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addPhoto('images/21220.jpg','Petterik Wiggers','In August 2005, Doctors Without Border/Médecins Sans Frontières (MSF) responded to a suspected malaria outbreak in Gamo Gofa area of Ethiopia, a few hundred miles north of the Kenyan border. The medical teams found alarmingly high numbers of people dying from the disease—one small village had counted 73 deaths from suspected malaria in the last two months. Since then, MSF has launched an emergency response to get treatment to people as quickly as possible and assess the full scale of the epidemic. Ethiopia is no stranger to malaria epidemics. It kills more people in the country than any other disease, and is the most commonly diagnosed health problem. In 2003, an epidemic killed 170,000 people, according to government figures.');

addPhoto('images/21214.jpg','Petterik Wiggers','The region where MSF has been working is a 30-mile stretch along a mountainside, at an altitude of between about 4,500 and 5,500 feet. The roads are simple tracks or pathways that rarely see vehicles and turn into deep, sticky clay mud during the rainy season. Sometimes the path simply runs out, or turns into a small cliff, leaving you no option but to drive cross-country. There are no power or water facilities and only seven very basic health clinics in the region. In the villages people live in dome shaped ‘tukul’ huts that resemble giant haystacks, with thickly thatched walls of wood and mud. The rough terrain forced an MSF mobile medical team on its way to the village of Ganda to abandon one of their vehicles.');

addPhoto('images/21218.jpg','Petterik Wiggers','When the MSF team finally reached Ganda there were about a hundred people already waiting outside the village health post—some sitting, some lying on the ground, and one woman who had been carried from home on her bed. The team of one doctor, two nurses, a pharmacist, and a health educator gave rapid malaria tests to everyone with fevers above 99.5 degrees Fahrenheit. There are two main strains of the disease—<i>falciparum</i> and <i>vivax</i>. Falciparum usually accounts for about 70 percent of malaria cases and the vast majority of malaria deaths. Those patients who tested positive for falciparum were given a three-day treatment of an artemisinin-based combination therapy (ACT).');

addPhoto('images/21217.jpg','Petterik Wiggers','ACTs are extremely effective, but need to be taken correctly—in this case four pills in the morning and night for three days for adults. Although people may feel better by the second day of treatment, they must complete the course to avoid relapsing and the risk of eventually creating resistance to the drug. The MSF staff emphasized again and again how the drugs should be taken, asked members of the crowd to repeat the instructions back to them. People were discouraged from sharing the drugs with family members. As in many other parts of the world, growing resistance to anti-malarial drugs is a very serious problem in Ethiopia. Studies carried out by the Ministry of Health and World Health Organization in 2003 and 2004 showed that the existing first-line treatment—Fansidar—was simply not working in many cases because the malaria parasite had developed resistance to it.');

addPhoto('images/21215.jpg','Petterik Wiggers','In Ganda, one man told the MSF team that around 150 people in his village have died of suspected malaria in the last three months. His wife and his three young children all had fever and shivering symptoms, and he himself had been ill for a week. A community leader from a neighboring village who walked for an hour and a half to get to Ganda told a similar story: 60 people dead in the last four months. Although its impossible to verify how many of these deaths were actual malaria cases, the results from the blood tests carried out by the team showed very high numbers of patients testing positive for the disease. ');

addPhoto('images/21221.jpg','Petterik Wiggers','The team worked its way through the ever-growing line of patients, taking temperatures, testing blood samples, checking for clinical symptoms, and prescribing drugs. To save hundreds of lives the team only needed a good car; rope for channeling the patients into a line; a fold up table, four stools, a water container and some plastic beakers; four thermometers; the rapid malaria tests that give a blood test result in 15 minutes; the malaria medication; some paracetemol; and quinine for treating cases of severe malaria.');

addPhoto('images/21211.jpg','Petterik Wiggers','Having seen more than 100 patients in an afternoon, the team set up camp and prepared to visit the village of Shanibara. MSF had been through the village several times before and the village chairman reported high numbers of people suffering malaria symptoms. In this village there isn’t even a basic health post, so the team drove to the top of a hill, parked the car to block off a space, stretched a blue tarpaulin between the car and tree, and set up the tables and chairs underneath. ');

addPhoto('images/21204.jpg','Petterik Wiggers','When Dr. Helmy Mekaoui, the MSF project coordinator, asked the village chairman to spread the word that MSF was treating malaria, the chairman walked to the edge of the mountain and bellowed in three directions across the valley. The impact was pretty immediate and people started trickling up the hill—some just curious and excited by the strange goings on, others clearly weak and ill. The health educators repeated their message about taking the drugs correctly, and then people formed a line to have their temperature taken, three at a time. ');

addPhoto('images/21206.jpg','Petterik Wiggers','The same protocol was followed with people who had fevers above 99.5 degrees Fahrenheit being sent for a blood test, those below were sent away, unless they had other clinical signs of malaria, in which case the doctor examined them. A nurse tested for falciparum malaria using a rapid test that detects malaria without the need for a laboratory. In a country like Ethiopia, where microscopes and trained lab scientists are few and far between, the introduction of rapid testing kits have been critical. ');

addPhoto('images/21219.jpg','Petterik Wiggers','In the village of Geesa, a number of small babies needed treatment, a challenge for the team since the drugs are only available in tablet form. The pharmacist carefully crushed the pills with a spoon and mixed them with water in an orange plastic beaker. It’s up to the parents to get the babies to drink the bitter mixture. The staff watched over these children to make sure that enough of the medication is actually swallowed—an inexact science, but unfortunately the only option.');