Amos’s story

Rectal Artesunate in Nchelenge, Zambia

As the summer rains approach the Nchelenge District of Zambia, the community is equally aware of the benefits water provides, and the breeding ground for malaria-carrying mosquitoes it creates. As a community health care worker puts it, ‘Life, and death revolve around water here.’

Amos, a young child with malaria, arrived at the hospital in the district of Nchelenge, St Paul’s Hospital, severely ill and strapped to his father’s back. Amos’ father had walked to the hospital from their home in Mulumba Village, which is an hour away on foot.

Some families are not as fortunate. The furthest communities from St Paul’s live 35km away, where the only possible transfer is by motorbike taxi. The transfer costs 50 Kwacha, about 10% of the average monthly household income. For these families, a hospital may be out of reach, due to lack of transportation (particularly due to flooding during the rainy season), challenging infrastructure, low availability of services, security concerns or cost.

Amos’s mother, Beatrice Mutobola, has lost count of the number of times malaria has affected their family. For numerous days each year she or her husband have had to abandon their farms and income generation to make the trip to St Paul’s Hospital with whichever of their children has most recently been infected.

Beatrice reflects on her experience this time. “The trip was significantly less complicated than usual” she says. So, I ask, what was done that was different from usual? “Amos was very weak and could not eat.” she explained, “So the community health worker inserted a medicine into his anus which made him healthier before we left for the hospital.”

The medicine Amos received was rectal artesunate, a ‘pre-referral’ intervention used to buy time for patients living in rural communities to reach higher-level healthcare facilities. Once at the facility, patients receive intravenous treatment and follow-up care.

When Amos arrived at St. Paul’s hospital, he received injectable artesunate intravenously and was given artemisinin-based combination therapies (oral medicine) to clear his infection.

Amos is now back home, playing in the yard as the story is relived. Silhouettes of the dancing children break the evening light, that pushes through and glimmers off the stagnant water in the irrigation canals. Today, thankfully there was more life around water than death.