Located more than 500 kilometres from the Central African Republic capital of Bangui, the city of Carnot faces a severe shortage of medical specialists. Telemedicine has become an indispensable and daily tool to support the Doctors Without Borders (MSF) teams working at the local public hospital run by the Ministry of Health in treating patients and saving lives.
Providing Remote Care in a Remote Hospital
Access to specialised medical care is often a challenge in the Central African Republic (CAR), where there were only seven medical doctors per 100,000 inhabitants in 2023—a figure covering generalist physicians as well as specialist practitioners—according to the World Bank. For comparison, the EU average is 415 medical doctors per 100,000 people. At Carnot Hospital, medical activity is intense: in 2025, MSF teams recorded more than 8,000 visits to the paediatric emergency room and nearly 6,300 admissions. Faced with this heavy workload and limited staff, at night or when some other departments may be closed, on-call doctors sometimes find themselves making life-or-death decisions alone.
That’s where telemedicine comes in. Using a secure mobile app designed to work even with slow internet connections, healthcare workers in patient consultations can send X-rays or test results directly to the telemedicine platform to obtain expert opinion from around the world. The experts are mostly doctors, but also include nurses, midwives, physical therapists and psychologists. Their specialties are wide-ranging: paramedical services, emergency medicine, internal medicine, infectious disease, paediatrics, reproductive health, surgery, mental health and radiology.
“Most of the specialists on the other end of the line are MSF healthcare workers, including volunteer specialists from the MSF telemedicine network and MSF medical advisors, but if we don’t have the specialist in our network, we’ll seek one out from among other experts who wish to work with MSF. Sometimes, even after MSF support to a health facility has stopped, we continue to support the teams from the ministry of health through this tool,” explains Clara Mazon, Director of the MSF Telemedicine Program.
The system’s comprehensive features consist of an online case management platform, a secure instant messaging app that facilitates the exchange of patient information and documents among MSF teams, and a videoconferencing service that enables real-time discussions.
“Sometimes, I find myself alone, having to make a decision in a complex medical situation with limited resources. Advice from telemedicine experts has helped me determine the best possible care for the patient,” says Dr Kana Yamada, a general practitioner and specialist in antibiotic resistance.
The responsiveness of this global network is also a major asset in emergency situations: 75 per cent of submitted cases receive an initial response within 24 hours, and nearly half within eight hours.
Expert assessments to avoid costly and risky transfers
Access to remote medical consultation via telemedicine is profoundly changing the management of complex conditions. In a setting where human and material resources remain limited to support a hospital of 121 beds, the ability to seek a second opinion becomes crucial.
“When a patient’s condition does not improve despite treatment, this allows us to benefit from the perspective of more experienced specialists,” says Dr Anaïs Kale-Mea-Kale, a Central African general practitioner working in Carnot’s hospital.
Beyond medical accuracy, telemedicine helps in making decisions that can be particularly difficult: for example, whether to transfer a patient to Bangui, 500 kilometres away. Evacuating a patient requires using an MSF airliner or chartering an emergency flight, which costs around 8,000 euros. Obtaining a second medical opinion helps confirm whether this gruelling and costly journey is medically necessary.
A technology adopted by field teams
The use of connected medicine is growing every year within the medical facilities supported by MSF. Globally, more than 5,300 cases were shared with experts in 2025 from 212 projects led by our teams across 58 countries. That same year, more than 1,200 MSF staff members were trained in telemedicine.
Far from being merely a technological tool, this system strengthens the skills of healthcare workers in resource-limited locations. According to internal surveys, 96 per cent of MSF medical staff believe that engagement with telemedicine enriches their clinical knowledge and directly improves the quality of care. In Carnot Hospital, this overall strengthening of clinical skills helped stabilise the hospital’s occupancy rate at around 77 per cent and reduce in-hospital mortality to 2 per cent in 2025.
The evolution of MSF's activities in Carnot
Present in Carnot since 2009—initially to respond to a nutritional crisis—MSF has gradually expanded its healthcare services to meet wider health needs:
• Comprehensive healthcare: internal medicine and treatment for HIV, tuberculosis and noncommunicable diseases, and assistance with responses to recent infectious disease outbreaks, particularly of measles.
• Support for survivors of sexual violence.
• Decentralised of care: to bring medical care closer to patients, more than 1,100 people living with HIV are now treated directly at peripheral health centres rather than at the hospital.
MSF hopes to continue developing telemedicine in the health facilities where it operates in support of the Ministry of Health. While telemedicine does not replace direct surgical procedures or clinical examinations, it helps break the isolation of patients living far from medical facilities in the country’s most remote areas and improves the equity of their access to care.