Being a doctor in Africa

by Igor Kindler

Daily hospital routine

Since the beginning of April, I am working as a doctor for the Cap-Anamur project in Bossembélé. My day starts at 8 am with ward rounds. Interns, local students in their last year of training, and the team of the corresponding department participate. During rounds, the treatment plan is decided on and new patients are examined. Subsequently, diagnostic and therapeutic measures, as punctures and ultrasonic tests, are being performed.

The clinical training of doctors in the Central African Republic is excellent and the interns only need my assistance during sonography. They are very proficient in all other examination methods and punctures. In the afternoon, we discuss the upcoming tasks.

During the night I am often called to emergencies, especially to the pediatrics department. Most of the times, these emergencies are about acute breathing problems and neurological complications due to severe malaria including seizures and red blood cell deficiency. Due to limited diagnostic possibilities, treatment is more or less uniform with ventilation, blood transfusion, administration of fluids and medication, which reduce the fever.

High infant mortality

Many children only reach our hospital at a far progressed stage of illness and sadly not every life can be saved. But why do some patients come so late, and in some cases too late?

The Central African Republic is a poor country with a, compared to Europe, bad infrastructure. For example, only 643 of 23.810 kilometers of road are tarred. Our patients come from a radius of about 50 kilometers. Even though, most have access to medical attention in their near surroundings at health posts, but it is mostly restricted to malaria treatment as well as administration of antibiotics, pain killers and vitamin products, in a few cases also infusions, many of our patients cannot afford this treatment. Therefore, the necessary measures for treatment are only taken partially or not at all. Due to the costs, transfer of patients to our hospital also often takes place too late. Therefore, sustainable help can mostly be provided to people living in proximity of the hospital.

Malnutrition

Another reason for the high infant mortality is the nutritional status: Many children suffer from under- and malnutrition which result in a weakened immune system. The risk for these children to die from malaria, an HIV infection or tuberculosis is elevated under these conditions.

The government is not inactive. Free national treatment programs against HIV and tuberculosis exist and also prenatal care and vaccination programs are offered free of charge. These programs only reach 3 % of the population, a minor share compared to the neighboring countries Chad and Congo with 17 %.

Apart from modern medicine, many Central Africans often consult their local healer first, when they are ill. This traditional way cannot provide long-term help with severe malaria infections, sepsis or other here common infectious diseases and nutrient deficiencies.

Severe poverty

It can be concluded, that poverty represents the most common cause of illness. The Central African Republic is one of the ten poorest countries on earth. Memories of children, that came to us with life-threatening conditions, stay in mind: The boys and girls, weakened by malnutrition, malaria or tuberculosis, who were treated by nurses for weeks and who overcame their illness to be sent home in a stable condition. Each time, this is a great success. We are able to help most of our little and grown-up patients.

A look ahead

Apart from the engagement in Bossembélé we are also financially supporting a hospital in Yaloké as well as in Ndjoh. In the latter, we regularly offer consultations together with the local team. These are visited by numerous patients. By financially supporting the state healthcare structures, Cap Anamur contributes significantly: Thanks to the free medical care in Bossembélé and the surrounding area, more sick people recover from illness than in comparable regions. By the expansion and modernization of the hospital in Bossembélé we, together with our local partners, achieve a long-term improvement of local healthcare structures and therefore hopefully also promote the desired economical boost of the county.