I’m being eaten alive. We’re outnumbered and the mosquitoes are ravenous! Every inch of skin is covered in bites. I’m one big allergic mess.
I’ve arrived in Am Timan, the main town in Salamat region, SE Chad because of a staggering rise in malaria. They have reported more than 15,000 cases so far this year, almost twice the number seen in the whole of 2012. Malaria is a parasitic infection spread by mosquito bites. It causes waves of debilitating fever and at its most severe it can lead to jaundice, severe anaemia, coma and death. It is generally infants that suffer the severe consequences of malaria.
So I’ve been dispatched to investigate this unusual outbreak and help support an exhausted team. After landing in N’Djamena, the capital city, at 4am, I’m allowed two hours sleep before being given a quick briefing by the medical coordinator at the same time as having my passport taken for various authorizations at the same time as being piled with documents, forms, insect repellent and malaria prophylaxis and finally being stuffed into a car. I have a two day drive to catch up on my sleep!
The journey is stunning. The last time I was in Chad it was barren and dry, but with the rains come lush green countryside, spontaneous lakes and beautiful migrating birds. And a hair-raising ride in a narrow boat loaded with all our malaria drugs and kits. The road is somewhere under several feet of water. With the rains come business opportunities (for anyone that can build a boat)!
And we finally arrive in Am Timan, just in time for lunch and to meet the large MSF team. Denise is Swiss with an American accent and is usually in charge of finances and administration but is currently acting Project Coordinator. Bienfait is the Medical Team Leader and part of the jovial Congolese posse that includes Guy, the TB/HIV doctor, and Jean Claude, the outreach nurse. Judith, Karla, Andreas and Andreas, the midwife, paediatric doctors and logistician, are the talkative Germans and calm Vincent (lab technician, Kenya), quiet Jeremy (Obstetrician, Australia), bubbly Louise (Pharmacist, Ireland), dapper Richard (Logistician, Liberia), reliable Miet (Nurse, Belgium) and fun Prosper (IEC officer, Burundi) are the sole representatives of their countries. We could almost have a mini-Eurovision Song Contest here!
I waste no time in interviewing Bienfait, Prosper and Jean-Claude. They have implemented Phase 1 of their malaria intervention plan including:
- creating a malaria tent at the hospital to diagnose and treat the overwhelming numbers of patients arriving at the hospital
- providing intensive care for severe malaria cases,
- upscaling the mobile malnutrition clinics led by Jean-Claude to include malaria diagnosis and treatment
- creating a mobile malaria team led by Prosper that delivers rapid diagnostic tests and drugs to health centres
- as well as training and information, education and communication (IEC) advice to the health centre staff and community.
It’s an impressive response that owes its success to a close collaboration with the Ministry of Health. Abdel Aziz, Idis Kas and Dr. Mahamat Abakar the district surveillance, district and regional chief health and representatives recognised the issues and worked alongside MSF to support an overwhelmed health staff.
This astonishing rise in malaria has caught everyone off guard. The health centres quickly ran out of rapid diagnostic tests which are needed to confirm a malaria diagnosis and malaria drugs to treat the disease. Am Timan hospital was simply too far for some of these patients to travel. In addition an inability to pay for the usual health care costs might have meant some people did not seek health care. We heard of increased mortality rates in the communities. But with this joint Ministry of Health-MSF response, the tests and drugs are reaching the people that need them, the health centres have increased their staffing and opening hours, and with our IEC campaigns people are coming forward for free treatment at the first signs of fever.
The work involves long drives to hard to reach places (of course when I joined we got well and truly stuck in the mud!) but it’s moving to see the health staff light up at the sight of our cars and to hear that their consultation rates have increased because people have heard our health education messages. The only thing left to do is increase our coverage of the Am Timan population, including those cut off by the rains and to fill gaps in bednet coverage (an effective protection against mosquito bites and therefore malaria). We make plans for a nurse and logistician to help with the former and another epidemiologist to help with the latter.
Next stop Tissi, where MSF supports a refugee camp on the border with Sudan (Darfur). We’ve observed increasing malaria there too. But rains are preventing any flights from landing there at the moment….