The Bite of a Mosquito

We're back in Sagam. After an easy 40 minute flight from Nairobi to Kisumu, I met up with the local team on the ground. We had some time to catch up and unwind before hitting the road for the hour long drive to the little town of Sagam.  Arriving in the late afternoon, we visited the hospital to say hello and make sure there were no patients they needed our help on. We found a very sick toddler on the ward, his grandmother in the next bed over watching on worriedly.  The child presented in the morning, after having been sick for about three days before coming to the hospital. Earlier that day he tested positive for malaria, and now it was clear that he was on death’s door. He was barely conscious, very pale, and breathing fast and hard. As we started to examine him, he began to seize.  Piecing things together, he most likely had malaria affecting his brain, a life threatening state called cerebral malaria. As we started our treatments, we watched him deteriorate. After considering all the options, we decided that he had received too much IV fluid during his resuscitation, and he was entering heart failure. We gave some medicine to help relieve the stress on his heart, set up orders and plans for checks during the evening, and left feeling pretty sure that we wouldn’t find him alive in the morning. Amazingly, he stabilized over night. Rechecking his hemoglobin level in the morning, we found that the malaria had wrecked serious havoc on his red blood cells. He was left with only a third of the amount of blood that he should have had. He was in urgent need of a blood transfusion, and the closest blood bank that we could access was at least a two hour round trip from us. We ordered the blood and hoped for the best.

Malaria kills about 900,000 people a year around the world, and 91% of these deaths happen in Africa. Due probably mostly to a lack of immunity, 85% of all deaths from malaria are in children under 5 years of age. In the States, most toddlers die of trauma (accidents and homicide), congenital anomalies, and cancer. It’s sad to see a child in the States die of a difficult to treat congenital cardiac anomaly. Teams of medical experts give it their best, and much time, effort and hundreds of thousands of dollars are spent to try to save a valuable life. Here, things are different.  Many sick children with malaria never see a health worker, and fewer ever reach a hospital. An insecticide impregnated bed net costs about 10 dollars. A three-day course of newer “expensive” oral medications that cures the majority of cases of malaria costs less than 2 dollars. We’re back in Sagam. It is an interesting world.