By Ester Gutiérrez - project coordinator for Médecins Sans Frontières (MSF) in Kabo
Zoumanga (CAR) – Even though it is 40ºC and there are still two months till the first rains, we are being flooded… with people. We are in Zoumanga, a small village in northern Central African Republic (CAR) and we are carrying out what we call one-shot. In short, it is an intervention that tries to reach the maximum number of children and pregnant women, combining health promotion and prevention.
In this case, it was scheduled for 27 February, two days ago, but the local population had fled into hiding in the surrounding vegetation in fear of the violence constantly ravaging this country. Sometimes just a rumour is enough for people to run away with the energy that comes with fear. But today it is hard to believe that this town was empty just two days ago.
While I see the queue of mothers with hundreds of little children strapped to their backs or clinging to their legs, waiting their turn to be attended, I cannot help but feel a deep empathy. They sing and dance in the break in a psychosocial exercise led by our mental health community agent. They have waited their turn uncomplainingly for hours to receive vaccination or prenatal care. It is just a tiny fragment in all the time that has forged in them an infinite patience.
And we are here, under four mango trees. We organise a circuit for mothers and children in which we first detect cases of malnutrition and malaria, then the children are dewormed and given vitamin A. The children under one year of age receive several vaccines, and finally each household receives a couple of mosquito nets impregnated with insecticide to prevent malaria.
In a modest brick building, we improvise a clinic for antenatal and postnatal control. We have brought one of the midwives from the health centre in the nearby town of Kabo to provide a service that would otherwise be difficult for these women to access. A simple dirt road joins Zoumanga and Kabo, where there is a hospital run by MSF. It is only half an hour by car, an inaccessible means of transport for the vast majority. Those who can afford it go by mototaxi, and those who can’t, go by bicycle or on foot. In addition to the transportation difficulties, there are also two local militia checkpoints on the way, so travelling to the health centre means the possibility of being assaulted by armed militia. It is a risk that many prefer not to take.
To reach isolated communities like Zoumanga, MSF has implemented strategies to bring health services to the people. In doing so, our staff also face security risks, and therefore we try to make sure the medical impact of each intervention is high. Just as we finish this one-shot, we are informed that a convoy of another humanitarian organisation has been attacked on the road between Kabo and Zoumanga, just five kilometres from our position. We have to wait for the green light before we can return to the base in Kabo. All the way there I silently pray that nothing similar happens to us.
They call us 'field people'. We’re 'all-terrain people’, that's for sure. And that’s what our patients are. People with an incredible capacity for endurance, whose life stories are very difficult to understand from outside, and who possess an admirable tenacity.
I am left with the image of a woman who, with her child in her arms, walks home with the two nets that we have given her carefully placed on her head. She lets nothing fall. I see in her the best proof of how to walk the world burdened but maintaining your dignity.