A single bite…

Brigitte​ is working for Médecins Sans Frontières / Doctors Without Borders (MSF) in the Democratic Republic of Congo (DRC). Today she blogs about the importance of free malaria diangnosis and treatment in remote regions...

Throughout my many visits to Africa I have always been amazed by it’s pure beauty, and the Democratic Republic of the Congo (DRC) is no exception. In the early mornings I feel as though I am waking up in a castle in the clouds, not being able to see the hilltops as they are covered by thick, white mist and all that surrounds me is a rich green of vegetation. As I brush my teeth at night I gaze up to the thousands of stars that are hidden by the city lights back home in Montreal. The expat team and I have been fortunate enough to have been treated with occasional weekend trips to a local waterfall where, if the water is low enough, we get to swim in the refreshing water after the 45 minute hike into the jungle walking by gigantic trees, flowering bushes and frequent trips of passing exotic butterflies. When I sit there watching the water rush down the falls I am mesmerized by its splendor. While on outreach movements I am treated to even more striking landscapes including lush mountainsides, brush so thick it is as though I am driving between two strong walls of shrub and swamp beds covered by lily pads and blooming flowers.

Unfortunately, with this beauty comes consequences, including the region's number one health enemy: malaria. Malaria is spread by a single bite of an infected mosquito, but it can cause severe health problems including low-birth weight infants and spontaneous abortions in pregnant women and seizures, respiratory distress, severe anemia and death. The number one reason for consultation in all three of our health centers is malaria. Severe malaria is also the number reason for admission into our pediatrics ward for children under 5 and aged 5-15. Before MSF’s arrival to Walikale in 2012 it was the number one cause of death in all age categories. 
As malaria is spread through mosquitos prevention should be fairly simple; prevent people from getting bit by a mosquito; easier said than done. As mentioned above, the Walikale territory is filled with ponds and in the rainy seasons, which are almost year-round, water pools in any uneven surface; in tire tracks on the road, the bottom of a hill or any open container, perfect breeding receptacles for mosquitos. The best form of prevention is an insecticide treated mosquito net, which MSF distributes to pregnant women during prenatal visits, and to children discharged from the hospital, however, they are not readily available in the local markets and, when available, often have many other more prioritized functions. I have seen mosquito nets used as fishing nets, to protect garden crops, to soak vegetables in the river, to secure roofs and fences and even as a childhood jumping game. If you had to choose between sleeping under a mosquito net at night or securing and providing food for your family, the food will always come first. 
Almost daily I am faced with the realities of the parasitic infection. At one of our mobile clinics for malaria we encountered a semi-conscious three-year-old brought by her mother. She was having difficulties breathing and was not able to drink or eat for the past few days. It was clear that the sugar and red blood cell levels in her blood were low because of the malaria. We couldn’t wait the four hours until the end of the clinic to bring her back with us, so we immediately found a motorbike to send them to the hospital. Heartbreakingly, despite intravenous sugar and a blood transfusion, malaria won over her little body the next day.
At another mobile clinic an 18-year-old male had been lying down after his first dose of anti-malarials and when he stood up to leave he was stumbling, fell over into a full seizure with incontinence. We sprung into action and gave him an intravenous dose of anti-malarial and I sat spoon-feeding him sugar water. By the time we left he was conscious and we brought him to the hospital for further treatments. While visiting our most remote health center I was asked to visit a young girl who had been diagnosed with malaria two days before and sent home but her mother brought her back as she had stopped eating. Her fingertips were cold and pale and her gums were the same color as her teeth, she was severely anemic because the malaria was destroying her red blood cells. Once again we quickly transferred her to the hospital over 50 kms away by motorbike where she needed two transfusions. I have since been told that she luckily is back in the community doing well. Sadly, these are only a few examples of the impacts of malaria we encounter daily, however, fortunately MSF is present in order to care and treat these cases.

Given the malaria burden, it is one of our mission’s main priorities, and one of my main objectives, to implement our new community approach to treating malaria. This strategy will be run by the community health workers (CHWs) in selected villages and will be treating malaria at the source. Community health workers are villagers who volunteer to help spread health messages or with vaccination campaigns or by being a role model and resource to the populations. Often they do not have any formal health care training but have a will to help their community. We work with CHWs daily in our health centers but are now expanding our network to treat beyond our health centers catchment areas and where access to health care is difficult for multiple reasons.
This past week the new supervisor for this strategy and I invited our selected CHWs to a week-long training on malaria; it’s symptoms, diagnosis, treatment and all the “administrative” work that encompasses this new strategy. After months of planning, analyzing and meetings with community leaders the 6 chosen CHWs left the compound with huge smiles, new theoretical and practical competencies and the entire “package” to start the strategy upon arrival home. We are anxiously awaiting our first “on the ground visits” to these communities that we previously had not worked with and see our concept and hard work in practice.
The number of lives that will be saved by offering free diagnosis and treatment of malaria in remote regions is not yet known but the potential impact is high. After the many tragic stories caused by malaria that we encounter daily, it is the moments like these when I was waving the motos off carrying our CHWs and the loads of medications to their communities that gives me the strength and passion to work in these settings.