Treating refugees in Tanzania: Malaria

Saschveen has recently returned from assignment with Médecins Sans Frontières / Doctors Without Borders (MSF) in Nduta, Tanzania, where she was providing vital healthcare to the many Burundian refugees there. She shares her diary from the time...

One of the things that shocked me most on my arrival in this project was the number of malaria cases.

I arrived just after the rainy season ended, expecting the malaria rates to be start dropping then. However this year saw another surge of malaria after the usual peak time.

A young boy is tested for malaria by a member of MSF staff

A boy is tested for malaria. Photo: Saschveen Singh / MSF

I was prepared to see many cases of severe malaria, and was well versed in the emergency management of these cases from my previous training and from reading all the MSF clinical guidelines.

But it was quite overwhelming to see how many admissions we had on the wards, and to see the outpatient area absolutely overflowing with patients with malarious fevers, and the number of our Burundian staff succumbing to the disease.

With malaria, the worst of the worst cases are sadly always children. Our paediatric intensive care unit was filled with kids with such complicated cases of malaria that they were still having convulsions and haemorrhaging blood in their urine, requiring blood transfusions and intensive emergency care. 

Patients with the most severe cases of malaria, even if they survive thanks to treatment, often have long-term secondary effects that can haunt them for life. These effects can include brain damage and other essential organ damage, so seeing kids on the ward in this state was gruelling to say the least.

The waiting room at the MSF hospital in Nduta Refugee Camp, Tanzania

The waiting room. Photo: Saschveen Singh / MSF.

Malaria is a truly awful disease that is hugely prevalent across the world. Approximately 3.2 billion people (nearly half of the world’s population) were at risk of malaria in 2015, and approximately 400,000 people die from malaria each year, with 90% of those deaths occurring in Sub-Saharan Africa, and 70% of those deaths being in children. (Source: WHO)

Here in our project it is one of the most common illnesses that we treat, yet one of the biggest challenges to prevent as this requires a combination of public health measures such as health education, insect control, distribution of mosquito nets, and early diagnosis and treatment.

Meanwhile, back at the MSF house, I feel very lucky indeed, taking my anti-malarial tablets every day without fail, and sleeping soundly under the protection of a mosquito net. Refugees however don't always have access to these and malaria traps people in an unfair cycle of suffering and illness. 

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Sachy's feet are silhouetted against her mosquito net as she lies in bed.

Under my mosquito net. Photo: Saschveen Singh / MSF.

Huge efforts are required to ensure that people have access to health promotion messages, adequate insect control measures and mosquito nets. But these interventions are costly and difficult to sustain in an ongoing crisis context. 

There is no one-off quick fix: the nets need frequent distribution as they get damaged with time; many families I meet are currently living in tents without them.

For now, a few months after the peak, the rates have dropped temporarily, but with another rainy season rapidly approaching us yet again, we are already in preparedness planning mode and bracing ourselves for the next waves of malaria to hit our little hospital.