A paediatrician in Guinea-Bissau: Malaria season is here

With the rains come the mosquitos. Mårten blogs from the rainy season in Guinea-Bissua, where the hospital is ready for an influx of patients with potentially deadly malaria...

I am sitting on the veranda to my room and watching the rain pour down outside. Fresh, cool winds pass by. We have entered the rainy season and right now, and almost every day, there is rain for a few hours. Sometimes it decreases quickly and after that it’s sunny, warm and humid.

Sometimes the rain continues throughout the day. Everywhere there are puddles, or rather ponds of water, and on the dirt roads with a slight slope, the water drains and creates deep lakes in the fields. It's not just a status marker, you really need a four-wheel drive to get around here.

Image shows a boy lying on his side in a hospital bed with his back to us.

A young patient in an MSF paediatric project in Guinea-Bissau.  Photo: Ana Lilia Banda / MSF

As expected, the combination of the ponds and the heat makes perfect breeding grounds for mosquitoes, which carry malaria. From now on, patient flow will increase until sometime after the rain ends, when both the number of mosquitos and the resultant malaria cases starts to drop.

In 2015, the first year MSF was active here, the team became somewhat overwhelmed by the many malaria patients that flooded the hospital. Most beds were shared by two or more patients and not enough staff were available. Since then, plans have been made to increase resources during the malaria season. This year we opened an extra department and have emergency preparedness with extra tents, and this month we’re hiring three additional national doctors and six nurses to staff up.

On my sixth semester of medical training, I did an exchange to Rio de Janeiro and did a research project on cerebral malaria on mice. When I saw the poor mice stumble around with jerky movements and having seizures, I didn’t really imagine that I would work with children affected by this terrible disease.

We still don’t know why some people who contract malaria also get infection in the brain

We still don’t know why some people who contract malaria also get infection in the brain. There is no specific treatment for this type of malaria, but statistics show that 80% of people with cerebral malaria survive with antimalarial medicine (Artesunate) and conventional intensive care treatment. However some of the survivors will have neurological damage.

Issufai, who was 10 years old, came to the emergency room with seizures that we managed to stop with Stesolid. A thin layer of dried clay covered his body: an attempt to treat the seizures by the village's medicine man, and evidence that traditional medicine has high public confidence. Often the medicine man is the first person families consult.

Issufai had had fever for three days and had had several seizures, but eventually the family took him to the health centre, which then sent him to the hospital with MSF transport. The test for malaria was positive and Issfai’s fever was over 40 degrees. One hour after the seizure stopped, he lay still on the bed with his eyes open and blank.

He lay still on the bed with his eyes open and blank

Issufai was still unconscious even though the seizure was lifted and the effect of anticonvulsants decreased. We pinched his fingertip, and he responded by pulling his finger away.  

That fact that had been brought to the hospital for treatment three days after his symptoms had started obviously made his prognosis worse. For two days, Issufai received antimalarial medicine, intravenous fluid and a broad-spectrum antibiotic against possible bacterial infection.

But the fever continued and Issfuai’s breathing became faster. Perhaps he had aspirated saliva and had pneumonia?

On the morning of the third day, he was even worse. We tried the pinching test again - he responded only by stretching his arms and legs. His breathing slowed and became irregular. A few hours later, he died, despite our resuscitation attempts, and the hospital hall was filled by the mother's mourning song.

Issufai was one of the 20% who did not survive cerebral malaria.