Each morning, Marie Noella Kango walks over to the local clinic here and takes her spot behind the main desk by 8 a.m. Often, mothers and their children are already waiting in a line outside. One by one, the mothers meet with Ms. Kango and describe their children’s symptoms: fever, diarrhea, vomiting and stomach pains. These are all symptoms Ms. Kango can easily diagnose as malaria or parasites, the two most common ailments in this village. Then she prescribes a treatment plan.
Ms. Kango, a BaAka Pygmy woman who grew up in the village, has no formal medical training, but under the guidance of Emilia Bylicka, a Polish doctor who oversees the small clinic, she has emerged as a critical part of the operation.
With young children dying all too frequently from treatable diseases, Ms. Kango and Dr. Bylicka’s partnership provides a burst of optimism and inspiration. Along with three other local workers, they are transforming the medical services available to the local population and making serious strides in building local capacity.
According to the Institute for Health Metrics and Evaluation, easily treatable health problems like malaria, respiratory infections, malnutrition and diarrheal diseases are among the top causes of death in the Central African Republic. But there are only 0.05 physicians per 1,000 people in the nation, so even these simple diseases often go ignored. There’s a solution: training locals to take on the responsibilities traditionally reserved for highly trained doctors to fill the gap in resources.
“It has been tested over and over again that a layperson can be trained to provide basic interventions that are safe and sound,” said Jean Kagubare, the deputy director of global primary health care systems at the Bill and Melinda Gates Foundation.
Dr. Bylicka agrees. So besides tending patients all day, she spends much of her time teaching her staff and people from neighboring villages. Her training efforts are particularly urgent because she plans to leave in September, and she’s not sure that someone will replace her.
“It’s the most important because I’m going to leave and they’re going to stay, and they’re going to serve the population for many years,” Ms. Bylicka said.
Every month, for a day and a half, Dr. Bylicka holds a formal training session for her local staff and medical workers in nearby villages. She always begins with a review of how to diagnose and treat the most common diseases in the village, and then she introduces a new medical topic — meningitis, caring for pregnant women, STDs. Last month, for example, Dr. Bylicka taught the roughly 15 attendees how to treat skin diseases.
“I’m trying to improve their capacity to work” in the clinics, she said. “I’m trying to teach them how to use medication as they should be used, in the right doses.”
Ms. Kango, who was the first BaAka in the village to finish high school in 40 years, has turned into her star pupil. The two first met five years ago when they both worked in a hospital in Bangadou, roughly 250 miles away from Monasao.
In May, Dr. Bylicka returned to the Central African Republic to oversee the medical clinic in Monasao and an expansion of the current building. The clinic and the expansion are supported by the local Roman Catholic mission and the World Wildlife Fund, which has conservation efforts in the area.
On the day I visited the clinic, I watched Dr. Bylicka shuffle between the clinic’s rooms — deftly switching between English, French and Sango (the local language) — tending to patients’ needs, explaining procedures to parents and giving tips to her local staff.
In one room, a young boy with severe anemia was awaiting a blood transfusion from a relative. Blood transfusions, which Dr. Bylicka introduced to the local staff and clinic, are often the only possible treatment to save children who have severe cases of anemia.
“If they don’t get blood transfusions, some of them will surely die,” Dr. Bylicka said.
Since she arrived in September, Dr. Bylicka estimates that she has performed 20 to 25 blood transfusions. Now, Ms. Kango has learned to do them as well.
For Ms. Kango, each new procedure she learns, she becomes closer to fulfilling her lifelong goal: She’s dreamed of being a doctor ever since she learned that she had almost died at birth from being unable to breathe. A Catholic missionary working in the hospital saved her life.
“I also want to save people’s lives,” she told me.
Tyler Pager is the winner of Nicholas Kristof’s 2018 “Win-A-Trip” contest to take a university student on a reporting trip. Mr. Pager, 22, graduated from Northwestern University and is now studying at Oxford University. He and Mr. Kristof recently traveled to Central African Republic, a small, landlocked country in the middle of the continent. Mr. Pager has also written about education and a 15-hour road trip in the country.