A few weeks ago, I gave a staff member a call.

“How are you, and how’s the baby?”
“I’m not so good, I’m due to give birth next week but I’ve got malaria and I’m really sick”

When I first came to Northern Uganda, I wondered what all the fuss was about. Yes, malaria was around, but in my year working at Lacor Hospital I only saw one person die from it on the adult ward. When I started my current job co-ordinating the anglican health centres, out of every 10 malaria tests only one would be positive.

In May this year, everything changed. I remember getting a call from one of our health centres “Doctor, Doctor we’re going to run out of malaria drugs tomorrow at the health centre”

“Oh dear. But you ordered enough for 5 months just 2 months ago!”
“Yes we did, but now they’re gone”
“Ah…       OK, we’ll see what we can do”

On a random visit to St. Lukes, 9 out of their 10 most recent tests were positive.

Malaria went from a minor problem to a monster in about 3 weeks, and then kept getting worse All our friends, even 2 mzungu (white) friends started getting malaria. One of our health centres treated over 600 patients for malaria in June. The number of patients visiting our health centres doubled. Lacor’s children ward was full with 2  children on some beds for the first time in 5 years.  An epidemic was declared 2 months too late, and extra training and help on Malaria only happened at the end of last month after the epidemic was already subsiding. Luckily with a lot of yelling down the phone we managed to get an emergency order of malaria drugs, with a couple of our health centers going only a day or two without drugs.

Nancy Looks for Malaria Parasites down the microscope

The obvious question “why an epidemic now?”, may have a very simple answer. For the last 5 years there’s been a comprehensive indoor mosquito-slaughter spraying program, with the inside of nearly every home in Northern Uganda sprayed with a safe insecticide. This was wildly successful, with malaria prevalence plummeting. This slightly ironic article “Using indoor residual spraying to win a battle against malaria” was written only this year. The children’s ward at Lacor saw a 90% reduction in malaria cases from 2009 to 2014, before skyrocketing from May to July this year.

http://abtassociates.com/Impact/2015/Using-Indoor-Residual-Spraying-to-Win-a-Battle-aga.aspx

The World Health Organisation has ruled out more spraying, apparently because it is too expensive and not sustainable at 6-8 US dollars a household. I reckon we could do it for $4 a household but that’s beside the point. So what’s the plan now?

The ethics of the whole thing are mind boggling. Could things be worse now than before as people have lost their resistance to malaria built up over years? Could their be some other rebound mechanism post-spray causing the overwhelming number of cases? How much is a life worth? Is there a solution? Is this someone’s fault? Who’s responsible? Does anyone not in Northern Uganda really care?

People are saying the fresh rains in October could lead to another epidemic. Pray no.