As the rainy season begins in South Sudan, hundreds of thousands of people in the country are at risk of contracting malaria, one of the leading causes of sickness and death, especially among children. In 2016, Doctors Without Borders/Médecins Sans Frontières (MSF) treated more than 300,000 cases of malaria in South Sudan, most of which occurred during the annual three-month “malaria peak” over the rainy season. This year, MSF is working to head off the spread of the disease by increasing capacity at health care centers and providing rural communities with the tools to test and treat the disease themselves.
In the northwest of the country, MSF manages the pediatric and maternity wards at Aweil State Hospital. The hospital recently added 20 pediatric beds, resupplied the pharmacy, and organized medical trainings to prepare staff for the expected influx of severe pediatric cases. These efforts may prove crucial: During last year’s malaria peak, MSF treated more than 5,500 children for severe malaria in the city of Aweil alone.
"During the malaria season, the hospital becomes overcrowded with patients suffering from complicated cases of malaria," says Aline Serin, MSF project coordinator in Aweil. "What is extremely worrying is that many local health centers have not yet received medicine and supplies to test and treat malaria in the Aweil area. Without prompt testing and treatment, local people are more likely to develop severe malaria, which can be life-threatening."
Providing primary care at the community level is essential, yet many people in South Sudan are forced to travel great distances for basic treatment. This lack of medicine at the local level can increase the risk of children developing severe malaria.
"Though the people in South Sudan are struggling with ongoing civil war, preventing and treating malaria can make a real difference in their lives," Serin says. "People die, simply because they cannot get access to the basic treatment they need."
Empowering Communities to Treat Patients
Nearby, further efforts are underway to provide these rural communities with access to tests and treatment for simple malaria. For the third year in a row, MSF is setting up community advanced malaria posts in the town of Agok in the Abyei Special Administrative Area (ASAA), a disputed territory between Sudan and South Sudan. The community malaria project, known as CMAP, started in 2015 as a response to the severe malaria outbreak that hit the area.
“We wanted the people in the community to be able to test and treat simple malaria, so that patients don’t come to the hospital [only after they’re already] very sick,” explains Tara Smith, supervisor of the community malaria project in Agok. This year, 22 villages will be part of this special program aimed at reducing the morbidity of severe malaria in the area around Agok town. MSF trains two volunteers in each village and provides the rapid test to diagnose malaria as well as the drugs for treatment of simple malaria. Last year, 40,000 people were tested and treated in their community.
“In many villages, it is extremely difficult to reach the hospital during the rainy season. People would have to carry the patient on a blanket or a sheet and walk for several hours,” says Smith. In remote areas, primary health care centers are sometimes too distant or impossible to reach after the rains arrive. Because many South Sudanese cultivate crops during the rainy season, the decision to spend days on the road can be difficult for people who already struggle to provide enough food to survive. “Sometimes a few hours can make the difference between life and death,” Smith says. Community-based care “allows people to have a normal life during the rains, to go to the field, to go to church, and to take care of their family and not have to walk for hours to get treatment for a simple disease.”
MSF is training volunteers to recognize malaria, perform tests, treat simple cases, and refer complicated cases quickly. Abaraham Kalei, a volunteer in Rumkor, says, “Since the training, we can recognize the symptoms of malaria and refer the patients on time. Before, we had a lot of people dying in the community, and it was not always possible for patients to go to the primary health care unit…. Now we can treat it very easily.”
“What I hear over and over is, ‘I just want to help my people.’ This is the motivation. They look out for each other,” says Smith, whose team goes to each village every week to follow up with volunteers and bring supplies. “The community takes a lot of pride in being able to do this for themselves. One chief told me, ‘Thanks for bringing a small hospital to us.’”
MSF has worked since 1983 in the region that today constitutes South Sudan. Today, we employ more than 3,000 South Sudanese staff and 330 international staff to respond to a wide range of medical emergencies and provide free and high quality health care to people in need in 17 project locations across seven of South Sudan's 10 states and the Abyei Special Administrative Area.