We are in the so-called "African meningitis belt" in southern Sudan. The belt stretches from the eastern part of Ethiopia, across southern Sudan, southern Chad, Nigeria, Niger, Burkino Faso and Mali, to Guinea and Senegal.
The area is subject to regular, explosive epidemics of meningococcal meningitis caused by the bacterium Neisseria meningitidis. Epidemics occur in vaguely periodic patterns about every 8-10 years. I am told that the time is ripe for an out-break. MSF carefully monitors cases of meningitis, a kind of early warning system.
The boy is about 6 years old. He has a fever and is unwell. His neck is rigid and he cries miserably when I try to lift his head off the examining table. The lumbar puncture is positive. We start him on high doses of an antibiotic called Ceftriaxone. Within 24 hours he is eating and sitting up; I have to check the chart and make sure I have the right child.
This boy is younger, about 3 years old. When he arrived at the in-patient department he was already semi-comatose. We think he has meningitis; he dies as I am positioning him for his lumbar puncture. The mother is frantic, talking loudly and angrily. I suspect that I am being blamed; the interpreter does not translate for me.