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| The Doctor Who Stayed Behind to Save Babies in His Long-Suffering Homeland | The Doctor Who Stayed Behind to Save Babies in His Long-Suffering Homeland |
| (about 7 hours later) | |
| BANGUI, Central African Republic — Dr. Jean Chrysostome Gody bounds down a stench-filled hallway in the Central African Republic’s only pediatric hospital, his daily soundtrack the high-pitched crying of dozens of babies in the malnutrition wing. | BANGUI, Central African Republic — Dr. Jean Chrysostome Gody bounds down a stench-filled hallway in the Central African Republic’s only pediatric hospital, his daily soundtrack the high-pitched crying of dozens of babies in the malnutrition wing. |
| The sickest of infants lie silent and listless. One baby’s skin is gray and splotchy. A nurse pokes at his head to make sure he’s still alive. | The sickest of infants lie silent and listless. One baby’s skin is gray and splotchy. A nurse pokes at his head to make sure he’s still alive. |
| Yet amid all the suffering, Dr. Gody offers something rarely heard in this conflict-plagued country: optimism. | Yet amid all the suffering, Dr. Gody offers something rarely heard in this conflict-plagued country: optimism. |
| The hospital is no longer filled with children suffering from gunshot wounds and missing limbs from bomb blasts. A fragile calm has settled over Bangui, the capital of the Central African Republic, where the government recently signed a peace accord with rebel groups it had been battling for years. The agreement seems to be holding for now, despite an apparently isolated attack in the countryside in May that killed more than two dozen people. | The hospital is no longer filled with children suffering from gunshot wounds and missing limbs from bomb blasts. A fragile calm has settled over Bangui, the capital of the Central African Republic, where the government recently signed a peace accord with rebel groups it had been battling for years. The agreement seems to be holding for now, despite an apparently isolated attack in the countryside in May that killed more than two dozen people. |
| In May, Dr. Gody congratulated the first-ever class of pediatricians to graduate from the country’s only medical school. The hospital has just opened a new multimillion dollar malnutrition wing, doubling the number of beds and offering clean rooms with fresh paint and new mosquito nets. More patients than ever are coming through the doors — a sign not that more children are sick, Dr. Gody said, but rather that word finally is spreading that treatment there is free. | In May, Dr. Gody congratulated the first-ever class of pediatricians to graduate from the country’s only medical school. The hospital has just opened a new multimillion dollar malnutrition wing, doubling the number of beds and offering clean rooms with fresh paint and new mosquito nets. More patients than ever are coming through the doors — a sign not that more children are sick, Dr. Gody said, but rather that word finally is spreading that treatment there is free. |
| “It is not the time and place to be pessimistic,” said Dr. Gody, director of the Bangui Pediatric Hospital for the past 16 years. | “It is not the time and place to be pessimistic,” said Dr. Gody, director of the Bangui Pediatric Hospital for the past 16 years. |
| Nearly seven years ago, Muslim rebels fed up with a lack of government services in rural areas — basics like schools, roads and hospitals — invaded the capital and clashed with Christian militias in fighting that slid toward genocide, the United Nations said at the time. Armed groups have been battling over turf ever since in this mineral-rich nation, which has suffered regular upheavals since independence from France in 1960. | |
| The conflicts have left this country, with its lush forests and butterflies flitting about, in absolute tatters. | The conflicts have left this country, with its lush forests and butterflies flitting about, in absolute tatters. |
| Most of Bangui, situated along the banks of the wide Ubangi River, hasn’t had running water for more than a year. At night people spill into the streets in search of water, lugging empty yellow jerrycans on bikes and motorcycles. Men strip naked and lather up in the gutter, where runoff flows from the country’s only water treatment plant. | Most of Bangui, situated along the banks of the wide Ubangi River, hasn’t had running water for more than a year. At night people spill into the streets in search of water, lugging empty yellow jerrycans on bikes and motorcycles. Men strip naked and lather up in the gutter, where runoff flows from the country’s only water treatment plant. |
| Electricity is also in short supply in Bangui. Planes can’t land at night because the main airport has no lights. | Electricity is also in short supply in Bangui. Planes can’t land at night because the main airport has no lights. |
| The state of the country, which ranks second to last of 189 countries in the United Nations’ Human Development Index, is especially hard on children. Many have been recruited into the war. | The state of the country, which ranks second to last of 189 countries in the United Nations’ Human Development Index, is especially hard on children. Many have been recruited into the war. |
| “And here are our child soldiers,” the chief of staff for one local warlord who calls himself “Force” chirped on a tour of his militia’s compound in Bangui. He pointed to two frowning 15-year-old boys with AK-47s slung over their shoulders. | “And here are our child soldiers,” the chief of staff for one local warlord who calls himself “Force” chirped on a tour of his militia’s compound in Bangui. He pointed to two frowning 15-year-old boys with AK-47s slung over their shoulders. |
