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Doctors Without Borders are currently driving a mobile clinic to visit the people in the village - otherwise they would not be able to reach the patients
Photo: Benjamin Moscovici / DER SPIEGEL
When the oxygen content in the blood of the little Zainab suddenly drops, the sun is setting over the jungle.
Outside, monkeys roar, flocks of bats soar into the evening sky - inside, in the intensive care unit of a small field hospital in southern Sierra Leone, a team from MSF is fighting for the life of the six-month-old girl.
The little one has malaria.
Around half a million people die of malaria every year, as figures from the World Health Organization show.
94 percent of them in Africa.
Two thirds of the fatalities are children under five.
And in hardly any other country is the disease raging as badly as in Sierra Leone.
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Six month old Zainab is given a blood transfusion
Photo: Benjamin Moscovici / DER SPIEGEL
According to the United Nations, 109 out of 1,000 children in the West African country die before they reach the age of five.
It is one of the highest child mortality rates in the world, almost 30 times higher than in Germany.
It has now got dark outside, inside the neon lights illuminate the room.
Marianella Rodriguez takes a look at the medical record.
"Typical case," says the pediatrician from Argentina.
Severe malaria, pneumonia and anemia.
"If the mother hadn't brought her baby to us, it would probably be dead tomorrow."
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Doctor Marianella Rodriguez with nurses: “Anyone who has made it to us will usually make it out of here alive.
The others are what I worry about "
Photo: Benjamin Moscovici / DER SPIEGEL
"That's exactly where the problem lies," says Fabio Biolchini.
The Brazilian took over the post of clinic director shortly before the outbreak of the corona pandemic.
Now he is sitting in his small office, deep shadows under his eyes.
“Look,” he says, scrolling through a long table, “in the meantime our patient numbers have plummeted by 70 percent.
That's a catastrophe."
The problem is not that aid organizations like MSF are neglecting other diseases in the face of the pandemic.
The problem is that people no longer dare to go to the emergency rooms and hospitals - and that is why far more patients are now dying from malaria than from Covid-19.
“The phenomenon can be observed all over the world.
But here in Sierra Leone it is made worse by the experience with Ebola, ”says clinic director Biolchini.
During the Ebola outbreak from 2014 to 2016, health centers developed into infection hotspots.
Of the people who went to the hospital, many never came back.
"If the children stop coming, they'll die"
The fear of the population about a visit to a clinic is currently the greatest concern of MSF staff: "With the children who come to us, it is often a matter of life or death," says clinic director Fabio Biolchini.
"If these children stop coming, they'll die."
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Fabio Biolchini, 39, runs the MSF field hospital in southern Sierra Leone
Photo:
Benjamin Moscovici / DER SPIEGEL
In the intensive care unit, little Zainab stares at her mother with wide eyes.
Her fever has risen, her heart is racing, her fingernails are turning purple.
Every breath acts like the first gasp after a long dive.
The baby is threatened with suffocation and needs a blood transfusion.
The fact that seriously ill patients have been avoiding the hospital wards for months is not only due to the fear of corona infection in the clinics.
The overcrowded buses and taxis also put people off - and rightly so.
And when an administration tries to reduce the number of people using public transport, prices immediately rise.
The number of people who cannot afford to be transported to the hospital has increased massively since the outbreak of the pandemic.
A problem that extends far beyond Sierra Leone.
In a survey of 24,000 people in 18 African countries, almost half of those questioned in need of treatment stated that they had not made necessary doctor visits since the outbreak of the pandemic.
According to the study on behalf of the African Union, the main focus is on research into heart disease and diabetes.
Most affected, however, is the fight against malaria.
How does an aid organization like Doctors Without Borders deal with such a situation?
What does she do when she realizes that patients like Zainab are suddenly absent?
"It quickly became clear to us: if the patients no longer come to us, we have to come to the patients," says clinic director Biolchini.
In fact, in the middle of the pandemic, MSF completely redesigned a significant part of its work in Sierra Leone and is now increasingly relying on mobile teams that drive across the villages.
