In the middle of the African continent, Central African Republic (CAR) is only slightly smaller than France, but has limited roads connecting regional centres with the capital Bangui. Four million people are dispersed countrywide, many still displaced since intense conflict in 2013-2014. Security remains a concern. Paediatrics Advisor Dr Belen Caminoa recently criss-crossed the countries by plane to assess three hospitals run by Médecins Sans Frontières, where providing and reaching care comes with many challenges. She explains how a visit from an advisor helps review skills and protocols with the hard-working teams.
For a Medical Advisor like Dr Caminoa, a field visit typically entails assessing how the activities are progressing, following up any training that has been conducted, provide additional training where needed, discussing any queries the team has regarding protocols or guidelines, and reviewing first-hand any critical cases that are in care during the visit. Depending on the country there is quite a bit of travel involved. “I have been following CAR since the end of 2015; specifically, I’m looking after three projects with neonatal and paediatric activities. I spent four days in each: Carnot, in the west near Cameroon; Paoua in the northwest towards Chad; and Bria in the east, close to the border with Congo and Sudan. I flew back to the capital Bangui in between each time.
"As a paediatrician you’re always focused on individual cases, case by case. But as an advisor your aim is to have an overview of the situation, to understand the context and the challenges of the project"
I start each visit by attending the morning handover. It’s the opportunity to introduce myself and explain why I am visiting. Then I go through the different departments: from emergency and intensive care, then on to the rest of the wards, including the neonatal unit. I also make sure I see all the workings of the hospital—for example, the maternity ward, the pharmacy, the kitchen—to understand how everything works together”, explains Dr Caminoa. The health system in CAR has numerous gaps, including qualified staff, and child and newborn mortality remain high. Médecins Sans Frontières services are busy with high numbers of patients, so ongoing training to improve and maintain the quality of care is vital.
“I especially wanted to get feedback from our staff and to see how they had benefited from working with the new ‘Flying Paediatrician’. This is an international staff position we’ve created for these projects in CAR. The paediatrician rotates through the three projects back-to-back, for two months in each, focusing on a different aspect of care each time. This time she had worked closely on neonatal care so I was expecting to see the results of that, especially in terms of good organisation of care and correct use of protocols. As a paediatrician you’re always focused on individual cases, case by case. But as an advisor your aim is to have an overview of the situation, to understand the context and the challenges of the project, including the wider issues like logistics and human resources, which are also linked to the care that a patient can receive. By guiding the medical care taking all these things into account I can support the team in the field to achieve what they want to achieve, but also help them adapt to any limitations.”