Something wasn’t quite right in the Yusuf Batil refugee camp in the early summer of 2016. It was hardly unusual for the staff at Medair’s primary health care clinic to treat malaria cases in this camp of 41,000 people in South Sudan, but the numbers were higher than usual. Much higher.
Story and photos by LuAnne Cadd
'We were concerned that it was the start of the malaria season, but the upsurge in cases was unexpected as it was four weeks early,' explained Gerard Adema, Medair’s Project Coordinator for the Yusuf Batil refugee camp at the time, one of four camps in the far northeast of the country.
Nearly all of the camp refugees had fled violent conflict in the Blue Nile region of Sudan six years ago and lived in small makeshift huts on barren ground.
'The other camps hadn’t noticed a significant increase in malaria cases, but as the weeks started going by, we saw it was increasing quite rapidly. In four weeks the cases jumped from about 80 in one week to 849. A week after that it jumped to 1,300, then over 2,000 in just one week. We started to look at what could be the root causes.'
There were several obvious issues. Yusuf Batil refugee camp sits in a low flood-prone area where stagnant pools of water form quickly once the rains come, offering a perfect environment for breeding mosquitoes. An agency is tasked with spraying the area to keep the mosquito population down during the rainy season, but unfortunately they had run out of the necessary chemical.
Earlier in the year, another agency had distributed mosquito nets, but the ratio for households averaged only one net per six people. UNHCR recommends one per two people. As well, Ramadan began on 6 June for a month. It was common practice to break the fast by eating the evening meal outside at dusk, the most common time for contracting malaria.
While the Medair clinic staff dealt with the overwhelming increase in malaria cases, Medair’s Emergency Response Team flew in 10,000 mosquito nets via a large charter providing each household with one more net. Community groups and leaders spread the message on the critical importance of using the nets as a preventative measure. MAF and others flew in medicine and testing kits as the numbers peaked at a high of 3,198 cases in one week of mid-July.
'We were running low on testing kits and medicine, but didn’t run out,' said Gerard. 'We put in an emergency drug order and it came in. At that time a combination of MAF flights and charters were bringing in the stock. Often, when supplies had to be left behind in Juba, we’d get a MAF flight in for things that were quite crucial–things we really needed to be able to continue our work. So we often used MAF to make sure that we could get enough supplies of all the drugs and all the testing kits that we needed.'
At the clinic, Medair’s policy was for staff to stay until every patient was seen, which made for long work hours during the malaria crisis. 'It doesn’t matter how many hours they spend at the clinic,' Gerard explains. 'The seating area was full, so we put tarpaulins all over the ground for people to sit outside. Sometimes it would be raining. They would sit in this whole open area, and even around the corner.'
New Year, Fewer Cases
One year later in May, some patients at the Medair clinic display malaria-like symptoms: fever, headache, vomiting, and diarrhoea. A clinician uses a Malaria Rapid Diagnostic Test (RDT) to determine the presence of malaria in each patient’s blood with a finger-prick and a 15-minute wait for the results. Fortunately, most of the patients are negative. Eighteen-year-old Zenab and 7-year-old Amal are the unlucky two to have developed malaria, but their symptoms are mild at this point and they receive medication from the pharmacy. It’s Zenab’s third time to contract malaria, the last time in October of last year.
Amal was a baby when the family had to flee their home in the Blue Nile region of Sudan due to conflict. Mother Achol says Amal is her youngest, still her baby. While they wait to see a clinician, Amal lays her head on her mother’s lap and Achol strokes her feverish face. Although Achol dreams of someday returning to their home in Blue Nile, she has a grateful heart for the help Medair provides.
'My child is sick, but Medair is here so I don’t worry,' Achol says. 'I’m happy because Medair has medicine. Everything is well.'
When the rains began their annual cycle in May this year, it was already clear that malaria numbers were down compared to last year. The spraying began earlier than usual as a safety precaution, and the ratio of mosquito nets per family is significantly better than a year ago. Best of all, the population appears to understand the importance of the life-saving nets distributed last year. In January 2017, 95.6% of surveyed mothers with children under five reported that the child had slept under a net the night before. Thanks to Medair’s Care Group programme that trains groups of women in health and sanitation, information has spread throughout the camp on how malaria is contracted, how to prevent it, and the early signs of the disease. Local leadership in the camp has supported the efforts to prevent another malaria outbreak. Medair increased the size of the covered waiting areas at the clinic and expanded the pharmacy from two to four windows to increase patient flow, but thankfully they have not needed it this year.
'If we look at this year, malaria has not increased at all up to now,' Gerard said in May, pointing to a coloured graph that showed malaria cases in the refugee camp beginning in 2014 through 2017. 'There was a slight increase but now we are up to week 19 and still nothing much.' In fact, during the 28th week, mid- July last year, cases peaked at 3,198 in one week. During the same week this year, Medair confirmed only 57 cases. At the end of August, through the worst of the malaria season, total cases for 2017 came to 1,974 as compared to 27,436 a year ago.
MAF continues to fly supplies to Medair in Maban, a three-hour flight from Juba. 'We would like to thank MAF and our other partners for their support in bringing in the medical supplies needed for the significant outbreak last year,' Gerard says. 'Our hope is that we won’t have this problem again.'
By the beginning of August, the number of cases began dropping significantly and the worst was over. From the end of May, when the surge in malaria cases began, to the end of 2016, Medair treated over 32,000 confirmed cases of malaria at Yusuf Batil camp.