Fieldset
The surprise of meeting Mandro

A story about a forgotten disease and forgotten people, living through a forgotten conflict

In an MSF guesthouse in Bunia – the capital of Ituri province in the east of the Democratic Republic of Congo – the waves of people coming and going every day is impressive.

Either they are on short breaks, or at the start or end of their assignments working in health projects in more remote areas of the province. However, the casual exchanges you have there often translate into great stories about their experiences working for MSF.

I was looking, somewhat in awe, but still not really understanding what had happened in between the child’s arrival at the hospital and the day he was cured

It was during breakfast at our base that I started talking with Alejandra. A small woman with long, lustrous, curly hair and a smile that can only brighten you up ahead of a busy work day.

Alejandra is our paediatrician working in the regional hospitals and healthcare centres that MSF supports here. She’s been working with MSF for almost 10 years now.

Meeting Mandro

Sipping her coffee while I complain about the lack of sun, on a yet another gloomy day during the rainy season, she starts to talk.

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Dr Alejandra Garcia Naranjo (on the right of the picture) is a paediatrician with 10 years' experience with MSF
Dr Alejandra Garcia Naranjo (on the right of the picture) is a paediatrician with 10 years' experience with MSF

She tells me about this little boy called Mandro*. She met Mandro in Drodro, an area not very far from Bunia, that has been heavily affected by the long intra-ethnic conflict here.

She showed me a photograph of Mandro before and after his treatment for what seemed like terrible scars. I was looking, somewhat in awe, but still not really understanding what had happened in between the child’s arrival at the hospital and the day he was cured.

I asked Alejandra to tell me more about Mandro’s story…

One of the worst cases…

“I was on my way to the Drodo general hospital when Diakaridia, our health promoter manager, called me. I remember he said with great enthusiasm - I have a child patient for you!  

“Little did I know at the time,” she went on, “that this child would have one of the worse cases of scabies that I’ve seen in my medical career.”

Alejandra pauses.

Diakaridia brought the child to the hospital. When I saw him I almost jumped in shock. His hands, arms, neck, his whole body from top to bottom were covered in severely infected scars. He clearly had one of the worse forms of scabies – what’s known as ‘Norwegian scabies’.

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The scars caused by scabies and infection on Mandro's skin
The scars caused by scabies and infection on Mandro's skin

“The marks were everywhere! But it’s his hands that made the biggest impression on me… They were so inflamed he could barely move them.

“Scabies is incredibly itchy, and when people scratch it, infections can get into the skin. The hand are the easiest spot for anyone to scratch!”

A bigger problem

Here Alejandra showed me the photograph again, and I could see that the wounds from the disease and the constant scratching were severely infected. I started thinking about the challenges of treating scabies in a place like Drodro.

Although highly infectious, scabies an easily curable skin disease. The medicines for it can be found for a very low price or even for free.

However, the medicine is only one part of the solution.

It struck me that a paediatrician so experienced in humanitarian work, so used to thinking in terms of whole populations and their health, was still so moved by the case of this one little boy

The bigger challenge is in the need to clean everything at home, in order to kill the parasite that causes the disease. The family is asked to wash all of their clothes, bed-sheets and at times even the mattresses with soap.

How could this draconian task be achieved by families who are among the hundreds of thousands of displaced people in DRC living in deplorable living conditions? Many people barely have water to drink, let alone soap to wash their clothes or bedding.

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Diakaridia, the health promotion manager for MSF in Drodro
Diakaridia, the health promotion manager for MSF in Drodro

“Mandro was lucky. Diakaridia found and brought him to the hospital. We immediately gave him the medicine and skin cream, threw his infected clothes away and gave him some new ones.

“It is extremely rare to hospitalise cases of scabies, but this child was one of them. Fortunately, a couple of days later he was fully recovered and could leave the hospital.

“Meanwhile, MSF teams have been distributing soap, including to the exact displaced people’s camp where he was living.”

Alejandra smiles remembering Mandro, “What an incredibly vivacious child he was!”

Forgotten places

I have been to the areas Alejandra is talking about. Forgotten-from-the-world places, here in Ituri, where nearly a million displaced people live. There are barely any words to describe the living conditions.

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The healed wounds on the palms of Mandro's hands
The healed wounds on the palms of Mandro's hands

Still, talking to Alejandra, it struck me that a paediatrician so experienced in humanitarian work, so used to thinking in terms of whole populations and their health, was still so moved by the case of this one little boy.

When the medics themselves still have the capacity to be surprised by a patient’s case, then you are only left with the hope that maybe one day the wider world will wake up to the humanity here, and more will be done to improve the living conditions and health of these forgotten, displaced people.

* The name of the boy has been changed for this story

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