| Infant mortality rates here are some of the highest on earth; one in five children won’t live to see their fifth birthday. Malnutrition rates are rising. | Infant mortality rates here are some of the highest on earth; one in five children won’t live to see their fifth birthday. Malnutrition rates are rising. |
| Forty percent of the nation’s health budget is supported by international funds, said Dr. Pierre Somse, who is minister of health. Government revenue supports just 20 percent, and the rest comes from patient fees in a nation where few can afford them. | Forty percent of the nation’s health budget is supported by international funds, said Dr. Pierre Somse, who is minister of health. Government revenue supports just 20 percent, and the rest comes from patient fees in a nation where few can afford them. |
| If peace holds, people will flow back to their homes, Dr. Somse said, and such gatherings can launch disease outbreaks, especially for babies who went without vaccinations while their families were in hiding. One region suffered a measles outbreak in April. | If peace holds, people will flow back to their homes, Dr. Somse said, and such gatherings can launch disease outbreaks, especially for babies who went without vaccinations while their families were in hiding. One region suffered a measles outbreak in April. |
| “It will get worse before it gets better,” Dr. Somse said. | “It will get worse before it gets better,” Dr. Somse said. |
| But the country has made progress. | But the country has made progress. |
| A vaccination program that required cooperation from militias has succeeded in immunizing 74 percent of children, Dr. Somse said. And a new program has been created to offer free care to pregnant mothers and children under 5, based on Dr. Gody’s model at the pediatric hospital. | A vaccination program that required cooperation from militias has succeeded in immunizing 74 percent of children, Dr. Somse said. And a new program has been created to offer free care to pregnant mothers and children under 5, based on Dr. Gody’s model at the pediatric hospital. |
| Dr. Gody already has executed the first step in his plan to revive health care: He stayed. | Dr. Gody already has executed the first step in his plan to revive health care: He stayed. |
| Doctors who graduate from the University of Bangui’s medical school must go abroad to complete their specialty degrees. Most never come home. Dr. Gody, who is 60, thought about doing the same when he was in Ivory Coast completing his degree. Shame overtook him for even considering the notion. | Doctors who graduate from the University of Bangui’s medical school must go abroad to complete their specialty degrees. Most never come home. Dr. Gody, who is 60, thought about doing the same when he was in Ivory Coast completing his degree. Shame overtook him for even considering the notion. |
| “For a doctor — a real doctor,” he said, “should we flee the people who are suffering?” | “For a doctor — a real doctor,” he said, “should we flee the people who are suffering?” |
| “I could have waited for everything to be fixed here and come back but how could I look them all in the eye?” he said. | “I could have waited for everything to be fixed here and come back but how could I look them all in the eye?” he said. |
| One of Dr. Gody’s professors in Ivory Coast had created more specialty degree programs at a university there to encourage students to stay. Dr. Gody decided to do the same with pediatrics in Bangui, and designed the program at the medical school. | One of Dr. Gody’s professors in Ivory Coast had created more specialty degree programs at a university there to encourage students to stay. Dr. Gody decided to do the same with pediatrics in Bangui, and designed the program at the medical school. |
| This May’s graduating class will more than double the number of Central African pediatricians in the country, to a total of eight. Ten more are in training. | This May’s graduating class will more than double the number of Central African pediatricians in the country, to a total of eight. Ten more are in training. |
| To boost the ranks, Dr. Gody has helped lure health professionals from global organizations to Bangui. Unicef provides support, and after Pope Francis visited the hospital in 2015, the Vatican announced a donation to help pay for the new malnutrition wing. | To boost the ranks, Dr. Gody has helped lure health professionals from global organizations to Bangui. Unicef provides support, and after Pope Francis visited the hospital in 2015, the Vatican announced a donation to help pay for the new malnutrition wing. |
| The pediatric hospital treated 72,000 children last year and admitted 18,000 of them. The old critical care malnutrition unit was so full that two babies, along with their mothers, all shared a single bed. Many of the children’s conditions are complicated by malaria, H.I.V. or other illnesses. | The pediatric hospital treated 72,000 children last year and admitted 18,000 of them. The old critical care malnutrition unit was so full that two babies, along with their mothers, all shared a single bed. Many of the children’s conditions are complicated by malaria, H.I.V. or other illnesses. |
| One 10-month-old boy, Fils Banga, lay on his back on a recent afternoon, his vacant stare broken only by his eyes rolling back in his head. Not even 13 pounds, he suffered from sepsis and malnutrition, and his body was in shock. | One 10-month-old boy, Fils Banga, lay on his back on a recent afternoon, his vacant stare broken only by his eyes rolling back in his head. Not even 13 pounds, he suffered from sepsis and malnutrition, and his body was in shock. |
