MSF Blogs: Battling through the Malaria Season in DRC

Working in a remote clinic in DRC brings daily challenges—and growing queues. Dr. Chris Bird blogs from the hospital in Kimbi Lulenge health zone in Lulimba. 

DRC 2011 © MSF

Dr. Chris Bird examines a seven-year-old boy in the makeshift pediatric ward at Lulimba hospital.


Dr. Chris Bird

This post originally appeared on the Guardian's (UK) "Poverty Matters" blog

Chris Bird, a former Reuters and Guardian reporter, put down his notepad and left more than 10 years of news reporting to study medicine with the intention of returning to the front lines where he can be hands-on saving lives and alleviating the kind of suffering he once wrote about.

Dr. Bird left for his first assignment in October as an aid worker with Doctors Without Borders/Médecins Sans Frontières (MSF) and blogs from the hospital in Kimbi Lulenge health zone in Lulimba, a small town in South Kivu, in the Democratic Republic of Congo (DRC). South Kivu is a hotbed of violence where civilians bear the brunt of the conflict leaving them often displaced and vulnerable to disease, malnutrition, and war-related injuries. Dr. Bird works in a hospital that provides free primary and secondary health care.

Read his previous blog post here.

Our team arrived to start working at the Lulimba hospital at the height of the malaria season. We barely had time to unpack our boxes because we were greeted by a crowd of sick children, and more have been arriving in ever-greater numbers since. We also found out very quickly that the hospital had only one thermometer.

When you are unable to do most tests, being able to take someone's temperature in an area endemic for malaria and other tropical diseases is critical. So the staff spent the first few days running between the outpatient clinic, maternity, pediatrics, and internal medicine, chasing the small tube of glass and mercury needed to place under the arm of a hot, lethargic child. We found two more thermometers in MSF's own medical kits, kept in our vehicles.

The lack of thermometers is only one of many shortages that beset the hospital, which is now trying to cope with a surge in patient numbers since health care was declared free with the arrival of our team.

There are plans to build a new hospital. But in the meantime, we are roaring through our first supply of medications, especially antimalarials and paracetamol. The number of children is growing, with two or three having to share a mattress, along with mothers and often siblings. The hospital staff are overworked, but are handling the white-water ride of this startup with patience and humor.

When I asked one mother, after seeing her child, if there was anything else I could do to help, her reply in Swahili prompted laughter from the other mothers. The nurse on duty, Silele, grinned and translated for me: "She was asking if you could sort out the problems between her and her husband, but I think we have enough to do already.''

The shortages, particularly of nursing staff, impede our work at every turn. At the start, we lacked a rapid test for malaria (there's apparently a shortage of these tests across the globe) and the large number of children presenting with fever overwhelmed the tiny lab, a dusty little room where the single microscope is placed carefully in front of a window to capture enough light to be able to search for the parasites that plague our patients. The lab technicians use a torch at night to bounce off the microscope's mirror.

In the operating theater the patient is anesthetized with ketamine and a small wisp of cotton wool is placed over one nostril. If it moves up and down, the operating team knows the patient is breathing. The wisp of cotton wool in place of winking, bleeping machines found at the anesthetic end of operating tables in the U.K. is the perfect illustration of why a certain phrase in French is never far from everybody's lips—Il faut se débrouiller! (You'll just have to muddle through).

Building a hospital takes time, but the flood of patients means we've had to improvise quickly. We've moved the internal medicine and pediatric services out of their overcrowded, dark rooms into four large tents while we wait for the new hospital. This has also created space for other services.

We now have bed nets for each patient to prevent the mosquito vector from spreading malaria from one patient to another. Each service has buckets with chlorinated water for drinking and hand-washing to help prevent cross infection.

The operating theater now has a light, and the instruments are properly sterilized, instead of being placed in pressure cookers on charcoal braziers as they were when we arrived. We now have a generator that we can use to provide oxygen to patients with breathing problems. We simply treated all feverish children for malaria until the rapid tests arrived. When we started collecting data from the tests, 85 percent of them were positive for the potentially deadly P. falciparum form of malaria.

I was woken this morning by a crack of thunder and the pummeling of heavy rain on the tin roof. The rains threaten more malaria and more patients, and the already perilous dirt roads and airstrip that we rely on for the delivery of drugs and equipment that this isolated hospital so desperately needs.