In February 2020 the On Call Africa team of doctors arrived at Mukamba health post to set up their clinic for the day. There was a queue of over 70 patients waiting to see the doctors with a variety of health concerns. While setting up clinic it became clear that an 8 year old boy was critically ill and needed urgent attention.
Doctors were setting up clinic for the day Community Health Workers and On Call Africa staff were handing out number cards to let patients know when they would be attended to.
Whilst this is being done, Community Health Workers triage patients and use their learning to help identify any patients that may need to be seen urgently. Titus (one of our Community Health Workers) identified that a young boy was critically ill with a severe fever. He asked if he could be seen first and, suggested to the doctor in question that symptoms were consistent with cerebral malaria.
When the patient sat down with his mother and brothers the doctor quickly realised that the whole family were unwell and in need of quick attention. The doctor agreed with the assessment made by Titus and conducted malaria tests on the whole family. While testing was being carried out one of the boys started to fit, a sign that the malaria was extremely severe. The team of doctors responded quickly to set up an IV drip with quinine to provide rapid treatment to the patient. Clinic was put on hold while the team of 4 doctors worked together with the Community Health Workers to provide life saving support and to ensure that the rest of the family were provided with malaria medication, including a young baby. While being attended to the baby vomited, it was clear that the whole family needed urgent care in a hospital. While two doctors and two Community Health Workers attended to the family the remaining Community Health Workers quickly triaged the remaining patients to identify any others that were critically ill and in need of support. These patients were attended to while On Call Africa staff packed up the vehicle and prepared to depart.
The family were quickly transported to Livingstone hospital (approximately 80km away on bad roads, with no public transport available) along with the doctors. The remaining patients were consulted with and provided with malaria testing kits in order to follow up with the families living in close proximity to the ill family to test them for malaria and ensure that they receive treatment promptly.
Achievement and changes made
The family in question received the medical attention that they required, and were able to return home a few days later fit and healthy. Community Health Workers were able to identify others in the community who had malaria and provide them with treatment promptly before their conditions worsened. Treating everyone in the area also helped to prevent further spread of malaria in the community. The Community Health Worker worked through the health centre ensuring that they were informed of the outbreak and able to support the response.
Learning from the experience
Our Community Health Workers are highly skilled in triage and referral, there training has been effective. We also learnt the importance of transport in this situation and the potential impact of our doctors not being on site. Had we not been there the Community Health Workers would have been able to identify malaria, provide medication and make a referral to the health centre. However, due to the severity of the malaria that presented, and because transport links are so poor, it is unlikely that the family would have all received the treatment that they need quickly enough.
Similar incidents have been common in our clinics with On Call Africa doctors and Community Health Workers working together to provide often life saving treatment and transfers. As part of our sustainability plans we have learnt that transport will be a key element in ensuring that urgent care can be provided. With this in mind we intend to equip health centres with better transport, and provide communities with bicycle ambulances to ensure that community members can get to a health professional when needed.
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