Last week, I have mainly been seeing patients with malaria or HIV, sometimes both together.
My stay in the Valley corresponds with the malaria season, at the end of the rains and the beginning of the dry season. Heavy downpours of rain flush out the mosquito larvae breeding in standing water, but if the pools are undisturbed for a couple of weeks, the mosquito population flourishes. With the last rain a week ago, the pools are beginning to dry out. Last week we were seeing 20 patients a day with confirmed malaria. Most of these patients said they slept under nets impregnated with mosquito repellent, but unless they go to bed at 6pm, they will probably get bitten.
On Thursday, I spoke to a colleague who was working in a remote health centre in Nsefu, about an hour away from Kakumbi by motorbike, who said that every day he was seeing about 80 patients, and 50 of them are testing positive for malaria. We should count our blessings.
I expect that May will be the worst month. In May 2013, there were 450 cases of malaria; in May 2014 when I was last here, we had over 800 cases. At the moment, we have enough Coartem (for chloroquine resistant malaria) for two and a half weeks. However, we are running out of rapid diagnostic tests and will have to start staining and examining thick blood films, which is much more time consuming.
Touch wood, I have seen no cerebral malaria yet, and no one has died who has attended the clinic. Last year, I lost two children from malaria, both of whom were living with HIV. They seemed to be improving when they suddenly developed an overwhelming pneumonia. So I have resolved to give prophylactic broad spectrum antibiotics to all HIV positive children with severe malaria this season.