Fieldset
Beginning of the hardest month – the rainy Season

"My youngest patient with malaria was just six weeks old."

Daniela is a nurse from Germany, who is working in Sierra Leone, a country where healthcare has been seriously impacted by the 2014 Ebola outbreak.

Sultry, warm and shaken well: that’s what the rainy season feels like for us. A couple of weeks ago, it would take us one and a half hours to reach the small health centre by Land Cruiser. Today, it takes up to three. The streets are littered with huge puddles – pure mud slopes. We drive around the ‘lakes’ as well as we possibly can so we don’t get stuck, but we feel every pothole.

On Monday morning it’s time to leave to the health centre in the small town of Mile 91. Before leaving, my colleague Maura and I know that we’ve got a long journey ahead of us. We already feel tired, but we’re grateful for our fantastic drivers who take us safely to our destination despite these extreme conditions.

Early in the morning, the health center at Mile 91 is already full to the brim. © MSF

Early in the morning, the health center at Mile 91 is already full to the brim. © MSF

Treatment with obstacles

During the trip I keep asking myself how our patients must feel on the way to the hospital in Magburaka, where they are referred to with serious illnesses. On a motorbike – the usual means of transport for patients – it can take even longer than our Land Cruisers. When it rains, motorcyclists have to stop and valuable time is lost. There’s also the risk of accidents if the driver isn’t careful and makes a mistake driving through the fords of water. Finding different routes simply isn’t possible in many places when entire roads are flooded. And we’re still not at the peak of the rainy season.

With the onset of the rains, the number of children admitted to Mile 91’s Health Centre has dramatically increased. When we reach the hospital on Monday morning, the waiting area is already full with young patients.  After the weekend, this number can be as high as 150. Most suffer from malaria, and pneumonia cases have risen sharply. Unfortunately, both malaria and pneumonia affect even the smallest patients. My youngest patient with malaria was just six weeks old.

For children under five years old, the disease is particularly dangerous if the correct therapy is not started soon enough; malaria has a high mortality rate. We always give our patients and their parents mosquito nets to take home. But we need to be clear about their use when we do so. Some parents use the nets for things other than protecting them and their children when they sleep: some use them to fish with while others use them to transport goods. This is why the work of our mobile teams that go out to villages and carry out health promotion activities is so important.

Here I visit my little malaria patient, Ramatu, in the hospital. © MSF

Here I visit my little malaria patient, Ramatu, in the hospital. © MSF

Two to three children per bed

Malaria comes with a high fever, nausea and vomiting, which weakens a child’s body very quickly. Because of recurring infections, children often suffer from anaemia so they have to be brought to the state hospital in Magburaka to receive blood transfusions. We’ve opened a blood bank in the hospital that’s actively supported by many blood donors. It’s great to see how the people of Sierra Leone are trying to help their children in this way.

In recent weeks I’ve been working hard to set up a small in-patient area at Mile 91 so we can treat children in a more intensive way. My colleagues and I always decide from case to case how to go ahead and sometimes we have to refer a child because their condition has deteriorated rapidly. This shows how insidious malaria is. We have two beds in the small health centre. We often have to occupy a bed with two or even three children – the need is so huge.

Ramatu was lucky

Ramatu is one of my young patients that we had to keep in our small inpatient area at Mile 91. Her condition was worrying. She didn’t respond to the drugs we prescribed immediately, as we had hoped. She had seizures again and glucose levels in her blood dropped dramatically. We had to watch her closely. Because of this, we decided against transporting her to the hospital – it just takes too long at the moment because of the rains. But, after three days she was finally stable enough to be taken to the hospital .

Ramatu’s father, Abdul, accompanied his little daughter to Magburaka. Her mother stayed behind to take care of her sisters. Friends and family helped her with work in the fields and took over Abdul’s duties. Ramatu spent a total of two weeks in hospital, the first three days of which were in a coma. She recovered slowly, piece by piece, until finally she could go home.

These are the most difficult moments: those when we have to decide whether patients like Ramatu should be referred to hospital or if we should wait. Every day in our small secluded project at Mile 91 we have to deal with this responsibility. Remote and far from hospital, it’s only us and our skills here – my local team and I – and we are getting to know each other more and more. I’m so pleased that I still have the opportunity to save some lives with them here.

Bye for now and many regards from Mile 91. © MSF

Bye for now and many regards from Mile 91. © MSF