- Alphonsine Colombe Irahali is a Rwandan doctor stationed in Bayanga, a remote outpost near Dzanga-Sangha National Park in the Central African Republic.
- Her daily routine consists of traveling from village to village to provide care to communities that rarely have access to it.
- She says she fully embraces her calling as a doctor in communities that are virtually excluded from the formal health care system, with very positive results.
- Through mobile clinics, her team conducts tuberculosis and HIV screenings, raises awareness among the population and encourages vaccination, thereby helping to improve the health conditions of the people living around the protected area.
BAYANGA, Central African Republic — Before the consultations, screenings and discreet discussions about disease, a makeshift enclosure is set up in the middle of the village, where residents gradually gather to the sound of music playing — at first they are curious, then attentive. Here, in the heart of the forests of southwestern Central African Republic, Alphonsine Colombe Irahali, a Rwandan medical doctor, spends much of her time traveling from village to village to provide care to communities that rarely have access to it.
“What we do is go from village to village to make a significant impact,” she told Mongabay during a recent mobile clinic mission. “In the morning, when we arrive, we start by playing music. Then we raise awareness: What signs to watch for? When to go to the hospital? What to expect?”
At 36, Irahali could have chosen a different path. Many medical practitioners across Africa are drawn to cities or leave the continent in search of better pay and working conditions. But Irahali chose instead to work in Bayanga, a remote post near Dzanga-Sangha National Park, where the dense forest meets a fragile health care system, and where access to basic care is difficult.
Irahali said she applied for the position at least three times before she was finally selected.
“I am committed to caring for underserved communities,” she said. “I believe this work is in line with my oath.” For her, it was a conscious choice, as she seized the opportunity to work in the Central African Republic when it arose.
Mobile clinics
In Bayanga, the needs are immediate and visible. The region is home to both Ba’aka Indigenous communities and the Bilo, a non-Indigenous population. Many live far from health facilities. Some prefer traditional medicine. Others only make it to the hospital when their condition is already critical.
“Indigenous communities generally don’t come to us, which is why we go to them,” she explains.
Through mobile clinics, her team conducts tuberculosis and HIV screenings, raises awareness among the population and encourages vaccination. She works closely with the local hospital and coordinates data with the health ministry. But despite these efforts, many problems remain.
“We don’t vaccinate on-site; we encourage mothers to come to the hospital,” she said. “The first vaccine is for tuberculosis. Indigenous communities generally don’t come to us, so we go to them.”
Good and bad stories
Access isn’t the only challenge. Resources are limited. “Sometimes we can’t treat them because we don’t have the medications,” she said. “We have to order them.”
Equipment is also lacking. Without basic tools like an X-ray machine or specialized equipment, certain diagnoses and treatments become extremely difficult. For patients coming from remote villages, delays can be fatal.
“Children are still dying of malaria because of anemia,” she explained. “Often, because they arrive at the hospital too late.”
The work leaves its mark, both pleasant and painful. Some days, she said, everything seems possible — a patient recovers, a child gets better, the community trusts us [health care workers]. And then there are the other days, the ones that linger long after the care is provided.
“I have good and bad stories,” she said. She recalled a recent case in which a mother and her child were brought in for treatment. The team managed to stabilize the child. But the mother, who didn’t initially seem seriously ill, died.
“We saved the child,” she said. “But the mother … that was hard.”
Moments like these affect not only the patients but also the staff. In an environment without psychologists or support systems, caregivers often bear this burden alone.
“Watching patients die isn’t easy,” she said. “You have to keep working, even when people have lost their motivation.”
And yet, there are also moments that remind her why she still stays to do this work.
She recalls the case of a patient attacked by a gorilla — a rare but serious situation in a region where humans and wildlife coexist. The injuries were severe, and treatment required improvising with the resources available.
“We had to manage the infection, the wound and the vaccinations,” she said. “We gave antibiotics, cleaned the wound, administered a tetanus booster and a rabies vaccine.”
The patient has recovered. “He’s doing better. He can walk,” she said.
For Irahali, it is the most challenging cases that give her work its meaning. “What really gives me hope are the difficult cases,” she said.
In step with the imperatives
Her work in Bayanga is partly supported by the World Wildlife Fund (WWF), which operates in the Dzanga-Sangha landscape alongside the Central African government. The health program, carried out in collaboration with the health ministry, aims to improve health conditions for people living around and within the protected area.
For park officials, the link between health and conservation is significant. Providing basic services, they explain, helps build trust between communities and conservation stakeholders in a region where this relationship has not always been straightforward.
But for Irahali, the motivation is above all personal. Since her arrival, she said, progress is visible. More and more people are willing to seek medical care. Communities are beginning to report critical cases. Trust is being built, slowly.
“It’s like walking hand in hand,” she said. “We’ve done a lot, but there’s still a lot to do.”
Her journey is far from over. Alongside her fieldwork, she is pursuing a master’s degree in international health, with a focus on health systems and improving care in low-resource settings. She hopes to go further — perhaps even earn a Ph.D. — and contribute to broader reforms beyond Bayanga.
“We can work here,” she said, “but elsewhere, someone is facing the same challenges.”
For now, however, her work remains rooted in the forest communities of southwestern Central African Republic, punctuated by mornings in the field, mobile clinics, inspiring music and the quiet perseverance required to deliver care in a place where it is never guaranteed.
Rhett A. Butler contributed to this article.
This article was first published here on April 1 in French.
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