Late for the emergency

It’s shortly after 8am and I’ve just arrived, huffing and puffing, at the MSF base in Bikenge, Maniema Province. The health promotion team – Albert, Daniel and Gaston – is already there waiting for me.

It’s shortly after 8am and I’ve just arrived, huffing and puffing, at the MSF base in Bikenge, Maniema Province. The health promotion team – Albert, Daniel and Gaston – is already there waiting for me. They look sharp enough in their collared shirts to meet the Queen of England; but today our task is to raise awareness in the community about malaria.

“I’m sorry I’m late,” I say breathlessly. “I had to take a call – it was an emergency.”

They don’t make a fuss; but something in their regard says, “And this isn’t?”

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As we make our way along Bikenge’s main avenue, we exchange jambos* with other pedestrians and dodge the odd motorbike. A few cyclists wobble past. There are no cars on these roads: those leading into town are so bad that only four-by-fours can negotiate them.  As a result, goods are moved into, out of and around Bikenge almost exclusively on bikes or on someone’s back.

In the shade of a banana tree we gather a crowd, and the guys start their spiel. They explain what malaria is: a parasitic disease transmitted by a mosquito that can bring on some nasty symptoms. Without treatment it turns into its severe form, which causes complications like anaemia. Once the illness gets to this point, it can actually kill. 

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Daniel explains what malaria looks like in a child.© Sandra Smiley

From what my survivor’s Swahili allows me to understand, the crowd knows their stuff. They know they should use a mosquito net to avoid being bitten. They know what how to identify malaria, and that they should visit a medical clinic when their children fall ill.

But the trouble is, they say, that the prices charged for healthcare are too high. Most hospitals and clinics in Congo operate on a cost recovery basis, meaning that though the service itself is free, the patient must still pay for everything else: gloves, tests, medications and so on. It can cost upwards of $50 to treat a child for malaria – a sum that few here can afford. And by the time the situation is desperate enough to beg, it’s often too late.

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The discussion moves on to the signs and symptoms of malaria: lack of appetite, headache, chills and vomiting. And as if on cue, there’s a loud, unpleasant sound from within the crowd. Someone being sick. All heads turn toward its source: a little girl in her grandmother’s arms, sputtering, coughing and gagging.

Now I’m not a medical professional: indeed, the extent of my medical training is a course in First Aid and a couple of seasons of Gray’s Anatomy. But I know a sick kid when I see one. I reach out to feel the little girl’s forehead: hot to the touch.

“Do you know where the MSF health centre is?” I ask. Grandma says yes.

“Come and see the nurses there,” I say. “It won’t cost you anything. And it’s better safe than sorry.”

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Outpatient department nurse supervisor Mwinyi finishes up his paperwork. On any given day, more than half of the patients he will see will have malaria. © Sandra Smiley

Back at base that afternoon, I scan the most recent activity report for the MSF-supported health centre in Bikenge. Amidst all the graphs, tables and charts, one stat in particular stands out: of the patients admitted to the emergency ward last week, half of them were suffering from malaria.

I like to think that where I come from, if every second patient coming in to the emergency ward was suffering from the same life-threatening but preventable illness, there would be massive and immediate action. There would be large-scale prevention campaigns, politicians on high horses and the public baying for blood. 

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The nurse takes a sample of a young patient’s blood to do a malaria rapid test in the triage area of the Bikenge health centre. © Sandra Smiley

But here, no. People seem to have accepted their children getting ill with the parasite. And why shouldn’t they have? What else can they do?  Despite the clear and urgent need, mosquito nets do not get distributed. Malarial pools of stagnant waters do not get drained. Health centres make people pay with money they don’t have. 

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At the MSF-supported health centre in Bikenge, everything – including medicines from the on-site pharmacy – is free. © Sandra Smiley

Malaria makes people sick in huge numbers in Congo: MSF provided free, high-quality treatment to 500,000 of them in our health structures last year. Those whom we could help in time had a good chance of getting better; and those whom we couldn’t, did not. So if we understand “emergency” not as a percentage or a threshold or a rate but as “a situation requiring urgent action,” malaria is definitely one.  It’s a particular kind, taking its victims quietly and without spectacle. But it’s an emergency all the same.

I shut down the computer: time to go home. Tomorrow I’m going out with the health promotion team, and 8 o’clock comes early.

* Jambo: Swahili for “hello”