World Health Day

Professor Nestor Mamadou Nali: "Medicine is a lifelong religion; it is a calling."

Heroes for health in the Central African Republic

A Fellow of the Royal College of Surgeons of Canada, Professor Nali is head surgeon at Bangui's Hôpital de l’Amitié. Formerly Dean of the Medical School and rector of the university, Professor Nali was the CAR’s Minister of Health from March 2003 to June 2005.

Professor Nestor Mamadou Nali

Professor Nali had a comprehensive agenda to rebuild the country's collapsed health system. This included setting up regional pharmaceutical depots, allocating material in community health centres and launching the National Sanitation Programme to provide new norms and standards for best practices.

"Efficiency, accountability and transparency of governance are key to progress. But above all, health systems rebuilding has to start with caring for the health workforce," declares the Professor.

"Many have died, retired or left and have not been replaced. The current lack in human resources is appalling: some trained personnel are there, but remain unemployed. As a result, most of the paramedics end up working in a different field, often completely unrelated to health, and lose all their training in a matter of months."

When he was the Minister, Professor Nali had 15 physicians integrated in the state health system. He says there now are about 700 paramedics and about 25 fully trained physicians who have not been integrated into the system: the state's financial situation does not allow it.

This waste of trained health professionals – a scarce resource in the country - is one of the major difficulties facing the CAR today, says Professor Nali, who dreams of a universal health care system for his country.

His presence at the front-lines during the Bangui massacres of 2002 has left its mark on Professor Nali's political action: in government, he and Mme Doumta spoke in unison in support of the victims of violence, particularly through championing Bernadette Sayo's OCODEFAD.

Boeing in lethal waters

Man-made chaos is compounded with natural disasters in the CAR, where floods often occur, as in August 2005. It took the army six weeks to start relief operations in Boeing, a suburb of Bangui, next to the airport. For two days, thousands of people lined up to get access to the only medical tent and its malaria medication. There were also cases of hepatitis, typhoid and yellow fever.

A local Red Cross volunteer speaks out: "People are suffering - particularly children under 5 and pregnant women, and the situation is getting worse with the water pollution, which is due to flood waters overflowing latrines and uncovering shallow graves." For weeks, all of the urgent assistance operations were carried out unaided by volunteer health workers.

The "events" of 25 October 2002, as seen by Professor Nali

"It was 1 p.m. and I was in the middle of an operation when the soldiers broke into the hospital and the Operating Room. I was to be stuck there for six days. During that time I had no idea what my family was enduring – I had no contact with them. A tidal wave of patients overcame us very quickly, particularly [those with] bullet wounds. I was in the operating theatre non-stop for those six days, except for a couple of calm spots when I managed to catch some sleep and have a bite to eat. Never had I endured these kinds of work conditions."