In Nyalagusha, South Kivu Province, Democratic Republic of Congo (DRC), MSF set up the malaria treatment center in a structure next to the health post on top of a hill visible for miles.
As I sip my morning coffee perched on the half-built wall that surrounds our base, I look out onto an amazingly verdant landscape of hills surrounding the small village of Tushunguti. I can see the sun rising above the hills that we walked over to reach this farthest outpost of MSF’s project in the Minova Health Zone.
As I focus in on the hills, I see the endless fields of corn, manioc and peanuts, which are the staples here. I also see some banana and avocado trees.
I focus in more closely and I see women and girls wrapped in colorful fabric walking on the village paths to and from the well carrying large jerry-cans full of water. I see men and women leaving the village and heading towards their fields where they will put in a full day of work in order to feed their families.
Freddy, a nurse, set up the mobile clinic in a mud hut where he saw up to 50 patients per day.
But no matter how closely I look, I cannot see what it is that causes the most illness in this community. I cannot see the cause of what some community leaders have called “la maladie inconnue que ravage” or “the unknown illness that is ravaging the community.” No matter how closely I look, I cannot see the Plasmodium falciparum, the protozoan parasite that causes the malaria that has been ravaging the communities in the health area served by the Tushunguti health center. While malaria is generally easy to diagnose using a rapid test and to treat with artemisinin-based therapies (ACT), millions die every year from malaria due to lack of access to adequate health care and the early diagnosis and treatment needed to prevent these deaths.
I arrived at this beautiful and isolated place with a doctor, three nurses, three health promoters, a logistician and an administrator from the emergency response team based in Bukavu and the project in Minova. We were there to provide early diagnosis and treatment for malaria. We came equipped with rapid tests and the appropriate treatments.
And most importantly we came ready to walk to where the people were dying from malaria. In this area with a population of 15,000, many people did not come to the health center for their free early diagnosis and treatment. Instead, they stayed in their villages and sometimes paid for substandard care at the local health post. But it seems that more often, they visited the prayer rooms and prayed to get better. Or they paid traditional healers for their services.
Like me, the members of these communities cannot see what causes the illness and deaths. But unlike me, who is well versed in modern medicine and believes in the germ theory and knows that this unknown illness is, in fact, well known and treatable, the members of this community believe that the unknown illness is caused by sorcery.
So, as I said, we came ready to walk. And walk we did—to Nyalagusha, Bundje, and Bundengi. We walked for hours in order to reach the people with early diagnosis and treatment and with a host of health promotion messages. We talked to the community members about malaria—its cause, the importance of early diagnosis and treatment, and how to prevent it.
We worked to convince them that, in fact, it was the Plasmodium falciparum causing the illness and death. And we provided free, appropriate and respectful care so that they could learn to trust MSF and turn to us for care in the future.
As an avid hiker and camper, I was in my element. Here I was camping out with a great group of MSF colleagues, walking hours in the mountains and crossing rivers on log bridges every day in order to reach the communities.
But best of all, when I reached my destination I was working side by side with these colleagues to treat people and to educate them about health and wellness. We provided free consultations and treatment. We referred the people with severe malaria to the health center. And perhaps most importantly, we convinced people that they should access the free and appropriate health services at the health center in Tushunguti, which would remain long after our intervention ended.
During the three weeks of our intervention, we treated approximately 8% of the total population of the area for malaria. To put this into perspective, it is equivalent to treating 3.76 million Spaniards, or more than the entire population of Madrid, for the same illness within three weeks. And if you are sitting in the United States, it is the equivalent of treating 25.8 million people, or the equivalent of the populations of the ten largest cities in that country, within three weeks for the same illness.
While malaria has been on the rise all over the Democratic Republic of Congo and while there needs to be some massive prevention work in order to reduce the number of cases, I do believe that we made a difference in Tushunguti.
Each evening, as I returned to our base after a day of treating patients, I would see people whom we had referred for severe malaria or for the other illnesses that we were not treating walking along the same path in the opposite direction.
They would greet me with a smile and wave their MSF health card—proof that they knew where to get care for whatever illness ravaged their community.