Yékoua village, near Magaria, Niger - An MSF logistics team has just cleaned two rooms near the village health centre, preparing them for possible patient visits, when the nurse, Madame Souéba, approached us.
“A patient just arrived and I treated him,” she said. “That’s the second case of meningitis this morning. Luckily, we received the new drug - Ceftriaxone. It is very effective. I'm so relieved to be able to give it to my patients.”
Distributing these treatments and training employees in their use are critical activities.
“That’s what saves lives,” said Nico Heijenberg, the MSF doctor in charge of the Magaria operation, as he briefs the team’s new arrivals. “People only know about vaccinations. It’s true that vaccinations stop the epidemic from spreading, but without emergency medical treatment for patients with meningitis, the number of lives lost would be catastrophic.”
A man carrying a little girl descends the stairs into the health centre carefully. She appears to be unconscious. He lays the patient, still unconscious, on a mat under an awning. The heat is unbearable - more than 40°C in the shade, and the dust has penetrated every corner. This dust irritates the mucus membranes of the throat, exposing people to the meningococcal bacteria that cause the disease.
“I am her teacher,” the man tells us, as he dampened the girl’s forehead. She did not respond. “Yesterday she was fine and today she’s in a coma. We have come from Toubé, a village 14 kilometres away. It’s a long trip.”
People here are very familiar with chankarow - meningitis
We later learn that the village of Toubé does not have supplies of the meningitis drugs that MSF distributes but it has no health centre, which is a prerequisite for administering these injectable medications. In the rural areas, villagers must often walk more than five kilometres to find a clinic, which limits access to proper care for many.
Fortunately, villagers organized immediately to bring the sick child here. Her father had left the village to work in Nigeria. People in this area are very familiar with chankarow - the Hausa word for meningitis - which means someone who cannot move his head. The symptom is unmistakable.
A few days earlier, one of the two MSF teams providing medical care had passed through Yékoua, a village at least an hour west of Magaria, the district’s main town, to see if people were sick, collect information on those receiving treatment and deliver medication. Many people are now ill. Madame Souéba would like the MSF team and its traveling doctor to return - as soon as possible. The logistics team promises to pass on the information that evening in Magaria. With a little luck, one of the two teams sharing responsibility for monitoring the district’s 14 health centres may have planned to visit the area west of Magaria. At this point, Madame Souéba does not think that any of her young patients need to be referred to the Magaria hospital. The sun was low by the time we left Yékoua.
Going into the villages in search of the ill
The next day, three teams are scheduled to perform vaccinations in Yékoua. They expect 5,000 people. Dr. Simon’s medical team heads out at dawn, detouring to stop at the Magaria health centre. A young Fulani child was brought in, unconscious, during the night. The medical staff on the night shift performed a lumbar puncture and treatment has begun. It’s still very early when we leave for Yékoua.
At the health centre, only the little girl from Toubé and another child, who appears to still have neck pain, remained.
“It can take several days for the pain to ease,” Dr. Simon said. He watches the two young patients and seemed satisfied with their progress. “Now we’ll visit Toubé, the village where this little girl comes from. There may be others who are ill there.”
It takes us half an hour to find the village, which is already experiencing crushing heat early in the morning. The village chief was there and welcomed the MSF team. The team visited the girl’s mother, who stayed at home with her seven other children. No one else shows signs of illness. The team moved quickly and was soon back on the road. Its day has barely begun.
Team members plan to check in on four health centres today. That is not counting any unplanned stops in isolated villages to search for meningitis cases.
In Yékoua, a line of people waiting to be vaccinated has formed under the acacia trees. At the health centre, Madame Souéba is pleased. She has received new medications and knows she can count on MSF’s Dr. Simon.