. . .the story of malaria in Bwindi. I also want you to see some of the posters that we are putting up throughout the Bwindi area to reduce stigma and encourage people to come for HIV testing and treatment. Vaster, George and Isabellah are three of 86 Ugandan staff at Bwindi Community Hospital. Malaria I still remember my first day in Bwindi as a doctor three years ago when a small child was carried in out of the rain seizing from cerebral malaria with blood like water from the damage caused by the malaria parasite. Despite injections and a blood transfusion this boy died an hour after arrival. Many of the youngest children with malaria in 2006 died and others ended up severely disabled. The graph below shows the diagnoses made on children who came here in 2006/7. Apart from the peak of dental cases from a visit from a group of overseas dentists, the most striking thing is the large band of yellow across the bottom representing children with malaria.

Malaria

I still remember my first day in Bwindi as a doctor three years ago when a small child was carried in out of the rain seizing from cerebral malaria with blood like water from the damage caused by the malaria parasite. Despite injections and a blood transfusion this boy died an hour after arrival. Many of the youngest children with malaria in 2006 died and others ended up severely disabled. The graph below shows the diagnoses made on children who came here in 2006/7. Apart from the peak of dental cases from a visit from a group of overseas dentists, the most striking thing is the large band of yellow across the bottom representing children with malaria.

In 2007 almost every household surveyed said that Malaria was the most important health problem in the area. The Hospital together with help from friends and supporters has made a massive effort to try to control the disease. We have bought thousands of insecticide-treated mosquito nets and worked together with local people to teach the population about malaria prevention. If you sleep under a net you are much less likely to get bitten by a mosquito, and much less likely to catch malaria.

We didn’t give away these nets. Selling them at very low prices means they are more likely to be used and valued, so we sold them at prices that people were prepared to pay or bartered them for chickens and crafts. You can see the impact of this when you look at the graph for 2007/8. We saw more children present to the Hospital with acute respiratory illness (a good thing, as this is easily treatable) and far fewer with malaria.

You will probably notice the red band which signifies the emergence of HIV in children as a serious problem. We have tested almost 15,000 people for HIV over the last two and a bit years, and found more than 1000 positive. When we find HIV in an adult we offer tests to all their children, and some have been found to be positive. I have written before about prevention of mother to child transmission – how we test hundreds of pregnant women each year and help them to give birth to babies who are not infected. But there is a legacy of children with HIV that still needs to be addressed.

This latest graph still shows malaria at low levels, but we cannot be complacent. The community health team have trained hundreds of village health promoters who work on behalf of the Hospital in every village to teach people about safe water, sanitation, family planning, TB detection and of course malaria. This is Adah, an HIV positive lady who works with the Hospital making sure that all people with HIV get a basic care package including mosquito nets, water purification tablets and condoms.

Malaria is now an unusual diagnosis to make in Bwindi – the most important health problem is under control. And I haven’t seen a death from malaria in the hospital in more than 18 months. We can only make this kind of impact with your help. Next month we will start another malaria campaign to try to increase the proportion of children sleeping under nets from 50% to our target of 90%. Thank you to everyone who has already helped us to make a difference. If you want to find out more about how to donate to the charities in the UK and US who support the Hospital, or to read the latest news about what we have been doing in health insurance, women’s health, family planning and child health look at www.BCHC.ug.

With very best wishes

Dr Paul Williams
Medical Superintendent
Bwindi Community Hospital
www.BCHC.ug

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