The first approved malaria vaccine was released. The majority of malaria deaths occur in sub-Saharan Africa, where 400,000 people are affected annually.
Diana Zeyneb Alhindawi, a photographer, documented the devastating effects of the epidemic during the worst outbreak in South Sudan.
When the guard saw that the little girl was sleeping in her uncle's arms, he rushed them through the busy waiting area and into the consultation room. The child's vital signs were checked by a health worker who walked away from the patient. He said, "She's already deceased," quietly.
Atony, four years old, had been feeling sick for several days. But it wasn't until the previous evening that she got a fever and stomach pains. With her grandmother, she lived in a remote area of South Sudan's northwest corner. Her parents were employed in Aweil, the capital of the state. Atony's grandmother had organized a motorcycle taxi for them to get to the hospital that she heard was open. Atony was already too late when they arrived.
Although it sounds like a tragic story about a place that has been hardest hit by the Covid19 epidemic, it's not. This is a story on malaria, an infectious disease that kills approximately 500,000 people annually. More than half of these are children under five years old.
The World Health Organization (WHO), approved last week the first ever malaria vaccine for widespread usage.
The vaccine, also known as RTS,S or Mosquirix and developed by GlaxoSmithKline in the UK, is effective against Plasmodium falciparum. This deadly variant of malaria is the most common in Africa. It's also the first vaccine to target parasitic diseases, which could lead to the creation of a new class of vaccines. Tedros Adhanom Ghebreyesus (director-general of WHO) called it "a breakthrough in science, child health, and malaria control".
This is encouraging news, but there are still questions regarding production, distribution, funding, and distribution. Other preventative measures will also be required. Ghebreyesus stated that "Using this vaccine along with other tools to prevent malaria could save the lives of tens to thousands of children each year."
The Covid19 vaccine was introduced earlier in the year, but the malaria vaccine didn't generate as much attention. The vaccine could alter the fabric of society in sub-Saharan Africa where 94% of malaria cases are found.
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In 2015, malaria hit South Sudan hardest. In 2015, South Sudan was hit the hardest by malaria. 2.28 million malaria cases were reported that year. According to Doctors Without Borders (Doctors Without Borders), malaria killed more people than bullets in South Sudan in 2015. This is a shocking statement considering the country hosts one of the most deadly conflicts in the world.
To document the outbreak, I went with Doctors Without Borders to Northern Bahr el Ghazal in October. It is the most remote state in the northwest corner of the country.
A nurse checks blood type compatibility before giving a blood transfusion for Adut Chuor Kujal (8), who is being treated for cerebral malaria at Doctors Without Borders in Aweil. Adut's parents live in remote villages so she was already sick several days before her father arrived in Aweil. He took her to a private clinic in the area, but they didn't have any malaria drugs. Diana Zeyneb Alhindawi
Panthou is the only county health center that provides free diagnosis and treatment for malaria. It is surrounded by swamps. Swamps are a common feature of South Sudan's geography. They provide the perfect breeding ground for mosquitoes. Diana Zeyneb Alhindawi
18-year-old Abuk Akuoc is semi-conscious, letting out cries in pain, and receives intravenous quinine treatment at the Panthou health center. A week earlier, she had visited the health center and was also diagnosed with malaria. She was then prescribed the oral medication ACT. Her condition deteriorated rapidly after the medication was unavailable at the local pharmacy or the health center. Diana Zeyneb Alhindawi
After bathing her daughter, a mother takes her daughter to the hospital. The Doctors Without Borders hospital in Aweil is treating the young girl for severe cerebral malaria. Diana Zeyneb Alhindawi
Abuk Akuoc (18) receives intravenous quinine treatment for malaria. A nurse uses a moist compress to relieve fever. Abuk is comforted by her family. Diana Zeyneb Alhindawi
Two years after South Sudan gained independence in 2011, civil war erupted due to a dispute between President Salva Kiir, and Vice President Riek Makar. The conflict pitted Kiir's ethnic Dinka against Machar's Nuer. A fragile peace deal was reached in 2018. An estimated 400,000 people died and 4 million of the country's inhabitants were displaced. This led to the worst refugee crisis in Africa since 1994's Rwandan genocide.
