If you put a classic world map in front of you and put your eyes in the middle of the map, or in the heart, if you will, there you will find a large African country called the Democratic Republic of Congo.
A country with one hand in the Atlantic and the other in Lake Tanganyika - in the shadow of the volcanoes of the Great Rift Valley.
I have just started my mission for MSF in the Katanga Province in the southeast part of the country. It is something of a highland, where the great Congo River originates. It is a bushy landscape, occasionally crossed by sandy gravel roads.
Since March this year, there has been a measles epidemic here. Vaccination coverage is not good enough to avoid outbreaks such as this. The latest outbreak began in 2009 and lasted for more than a year.
When I arrive at the village of Mulongo by Lake Kabamba’s northern shore, the team has already installed itself in an empty hospital building. This building is full of patients when I arrive and they are already preparing the next building.
I step into the ward, and see a room full of febrile, tired children. The mothers and other companions sit on the sides of the beds and take care of their little ones. And I admit this is the first time I have ever seen a case of measles, but now there is a complete ward full of children with measles right there before my eyes.
The following day and my first morning at the hospital, a two-year-old girl arrives. She is in a state of “shock” in the medical sense of the word. She is barely conscious and is taken directly to our little emergency room.
She is breathing very fast and the skin sinks in between the ribs and below the rib cage - a sign of respiratory distress in children. She is not getting enough air. Her lungs rattle. There is no X-ray, but in this case it is not needed. She has got all the signs of severe pneumonia. She breathes 70 times per minute, an oxygen mask is already in place.
The signs of measles are there. The dots, the fever, the mucus, the cough and the inflammation of the mouth and eyes. We take the measurements we can. Blood sugar test shows the blood sugar is dangerously low, so she gets a rapid bolus dose of sugar solution intravenously and then a continuous sugar drip. She gets a urinary catheter and a nasogastric tube. When we check her blood sugar again, it is still far too low. She has a severe anemia. And she has malaria.
It gets extremely hot in the little room, the metal roof warms up quickly as the sun rises, and the oxygen extractor runs hot. We are several physicians who work and several nurses. The girl requires a lot of work.
For a few moments the discussion ends, and then the only sound in the room is her strained, rapid breaths and the old table fan that plays a monotonous sound. The sweat runs down her back, and now and then a drop of sweat from the tip of my nose hits the floor. A gecko lizard runs along the fixed mosquito net over the otherwise empty little hole that’s supposed to be a window.
She gets an acute transfusion for her anaemia and diuretic agents for her heart. Furthermore she is given three different antibiotics and intravenous treatment for malaria. She gets antipyretics, but the fever persists. The low levels of blood sugar persists. The urinary output decreases slowly. The night falls and with it the bradycardias sets in - when the heartbeat becomes very slow.
These episodes get more frequent during the night. The blood oxygenation levels decrease. And shortly after sunrise the two-year-old heart in the girl's thorax gives up. Our resuscitation efforts are not successful.
Measles is not only about fever and a red rash. It's for real. And it’s about life and death.