Kenya: A day in an outreach activity - Triple burden of measles, malaria and malnutrition in a family
A 10-year-old patient's blood sample is taken for a malaria test during a medical outreach activity in Lodakach ward, Turkana West sub-County. Kenya, July 2023. © Lucy Makori/MSF
Since June, Doctors Without Borders / Médecins Sans Frontières (MSF) has been working with the Turkana West sub-county team in combating the dual threat of measles and malaria through mass vaccination, integrated case management, treatment at two health facilities, and vital medical outreach at the community level. 26,862 children have been vaccinated in the mass measles vaccination campaign in the vast sub-county reaching villages over 170 kilometers away. This is accompanied by strengthened health promotion through community engagement, sensitization, and surveillance.
Doctors Without Borders teams load cool boxes and vaccine carriers into cars for a vaccination campaign activity in Kakuma. Kenya, July 2023. © Lucy Makori/MSF
The Ekope family from one of the villages in Lodakach is one of the families that bears the brunt of these diseases.
Hellen Adir is a worried mother. We meet at the community outreach in Lodakach ward. With her are two of her three children, two-year-old son Ekidor Ekope and ten-year-old daughter Abenyo Ekope, who have accompanied her to the medical outreach. Her daughter, Abenyo looks frail as she goes through triage. The scorching sun makes her symptoms almost unbearable. She watches the medical team as they ask her mother questions.
“She started having pain in her joints, stomach and legs. I have come to get medication for her. I suspect it is malaria,” Hellen explains. “For two weeks now, I have known no peace. The children have been sick one after the other. My five-year-old son Longem Ekope is currently home, recovering from measles and malaria too. I took him to the Lopur dispensary last week and he got treatment.”
A mother feeds her two year old son with supplementary food given after a nutrition review during a medical outreach in Lodakach. The son has severe acute malnutrition and her sister and brother both have measles and malaria. Kenya, July 2023. © Lucy Makori/MSF
Nancy Gichiki, Doctors Without Borders clinical officer checks Abenyo’s temperature and it is very high - consistent with what she has been witnessing in children and adults in the medical outreach activities. She also observes some rashes around Abenyo’s ear and asks her to open her mouth checking for throat inflammation. The symptoms confirm measles. The next step is to test for malaria as she has also complained of body aches. Her test turns positive, and her treatment must start now.
Abenyo is one of the 451 people who have been reported to have measles and the 1,475 with malaria in Turkana West sub-county alone. The diseases have affected many, from infants to the aged. The sweltering sun has not deterred them from coming to the medical outreach. Some of them are ill and lie under the shadows of the shade-devoid trees to shake off the heat, all waiting for medical care. Most of the old complain of pains in the joints while children under five years are the most affected.
But this is not the only struggle for this pastoralist community unspared by the ravaging drought. Its ugly impact is visible in the form of malnutrition among children, pregnant, and breastfeeding mothers. With livelihoods shattered due to the death of livestock, many are now struggling to secure enough food to feed their families.
Doctors Without Borders nutritionist measures the mid- upper arm circumference (MUAC) of a child to help identify cases of malnutrition during an outreach activity in Lodakach Ward. Kenya, July 2023. © Lucy Makori/MSF
Hellen's two-year-old Ekidor, has been brought for a nutrition review and has just received a two-weeks supply of supplementary food- plumpy nuts for severe acute malnutrition from MSF nutritionist Phinnah Botta. Doctors Without Borders medical teams have been providing nutrition screenings for the most vulnerable- children between 9 months to 5 years, pregnant and breastfeeding mothers in outreach activities and at health facilities. The identified patients are then referred to facilities nearby for follow-up and reviews on their progress.
The outreach team keeps asking parents. “Is any child at home with the symptoms? Please bring them.” A distressed father responds. “I did not have the energy to carry my other son, he was too heavy and frail at least I could carry this other one slowly with the bicycle.” It is a race to leave no child unvaccinated for measles as well as untreated for malaria. The team listens to him and asks him if he could guide the community health promoters to his house. They finally go to his home and come back with the young boy.
Patients wait for medical consultations outside the Lopur dispensary. Doctors Without Borders is also supporting the Turkana County Ministry of Health in strengthening measles and malaria case management in two primary health facilities in Lopur, one of the wards reporting the highest cases of measles and malaria. Kenya, July 2023. © Lucy Makori/MSF
A stone’s throw away, net distribution is ongoing. During the response, 8,403 nets were distributed reaching children under fifteen years and pregnant and lactating mothers. Ekidor’s family received a mosquito net to protect him and his recovering brother and sister.
Today alone, the team has conducted over 100 medical consultations in Lodakach and 1,466 consultations at facilities and during the medical outreaches during the response.