Just a few days ago, I was in Bentiu. It was a camp for people who were displaced from war. With a population of over 200,000, it is the second largest city in South Sudan. There, survivors told me about massacres, gang rapes and other horrifying atrocities. Yet, I was just as shocked when I arrived at Aweil, the quiet capital in Northern Bahr el Ghazar, to see what I saw. There was no war here, but I saw suffering and death everywhere. The silent killer was malaria.
The disease spread quickly across a territory that was dotted with swamps. This is because mosquitoes are perfect breeding grounds for malaria. Concerning was also the fact that the state, which is home to 1.2million people, only had one hospital. It was a facility called Aweil, run by Doctors Without Borders and South Sudan's Ministry of Health.
The hospital had already been overcrowded with malaria cases, so hallways were now crammed with people sleeping on mattresses on the ground. Nearly every person I saw was carrying a relative or child, often with a fever, who was trying to get medical attention.
Many government-run hospitals were shut down due to a lack of qualified staff or lack of medicine. Private clinics were too expensive for most people. It was often too late when an infected person was referred to medical care. The painful effects of the malaria epidemic, drug shortages, inaccessible and adequate health care, and a lack of prevention were all evident.
Patients were able to lie on sheets or mattresses outside, while IVs were hung from trees at a government-run hospital in Aquem. The wards were crowded with patients, making it unbearably hot in the building. Temperatures reached the high 90s during the day and even 100 at night.
I found her grandmother again at the hospital where Atony was brought.
As she sat on a bench in the waiting area of the health center, she looked down at the little girl across her lap in shock, and clasped her tiny leg every now and again to make sure warmth had returned.
When her name is called at the Panthou village health center, a woman rushes up. This is the only area in the county that offers free treatment for malaria. There were approximately 150 patients treated by the two medical assistants who were qualified to diagnose and treat malaria. There were no rapid diagnostic tests available at the center, so it was only possible to diagnose patients based on the symptoms that were observed. The availability of medicine was sometimes limited or outright unavailable. Diana Zeyneb Alhindawi
Abdifatah Mohamed (a Doctors Without Borders nurse) administers a Rapid Detection Test to Agok Yel, a four-year-old, for diagnosing malaria. Diana Zeyneb Alhindawi
Atiel Akech (3 years old) lies in her mother's lap in the government-run Aquem health center. Because the wards are too warm and lack beds, patients here sleep on outdoor mattresses with IVs suspended from trees. Atiel's mother claimed that she was not allowed to receive free rapid diagnosis tests or medication. However, the center was supposed to provide both. Atiel didn't have the money so she was given insulin and diagnosed with malaria. Her condition was rapidly deteriorating, as expected. Diana Zeyneb Alhindawi
Abuk Akuoc (18) is held up by a relative. She is now semi-conscious and has clenched her body in feverish pain. John Mayen, a medical assistant and director at Panthou's health center, recommends that she receive immediate treatment for severe, acute malaria. Abuk's family spent 30 SSP (2 US$) on a motorcycle for the 15-minute journey from Malithbuol. This was an expensive option for a rural family in South Sudan. It would have taken them one hour to walk and Abuk would have been required to ride the motorcycle. Diana Zeyneb Alhindawi
Panthou village's health center has a waiting list for patients who want to be given medicine. The center just received an oral malaria medication supply, which was likely to last for one to two weeks. It had been out of stock for over 2 months. Quinine, an intravenous drug, was rapidly running out so it was reserved only for severe cases. Diana Zeyneb Alhindawi
As her child waits to be admitted at the Doctors Without Borders hospital, Aweil city, a mother comforts her child. As all beds in the wards were occupied, there was an overflow of patients suffering from malaria. Diana Zeyneb Alhindawi
Abuk Akuoc (18) receives intravenous quinine treatment for severe malaria at the Panthou health center. Diana Zeyneb Alhindawi
