It started just after Christmas, when two-year-old Merveille came to our hospital.
For a few days she had been very tired, with a cough, fever, and conjunctivitis: an infection of the eye that can be associated with viral diseases.
She also had a bumpy rash and the skin on her face and arms looked like swollen. In my medical career in Sweden I’d not seen that before. Now I know that's how the measles rash looks on darker skin.
The safe side
I’m currently on assignment with MSF in the Central African Republic. Earlier this year there was an outbreak of measles in another part of the country, but at first it felt very unlikely that it would spread to us.
In this part of the country they haven’t had a major measles outbreak in many years. None of us on the team were used to seeing people with the disease. Still, to be on the safe side, little Merveille was isolated from the other patients. Measles is tremendously contagious, and can be fatal, especially for children.
Looking for answers about Merveille’s symptoms, we took some samples and sent them to the lab in Bangui, the capital city. Unfortunately, this takes time.
A growing concern
In the following days, a few more patients with similar symptoms appeared.
The children with suspected measles had to be isolated together in a separate building.
Our mobile team, which goes out and supports the health stations in the villages around Bossangoa, was informed that an unusually large number of children were ill.
This didn’t feel right.
One evening a week later, I was on duty in the hospital. Suddenly, the emergency room and the area outside were full.
Most of the people were parents from surrounding villages who had travelled, many for several hours by moped taxi, to come to us in the hospital with their sick children.
I remember thinking, “Help, now we have an epidemic!”
All our beds in the isolation building were already full and we now had to put two children in almost every bed. I was so impressed with how quickly my local colleagues adapted to the situation and somehow made sure everyone was accommodated.
A torrent of patients
More people continued to arrive, and after a few days the trickle of tired, coughing children with swallowed eyes and bumpy skin turned into a torrent.
At each health station, mobile teams were being met by 50 parents with their sick children. In one village we were told that 17 children had died, in another, nine. And those families who manage to reach us at the hospital in Bossangoa were often arriving too late.
At extra risk
The health care system in the Central African Republic is incredibly weak. According to estimates by the World Health Organization only about 60% of children receive the first vaccination dose at nine months old. Unfortunately, no other dose is given in the national vaccination program.
As a result, a huge proportion of children are susceptible to the virus, and children who are already weak from malnutrition and malaria are at extra risk.
A hundred children a day
Our team has been working at the breaking point since January. For several weeks almost a hundred children a day came to our emergency room.
The only thing that can stop the epidemic is vaccinations, but there are no local resources for this.
Fortunately, MSF, together with the local authorities, have succeeded in carrying out a large vaccination campaign just north of where I am, and next week we hope to be able to carry out another campaign in our district.
Thanks to this vaccination campaign, the burden on our hospital has finally begun to decrease.
A simple injection
No more dehydrated children with bloodshot eyes arrive from the villages where we have been vaccinated. And it feels so good!
Even though a vaccination campaign involves a lot of work, it is great how easy it is to protect children from this terrible disease: a simple injection is all it takes.
With my own eyes
All this really makes me think about MSF’s donors around the world. None of this would be possible without them. If you’re a supporter reading this, please know that thanks to you, we’re able to do not only the daily work of supporting the hospital and health care facilities here, but also to quickly adjust and act in the crisis situation that a major epidemic entails.
With my own eyes I have what a difference it makes!
So, what happened to Merveille? She became one of the first confirmed cases of measles and stayed at the hospital for almost a week to get medical care while her body battled the disease and the pneumonia that had come with it.
Every day, she became a little more cheerful and eventually started playing and eating as usual.
On the last day of the illness, her mother dressed her in an extra fine white dress. I could see that they were ready to go home.
It felt so good to see this little one, who came to us in the arms of her mother, walk out of here by herself with small plucky steps.