Trip to Central African Republic, Feb 5-18th 2024

We met in Berlin on Monday night, and embarked on a flight to Paris where we stayed overnight. We spent Tuesday in the air between Paris and Bangui, where we arrived safely in the late afternoon.

Bangui is the capital city of CAR, with a population of around 900,000, and it is the political center of the nation. It is located in the South of the country, on the banks of a large tributary to the Congo river, the Ubangui. The Democratic Republic of the Congo lies on the other side of the river, within eye (and, amazingly, ear) sight. We stayed at the well-named Ubangui hotel, which offers a stunning view of the river and the southern edge of the city. The city itself sprawls at the bottom of forested hills, dusty roads connecting poor neighborhoods and old and new official buildings. A lot happens on the streets, which are busy with cars, motorcycles and pedestrians going their way, amid little shops.

We stayed two days in Bangui to meet and discuss with officials. Frédéric is Centrafrican, and Adrienne spent years in CAR, covering the conflict as a photographer, and they both gently took the job of local guides.

On Wednesday morning, we started by changing money (EUR for francs CFA) and bought SIM cards (thanks, monsieur Guy!) downtown at the get-everything-you-want bakery, le Grand Café. In the afternoon, we visited the national veterinary laboratory, a directorate within the ministry of animal husbandry.

Marie-Noëlle Mbaïkoua and her team are responsible for animal health surveillance and plan interventions aimed at containing the spread of pathogens in domestic animals. Rabies is a major focus, as well as a good illustration of the interplay of animal and human health, and of how powerful One Health approaches can be.

Human rabies cases are nearly always the result of a dog bite. This viral disease is fatal if post-exposure prophylaxis is not administered before symptom onset. In CAR, dog-related rabies still exerts a significant toll on populations. It is vaccine-preventable in both humans and dogs, but because dogs are the reservoir, the most effective control method is to vaccinate dogs. This protects both dogs and humans and can lead to the local eradication of the disease if performed at scale. The lab of Marie-Noëlle is small but well equipped for basic diagnostic tasks, and her people are already well-trained and eager to learn new methods. Unfortunately, the real challenge here is the lack of core funding for reagents and instrument maintenance which jeopardizes the continuity of operations – a limitation all too familiar to laboratories in sub-Saharan Africa. We will spend more time with Marie-Noëlle in the days to come, since she will also join our trip to the DSPA.

In the evening, soccer fever au menu with the two semifinals of the Coupe d’Afrique des Nations 2024 (CAN2024). Josef worked in Nigeria as a young(er) M.D. and a good part of the HIOH team had their first field experience and have since worked for years if not decades in Côte d’Ivoire. The qualification of the two teams against South Africa and the Democratic Republic of the Congo pushes friendly sarcasms into the future (the final will take place on Sunday, though).

In the early hours of Thursday morning, we are back to the ministry of animal husbandry to meet the minister, Mr. Hassan Bouba. He is supportive of our work with WWF CAR in the DSPA, and appreciative of the will to establish strong partnerships with local stakeholders. Together with Marie-Noelle, he calls for more frequent exchanges and information flow; we fully agree!

We then continue our day with a visit to the Institut Pasteur Bangui (IPB). Pasteur famously developed the first rabies vaccine, and he and his successors also established a large network of public health institutes throughout the world. In 1961, a year after the independence of CAR, IPB was created. The institute operates in a large 5 hectares compound within the city. It is home to 150 researchers and support staff and 200,000 straw-colored fruit bats (Eidolon helvum) that form a large colony in the surrounding trees.

Bayanga is a village of 8,000 inhabitants. The fastest route is airborne: a 50 min flight brings you from Bangui to the airstrip of the little town. Shortly before landing, the plane flies over the forest, the village and the river next to it, the Sangha river.

