COTE D'IVOIRE: AIDS services still suspended by conflict

BOUAKE, 28 April 2008 (PlusNews) - War has left its mark on Bouake, Cote d'Ivoire's second largest town and the stronghold of the New Forces rebels, about 300km north of the port city of Abidjan. Many public buildings are empty and dilapidated, roads are in disrepair and carry few vehicles.

The university hospital centre (CHU) in Bouake did not escape attack. Some
buildings still bear scars from the conflict, which tore across the country in the wake of armed insurrection against the government in September 2002.

"CHU was ransacked during the attacks," Professor Yapo Félix Boa, CHU's
director-general, told IRIN/PlusNews. "Most of the supplies were also looted, and apart from a Medecins Sans Frontieres (MSF) unit [the international medical relief agency] that was still running, CHU was no longer able to operate."

More than four and a half years after the political crisis that split Cote d'Ivoire in two started, the situation is far from resolved. The Ouagadougou agreement, signed in March 2007 between Laurent Gbagdo, Cote d'Ivoire's president, and the ex-rebel leader, Guillaume Soro, should have marked the resumption of state administration in areas under rebel control, but many services, including HIV/AIDS services, are still unavailable.

"CHU is working at a slow pace: the gynaecology, surgical and children's units, and the emergency services ... are all operating at a minimum level, and some [units], such as radiology, are not operating at all," said Boa. "Most of the buildings, which have been left abandoned all these years, need to be repaired."

Most of the administrative and health workers employed at the hospital took refuge in the south of the country, which remained under government control, and many are still reluctant to return.

Others have returned and then left again, either because their families stayed in the southern half of the country or because their employee accommodation was illegally occupied.

Boa noted that some of the hospital's administrative services, such as the finance department, were still located in Abidjan, meaning that hospital officials have to travel between the two towns, a round trip of 600km.

Staff shortages

Like many state institutions, CHU is experiencing a severe staff shortage. CHU officials have estimated that about 70 nurses are needed for the hospital to function properly, but less than half that number struggle to deal with urgent medical issues. Routine consultations had yet to start up again, said Prof N'Dri N'Guessan, CHU's medical director.

There is no need to dramatise the security issue ... We are here and we can work

According to data compiled by UN agencies, of the 729 nurses working in the central, northern and eastern regions of the country before the crisis, only 440 were left by the end of 2007.

The university hospital centre in Abidjan is providing care for people living with HIV and prescribing antiretrovirals (ARV), but the centre in Bouake is unable to offer these services. "We already have a shortage of staff; we can't assign doctors or nurses [to HIV/AIDS issues]," N'Guessan said.

"We have been delayed by the war," Bao agreed, who said he hoped to reintroduce these services once CHU had "found its feet". N'Guessan said, "We have organised training sessions for doctors in CNO areas [central, northern and eastern areas under control of the former rebels] on HIV care, and one pharmacist has already been trained."

Only one laboratory in Bouake is processing HIV tests for 40 patients a week, and there are hundreds of patients on the waiting list.

A ministry devoted to the fight against HIV/AIDS is based in Abidjan, but does not have representation all of the country's 19 administrative regions. The process of recruiting new doctors from a pool of 1,200 applicants has begun, according to Dr Massagnon Soro, the ministry's inspector general.

Most of the applicants are young practitioners who have completed their HIV/AIDS training. "They are ready to go and take on the challenge," she told IRIN/PlusNews.

A humanitarian worker, who preferred to remain anonymous, noted that even those public sector health workers who had received HIV/AIDS training often came up against interruptions in the supply of HIV testing kits and antiretroviral drugs, and were forced to suspend services.

While the hospital in Bouake awaits improvements, they make do with treating
opportunistic illnesses linked to HIV infection, and referring HIV-positive patients to treatment centres run by non-governmental organisations (NGOs).

Through partnerships with UN agencies and NGOs, the hospital is able to provide an emergency course of post-exposure prophylaxis antiretrovirals to victims of sexual violence, to limit their risk of HIV infection.

More needs to be done and at a faster pace, but CHU officials refuse to view the crisis as insurmountable. "There is no need to dramatise the security issue," said N'Guessan. "We are here and we can work."

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Theme (s): Care/Treatment - PlusNews, Conflict, Prevention - PlusNews,

[This report does not necessarily reflect the views of the United Nations]