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Treatment and prevention by the mobile clinic
Photo: Benjamin Moscovici / DER SPIEGEL
And the need is great.
When the helpers come into the villages in their white off-road vehicles with the red logo, set up their little tables and unpack the medicines, they can barely cope with the rush.
Even after hours, the group of women and girls who besiege the helpers with their children does not get any smaller.
While a colleague checks the vaccination records and refreshes the vaccination protection if necessary, another colleague measures a fever and tests for malaria.
At the same time, a woman carries out preventive check-ups for pregnant women a little apart and someone else gathers the rest of the village community together and explains what symptoms are with which one should go to the nearest health center, maybe even to the hospital.
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A woman comes to the Doctors Without Borders mobile clinic with her child on her back and her patient file
Photo: Benjamin Moscovici / DER SPIEGEL
Watta Momoh sits a little apart on a bench with her grandson and watches the work of the helpers.
She is one of the oldest women in the village and still remembers how it used to be when a child died every few days.
Since there is a small health station a few kilometers from here, it's better, she says.
But now with Corona they would hardly dare to leave the village.
Nobody wants to bring the virus in.
"The switch to mobile teams was an extremely important step," says Fouad Gammoudi.
The Tunisian is head of the MSF mission in Sierra Leone.
Of course he had sleepless nights, he says.
But there have never been any serious supply bottlenecks.
"So far we have managed to adapt to the pandemic pretty well."
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Malaria rapid test: A large pharmaceutical company is said to have announced that it would stop producing malaria rapid tests in favor of the more lucrative production of corona rapid tests
Photo: Benjamin Moscovici / DER SPIEGEL
If you want to understand how this was possible, you have to talk to the people behind the organization.
People like Laurent Sury, who runs one of the largest MSF logistics centers in France and who, with his long disheveled hair and stubbly beard, looks as if he has stayed in the office more than once in the past few months.
Flights were canceled, medicines could no longer be delivered, borders were closed.
A logistics nightmare.
And then, says Sury, representatives of the French government briefly considered confiscating its drug store in the spring and a large pharmaceutical company announced that it would stop the production of malaria rapid tests in favor of the more lucrative production of corona rapid tests, report other doctors. without borders employees.
Colleagues from the New York office then begged, threatened, negotiated - throwing the full weight of Doctors Without Borders on the scales - in order to finally get the pharmaceutical giant to continue producing rapid tests for malaria.
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Doctors Without Borders logistics center in Bordeaux, France
Photo: DER SPIEGEL
Or the manager of the logistics center in Dubai, who suddenly played a key role at the beginning of the year when the export of medical protective equipment from the European Union was largely restricted.
Almost overnight she and her team were responsible for ensuring that the staff in the countries of assignment did not run out of masks and gloves.
Fouad Gammoudi knows that it is not so easy for other aid organizations.
"They do important work too," he says.
"But very few have the same technical capabilities and financial resources as we do."
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Infirmary in Kenema, Sierra Leone: still just a drop in the ocean
Photo: Benjamin Moscovici / DER SPIEGEL
And despite all these resources, MSF's work is just a drop in the ocean in the end, he says.
A small clinic in the jungle on the border with Liberia and a few off-road vehicles that drive to the villages in the area from there did not change anything in the disastrous state of an entire health system.
But you have to start somewhere.
It saved little Zainab's life.
After a blood transfusion, your oxygen saturation has returned to normal.
The next morning the fever is gone, she drinks again and doesn't even need additional oxygen via the nasogastric tube.
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Zainab has quickly recovered from the life-threatening situation
Photo: Benjamin Moscovici / DER SPIEGEL
Marianella Rodriguez, the Argentine pediatrician, wants to keep Zainab and her mother for one more day to observe.
"But I'm sure they can both go home tomorrow," she says, then she has to move on.
Today is about bed three and twelve.
Bed three is acutely malnourished and may have something on the brain.
Bed twelve has malaria, pneumonia, and anemia.
“Neither of them look good,” says Rodriguez.
“But whoever made it to us usually makes it out of here alive.
It's the others I'm worried about. "
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