April 4, 2008
Leo Ho: “In Bo, I mainly worked in the intensive care unit; most of the time, I was taking care of the severely ill patients, most of whom were young children under five. Those are the most susceptible to malaria.”
Pediatrician Leo Ho worked in the intensive care unit (ICU) of the MSF-run Gondama Hospital in the Bo region of Sierra Leone from February to August 2007. Set in a region constantly plagued by malaria, even in the dry season, Gondama village has a high death rate due to this disease, especially among children. During his assignment, Dr. Ho was continually treating the most severe malaria cases: children brought to the hospital who had already fallen into a coma, were severely malnourished, or suffering from tuberculosis or HIV/ AIDS. “We were just trying to keep them alive,” he says.
Malaria can be prevented by sleeping under a bed net treated with insecticide, but many families in poor regions cannot afford this small luxury. The most effective treatment for malaria is ACT—artemisinin-based combination therapy—fast-working drugs with few side effects that combine multiple medicines into one, making them simple for patients and medical staff to manage. “Many patients start showing improvement in the first 24 hours of taking ACTs,” says Dr. Ho. The World Health Organization named ACTs the preferred method of treating malaria in 2001, but, in spite of 41 of 54 African countries having changed their treatment protocols accordingly, too many patients are still receiving older, less effective drugs.
Here, Dr. Ho reflects on his assignment through images captured by photojournalist Francesco Zizola.
“Quite frequently, little children would come in comatose, just incredibly sick. This usually happened in one of two ways. Sometimes, the infection is so severe, it can progress over a day or over a few hours where a child can be sitting up, alert, and then, hours later, in a coma. Or, a lot of parents would wait before they brought their children in, so, often, they would wait until the child became non-responsive before coming to the hospital. We saw a lot of this and it’s just really unfortunate because, obviously, the later they came in, the less we could do. So, we did have a lot of mortality. But many of our patients got better, also.”
“This baby is being tested in one of our clinics for malaria, with a little finger prick. We take a few drops of blood and it’s placed in this little plastic testing device, which is a rapid test for falciparum malaria. It tests for the most severe species of malaria, the one that was really prevalent there. And then, within 15 minutes you get a test result, whether it’s a severe malaria infection or not.”
“We were using the newer malarial treatment, which is the artemisinin-based derivatives. This has been implemented in the last few years with MSF. And it’s really been a great weapon because it’s extremely effective, very well tolerated, and easy to administer. It’s basically the treatment of choice. Usually, it takes just three days of treatment. Even children in a coma—within 24 to 48 hours, many of them were starting to move a little bit, and that’s who survived. Some would die because there was just no chance.”
“This is a really sad picture, but a really effective one, in that it demonstrates the devastating impact of malaria. We would have at least two children die at our hospital every day on average, sometimes even more. And it would happen so unexpectedly. And this picture shows how, when a child would die, he or she would usually be wrapped up in a lappa, the same cloth that held them against their mothers’ backs when they were well.”
“A lot of these families came from small villages and they didn’t have a large support network, and, obviously, couldn’t afford many things. So, the majority of the children, after they died, we would actually give the caretakers cardboard boxes—the same cardboard boxes our medical supplies came in. And that’s what they were buried in.”
“Here, an MSF nurse is resuscitating a child who had stopped breathing. I’m standing next to her, there is another child lying next to that one and two more behind us, all in critical condition. For me, a lot of the reflection happened after the mission. It just seemed that so many things were going on, you just had to stay strong and keep doing what you were doing. Now, when I see these pictures and I think about it, I just can’t believe the stuff that I saw and I can’t believe the environment I was working in. We were resuscitating children every day and just trying to keep them alive.”
All photos © Francesco Zizola/Noor
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)