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February 27, 2015

Pediatrician shares experience working in medically underserved regions of the globe

The Central African Republic (CAR) has a population of roughly five million people, yet there are fewer than 300 doctors in the entire country. Yolaine Civil has been working to address this health-care deficiency with Doctors Without Borders/Medécins Sans Frontières (MSF) since 2012. Civil spoke at the UChicago Medical Center on Thursday about her experience as a pediatric physician in the CAR. The event was co-sponsored by the Department of Pediatrics and the Institute of Politics.

Civil, an adjunct clinical instructor in pediatrics for the University of Michigan Health System, has gone on four trips with MSF. She traveled to Guinea in 2012, where she oversaw a cholera vaccination program. Shortly after, she worked as a supervisor in Chad at a hospital that cared for malnourished children.

MSF responds to medical crises in developing countries born from violence, natural disasters, and outbreaks of disease. Its presence in CAR has doubled since the outbreak of civil conflict in 2013, when a Muslim rebel group overthrew the government. There has since been tension and fighting between Christian and Muslim forces.

MSF faces the constant threat of violence, which is not expected to end soon. However, MSF plans to maintain its strong presence in the CAR. “The problem of pulling out is if you pull out, the people have nothing,” Civil said.

Civil’s first trip to the CAR in 2013 restarted medical activities in a hospital in Bossangoa after militants destroyed it. “This mission was my most challenging out of all of the four because we didn’t have the usual resources that we would have available for an emergency project,” Civil said. “The MSF office in Bangui had been looted and robbed three weeks earlier and they stole cars, money, and medical equipment.”

When MSF finally established its presence in the hospital, people began to emerge from villages to seek help. Civil primarily treated malnourished children and pregnant women. She also encountered many AIDS and tuberculosis patients, another effect of political unrest. The former government of the CAR had a program providing people with free AIDS and TB treatment, but the program disappeared with the government.

The purpose of Civil’s second  trip to the CAR was to provide health care to Muslim victims of violence. However, she saw little violence and instead treated high numbers of maternity and neonatal patients. Civil reorganized an entire hospital and instituted two newborn rooms and a basic neonatal intensive care unit.

Civil recalled some of the struggles she faced working in a foreign country with high risk. “The living conditions can be really variable when you’re in the field. When you’re on an emergency project, like CAR, or Guinea, the living conditions are pretty basic. We had a latrine, and really basic sleeping quarters. And we had an outdoor shower with a bucket. The working conditions are also stressful. There are long hours, high patient volumes, and high mortality rates,” she said.

One of her greatest struggles was readjusting to life in the U.S. She emphasized the importance of focusing on the positive aspects of the mission, such as helping people in a very tangible way. She closed her presentation by telling an audience full of medical students: “You can make a difference in the lives of children and families in critical conditions.”

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