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Voices from the Central African Republic: FELTP residents remain committed to strengthening disease surveillance and outbreak response in CAR

Categories: child health, immunization, infectious disease, refugee health

CAR refugees forced from their homes by rebels

CAR refugees forced from their homes by rebels

Dr. Els Mathieu, Resident Advisor, CAR- FELTP

Dr. Els Mathieu, Resident Advisor, CAR- FELTP

The Central African Republic (CAR) is a landlocked country in Central Africa, bordered by Chad in the north, Sudan in the northeast, South Sudan in the east, the Democratic Republic of the Congo and the Republic of the Congo in the south and Cameroon in the west.  CAR is one of the world’s least developed nations and has experienced several periods of political instability, as well as deadly attacks and violence by rebels that have forced nearly 1 million people from their homes in search of refuge.  With so many civilians fleeing to refugee camps in the capital, Bangui, and the provinces, there is an increased need to strengthen disease surveillance and response.

In 2010 the Centers for Disease Control and Prevention (CDC) with the support from the CDC Foundation and the Bill & Melinda Gates Foundation helped establish the CAR-Field Epidemiology Laboratory Training Program (CAR-FELTP) to build local capacity in disease surveillance and response.  Thousands of children in CAR die each year from vaccine-preventable diseases such as measles and polio. Improved surveillance through the CAR-FELTP has provided important information that can be used to develop effective vaccination campaigns and build local capacity to detect and respond to the spread of cholera, yellow fever, and other infectious diseases endemic in the region.  Despite the political unrest and insecurity in the CAR, FELTP residents remain committed to honing their skills and braving difficult terrain to save lives. Two residents give testimonials of their recent experiences in the field.

CAR FELTP Resident 1

There has been insecurity in the Central Africa Republic since the end of 2012.The crisis began in December 2012 and progressively took over the entire country in March 2013. Since November 2014, several waves of violence both in Bangui and in the provinces have occurred. Confrontations between armed groups and violence against the civilian population have led to massive displacement of populations.

Children affected by measles outbreak in Paoua, Central African Republic, April 2014

Children affected by measles outbreak in Paoua, Central African Republic, April 2014

In November 2014, we [CAR-FELTP] conducted a mission to investigate an outbreak of yellow fever in the town of Bambari. There was no political authority (administrative or military) on the site. The investigation area was controlled by rebel groups.  The violent clashes in Bangui and in the provinces led to numerous brutal killings that affected the neighborhood where I live. My house was completely looted and as a result, my family and I had to stay in a refugee camp for a month.

Earlier this year, as part of the re-launch of the fight against HIV, I led a Department of Health mission to raise awareness about HIV and conducted mass HIV screenings in two cities. A total of 350 individuals were screened. The first mass screening was conducted from February 12-19, 2014 about 200 kilometers (km) from the center of the country, and the other was conducted from March 5-12, 2014, about 450 kilometers northwest.

On February 19th, on our way back to Bangui after completing our mission in the first city, a group of armed men stopped our vehicle and forced us to change our route and drive towards the center of the country. During the six hour journey, several fights broke out between the armed men who had kidnapped us and other armed men dispersed in different villages that we passed through. When we arrived in the center of the country we managed to escape and spent the night in hiding. We returned to Bangui on February 20, 2014, shaken, but alive.

CAR-FELTP Resident 2

CAR FELTP Residents conducting a vaccination campaign in CAR, 2013.

CAR FELTP Residents conducting a vaccination campaign in CAR, 2013.

In April 2014, we conducted a measles outbreak investigation in the southwestern part of the country in the town Paoua. During the measles investigation, our team was caught between two armed groups. During the confrontation, there was an exchange of gun shots, grenades and rockets by the two opposing camps. Several lives were lost and many cattle were slaughtered.  The situation was very challenging and our team was forced to go to a nearby village where we stayed for several hours before continuing the mission.  We received protection from the MISCA (Mission internationale de soutien à la Centrafrique sous conduite africaine – French acronym for the African Union peace-keeping mission to CAR). We were squatting in the vehicle hoping to avoid the bullets that were coming from every angle. After struggling for a while, I suggested we should cancel the mission, but the MISCA reassured us that we would be protected so we continued.

MISCA opened gunfire for more than 20 minutes and threw grenades to intimidate and disperse the two adversaries. All along the road bands of young men – some armed with machetes and firearms – had erected barriers every 10 kilometers and were requiring money to cross each time.

CAR Refugees forced from their homes by rebels

CAR Refugees forced from their homes by rebels

Clashes between groups are very common; it is imperative to always ask for safety before beginning a mission. We did that, but unfortunately the area where we were conducting the measles outbreak investigation was in the heart of the rebel infested area and we were trapped in the cross fire. Heavily armed men with ill intentions were present virtually every day during the investigation. One day during an investigation in a village, a group of heavily armed rebels emerged from the bushes and walked in our direction. Quite naturally, we panicked as we thought we were about to be attacked. Later we found out that it was the rebel leader who was going to Church with his security men. Somehow this gave us a sense of security, and helped us to continue the work. Despite the constant threat of danger, we were able to confirm the measles outbreak which is critical for effective response activities.

Despite the ongoing political and civil unrest in CAR, residents of the CAR-FELTP continue their work and are hopeful that one day the violence will stop and they will no longer be forced to leave outbreak investigations, meetings, and classes due to civil unrest in their country.

For more information on the CAR-FELTP please contact Dr. Els Mathieu, Resident Advisor, CAR- FELTP at emm7@cdc.gov.

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  1. June 8, 2014 at 5:19 PM ET  -   Dr Charles Chengo

    What an ordeal! You are doing so much against the odds.
    Disease surveillance generally has been poor in Africa despite the need for robust surveillance systems due to high disease burden. Political denial- the fear to publish negative statistics also hinders the development of good surveillance systems as most of these diseases are a sign public health failures. I am a health informatics specialist and I am currently writing a project proposal on syndromic disease surveillance using smart phones and I would be happy to link up with anyone who has done a similar project. I am particularly interested in software/tools

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