Malaria cases in a Nairobi slum

Pamela is 35. She lives in Huruma, at the edge of the Mathare slum in Nairobi. For several days now, she has been feeling very ill. She has fever, headaches and she has been vomiting. Washing clothes is her only source of income, but she's too ill to work. She thinks she has malaria - she's had it before, especially after going to her village near Kakamega in the Western Province. That's what happened last time she went there, for Christmas day. So Pamela bought three tablets of Fansidar® (SP) and took them herself. But despite this, she is still ill. And scared too - her sister died of malaria last year. She's heard that other more effective drugs exist, but that they are expensive, so she won't be able to pay for them. Pamela therefore decides to go to MSF's clinic in Upendo, in the Mathare slum, where she's been treated two or three times for other problems without having to pay too much. At the clinic, she has to wait for a while in the queue before Florence, the nurse, can see her. Pamela explains her symptoms and that she's already taken three malaria tablets. Florence immediately sends her to the clinic's small laboratory to carry out a blood test and see if she has parasites in her blood - it's positive. The nurse sends Pamela to consult Moussa, the clinical officer, who explains that the tablets she took didn't cure her because the parasites are resistant to that drug, but that she's going to take another, much more effective treatment. Moussa prescribes a three-day course of artesunate and amodiaquine. He gives her the pills and watches her take the first dose. Pamela goes back home and already feels better a few hours later. A few days later, she is totally cured and has started working again. Christopher, 10, lives in Mathare 4A with his widowed mother and his four brothers and sisters. The family has gone back to their village but returned to the slum two weeks ago. Christopher fell ill - he had fever and a cough, so his mother took him to the Upendo clinic where she usually goes. A nurse examines Christopher and takes a drop of blood taken from him to carry out a rapid diagnostic test. Five minutes later, the nurse confirms that the test is positive for malaria. She prescribes Fansidar, and explains to his mother that she must bring him back if he doesn't get better. Three days later, Christopher is still ill and his mother brings him back to the clinic. This time, the nurse asks the lab technician to carry out a microscopic blood test, which shows the parasite is still present in his blood. Moussa, the clinical officer, prescribes Christopher a combination therapy of artesunate and amodiaquine. Christopher doesn't have to go back to Upendo a third time. Instead, he goes back to his neighbourhood's informal school.