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Seeking malaria treatment around Aweil, South Sudan
18-year-old Abuk Akuoc, semi-conscious and still letting out soft moans of pain, receives an IV treatment of quinine for her severe malaria at the government-run health center in Panthou. Abuk's family brought her to the health center from their village, called Malithbuol, by motorcycle, which they hired for 30 SSP. The journey took 15 minutes, but it would have taken one hour on foot. This wasn't the first time she had been at the health center: the previous week they had brought her in, suffering from malaria. She had been prescribed ACT but at the time, the health center had none in stock. It had run out back on August 17th. So, they instructed her to purchase it in the market. But the family couldn't find any ACT there either. It wasn't in stock. So they bought only paracetamol. Last night, Abuk didn't eat and complained of a headache. This morning, when she was cooking, she collapsed. Her family had never seen anything like this and didn't know what malaria looked like until now. Panthou health care center is the only one in Aweil South county and is currently treating about 150 malaria patients per day. They had just received a supply of ACT oral medication for malaria; their previous stock had ran out on August 17. This new stock will likely run out in one or two weeks. They have quinine, but not a lot, so they reserve it for serious cases. They have no RDT (rapid detection tests), so diagnosis is only done clinically based on observed symptoms.
© Diana Zeyneb Alhindawi

Malaria preparedness vital as rains begin

18-year-old Abuk Akuoc, semi-conscious and still letting out soft moans of pain, receives an IV treatment of quinine for her severe malaria at the government-run health center in Panthou. Abuk's family brought her to the health center from their village, called Malithbuol, by motorcycle, which they hired for 30 SSP. The journey took 15 minutes, but it would have taken one hour on foot. This wasn't the first time she had been at the health center: the previous week they had brought her in, suffering from malaria. She had been prescribed ACT but at the time, the health center had none in stock. It had run out back on August 17th. So, they instructed her to purchase it in the market. But the family couldn't find any ACT there either. It wasn't in stock. So they bought only paracetamol. Last night, Abuk didn't eat and complained of a headache. This morning, when she was cooking, she collapsed. Her family had never seen anything like this and didn't know what malaria looked like until now. Panthou health care center is the only one in Aweil South county and is currently treating about 150 malaria patients per day. They had just received a supply of ACT oral medication for malaria; their previous stock had ran out on August 17. This new stock will likely run out in one or two weeks. They have quinine, but not a lot, so they reserve it for serious cases. They have no RDT (rapid detection tests), so diagnosis is only done clinically based on observed symptoms.
© Diana Zeyneb Alhindawi

Hundreds of thousands of people in South Sudan are at risk of contracting malaria in the coming months during the annual peak of the disease, which begins in the country’s rainy season.

Malaria is one of the leading causes of sickness and death in South Sudan, especially among children. In 2016, MSF treated more than 300,000 cases of malaria in the country. Of these, 250,000  were during the three-month malaria peak, which can overwhelm medical workers. 

In Aweil, approximately 800 kilometres northwest of Juba, teams from Médecins Sans Frontières (MSF) are preparing to treat thousands of children for malaria. In Aweil State Hospital, where MSF manages the paediatric and maternity wards, MSF recently added 20 paediatric beds, resupplied the pharmacy and organised medical training to prepare its staff for the expected influx of severe paediatric cases.

These efforts may be sorely needed as, during last year’s malaria peak, MSF treated more than 5,500 children hospitalised for severe malaria in Aweil alone.

"During the malaria season, the hospital becomes overcrowded with patients suffering from complicated cases of malaria," said Aline Serin, MSF project coordinator in Aweil.

"What is extremely worrying is that many local health centres have not yet received medicines and supplies to test and treat malaria in the Aweil area. Without prompt testing and treatment, local people are more likely to develop severe malaria, which can be life-threatening."

In a primary health facility in Aweil Centre, for example, a clinical officer described to MSF how he lacks the necessary medicines and supplies to stabilise severe malaria patients.

Seeking malaria treatment around Aweil, South Sudan
The family of 18-year-old Abuk Akuoc, semi-conscious and letting out cries of pain, holds her still on a bed at Panthou health care center in preparation for the IV that the nurse will administer in order to give Abuk a treatment of quinine for her severe malaria.
Diana Zeyneb Alhindawi

Providing primary care at the community level is lifesaving and essential, yet many people in South Sudan must travel great distances for basic treatment. The lack of medicines at the local level can increase the risk that children will develop severe malaria. 

If parents know there are no drugs at their nearest health centre, they may wait to see whether or not their child's condition improves before deciding to start a long journey to a hospital. It is a season when people cultivate crops, so spending days on the road is not an easy decision for parents who already struggle to provide enough food.

"People in South Sudan are struggling in the midst of ongoing conflict and other crises, yet preventing and treating malaria can make a real difference in their lives," Serin said. "People die just because they cannot get access to the basic treatment they need."