April 25, 2012, 8:21 a.m.
Most of us in Canada only think about malaria when escaping on vacation or planning a backpacking adventure. Patients and friends have often asked me if they can contract the disease from mosquitoes when they travel.
But for millions of people who live in places where it is endemic, malaria is a constant threat to their lives - today, World Malaria Day, and every day.
I recently returned from such a place, working for 11 months with Médecins Sans Frontières (MSF) in a village called Mweso, in North Kivu province in the Democratic Republic of Congo (DRC). MSF supports the only general referral hospital in the area, as well as several health centres.
DRC is currently experiencing a surge in malaria - MSF has recorded a 250-per-cent increase compared to 2009 levels. The number of severe cases is alarming, characterized by coma and convulsions requiring hospitalization.
I saw first-hand the beginning and dramatic peak of the local epidemic. On our worst day, we received 25 patients with severe malaria. Most were children, already in a coma, and many needed blood transfusions.
I will never forget the arrival of the first three patients. Our team had found the patients at a health centre a bumpy one-hour drive north. A nurse rushed in, an unconscious 6-year-old boy limp in her arms. We quickly made room in a bed beside a child with severe pneumonia. The next child was pale and weak but able to sit in a bed with two other patients.
The last patient was the most shocking. She was a young woman brought in on a stretcher, struggling for air. She had just delivered prematurely and the baby had come too early to survive. Her symptoms were severe, suggesting she was also sick with something else. I looked around as more patients piled in. The malaria epidemic had announced itself.
That week we saw 1,200 malaria cases in just one health centre. During the coming weeks, we sometimes performed 10 blood transfusions a day and saw about 800 to 1,200 cases a week in the health centres. We often had 20 patients in 11 intensive care beds and our pediatric and malnutrition wards had two or three children plus their mothers in each bed.
We set up more beds and encouraged more blood donations. We treated malaria early in areas with the highest concentration of cases. I and another Canadian doctor working for MSF successfully lobbied local ministry of health leaders to change treatment policy to one injection a day instead of several hours-long infusions a day.
We sprayed homes with special insecticide, dug trenches to drain swampy areas and educated people about using mosquito nets.
But the numbers kept climbing. One reason: the Kivu provinces are a chronic conflict area. The beautiful scenery, perfect climate and wonderful people belie another reality. On the day I first arrived, a 14-year-old girl was raped outside our village and three children died during hospital rounds. Women walk for days with dying children on their backs to reach our hospital, and locals risk death from robbery on the roads. This is life in the Kivus.
People are afraid to use mosquito nets in their homes. They fear being trapped in them during a nighttime armed raid. Constant insecurity forces many people to sleep in the forest, sometimes in the very swamps that breed the malaria transmitting mosquitoes. People face an impossible choice: protecting themselves against a dangerous disease or protecting themselves against violence.
Ongoing research about malaria must be encouraged and supported, to find new interventions for areas that suffer from instability. MSF continues working throughout DRC to provide treatment and decrease mortality, but new preventative and sustainable measures must be implemented if we are to save lives in the long-term. We cannot continue to ask people to make impossible choices.
Every year, nearly 300,000 children in DRC under age 5 die of malaria, the leading cause of death in the country.
We lost the young mother that night. The team worked around the clock trying to help her breathe but she needed more than we could provide.
I learned of her passing on my walk to the hospital the next day. I saw the long face of a nurse who had worked overnight. I tried to tell him everyone had done everything they could.
But he responded, "When sickness takes the old, I can accept that. But when it is a young mother who leaves children behind, I just cannot understand."
Jennifer Turnbull is a former Montreal Children's Hospital doctor recently back from Africa.