We land on Friday morning, and quickly settle in before a visit of the WWF CAR laboratories, newcomers at the Doli Lodge (doli means elephant in sango, the co-official and most spoken language in CAR), regular visitors in the case de passage of the WWF CAR compound that lies near the entrance of the village. In close collaboration with the forest management authorities (APDS), WWF CAR spearheads a number of activities aimed at conserving the exceptionally rich wildlife in the region, including enforcement of protected areas, ecotourism and research, with a specific focus on Western lowland gorillas and forest elephants (Loxodonta cyclotis). HIOH provides support for gorilla health monitoring, and has sent veterinarians in the region for more than 10 years.

Yanthe Nobel is one of these extremely motivated young veterinarians, and she has been instrumental in organizing this trip. Her job does not only involve classic tasks such as running necropsies on wild animals found dead in the area or assisting local crews and WWF CAR in the field and in the lab in case of outbreaks. It also requires close interactions with local populations to understand their views and needs, and therefore their relationship to domestic animals and wildlife. Public outreach is also fundamental to engage and empower communities, and in the evening, Yanthe, Fee and Fabian partake in a local radio broadcast about One Health and our activities in the region.

On Saturday morning, we head to the Dzanga Bai. A bai is a clearing, and this one is world-famous for routinely hosting 50 to 200 forest elephants. The forest camp is about an hour drive from Bayanga, and from there you need a 30 minutes walk in the forest to reach the observation tower. Hikes in the forest require the assistance of a local guide and a Ba’aka tracker. Elephants are major ecosystem engineers, and the fastest route in the forest always follow their tracks, which contributes to making accidental encounters a frequent and potentially dangerous event. Ba’aka trackers are forest people, and they excel at spotting elephants from the hardly noticeable sounds they produce while progressing in the forest. Once arrived on the platform of the wooden tower bordering the bai, the view is breathtaking. On that particular morning, about 90 elephants have come to dig out minerals from the soil, which they obtain by digging large waterholes.

Ivonne Kienast is in charge of the forest elephant monitoring program, and deeply dedicated to the protection of this species, both via conservation and research. Researchers, including young Centralafrican scientists, continuously observe elephants during the day and a night per week. This week, they witnessed the killing of a female elephant by a large bull. He inflicted her a deep, fatal wound in the neck while pushing her away from the waterhole he was occupying. The carcass still lays close to the waterhole, and at our arrival the family of giant forest hogs that lives here is licking maggots on it and from the ground around it. Carcass monitoring and sampling is one of the activities that HIOH routinely implements. While the cause of death was obviously not infectious, sampling this carcass would have been interesting. It was unfortunately not possible in this case, and filling such loopholes is one of the reasons HIOH wants to reinforce their support to local projects.

In the afternoon, we are back in Bayanga, where we will take part to the first One Health soccer tournament. Soccer is a beloved sport in the region and an excellent vehicle for public outreach. All 10 teams receive jerseys with One Health diagrams and slogans that we will later see during our car rides and walks in the village. Of course, sports are also a very good occasion to share good moments together. The HIOH/HZI/WWF CAR team is pushed out of the tournament after the group phase, and an honorable one victory/three defeats score sheet. The winning goal of our single victory is scored by Josef during penalty kicks, crowning a lifelong passion for soccer. The victors of this first tournament are the Diamonds, who convincingly dominate the final with which our second day in Bayanga comes to an end.

On Sunday morning we drive back into the forest, this time taking the road leading to Bai Hokou. Bai Hokou is one of the sites where Western lowland gorilla habituation takes place within the DSPA. HIOH has advised WWF CAR and ADPS for more than a decade about how to best ensure gorilla protection from human pathogens. Fabian’s work was instrumental in showing that habituation, a major tool for great ape conservation, comes with its own risks. The most severe is the introduction of human-infecting respiratory viruses in naïve great apes, which in the past has resulted in significant morbidity and mortality [before leaving Bayanga, WWF CAR’s colleagues tested us all for COVID-19]. Today, the gorillas forage at about an hour’s walking distance from the beautiful camp.

