There are few in Africa who have not been laid low by malaria. It's the No. 1 killer of children, and a chronic affliction of adults. Deaths from malaria continue to rise.
The disease is preventable and treatable, but health campaigns promised by international organizations and African governments have not slowed or controlled it. The Global Fund to Fight AIDS, TB and Malaria, the Bill and Melinda Gates Foundation, the Bush administration and others have set their sights and new funding on beating the disease.
While they're gearing up, a freelance band of roving medics -- Doctors Without Borders -- is taking state-of-the-art malaria treatment into remote areas of Africa.
Yenagoa is the capitol of Bayelsa, a Nigerian state on the River Nun, a major tributary of the Niger River. It's supposed to be the dry season, but the rain is coming down by the buckets full, scattering the staff of Doctors Without Borders (Medecins Sans Frontieres) playing a game of pickup soccer in the compound.
At least two-thirds of the delta is water, year round. The rest is lush vegetation. All of it is infested with the anopheles mosquito, which transmits the parasite, Plasmodium malariae. There are many malaria parasites, but the one that kills is Plasmodium falciparum. It's a disease that spares almost no one in the delta.
"The prevalence of malaria here is incredible," says Adam Childs, a project coordinator for Doctors without Borders. "It's above 80 percent. They've all got malaria. They're just not symptomatic."
A New Treatment
Doctors without Borders is implementing a new protocol for treating malaria that the Nigerian government has been persuaded to adopt. The Health Ministry has decided to use artemisinin in combination with other drugs rather than the old mainstays -- chloroquine and fansidar -- which have lost their effectiveness in treating malaria. Childs realizes there are more aggressive preventive measures Doctors without Borders could take, but says the organization is limiting its role.
"I guess we're just trying to keep as many people alive and as healthy as possible until the state has eradicated most of the vectors and the vulnerabilities," Childs explains. Mass distribution of bed netting reduces contact with mosquitoes, and cutting down weeds and getting rid of old tires takes away breeding sites. Until a vaccine is found, these methods are some of the most effective when money is short.
"These are people who are sick, and we just try to get them back on their feet," says Childs.
The delta is also rich in oil, but it's last on either the state or the national government's list for direly needed health care services. Some are provided under a government health plan, but most people don't buy into it. Childs, who has worked for other relief organizations, is used to government schemes that don't work. It was the can-do spirit of Doctors without Borders that appealed to him.
With conflict brewing in one area they were considering as a site for a health center, Doctors Without Borders decided to work two hours up the road from Yenagoa, in Egbebiri. It's on the river but accessible by land. Word has already gotten out.
As a land rover carrying the team pulls up in the clinic yard in Egbebiri, about 70 people -- mainly mothers and children -- surge forward. Community liaison Kingsley Miyenye used to work in the human resources division of SmithKline Beecham, but took a pay cut because he wanted a life of public service.
"Money wise, working for SmithKline Beecham is 10 times working for Doctors Without Borders, but it is a like a childhood dream, that I wanted to work for people who are in distress and all that. I really had it in mind," says Mienye.
Today, he assures the throng -- in the local dialect -- that everyone will get a chance to see the doctor.
A Community's Need
Most of the people are here because they've heard that Doctors Without Borders treats people for free. And most, like Esther Mayeppa, a local school teacher, have children who are suffering from malaria or are ill themselves. Mayeppa describes a condition that she comes down with time and again each year. It feels like the flu -- just worse.
"I've had it. I've had it several times," Mayeppa says. "And I'm still feeling pain all over my body, dizziness, from time to time, pain at my joints."
Economists estimate that $10 to $12 billion a year in productivity is lost in Africa because of malaria. As bad as malaria can be for adults, it is worse for children, especially children under 5. They have not yet developed an immunity or tolerance for the disease -- a sort of side benefit from repeated infections for those who live where malaria is endemic. Their needs and the goals of Dr. Claire Colette are a match.
Colette wanted to work where the need was greatest, so Doctors Without Borders sent her to the Niger Delta.
Malaria's Assault on Children
More than 90 percent of life-threatening cases of malaria occur in children under 5 in sub-Saharan Africa. It accounts for a fifth of their deaths.
Malaria's assault on the children of Africa begins before they're born and plagues them throughout their early years. The parasites invade the placenta and sap vital nutrients, leading to low birth weights and anemia. Repeated bouts cause severe anemia, hypoglycemia and lower respiratory tract infections. All of these conditions can be fatal, but malaria is most devastating when it infects the brain. Children may suffer seizures or lapse into a coma and die. Survivors may experience lifelong disabilities, such as blindness, speech impediments, and difficulty learning.
"A couple of days ago, when I saw 57 children, I only saw two smile," says Colette. "And that's how I judge how sick they are, because the children here are so happy and playful, especially when they see a white person. They love me and they love to sort of play. But if they're sick, they're scared of me and they cry."
Of all the children Colette examined that day -- about 60 -- only one did not test positive for malaria.
"The children are all sick. Some of them are extremely sick and may die in the next few days," says Colette. "So we've had to send them to hospital, but every single one of them that I've seen needed to be seen that day. They were all dehydrated. They've all got high temperatures, with malaria, vomiting and diarrhea the main problems. But they're all very sick."
Malaria is so commonplace in the Niger Delta, it is sometimes ignored in the early stages. When fevers persist, mothers head to the local drug store for antimalarial drugs. As a consequence, the medicines used to treat malaria in this part of the world no longer work. The parasites are resistant to them.
Many countries are now switching to a treatment based on a new drug -- artemisinin. But there are concerns that the same thing will happen. Colette makes a point of explaining to mothers that not all fevers are caused by malaria.
"When we're introducing the new drugs, they all have to have a positive test before we will prescribe," she says.
Besides, used alone, artemisinin takes seven days to knock out the parasites and there's more of a chance that people will stop taking it as soon as they feel better. In combination with other drugs, just three days will do the trick.
End of a Day's Work
By late afternoon, it is clear that if Colette continues to see patients individually the team won't get back to base camp before dark. That can be risky. Two Germans working with the oil industry were taken hostage recently by rebel groups in the area. They were released.
Colette and Miyenye aren't taking chances. They want to get out quickly so they set up a kind of triage, moving at panic pace to determine which patients it's safe to delay seeing until the next week.
It's four o'clock and the crew piles into the land rover to head back to Yenagoa.
Kingsley Miyenye, who grew up in Bayelsa State, has no illusions about his home town.
"If MSF is not here, they will go back to what was operating here before we arrived. There were no drugs, no equipment," he says.
By the time the team heads back to its base camp in Yenagoa, the clinic yard in Egbebiri has emptied. The chaos of the morning and the din of fretting children has been stilled until the clinic doors open for another week of emergency care. Eventually, patient traffic will slow and Doctors Without Borders will look for another place to help. And they'll go where the need is greatest.
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