Amy Nyland is a Canadian nurse who recently returned from seven months in Bossangoa, in Central African Republic (CAR). She was part of Doctors Without Borders/Médecins Sans Frontières (MSF)'s continuing efforts to provide essential medical care in a country that has been turned upside down by violence over the last two years, as sectarian tensions have led to widespread bloodshed and the collapse of many elements of a functioning state.
But amid the many troubling challenges that MSF's teams face on the ground in CAR, there are also reasons for hope — starting with the many Central African MSF staff members who help the organization deliver lifesaving medical care under even the most difficult circumstances. In the piece below, Amy recalls some of the colleagues she worked with in CAR, who continue to enable MSF's work in the country they call home.
By Amy Nyland
“Please don’t forget us. Please tell people about us.”
This was one of the last things I heard from national staff colleagues before I boarded my flight on a long journey home to Canada. I had just finished seven months on mission as a nurse with Doctors without Borders/Médecins Sans Frontières (MSF) in Bossangoa, Central African Republic (CAR).
Honestly, it would be impossible to forget the people I worked with in CAR. They welcomed and supported me, teaching me countless lessons of dignity, survival, resilience and optimism. They offered me these gifts despite facing the ravages of extreme poverty, institutional collapse, violence and warfare that have affected their country for many years, and with particular virulence since 2013.
Occasional media coverage of CAR highlights brutal sectarian fighting, internal population displacements, and sexual violence as a weapon of war. It is a country where MSF has had a presence for many years. At the height of the crises in 2013-2014 there were areas of the country where MSF was the only international organization to stay on the ground, continuing to provide essential medical assistance to anyone in need, no matter their ethnic, political or religious identities.
Lifesaving work that relies on local staff
What is not always known or understood is that MSF’s work isn’t only done by international staff. There are of course a diverse group of international medical and logistical personnel who work in all MSF projects, bringing a variety of skills and supplies that might not be available locally. Importantly, international staff presence also helps to anchor MSF’s core mandate of impartiality and neutrality in conflict zones.
But it is imperative to understand that 90 per cent of MSF’s staff members are from local areas. They are either directly employed by MSF or are local Ministry of Health staff who work collaboratively with MSF. It is their country, and they work to assist their own people in every area, from patient care and logistics, to supply and transport. They are there before international staff arrive and still there after we leave. They are the heart of MSF’s humanitarian action.
- ‘There’s not a single Muslim left’: An MSF worker in Central African Republic on why his family had to flee
Stories of national workers are not often told — and when it comes to CAR, neither are there many stories that offer reasons for hope. In North American and European media, we’re much more likely to hear of horrors and atrocities, if we hear anything at all. We need to know about these dramatic events, and must not turn a blind eye — but they are not the whole picture.
But when it comes to my national staff colleagues in CAR — and my promise to remember —what stories should I tell?
Ausbert — pictured above centre alongside Canadian nurse Amy Nyland (right) and his fellow sécouriste Séraphine (left) — sought to improve his training so as to help better care for MSF patients in Bossangoa.
Ausbert, a sécouriste seeking to learn more
Should I speak of Ausbert, who works as a sécouriste at the hospital, providing crucial direct care to our patients — who told me with shy pride of starting construction on his first home? (This is an optimistic act in a country where the burning and looting of homes by militias occurs with disturbing frequency.) Ausbert made an impression on me in the early days of my posting when he asked me with great courtesy whether he could receive some more training for the work that he was doing at the hospital. He had already learned basic skills during earlier crisis events, and had a small amount of first aid training. He hoped to do more.
Ausbert’s background was similar to that of the vast majority of MSF’s direct care workers in Bossangoa: He had little or no formal health education, but a great desire to change that. Training was indeed offered at various times, frequently by MSF national staff doctors, nurses and lab technicians. Attendance at presentations tended to be excellent, and it wasn’t unusual for staff to come in on their days off for these sessions. People were often so eager to be there that I had to check and make sure we still had staff on the wards! I was touched by this enthusiasm. I remember looking across the benches at one point to see that a worker had found an empty cardboard carton which she had torn up to use as paper for notetaking. Even in the absence of material resources, many staff would find a way to learn.
Michel, a cleaner who goes above and beyond
I could perhaps also speak of Michel, the young hospital cleaner who I first met while he was wielding a mop in the outpatient department with a vigour that is rarely seen. I let him know that his hard work was noticed, and when I passed by a few hours later saw that he had found an extension for his broom and was going after the clinic rafters. I thanked him for his enthusiasm but suggested that perhaps that should wait for later when there weren’t any patients sitting underneath! (He laughed and agreed.) He eventually became an exceptional worker in the ICU area, constantly on the move and looking out for cleaning needs. One of my last memories of Michel was realizing that he had stayed on without being asked for many hours past the end of his work shift, in order to help the victims of a major road accident. He wasn’t alone that night. Many stayed on and many turned up once they heard what was happening.
