Pregnant with malaria
Patient, Zamukunda, 20 years old and pregnant - Mweso Hospital, North Kivu
"My name is Zamukunda.* I tested positive for malaria at the health centre. This morning I delivered my first child, a boy who weighed 1.6 kg. My labour began very late last night, which was a surprise because I was still far from my delivery date. I was in a lot of pain and was bleeding, which made me worry, so I left the house with my mother and we walked for two hours to reach this health centre.
My baby was born at 2am this morning. He was not breathing very well and I was continuing to bleed so MSF decided to transfer us in their car from Kashuga to the main hospital in Mweso. We picked up another woman and her child who was very sick with malaria. The trip took only an hour since there has not been much rain. Now I am in the intensive care unit at the hospital with my baby, who is on oxygen. So far we are doing ok."
Zamukunda's son was born at 7 months gestation. She did not know how the disease would affect her pregnancy or her baby. She had high fevers that come with malaria and can provoke contractions and lead to premature delivery. Zamukunda and her son are receiving treatment at the MSF Mweso hospital.
Accessing treatment by canoe, on foot, bike or motorcycle
Nurse, Bilesuku Lulinda Pacifique, Sebele Health Clinic, South Kivu
Some of our patients come from ten kilometres away to our health centre, on foot, bicycle, motorcycle or in a canoe if they live on the peninsula: most of them are ill with malaria. Before MSF supported this health clinic, it was difficult for the people to access health care because they could not afford to pay for consultations or medicines.
Each week we treat about 600 to 900 patients, often more than 100 patients per day. MSF distributes mosquito nets daily, they are given to pregnant women during their prenatal consultations, as well as to children who test positive for malaria and are under the age of 5.
Often people had used the mosquito nets at home, but they lived in a conflict zone, and when they fled, the nets were left behind or were stolen. This is part of the reason why we have been seeing more people with malaria.
Treating Severe Malaria in Mweso
Dr. Jennifer Turnbull, Mweso Hospital, North Kivu
In the thick of our malaria epidemic, we saw up to 25 patients a day with severe malaria at the hospital. Most of those patients required blood transfusions as they had developed anemia related to the severe form of malaria. Most patients were also in a coma. For a period, we were doing up to 10 blood transfusions a day! On our worst day, we had 25 patients in 11 beds in the Intensive Care unit. All of this was in addition to the 800-1200 cases a week of "simple" malaria that we were seeing at the health centres that MSF supports.
Everyone worked hard to set up extra beds, increase blood donations, and treat malaria cases as early as possible. This included setting up specific mobile malaria clinics that ran 5 days a week in the areas with the highest concentration of cases. We also successfully lobbied the local Ministry of Health leaders to change treatment policy in the area to more effective therapies. This meant the difference between one quick injection a day versus several hours-long infusions a day for severe malaria. We were able to make this treatment available in our supported health care centres, thereby decreasing time to treatment. Despite the heavy caseload and severity of cases, this treatment change helped us to keep mortality very low throughout the epidemic.
Each year, around eight million simple malaria cases progress to severe malaria, where patients show clinical signs of organ damage, which may involve the brain, lungs, kidneys, or blood vessels. It is therefore critical for people to be able to access health care more easily. Severe malaria cases often stay in the hospital for over a week. This can be much longer, especially in children with malnutrition who are prone to other infections. If caught early, however, simple malaria can be treated with a 3-day course of pills.