* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Andy Mews is head of programmes for Medecins Sans Frontieres/Doctors Without Borders (MSF) in Katanga Province, Democratic Republic of Congo. The opinions expressed are his own.
You begin feeling flushed. You get a fever which gradually worsens. You lose the desire to eat. All the colour leaves your face, hands and feet. Your limbs ache and you feel week, feeble to the point where you can’t even move. The hours, days mesh into each other as you drift in and out of consciousness. Somewhere in between the sleepless nights you might lose it altogether. And all of this is because a few mosquitoes bit you.
Malaria is a predictable disease. On the level of the individual, patients deteriorate slowly and consistently, experiencing the same flu-like symptoms as the parasite weakens and kills over days or even weeks. On a macro level, malaria is a dependable yearly presence where I work in Katanga Province, eastern Democratic Republic of Congo (DRC).
Nonetheless, we are currently responding to an alarming number of malaria cases in this area. We are running malaria treatment programmes in hospitals and daily mobile clinics in the area around Kinkondja, Katanga province, where last week our teams saw an incredible 3,000 suspected cases.
The intervention began as a response to a cholera outbreak, but as the teams saw more and more people suffering from the symptoms I’ve just described – and more and more deaths due to malaria-related complications – they switched gears and began treating the disease as a matter of urgency.
Malaria is not your bog-standard ‘emergency’, and it doesn’t conjure the same images of catastrophe that natural disasters or outbreaks of gruesome diseases like cholera do. But it is in Katanga province. With many living on or near lakes and rivers, Katangans are particularly vulnerable to the bite of the mosquitoes that carry the disease, which thrive on stagnant waters.
The numbers back this up: over 1.1 million cases of malaria in Katanga were reported to the Ministry of Health last year. And that’s just the number of cases reported – considering that many people do not or cannot seek care for this disease, who knows what the real numbers look like?
Operating in this area, we’ve also seen that the death rates for this preventable disease are very high: at Kinkondja, there have been weeks where more than 10 percent of our admitted patients have died. Most of those patients have come suffering from malaria in its severest stages. Many of them die within the first 24 hours of arriving at the clinic.
What’s more is that our health centres and hospitals have noticed that the number of people affected is getting bigger year-on-year. In our Shamwana project, the team has seen a triple-fold increase in cases since 2009, from 8,000 patients to 24,000 people last year.
This is a disease that is endemic to the area and that peaks and troughs predictably every year, yet for which numbers of affected are getting bigger and bigger. What exactly is behind this paradoxical situation we can’t determine definitively. But our teams are seeing parent after parent who has walked kilometres with a sick child on their back to get care.
They are seeing scores of people coming in to health posts suffering from severe malaria, which requires hospitalisation and often urgent blood transfusion due to anaemia. They are seeing people who have already tried alternative treatments at home before coming to a health post, who have put off visiting the health centre for a variety of reasons (including cost). All this considered, we think it’s fair to say that one major contributing factor is a lack of access.
As people continue to become infected with this disease but find themselves unable to access treatment in this area, humanitarian aid agencies are picking up the slack, doing vector control, distributing bed nets, sensitising people, and of course taking care of the tens of thousands of patients suffering from this preventable and sometimes deadly parasite.
People are relying on short-term humanitarian projects to treat this endemic disease, when what is really needed is a long-term response. Dependence on humanitarian aid is a precarious state of affairs, as aid is not predictable and is not meant to persist. We as a humanitarian organisation are meant to give care in response to events like wars and natural disasters. We do not have the means to deal with such major, mounting and persistent needs, year in and year out.
Other health groups, including the Ministry of Health, need to step in to assist existing health structures and put in more sustainable prevention and treatment measures, along with delivering more effective health care in the country to handle this increase in malaria cases. They need to outfit themselves with adequate equipment and increase and train staff sufficiently to deal with the complications when the illness becomes severe.
Medicines and services to treat this disease must be made freely available, otherwise people opt for alternative treatments – some of which can have fatal effects for the patients. The existing infrastructure needs to be overhauled and improved, but this won’t be possible without help. While Medecins San Frontieres/Doctors Without Borders (MSF) emergency response is saving lives in the short term, other health organisations, including the Ministry of Health and international actors, need to increase their efforts in providing rapid and sustainable prevention and treatment measures.
To see a child of five years old lying prostrate and struggling to breathe in one of our hospitals, his malaria having graduated from simple to severe, this state of affairs certainly seems like an emergency. With thousands of patients seeking treatment for this disease each week in Katanga, that’s what we’re calling it and that’s how we’re responding.
The simple fact is that it shouldn’t be. Permanent, reliable national health structures are needed to provide treatment and preventive measures for this disease. As MSF teams in Katanga province treat the thousands of patients suffering from the disease – sometimes in its severest states – presenting each week to our ongoing (25 April) emergency intervention, and as the numbers of infected people keep creeping up, it’s time for other actors to step in and ensure that this area sees the long-term response to this disease that it needs.
Our emergency response is saving lives on the short term, but MSF cannot address the crisis alone as it stretches out, consistently, for years into the future. We need help, and we’re calling on the Congolese government and other health-related non-governmental organisations (national and international) to set up a sustainable and sustained system of prevention and treatment to combat this scourge.
RELATED GRAPHIC: Malaria surge in DRC
AUDIO SLIDESHOW:
