Feldgruppe
On measles, malnutrition and malaria

In my eyes, there are three major acute diseases affecting children in this part of the world. The three "Ms" – measles, malnutrition and malaria.

I get up just before sunrise to run on the airstrip next to our base, it is the only place that is not too sandy to run.

In my eyes, there are three major acute diseases affecting children in this part of the world. The three "Ms" – measles, malnutrition and malaria.

I get up just before sunrise to run on the airstrip next to our base, it is the only place that is not too sandy to run.

I don’t really like to run in the mornings, but already shortly after 07:00 it is too hot, so I have no alternative.

The morning sun lights up red through the morning mist behind the hills to the east and slowly turns yellow, like the colour of the ripe mangoes that grow in abundance here.

It doesn’t take long before several groups of children stand along the runway to look at me. They scream and call for attention when I run past. Many definitely want to run with me for a bit.

They run as fast as their legs can carry them. They pant and their breath whistles in their chests. Most of them have to stop. Their pale palms, soles and eyes reveal the secret – they have anaemia. It is no wonder they pant.

A boy comes in early one morning; he has just turned seven-months-old. He is wrapped in a black, yellow and green cloth that hangs from his mother's back.

A few days ago she took him to the health centre where he was diagnosed with measles. He received the usual treatment but has only got worse.

Maybe it's because he's severely malnourished. He has no reserves in the body to speak of. The immune system is exhausted. He has what is called marasmus, the slow form of malnutrition, where the body converts body fat and muscle tissue for energy.

He is breast fed and sometimes gets a little light, liquid porridge made from cassava. Both measles and malnutrition impair the immune system. The body becomes susceptible to all kinds of infections.

Now he has diarrhoea and severe pneumonia on top. The thought has already crossed my mind, it is the pale palms and soles of the feet again; he has anaemia.

The most common cause of anaemia in this part of the world is due to another disease. The two red lines on the little plastic rapid malaria test (a test for the most severe falciparum type), indicate that it is positive. He has malaria.

The first rains of the rainy period have fallen. Flying termites fill the evening air before they lose their wings and drop to the ground. It is not just due to the rains, the proximity to the lakes in the area also plays an important role in malaria being endemic here.

Malaria is not associated with measles, but it is so common that many children who get measles also have malaria. About half of our patients admitted to the measles hospital have malaria too.

Many children have blood levels that are jaw-dropping to a doctor from Sweden. A value ​​down to 3.0-4.0 g/dL is not totally uncommon, and testifies that the child has had multiple malaria infections in recent times.

In the coming days, he has repeated spikes of fever up to 40 degrees, with hours and hours using extreme effort to breath.

He gets his treatment and after the first few days and nights dancing on the edge of tragedy, he starts to slowly improve.

The fever and the diarrhoea begin to subside as well as the cough and breathlessness. After one week he is referred to the malnutrition department in the ordinary hospital.

At the time of writing, he is doing better. The measles is over and now he's immune. The malaria parasites which turned his few blood cells and liver into their home, have left. The malnutrition is improving, but it will take longer before it is over.

He faced the three "M" diseases at the same time. And he survived.