A blue pick-up truck pulls to a sudden halt outside Tiriri health centre in Uganda. Many hands surround it, lift the woman lying in the back and carry her inside to the examination room. She cannot speak and her breathing is laboured.
Sister Mary Magdalene Anyait, registered nurse and the only member of the medical staff, has a look and takes the woman’s blood pressure. Then she strides rapidly out to the pick-up to try to persuade the driver to take the patient on to Soroti hospital, nearly 40km away. He will not do it. The boss has agreed only to him bringing the women this far. The truck backs away.
Anyait is calm. It’s up to her now. The ambulance that should be in the yard is at Soroti. The only doctor is there too — he’s unhappy at his posting to a rural health centre with inadequate facilities.
The sister is pretty sure this is cerebral malaria. She speaks to the woman’s husband and writes something on a piece of paper for him. He borrows a bicycle to go to a pharmacy at the trading centre five minutes away. The health centre is critically short of drugs and he must buy what is needed. He comes back with dextrose solution for rehydration, quinine and cannula that must be inserted in a hand to take a drip. It will have cost him maybe 3 500 shillings ($2) — more than two days’ income and money he may have to borrow.
”We will give her a bag of fluid and then one with the drug,” says the nurse. ”In 30 minutes we will assess whether there is some improvement.” Sister Anyait washes her hands and wrists and pulls on a new pair of surgical gloves. In moments, the drip is in place and the husband is given the bag to hold high: they have no metal stand. The nurse administers a painkilling injection in the woman’s thigh. Already the patient can say a few words and her breathing has eased.
It’s a normal day at Tiriri health centre, dealing with the usual foe. Malaria is the greatest health problem the people of Katine have to face. Usually these emergencies are babies — malaria and diarrhoea are the main killers of children under five — but pregnant women are also vulnerable and no adult is immune.
In the children’s ward, the scene is sometimes heartbreaking. Babies have drips in their heads, because their little bodies are so dehydrated the nurse cannot find a vein anywhere else. They are too sick to cry.
Down at Atiri trading centre, a group of people who have been making a real difference is gathered. In 2002, two people from each of the 66 villages in Katine sub-county, the administrative area that contains 25 000 people, were trained as drug distributors. It was an idea pioneered by the African Medical and Research Foundation (Amref) which is the partner for the Observer/Guardian project in Katine, and taken up nationally by the government.
These village health teams were taught to recognise the early symptoms of malaria in children, such as fever, vomiting and listlessness. They could go to families where children were ill and give them drugs promptly, hopefully preventing mild malaria becoming serious and avoiding deaths. Last year 165 small children were saved from dangerous severe malaria.
Sadly, the system, which ran on the goodwill of the volunteers, has come to a halt. Part of the reason is that the drugs — a combination of chloroquine and Fansidar — have now been replaced nationally by the World Health Organisation-recommended artemisinin combinations because of resistance to the older drugs by the malaria parasite. But there were also failings in the way the scheme was run. ”We were supposed to move around and were promised bicycles but they were not given,” says Emeru.
Jane Abulo, a volunteer from Abiya village, said: ”We were going to sensitise people to HIV/Aids and protection. We were told there would be pamphlets on HIV and condoms for the community. But they were not delivered.”
The village health teams are key players in plans to improve health care in Katine, which the Observer/Guardian and Barclays Bank are backing.
They will have training, bicycles, T-shirts and bags with supplies. Their proximity to children and adults who fall sick or need help should mean much faster treatment, swift referral where necessary and reduced pressure on the hard-pressed Tiriri health centre. It is a great example of how communities, with a bit of support, can help themselves. – Guardian Unlimited Â