MSF have been working here in Baraka for about 12 years, in a hospital which used to be a convent. It may not be the best building design for a hospital, it is fairly cramped and labyrinthine, but if there were prizes for creative use of limited space, it would be a contender.
We also support a health centre in town, and a further two in outlying areas, a cholera treatment centre and several community treatment centres for malaria.
It is cheering to see that although the incidence of cholera is steadily increasing, it has been lower than at this time last year. We are in dry season now, when cases of cholera increase as wells run dry and other, less suitable, sources of water are used. Solidarités International, an NGO specializing in water and sanitation, have a programme of chlorination in the area, and this seems to be having an effect.
Malaria is the biggest problem, particularly in children under five, who account for well over half of all patients seen. Each month, we treat around 500 patients in the hospital for severe malaria, and a further 10,000 or so in the community; these numbers will increase in the rainy season.
Although the public are encouraged to come to the health and treatment centres at an early stage, there is work going on in the communities to teach the basics about malaria; how you get it, how it spreads, how to recognize symptoms. Many patients arrive at a late stage of the disease.
Their condition is often aggravated by two traditional therapies which are commonly administered to sick children: cutting out the uvula and powerful enemas. The uvulectomies can be a source of infection, sometimes leading to septicaemia, and the enemas prevent the already weakened body from absorbing nutrients, adding malnutrition and dehydration to the problems. Efforts are underway to alert local communities to the potential dangers of these particular practices.
This week we have been hearing about plans to significantly increase community intervention for malaria, diarrhea and respiratory infections, with the intention of increasing early intervention which were described at a meeting for all MSF staff in Baraka – currently around 12 international staff and about 100 Congolese nationals.