Louise, a proud mother
Then there was Louise, one of the senior sécouristes who shared with me that her eldest daughter was about to graduate from university in the capital (the first in her family to do so). I knew that most of Louise’s family lived in the capital. (This was true of many staff — people will travel long distances and live apart from loved ones if there is work to be had). Louise almost didn’t make it to her daughter’s graduation. Why? The road to the capital wasn’t safe to travel due to militia roadblocks and violent attacks. She did make it there and back though, and wore a huge smile when she returned to work a few days later.
Prudence, far right, with her fellow sanitation educators at the hospital. "They treated our patient with dignity and respect, kept an eye out for her, let the nurses and doctors know if they were worried about something, and organized for practical needs like food and laundry."
Prudence, an educator who set an example on caring for others
So many local staff in quiet moments told me about their families, their dreams for their children, and their hopes for the future in their battered, but remarkably beautiful country. I could share a hundred stories. I will share one more.
Prudence is a young and extraordinarily beautiful woman who works at a CAR Ministry of Health Hospital where MSF is present to offer support. I first met her when she was wearing a less than glamorous pair of coveralls and long red rubber gloves, the uniform of the hospital cleaners. She was speaking animatedly in Sango (a local language) to a group of mothers and children waiting at the hospital’s outpatient department, and once she finished and went to pick up her equipment, I asked her what she had said. Prudence had been telling the mothers why it was so important to use the toilets, because often people coming from outlying villages had not seen a latrine before arrival the hospital, and why hand-washing afterwards mattered. She then gave me a brilliant smile and strode off to continue her cleaning work.
It made an impression, and when I had the chance a few months later to suggest potential people for the post of a sanitation educator, she was an obvious candidate. She was hired, and became part of a growing health and sanitation education team that roamed all over the hospital sharing important messages. Her oratorical skills, combined with her great beauty, were very real assets in capturing people’s attention. I actually heard applause once after she spoke.
Suddenly Prudence was with me. She spoke quietly in Sango to the patient, and didn’t flinch when the woman approached her, took her hand and began to sing and dance.
Her true beauty shone through for me shortly before I left CAR to return to Canada. I had rushed over to a conflict between two women in the hospital compound, one brandishing a large stick and threatening the other. It was quickly apparent that the second woman was suffering from some sort of mental illness and was in obvious distress. Apart from her mental state, the patient had several visible half-healed burn wounds, and was dressed in wet, filthy and torn-up clothes. The woman with the stick (along with a crowd that had gathered around) were laughing and threatening the woman who was clearly ill. I radioed for medical assistance and asked the crowd to disperse, but nothing really shifted.
Suddenly Prudence was with me. She spoke quietly in Sango to the patient, and didn’t flinch when the woman approached her, took her hand and began to sing and dance. Others watching laughed at this, but Prudence smiled kindly and simply danced. Soon after, the doctor arrived and together we all moved to a more sheltered area. The crowd gradually lost interest and disappeared. Prudence and several hospital cleaners stayed with the doctor and myself, translating, finding out our patient’s name, and figuring out how she had come to be at the hospital.
Over the next few hours and days we all worked together to stabilize this patient. Medications, dressings, a wash and a clean set of clothes were organized. I watched as some semblance of family and community was built for and around her. Prudence and the other health educators took the lead on this, along with the cleaners. They treated our patient with dignity and respect, kept an eye out for her, let the nurses and doctors know if they were worried about something, and organized for practical needs like food and laundry. The community of care expanded rapidly and soon many staff on the hospital had taken on similar attitudes.
Benithe, a sécouriste who works with MSF in Bossangoa, shows Amy her new baby Issa-Edo — a name Benithe and her husband Issa asked Amy to help provide for their boy. "I eventually gave them the name of my Dad (Edo), who passed away several years ago," said Amy. "I think he would have loved knowing that his name would carry on this way!"
'Are they safe? Are they happy?
I’d like to say there was a happy ending. The truth is that I don’t know. There were complicating factors even while I was there, and the likelihood of a positive outcome in the long term wasn’t obvious.
I’m now back in Canada, and I often think of many patients and colleagues in CAR. What are they living now? Do they have what they need to continue their work? Are they safe? Are they happy? Will they have a chance to develop to their full potential?
While I don’t know how so many things unfolded, I do hold onto a small and beautiful moment from that first evening with Prudence and our patient, who was by then calm and clean, wearing her new clothes. Beside her, Prudence picked up a colorful scarf that another local worker had found for her, beginning to wrap it for her in the fashionable style of the local women. Our patient reached up to touch both the wrap and the elegant hands moving gently over her head. Both women smiled.