| His parents sat on the edge of his bed, holding his tiny hand and rubbing moisturizer on his chapped lips as he gasped for air. A day later, the boy died. | His parents sat on the edge of his bed, holding his tiny hand and rubbing moisturizer on his chapped lips as he gasped for air. A day later, the boy died. |
| Another child, Esther Magnon, a severely underweight 19-month-old with tiny curls pressed against her head, lay still on her side. | Another child, Esther Magnon, a severely underweight 19-month-old with tiny curls pressed against her head, lay still on her side. |
| “I’ve lost hope,” said her mother, Larissa Korozon, 26, who sat at her bedside and pressed her eyes against the palms of her hands. | “I’ve lost hope,” said her mother, Larissa Korozon, 26, who sat at her bedside and pressed her eyes against the palms of her hands. |
| But a week later, Esther had been moved out of critical care. She was alert, smacking her mother on the head and cooing. | |
| “Today she ate spaghetti,” Ms. Korozon said, allowing herself a cautious smile. | “Today she ate spaghetti,” Ms. Korozon said, allowing herself a cautious smile. |
| Overall, administrators say, the hospital’s mortality rate has declined from 14 percent in the early 2000s to nine percent now. | Overall, administrators say, the hospital’s mortality rate has declined from 14 percent in the early 2000s to nine percent now. |
| Dr. Gody wants to replicate the hospital throughout the countryside. Doctors Without Borders operates a hospital in the capital and several clinics in rural areas, but only 35 local health centers exist in 230,000 square miles of territory. | Dr. Gody wants to replicate the hospital throughout the countryside. Doctors Without Borders operates a hospital in the capital and several clinics in rural areas, but only 35 local health centers exist in 230,000 square miles of territory. |
| One of them is in Bakala, far outside the capital, across a muddy river and past a sprawling camp for people who fled their homes because of violence. The barren clinic serves 12,000 people. It has no electricity and no doctor. The workers in charge include a nurse’s aide, one person who took a first aid course and a self-taught midwife. | One of them is in Bakala, far outside the capital, across a muddy river and past a sprawling camp for people who fled their homes because of violence. The barren clinic serves 12,000 people. It has no electricity and no doctor. The workers in charge include a nurse’s aide, one person who took a first aid course and a self-taught midwife. |
| The clinic has no water supply. A nearby well became unusable a year-and-a-half ago after 10 corpses were dumped inside during a battle between militias. A worker travels by bicycle to the river to get water, sometimes three times a day, depending on the patient load. | The clinic has no water supply. A nearby well became unusable a year-and-a-half ago after 10 corpses were dumped inside during a battle between militias. A worker travels by bicycle to the river to get water, sometimes three times a day, depending on the patient load. |
| Patients, including women in labor, who suffer complications must board a motorbike and travel across bumpy dirt roads for four hours to a clinic with better care, said Mathias Danga, deputy director of the center. | Patients, including women in labor, who suffer complications must board a motorbike and travel across bumpy dirt roads for four hours to a clinic with better care, said Mathias Danga, deputy director of the center. |
| Dr. Gody knows it will be challenging to staff clinics like the one in Bakala. He can promise doctors financial incentives to move there, but even getting paychecks to them is a problem. Most areas have no banks, and round-trip travel by taxi to Bangui from places like Bakala costs almost two months’ salary. | Dr. Gody knows it will be challenging to staff clinics like the one in Bakala. He can promise doctors financial incentives to move there, but even getting paychecks to them is a problem. Most areas have no banks, and round-trip travel by taxi to Bangui from places like Bakala costs almost two months’ salary. |
| And how will he convince doctors to bring their families to rural areas, Dr. Gody wonders, when schools don’t exist and threats from militants abound? Yet children in far-flung areas need special care. Dr. Gody is working on creating a special pediatric certificate at the university so general practitioners can get training. | And how will he convince doctors to bring their families to rural areas, Dr. Gody wonders, when schools don’t exist and threats from militants abound? Yet children in far-flung areas need special care. Dr. Gody is working on creating a special pediatric certificate at the university so general practitioners can get training. |
| “It takes a lot of courage,” Dr. Gody said. “Look at all the challenges, all the money needed, all the insecurity.” | “It takes a lot of courage,” Dr. Gody said. “Look at all the challenges, all the money needed, all the insecurity.” |
| Dr. Gody is confident he can overcome it all. His biggest worry is nine years away. In 2028, he will retire. And so far no one qualified has stepped up to say they will replace him. | Dr. Gody is confident he can overcome it all. His biggest worry is nine years away. In 2028, he will retire. And so far no one qualified has stepped up to say they will replace him. |