Like yesterday, we walk fast in the forest, following an experienced BaAka tracker – this part of the forest is also heavily exploited by elephants. Shortly before arriving where the gorillas are being observed by a small team of conservationists, we put on our face masks, a measure whose efficacy has been shown time and again. It has been implemented by Fabian at multiple sites since the late 2000s, where it has reduced the frequency of respiratory outbreaks. We will also maintain a minimum 7m distance to the gorillas.

A few more meters and we can see the back of one of the two adult females of the group. Then, Makoumba, the male silverback after whom the group is named, wakes up from a short nap and slowly reveals his gigantic silhouette. A few leaves later, the group follows the old male into the canopy, the four younger gorillas playfully running on branches that defy their father’s 300 kg weight.

On our way back two elephants cross our path, about 50m ahead. Our guides instruct us to make ourselves as discreet as possible. We crouch, observe complete silence and watch the impressive animals walk their way. Five minutes later we are back at the camp.

Fabian, Livia, Joseph and the GEO team stayed here during our visit to the gorillas, and they seized the occasion to catch and sample bats in a cave neighboring the camp. They placed nets at the entrance of the cave, and captured three individuals. Carefully equipped with protective face masks, clothing and thick gloves, they have swabbed the tiny creatures.

Noninvasive sampling often suffices to detect a fair number of bacteria and viruses. The swabs can be stored at ambient temperature in an appropriate medium, and later analyzed in a molecular biology laboratory, whether in country (HIOH’s favourite option) or in Germany.

Sunday night is the ultimate African soccer night of the year: the éléphants of Côte d’Ivoire and the Super Eagles of Nigeria compete for the continental title. We watch the game at Freddy’s place, and the entire HIOH’s team is delighted to see the Ivorian team win the CAN 2024 at home.

We also spend the next day in the forest, following BaAka net hunters. Fourteen BaAka (men and women) will demonstrate their incredible skills at navigating this extremely challenging environment. This stigmatized community legally hunt in some areas of the DSPA. Semi-nomadic hunting was their traditional lifestyle, and the activity is still an important source of food and revenue.

Once arrived in the forest, the BaAka identify places where the nets can be installed into a large half-circle. The hunters then drive the game towards the nets, making noise in various ways (shouts, shaking foliage, etc.). The entire process does not take more than 15 minutes, after which the group changes location. On their way, the hunters gather plants, some part of their pharmacopeia.

This time, the hunt is unsuccessful. A duiker (forest antelope) was pushed out to flee in the open, but it managed to avoid the nets, which triggered animated (but friendly) discussions among the hunters. For normal hunts, the BaAka typically stay days or weeks in the forest, settling in a promising zone until its game is exhausted.

The next morning, Fabian, Josef, Fee, Livia and our local partners take part to a meeting with local executives. The chiefs of Bayanga and 8 villages in its district as well as the district leadership have all been invited to discuss about intensifying our activities in the region, and linking them in a better (One Healthy) way to ongoing public actions. There is a lot of interest for One Health among the participants, and many important questions are raised about what One Health initiatives with practical benefits for local populations might look like. Such get-togethers are instrumental if we want to not only understand how human, animal and environmental health are connected, but also act on problems, leveraging this kind of knowledge.

In the afternoon, we visit the local public hospital. A single physician, Dr. Julien, is in charge of the entire district (>25,000 inhabitants), assisted by two qualified nurses. In Germany, a population of this size would typically be served by 100 medical doctors and 350 nurses. Needless to say health care challenges are immense. But even such a small team manages to deliver essential services to the community. People infected with HIV-1 (5% of the population) are provided with antiretroviral therapy, many vaccines are routinely rolled out (and are totally free for children under 5), and severe malaria prevention and treatment works well within the confines of the village. However, with such a small staff, there is no ambulance service so how healthy you are and how good your outcomes will be if you are sick is largely determined by how far from the hospital you leave. For example, infant mortality is much higher in peripheral BaAka villages. It is very clear to us that any research activity in the area should go hand in hand with direct benefits to the population.