling in details of how many cases of malaria, respiratory tract infections, diarrhoeal diseases or malnourished children we’re treating; now I’m classifying the admissions to the emergency department by wounds from gun shot, grenade or “arme blanche” – the latter being any other type of weapon, mostly machetes.

I’ve been here two weeks now, as the nurse/medical focal point for the hospital MSF started running on behalf of the Ministry of Health when the recent conflict started here in December last year. Previously a primarily maternity hospital, we provided a team to deal with the emergency trauma cases as well as keeping the maternity department going. I’m just beginning to get to grips with everyone’s names: as well as about 25 expats, I’m struggling to recognise the huge team of national staff and acknowledge a smiling “Bon jour, Alison,” with the correct name in response!

My first day our departure to the hospital was delayed because of an “incident” in a largely Muslim neighbourhood bordering the hospital; when we arrived, there were several people in the emergency room being treated for shrapnel wounds. It seems a young boy had thrown a grenade – an accident? A child soldier? We will never know. And so it has continued most days, although this last week the number of admissions for conflict trauma has diminished dramatically. From dozens every day a few weeks ago, it’s down to a handful.

But even one can be a tragedy: the young man who came in unconscious, from a deep machete wound to his head, never recovered consciousness and died after a few days. With no specialist neurosurgeons here, there was nothing we could do to save him. So I was overjoyed when another young man, let’s call him Jean-Claude, also admitted unconscious following a head injury, recovered consciousness. But he was deeply disturbed and agitated, and made no verbal response. Day after day, he would stare at us but would not talk, drink or eat. “He’s been tortured,” his brother, who stayed close to his side, told us.

So what a joy to be met one morning by one of our psychologists: “He’s talking!” And soon he was ready to be discharged.

There are other joys amongst the tragedies. Belen, one of our expat doctors, came into the pharmacy where I was doing the boring but necessary task of counting stock. “Do you want to see a miracle?” she asked me. Of course I did. I looked down at the tiny bundle, the 800 grams baby, who had arrived prematurely. Tiny but alive. This conflict brings hardship to so many, but delivering a baby safely can be especially difficult. This little mite could now be referred to a specialist paediatric centre run by another section of MSF.

It’s good to have the miracles in the midst of the ongoing tragedy.




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