Central African Republic Medical Insurance
The Central African Republic (CAR) is a landlocked country on the African continent. It is bordered by Sudan to the east, Chad to the north, Cameroon to the west and both the Democratic Republic of the Congo, and the Republic of the Congo to the south. The population is estimated at 4.4 million people, and the country covers a land mass of 240,000 square miles. The capital city of the Central African Republic is Bangui. Widespread poverty is endemic in the Central African Republic, with sixty two percent of the population living below the international poverty line.
The Central African Republic ranks 179 out of 182 countries on the Human Development Index. The index is a composite of statistical data gathered internationally on life expectancy, education and standard of living. One of the primary reasons for the Central African Republic’s poor standing on this index is due to the fact that the nation’s health care system has been largely disregarded; primarily because of widespread political turmoil. Healthcare in the CAR is dysfunctional in every area, and at every level. There is an estimated one doctor for every 3,000 people, and one nurse for every 1,000. The life expectancy at birth is 43 years old with child mortality rate in the range of 176 per 1,000 births; twenty percent of children die before they reach five years old, and ten percent of children under the age of five suffer from severe malnutrition.
The overall funding provided to health care services is only 1.5 percent of GDP resulting in the country being heavily dependent on foreign aid. During the Patasse regime relations with donor countries were tested as unpaid arrears mounted on loans. In 2006 the situation improved, and a second IMF Emergency Post Conflict Assistance Loan was issued.
It is recommended that before you visit the Central African Republic you consult your health care professional, preferably one experienced in travel medicine, at least six weeks before departure to the country. This is to ensure that you receive the best advice in regards to vaccinations, medications and precautionary information for the country. Comprehensive international medical insurance which covers repatriation and emergency evacuation is highly recommended for all travellers considering a trip to the Central African Republic.
Over 15 percent of the CAR population suffers from HIV/AIDS, placing the nation in the top ten worst effected countries worldwide. Transmission predominantly occurs by means of heterosexual intercourse, needle sharing or mother-to-child transmission (MTCT).
Routine vaccinations such as measles/mumps/rubella (MMR), diphtheria/pertussis/ tetanus (DPT), poliovirus, and Hepatitis should be up-to-date prior to arrival. Polio, measles and meningitis are wide spread throughout the country, and incidence rates of these diseases are considered to be of epidemic proportions. Due to low levels of water sanitation the risk of water borne disease is extremely high. Travellers should only drink boiled or bottled water and avoid ice in drinks.
Hepatitis A, a viral disease that causes inflammation of the liver, is contracted by ingestion of contaminated food or water, or by means of direct contact with an infected person. Hepatitis B and Hepatitis E also affect the liver causing inflammation, while Hep B causes vomiting, jaundice and in some causes death.
Hepatitis E is classes as a ‘self limiting disease’ as victims exhibit symptoms of fatigue, abdominal pain and dark coloured urine. Both are contracted from faecal matter with Hep B also being transmitted by bodily fluid or blood. Please be advised that there is widespread Hepatitis throughout the Central African Republic.
Typhoid fever is another high-risk disease present within the CAR, and is contracted by the consumption of food or water contaminated with faeces of an infected person. Symptoms are characterized by a progressive fever, profuse sweating and gastroenteritis. Travellers displaying the symptoms of Typhoid are advised to contact a medical professional as soon as possible.
Malaria, Yellow fever, River valley fever, Chikungunya and dengue fever are also listed as being a high risk in CAR. Malaria is a parasitic protozoa while dengue fever, chikungunya and yellow fever are viral diseases. All are contracted from the bite of the female Anopheles mosquito, with river valley fever being transmitted by all biting flies and contact with infected meat and blood.
Dengue fever and Chikungunya are similar in the way the diseases present themselves, with symptoms manifesting as sudden fever accompanied by severe headaches. Fatalities are reported in about 5 percent of cases of dengue fever. Some cases of Chikungunya result in arthritis. A person infected with yellow fever exhibits symptoms of fever, nausea and pain. In some cases the liver is damaged and jaundice occurs.
River valley fever is a viral disease that affects animals and humans. The geographical distribution of the disease is vast, affected areas include all of Eastern and Southern Africa. Symptoms present as fever and liver abnormalities. It is fatal in 1 percent of cases due to it progressing into hemorrhagic fever, encephalitis or ocular disease.
Preventative measures such as wearing insect repellent, long pants and sleeves, sleeping in air-conditioned rooms and using bed-nets are recommended. Some anti-malaria drugs that are available in your home country may not be available in CAR you are advised to bring all medication with you.
Rabies is a viral disease which causes inflammation of the brain and can be contracted from wild or domestic animals. Rabies is fatal unless post-exposure prophylaxis (PEP) treatment is sought within ten days of the infection. Treatment may not be available in certain areas of the Central African Republic; therefore repatriation or transportation of the victim is critical. For those planning on spending time in rural area, especially in the case of expatriates or long term travellers’, vaccinations should be considered, as well as comprehensive medical insurance to cover the cost of repatriation.
Other disease that might affect travellers while in CAR are filariasis, leshmaniasis and onchoceriasis (river blindness). These diseases are carried by insects. The Plague (Yersinia Pestis) occurs sporadically throughout the country. The Plague is transmitted by flies, and is normally associated with rats; however, person to person airborne infection can occur. The Plague is a rapidly progressing disease, and if left untreated can lead to a pneumonic form that has a death rate well in excess of 50 percent.
Leptospirosis, a bacterial disease that affects humans and animals, can be contracted from the faecal matter, water, food or soil contaminated by animal urine; if untreated the disease can lead to liver failure, kidney damage, meningitis or respiratory distress.
There is a low level of threat from terrorist activities in CAR, but areas frequented by foreigners and expatriates are always at risk. There have been reported attacks on Europeans in Bangui Pass, and French Lycee hill, causing physical injury to the victims; you are advised to be extra vigilant in these areas. Thefts and robbery occur in all areas of the country with armed gangs operating heavily on the outskirts of Bangui. Due to the political situation within the Central African Republic there have been many strikes and demonstrations in Bangui. Any public gathering has the potential to turn violent; travellers are advised to steer clear of any such gatherings.
In 2010 the British Government advised against all travel to the regional capital Birao due to rebels taking control of the town. In 2009 two French aid workers were kidnapped at gunpoint from Birao, and in 2008 a marked NGO medical vehicle was fired upon killing one patient, while in 2009 a truck carrying aid workers was attacked killing 8 people on the road between Mboki and Obo. There has also been outbreak of violence in Bamingui-Bangoran province, Ndele and the surrounding province and Mbomou and Haut Mbomou province.
Road travel in CAR during the rainy season is particularly difficult due to poorly maintained roads, with most requiring four-wheel-drive vehicles to navigate. In remote areas you may encounter illegal road blocks. In order to pass you will have to pay a fee or hand over some possessions. There have also been indiscriminate violent attacks on traveller in remote areas and in many cases victims have been taken hostage and there vehicles burnt out.
Pacific Prime can not confidently identify any high quality medical services within the Central African Republic. Any medical centres within the country will offer services far below the standard that western nationals will expect. In the event of a serious illness or accident occurring while you are in the Central African Republic emergency evacuation overseas is highly recommended.
Prime Pacific can provide professional assistance for you or your groups’ health care needs if you decide to travel in The Central African Republic. Our tailor made health insurance polices cover a wide range of services from repartitions, transportation, dental and many more. Call our team of world wide representatives today to discuss, free of charge, the options available.