Central African Republic: What success looks like
Malaria is the leading cause of illness and death in Central African Republic, accounting for 40 per cent of hospital cases and deaths nationwide. HIV/AIDS and tuberculosis are also major public health concerns — an estimated 4.9 per cent of the population is living with HIV, and some 520 cases of tuberculosis are reported per 100,000 inhabitants.
In 2013, the Central African Red Cross, in partnership with the Global Fund to fight Aids Tuberculosis and Malaria and the International Federation of Red Cross and Red Crescent Societies (IFRC), began a project to address these killer diseases and establish a nationwide mobile phone based reporting system, which would allow the country to rebuild a health reporting system that had collapsed as a result of years of conflict.
The initial forecast of the number of health facilities that would be supported with malaria prevention programmes was 166 — but 745 were reached. Over the past two years, Central African Red Cross volunteers have distributed most of the 2.1 million long-lasting insecticide-treated nets that are now offering protection to more than 60 per cent of the population of the country (several members of the same family sleeping under one net). Even when the fighting was at its worst, Red Cross volunteers were able to ensure uninterrupted distributions.
More than 25,000 people living with HIV were also reached with antiretroviral treatment — far exceeding the initial target of around 18,000 people.
As a result of this programme, the Central African Republic has been able to expand its health provision to many of its most vulnerable citizens. This was achieved during a conflict that has displaced more than 1 million people and left 2.1 million in need of urgent humanitarian assistance, and which threatened to bring already weak health systems to a complete standstill.
At a time when the country seemed to be on the brink of catastrophe, Red Cross volunteers were able to reach the most vulnerable people and make a tremendous difference to their lives. This is evidence not only of their courage and commitment, but also of the ability of local organizations and volunteers to operate effectively in environments where no one else can.
The Central African Red Cross has more than 12,000 volunteers providing a range of services across the country, including first aid, ambulance services, distributing relief items, providing water and sanitation services, peace education, managing burials, and giving psychosocial support. Many volunteers report being exposed to significant trauma and personal risk in the line of their humanitarian duties.
Edith: A daily struggle to feed her children
Edith is 40 years old. The first thing that strikes you when looking at her, is her seriousness, which dissipates as soon as a smile lightens her face.
But the occasions to smile are rare.
Edith was diagnosed as HIV positive in 2007, during a pregnancy visit at the clinic. She was expecting her sixth child, a boy who she named Giovanni after the doctor who took care of him.
The first days after she received the diagnosis were very difficult. Edith was alone with her five children then, as her husband had died three years earlier. She could not understand how this could have happened to her, as she had been faithful all her life.
But reality and her current situation did not leave much time to think and she quickly decided to take care of herself and seek treatment at the HIV reference centre in Bangui, where she got tested and received counseling and psychosocial support.
Unfortunately, Giovanni, who is now eight years old, has also been diagnosed HIV positive. Both are now on antiretroviral treatment provided for free at the health centre for her, and at the pediatric hospital for him.
When you ask Edith what is her biggest struggle, her answer is clear: food.
Edith has now seven children and struggles to feed them once a day. She can only count on the little money she makes selling manioc flour to provide food for her family. Giovanni is the most at risk, as the antiretroviral drugs require appropriate nutrition to limit the side effects and increase their positive impact.
Edith had a new partner for several years after she discovered her status, the father of her last girl who is four. When asked if she was using condoms with him during their relationship she answered that she did not. Her partner did not believe that he could get infected: it was her status, her problem. He left her a few months ago, saying that he cannot be with her anymore because of her situation.
Over the past two years, through its programme supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the International Federation of Red Cross and Red Crescent Societies (IFRC) has reached more than 25,000 people living with HIV with antiretroviral treatment.
Suzanne is a nurse at the Bédé Combattant Health Centre.
She is in charge of receiving incoming patients and giving them their first health assessments.
The main pathologies she sees are linked to respiratory infections, diarrhea, malaria, and road accidents.
For suspected cases of malaria, after running a Rapid Diagnostic Test, Suzanne is able to give free treatment to children under five and pregnant women, who are particularly at risk.
Elisé: Life-saving treatment interrupted by war
Elisé comes from Tembé, a small town situated 600km east of the Central African Republic’s capital Bangui, close to the border with the Democratic Republic of Congo. He is 35 years old.
Four years ago, Elisé was diagnosed HIV positive and prescribed antiretroviral treatment to combat the virus. Just a few months after he started his treatment, the conflict in Central African Republic erupted. Soon, the few health centres functioning in his region were destroyed and their drug stocks looted. As a result, Elisé could not continue to take his treatment.
The situation lasted for months, with his health deteriorating week after week. With no money and growing insecurity in the country, it was impossible for him to leave and reach Bangui to seek treatment. Finally, after two years, he managed to get the means to travel to the capital city with one of his daughters, leaving the other one behind.
When he arrived in Bangui, the situation did not get better. He had hoped to receive a helping hand from his relatives in the capital, but they rejected him when they learned of his HIV-positive status.
