Juliette sits up on the examining table and slowly pulls up her top to reveal a back marked by a constellation of fine scars and deformed by a huge abscess.

She smiles despite the nasty-looking growth on her back and her other symptoms: chest pains, dizziness and parasites.

Juliette is aged only in her fifties, yet this places her among the very oldest of the Aka -- a Pygmy people living in remote southwestern Central African Republic (CAR).

"I live between the forest and the village," she says.

It is the very first time she has had access to modern medicine.

That she has is thanks to a free clinic set up by Senitizo, a small US non-profit specialising in providing access to medical care in parts of the country that would not otherwise get it. They started work here last June.

The clinic is in Sakoungou, some 200 kilometres (120 miles) southwest of the capital Bangui.

The village has thankfully been spared so far from the civil conflict that has wracked the country since 2013.

But the Aka people -- also known as the Bayaka -- have their own problems, which are many.

- Stigma -

Ostracised and exploited by other communities, the Aka are among the poorest people in a country that according to the UN's Human Development Index is already the second-least-developed country in the world.

The CAR depends heavily on international aid to feed and care for its nearly five million inhabitants -- and the Aka are near the bottom of the social ladder.

"There is discrimination against Pygmies everywhere in Central Africa," anthropologist Alain Ebelpoin told AFP -- from low wages, to the hardest jobs.

"They are victims of humiliation, considered by the rest of the population as serfs," said Ebelpoin, a researcher at France's CNRS institute.

According to the UN cultural organisation UNESCO, the Aka are the original inhabitants of this part of Central Africa.

They are historically a forest nomad people, and many still adhere to the ancestral ways.

When they come for treatment at Senitizo's clinic, it is often for viruses or bacteria picked up from the modern world around them -- pathogens they had never encountered until recently.

The changing times have forced some of the Aka to change their ways, leading to more sedentary lifestyles in villages or towns -- often forced there after fleeing deforestation, civil conflict or intercommunal violence.

- Traditions at threat -

The red-earth track that leads to Juliette's village winds through luxuriant vegetation to a handful of earth-brick houses belonging to non-Pygmy villagers on the edge of the forest.

The Pygmies themselves live in more rudimentary shelters made from the dried foliage of the surrounding trees.

A sign near the clinic announces the community: "Pygmy village -- let's protect our minorities."

In 2003, UNESCO classed their polyphonic chants part of the world's intangible cultural heritage.

But their hunter-gatherer culture, which also includes seers and healers, is threatened by the gradual disappearance of the forest ecosystem that has been their home, said Ebelpoin, who sounded the alarm a decade ago in an academic paper.

"The Aka have a lot more health problems than other people and their life expectancy rarely exceeds 40," says Jacques Bebe, a doctor at the clinic.

"They consume non-drinkable, even stagnant water, they don't have durable shelters, no sheets, no mosquito nets," he says.

And they have trouble, too, getting used to taking medicines, preferring first to treat themselves using traditional methods, he adds.

"When they arrive at the centre, sometimes it's too late."

Jean-Claude, a patient in his 30s, has come to the clinic to pick up medicines before heading back into the jungle to search for a particular kind of shrub.

"This one's for headaches, and this one for a bad back," he explains, producing two different plants.

Juliette heads out from the clinic and back to her sparsely furnished home. The roof is covered in leaves and bark, drying in the sun.

Water bubbles in her only saucepan, as one of her female relatives prepares a treatment composed of several different plants.

"It's very effective for the stomach," she says. "Here, everyone knows the forest remedies."

Ebelpoin nevertheless says that if there is a health centre nearby and they don't sense discrimination, they will go there for treatment too.

Back in the clinic's waiting room, Gaspard, a man in his 50s dressed in rags, is there to get treatment for his back.

"Life in the forest is difficult, so from time to time I come to the village," he explains.

"To make a living, I gather caterpillars (a sought-after dish) but I also farm manioc and bananas, hunt and fish."

"I have nothing against modernisation," he says, "but I'm afraid that one day our traditions will disappear."

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