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Central African Republic: In the bush

11 Nov 22 | 11 Nov 20
This article is more than one year old

Central African Republic: In the bush

Dale Koninckx

Health promoter

Deep in a remote area of the Central African Republic, anthropologist Dale shares his diary of one day in the field with MSF...

Tuesday October 6, 2020, 8:09 p.m., Bakouma, Central African Republic

I’m sitting on a bench that is missing some planks. I've been sitting here for an hour and don't really care if it’s comfortable. I like what I see and what I hear, and I like thinking back about what I did today.

What I hear

First, there are the locusts. They’re known as "pembele" in the local dialect. But how can something so small make so much noise? Well, this has nothing to do with it, but it reminds me of my brother, to whom my mother used to say "little children shouldn’t make such big noises". Well. I don't know if he'll be happy to know that I'm comparing him to a pembele, but at least I'm thinking of him :)

Beyond the shrill noise of the locusts, loud enough to drown out the ringing of my phone, is the squawking of a chicken hidden in a crate, stored in the muddy Médecins Sans Frontières / Doctors Without Borders (MSF) car in front of me.

This chicken is our picnic tomorrow. I spare a thought for his fellow traveller who, unfortunately for him, ended up on our plates after five hours of travelling together on the dusty tracks of the Mbomou region.

I care about animal welfare, so I find it quite unusual that my lunch box has been replaced by a case of live chickens. I tell myself that this is part of being on assignment with MSF.

Chicken in a box Caption
The chicken

What I see

A little further to the left, there are three puppies playing, nine young goats pushing each other, head to head (really cute) and a henhouse-dovecote sheltering heaps of birds destined for the same sad fate as our friend in the crate.

The sky is wide and black. Then, in the middle of this deep bush, the stars are brighter than ever. There are also many fireflies, making me believe they’re shooting stars as they blend into the Milky Way.

There is no generator and, despite the Pembeles, I observe a unique calm.

On my right, I see the bedroom door. Its bars are smashed and I think back to the story my colleague told me earlier today.

Goats rest outside a building Caption
Goats in Bakouma

Terrible and recent

This parish where we are located was brutally attacked during the events that stirred up the region in 2017. Looted and vandalized, "people did anything," he told me.

The nuns who lived in the building did not return.

I tell myself that this place, this village, this region, is filled with a history as terrible as it is recent. This history still dwells in the minds of the local people here. And they are my colleagues and companions for the evening.

Because I am not alone.

Slowly, we get to know each other

Around me four colleagues are listening to a radio play. They translate it for me from the Sango – the local dialect.

It's a scene where a husband who has just landed a job is sent to the market by his wife to buy food for their children.

I ask questions, take an interest in their culture, what makes people laugh, how to have fun in a context where life is precarious.

The voices on the radio make me smile, even though I don't understand anything. Links are forged with the new team and, slowly, we get to know each other.

We just took our showers after drawing water from the well. We wait for the sugar, adding it to our black tea. Further on, a hut hosts a few village residents. I make out the voices and wonder what they're talking about. When are they going to sleep, what time do they get up and what they would think if I got up now and joined them?

The feeling

I really felt that sense of being part of MSF today. It’s like my boss, who is much more experienced than me, told me, "when you are in an MSF convoy with five motorbikes breaking the trail in front of you, and you know you’ll be on the back of one of them as soon it gets impassable for the car, that’s when I tell myself that I am really on assignment.”

It was true that the intervention we were doing felt good. Our white MSF flags were flying, we were going through the bush in an attempt to go where others don't, we had been driving for hours without stopping.


“When it rains, you go anyway.”

We meet valiant children, using the strength of their shoulders to push bikes loaded with tens of kilos, carrying meat, oil, coal, cassava, water, all for tens, even hundreds of kilometers.

The driver of my vehicle is a native of the region. He knows the effort the children are making. He made it himself, every week as a child, and as we drove, he told me about it in detail.

“You're eleven and you don't go to school on Fridays so that you can do this. You leave Nzako, making for Bangassou. It's 200 km.

You leave at 4 a.m. to arrive at 10 p.m. Or you sleep on a mat in a village and you leave the next day. You could bring back 25,000 CFA. You take money for school fees on Monday, and for eating. Bees sting you, too many of them. When it rains, you go anyway.”

As he told me his story, we crossed a flooded bridge and the water, a metre deep, swirled around the car.


Today, we had appointments in several health centres. We were there to assess health needs and coordinate referrals to the hospital that we support in Bangassou. This is particularly for the serious, complex cases, or those who need long-term, essential hospitalisation.

Once there, we greeted the head of the centre. I signed a guestbook and left my contact details. The man gives us a tour of the premises.

The place is relatively large, there were a lot of patients, and notably a mother-to-be in labour. My midwife colleague examined her for a long time and then came back with a serious expression.


It's going to be alright, mama

She reported that the patient was in great pain and in urgent need of a Cesarean. The only doctor who can do it was hundreds of miles away. There was also no ambulance: referrals are usually made by motorbike.

The only solution: send our car back to Bangassou with the mother on board, which we organise immediately. My health promoter teammate explains the situation to the crowd that has gathered around us, as I fold down the back seats and the patient is carried on a stretcher. I meet her worried, tearful gaze.

She's been in pain for hours. She is exhausted. I tell her "it's going to be alright, mama", nod at her husband, close the doors, then watch the car depart with them and our midwife inside. Later, I learned that that her life was saved by our teams in Bangassou but, unfortunately, the newborn did not survive.



The greatest wealth on earth

Moments later, a biker takes aboard an elderly dad with a severe wound in his left foot. He will also take him to Bangassou hospital.

We will meet them 15 hours later, on our way back, sitting next to the broken down motorcycle. There is nothing to fix it with, no one has come by because of the rain, there’s no phone network, no phone to call. Again, we’re able to get the patient to Bangassou and, without the lift, he would probably have arrived days later, too late to save his foot.

This first outing says a lot about why I love working with MSF. We had a whole programme for the day that we changed in five minutes to save lives. A reorganisation of priorities and logistics to focus on others and their needs.

We have a variety of teams, who feel in their guts the need to get closer to the community, but also to go and see what is going on to define our intervention.

We are in the field, we feel it, we live it and we can speak out knowledgably, from experience. Five minutes of conversation with someone is priceless, especially at the right time and in the right place. Taking the time to stop to chat is an investment. I keep reminding myself that the greatest wealth on earth is each other.



The radio play is finished. There is only my teammate left and for another half an hour we keep talking about the way of life here.

It must be said that as a good anthropologist, I can't help but ask him lots of questions. We then retire to our respective rooms. I tuck the edges of my mosquito net under my mattress, as much for fear of mosquitoes as of the other eight-legged animals that I will probably tell you about another time.

In the meantime, I fall asleep quickly, lulled by the screeching of the locusts which lurk in the night and which remind me that I am in the heart of Central Africa.