Cynthia, 26, a patient with HIV, tuberculosis, and Kaposi's sarcoma, is treated at MSF's HIV clinic in the Hôpital Communautaire, Central African Republic. © Alexis Huguet
Cynthia Dounkel, 26 years old, was referred to Hôpital Communautaire from MSF's clinic in the displacement camp Mpoko near Bangui airport. She has HIV and tuberculosis and suffers from Kaposi's sarcoma.
"My illness started with nausea, fever, headaches and pain in my legs. That’s why they brought me here. I don’t have money for medical treatment so I did not look for help for a long time. When I was admitted a month ago, they told me I was HIV positive and that I have tuberculosis.
Since 2013 I live in Mpoko camp. My father died when I was little. My husband and I separated a while ago – before I got sick. I have a little daughter who is 3 years old. I don’t have the means to get enough to eat. My mother and my brother are also hospitalized. I don’t have anybody who could take care of me.
I’m taking treatment now for tuberculosis. They say I should wait a bit before I start the treatment for HIV.
I feel a slight change. But I still have a lot of pain, especially in the stomach, and I am constantly tired. I don’t know how long I am going to stay in the hospital and what will happen afterwards. Sometimes I get very desperate. When I brood over it too much my family tells me to not worry and to always pray. I put my life into the hands of God."
Faustin, 34, a patient with HIV and tuberculosis, is treated in MSF's HIV clinic in the Hôpital Communautaire, Central African Republic. © Alexis Huguet
Faustin*, 34 years old, and his wife Olga have three children together. Faustin was transferred from MSF’s clinic in Mpoko displacement camp in the Central African Republic to Hôpital Communautaire. The couple are both HIV positive, while Faustin also suffers from extra-pulmonary tuberculosis which is not detected in the sputum.
"I have many professions. I used to be a driver but in my last job before falling ill, I was a guard. As I worked at night, I had malaria many times. Each time, I had very high fever with temperatures of over 40 degrees. I treated the illness each time in vain. One day I went to the pediatric hospital in Bangui to have my lungs x-rayed. They also tested my sputum. Three days later I got the results: The sputum was negative but there where spots on my lungs.
One Sunday my wife wanted to go to church but in the end stayed at home. If she had left that day, I would have died. While snoozing, I started shaking and couldn’t breathe. My wife called a taxi and brought me to the MSF clinic in Mpoko camp. They found out that I was severely anemic and I received a large blood transfusion. Then they transferred me to the Hôpital Communitaire. Here they extracted three liters of pus from my lungs, and they will repeat this today."
Olga, his wife, chimes in: "I had felt pain for a while and as his brother worked in the hospital, he asked me if I was scared to get tested for HIV. I said no and Faustin and I, we went to together and both received a positive test result. Since 2016 we have been on ARVs and we’ve been three times already to collect our medication."
Faustin continues: "It is important to respect the meetings with the doctor who prescribes your medication and to come on that day. He is your God on earth. If I was in another medical institution not with MSF, I would have to pay and would risk getting into debt."
*Faustin and Olga’s surnames are withheld.
MSF has been working in CAR since 1997. The Bangui project, in collaboration with the public establishment Hôpital Communautaire, started in March 2016 and, as of July 2016, is offering HIV and TB treatment to around 100 people a month. In MSF-supported facilities countrywide, some 4,813 patients are on antiretrovirals, about 19% of the national cohort, including in prefectures with the highest HIV prevalence. Patients are offered diagnosis, treatment and adherence support free of charge. Provision of HIV services in CAR is challenging, with recurrent bouts of violence further compounding an already fragile health system.