Eight months later, Elisé has temporary lodgings with one of his brothers, who lives a hundred kilometres away from Bangui.
Since August 2015, Elisé has registered at the HIV reference centre where he has been tested again, given counselling and psychosocial support, and provided with free antiretroviral treatment. In addition to the drugs, he also receives a nutrition supplement from the World Food Programme. But the two years he spent without appropriate treatment have left him very weak and tired. Every other week, Elisé takes the bus to travel the 100km between his home and the health centre that keeps him alive. Hopefully, soon, he will be able to access his treatment in a health centre closer to where he lives.
Over the past two years, through its programme supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the International Federation of Red Cross and Red Crescent Societies (IFRC) has reached more than 25,000 people living with HIV with antiretroviral treatment.
Mauricette is 34 years old. She has two children, a 15-year-old girl, and a two-year-old boy. Her husband died during the recent violence. Mauricette was diagnosed as HIV positive in 2008, and visits the health centre once a month to collect her free antiretroviral treatment. She suffers a lot from the side effects of her treatment, and a lack of food makes it even worse.
Irène: “They help me, so I help them”
Irène cried a lot when she was diagnosed HIV positive back in 2009. She was then pregnant with the last of her seven children, but thankfully the diagnosis was made early in the pregnancy and her baby was not infected.
Since then, Irène struggles to live. Her husband died of HIV in 2010 after refusing to take his treatment. Her oldest daughter is 22 and is now tasked with going to the field to cultivate and bring back enough food for the family while Irène takes care of her brothers and sisters.
In January 2015, Irène’s health quickly deteriorated. At the time she had been living for almost eight months under pieces of tarpaulin and plastic bags in a camp for internally displaced people just by the runway of the Bangui airport. At the peak of the crisis, more than 30,000 people took refuge in this camp, living in terrible conditions with very limited access to health care, water and sanitation, and food.
When she visited the Bédé Combattant Health Centre, where she collects her antiretroviral drugs every month, she was diagnosed with tuberculosis. Six months later, having followed the treatment regime carefully, she was cured of TB.
Irène and her six younger children now live with her sister. They still have very little to live on, but Irène has found a new vocation: she volunteers at the health centre to support the administrative work that needs to be done for people living with HIV.
“I was coming here so often, first to take my HIV treatment then the one for tuberculosis. Then I had the regular blood tests and the counselling. At one point I was here almost every day so I decided that instead of just coming to get something I could also give something,” she says.
Irène’s antiretroviral drugs and medical treatment are provided free of charge as part of an International Federation of Red Cross and Red Crescent Societies programme supported by the Global Fund to fight HIV, Tuberculosis and Malaria.
Stéphane is 42 years old and the father of seven children aged from 18 years to four years old.
He tested positive for HIV 2007.
His wife also tested positive, but had to return to cultivate the fields to provide food for the family. As a result, being far away from any health centre, she stopped her treatment and died in 2014. Only the eldest of Stéphane’s children is going to school. The others are staying in the small studio he is renting in town.
Victoria: “Women are not the problem, it’s the men”
Victoria is a midwife at the Bédé Combattant Health Centre in Bangui, and she is in charge of the HIV mother–to-child transmission unit. The centre, supported by the French Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC) through a financial grant from the Global Fund to fight AIDS, Tuberculosis and Malaria, receives patients coming for general consultation but also many women coming for antenatal and postnatal support.
One of Victoria’s main duties is to convince women coming for their first consultation to be tested for HIV as part of the regular tests pregnant women have to go through. The situation in that regard has considerably changed over the years — women rarely refuse to be tested, proof that HIV awareness campaigns in the country have had an effect.
“Because HIV can be diagnosed early in the pregnancy, the number of cases of transmission of HIV from mother to child has reduced dramatically,” Victoria says.
“But the problem is not the women — it’s the men.”
When Victoria receives a woman coming for the first time for consultation, after she advocates for her to be tested for HIV, she also asks for the woman’s husband or partner to come and get diagnosed himself.
“In 2015, 2,045 women came here for consultation. They were all asked to go back home and ask their husband to come and be tested too. Out of the 2,045, only 45 men came. Men are hiding behind the status of the women,” added Victoria.
While work to raise awareness of the need for HIV testing seems to have been effective, unfortunately women still continue to hide their status from their close relatives because of stigmatization.
“Men often run away from their homes when they learn about the status of their wives, leaving them behind with their children without any resources. Many women prefer not to take the risk and hide their status for as long as they can,” says Victoria.
Volunteers of the Central African Red Cross are conducting awareness campaigns in communities to educate the population on HIV and other sexually transmitted diseases. They also offer psychosocial support to patients coming for HIV and tuberculosis diagnosis and treatment at the health centre.
Sainte is a volunteer with the Central African Red Cross. She is 29 years old and has two children. Sainte is part of the team of volunteers who are providing daily support to people coming to get free HIV and tuberculosis treatment as part of the IFRC programme supported by the Global Fund to fight AIDS, Tuberculosis and Malaria.
