"The need for a swift reaction to the malaria epidemic in this region is genuinely pressing," explained Francois Fille, MSF Operational Co-ordinator for the region. "But the scattered nature of the islands means that it takes a great deal of time to travel between them. A further constraint is the eruption of a volcano in the provincial capital, Ternate, which means the temporary closure of important facilities such as the airport and the banks."
MSF has sent a team to South Halmahera, in North Maluku, Indonesia to tackle a malaria outbreak in the region. The decision to intervene was made based on information gathered with the provincial health authorities which revealed alarming malaria-related mortality rates over the last months, especially among children under the age of five.

The first MSF intervention took place from July 20 to 22 in the small town of Tawabi where in the preceding two weeks alone, six children had died from the disease. In two days the team carried out 259 consultations. Of a population of only 824, 117 people tested positive for the most deadly Falciparum malaria strain, and seven for Vivax or other strains of malaria.

The second intervention in Sumai resulted in 167 consultations, with 56 testing positive for Falciparum and 15 for one of the other three strains of malaria. Over the last week, the team visited Marimoi, Bumoi Rahmat, Cango and Loleba villages, where they also found worrying numbers of Falciparum positive patients.

"The need for a swift reaction to the malaria epidemic in this region is genuinely pressing," explained Francois Fille, MSF Operational Co-ordinator for the region. "But the scattered nature of the islands means that it takes a great deal of time to travel between them. A further constraint is the eruption of a volcano in the provincial capital, Ternate, which means the temporary closure of important facilities such as the airport and the banks."

The MSF project aims to reduce illness and deaths caused by malaria by introducing a treatment known as 'ACT' - Artemisinin-based combination therapy. This involves combining artemisinin derivatives (extracts of a Chinese plant) with another anti-malarial drug. ACT is currently considered to be the best available treatment for malaria in the region, since resistance to Chloroquine and Fansidar, the drugs which are generally used as the first-line treatment in Indonesia, has become widespread. The MSF project will be the first time that Artesunate-Amodiaquine combination therapy is used to fight against malaria in the country on such a large scale.

"Many of the people living in the remote, rural area have only recently returned to their homes after fighting in the region caused people to flee in 1999. The health system still lacks the staff, resources and medicines to cope with such malaria outbreaks," explained Fille.