"If we manage to successfully limit the infestation by mosquitoes and give prompt and effective treatment to the sick, we can literally help the community get back on their feet." - MSF doctor

In close collaboration with local health workers and authorities, an Medecins Sans Frontieres (MSF) team is fighting an outbreak of malaria in the distant Gorong Archipelago, in the eastern part of Maluku province in Indonesia.

In the village of Wawasa, with a population of 1,103, the medical team treated (between May 3-8) a total of 390 people, including 104 children under five and 15 pregnant women. Since the beginning of March, 36 people have died already from the disease, equalling one in 30 residents of Wawasa.

For those patients who need malaria treatment, the MSF team uses Artemisinin-based Combination Therapy (ACT). Such treatment has proven highly successful and avoids issues of drug resistance that have become common in case of more traditional malaria drugs.

"We are talking about a small population," said Dr Miladi Kurniasari. "But the toll that malaria takes among the people here is extremely high. As MSF, we can bring our experience in fighting malaria, and our resources to help the authorities take the disease head-on. If we manage to successfully limit the infestation by mosquitoes and give prompt and effective treatment to the sick, we can literally help the community get back on their feet."

MSF has begun converting a house, next to the village clinic, into a ward where seriously ill people can stay overnight and be monitored while they receive treatment. Three persons were being attended in this ward on May 8. Other patients are asked to check in daily so the team can administer the drugs. Referral of the most severely ill to hospitals in Geser or Ambon is impossible at the moment, as the seas are too rough to allow for safe crossing.

The Raja of Amarsekaru, whose territory includes Wawasa, has held a meeting with the villagers and urged them to attend the clinic without absence during the three-day treatment course. In addition, he has organised a measles vaccination campaign and recruited staff for the construction of the in-patient ward.

All houses in Wawasa have been sprayed previously by Ministry of Health staff, outside and indoors, to kill the mosquito that transmits malaria. Fifty bed nets were distributed for babies and pregnant women, but more will be needed to provide each family with two nets.

The lagoon on the edge of the village has been successfully treated with larvicide in order to stop the mosquito from breeding.

With most initial work done in Wawasa, the MSF team is now looking at five villages on nearby Panjang island with a combined population of 1,623. Three of the villages are known to have a high infestation of mosquitos and see malaria all through the year.

"Malaria is a very big problem in most of eastern Indonesia and the death toll in this particular area is extreme," added Katy Dalrymple, the MSF entomologist in Wawasa. "Our mobile approach and collaboration with the population and authorities hopefully means that many communities will be able to benefit from a comprehensive attack on malaria as has been organised here. No further malaria mosquitoes have been found after the mass spraying. By reducing the human reservoir, the number of people carrying the parasite, we can effectively cut the malaria incidence now."

MSF currently has seven staff, six of them Indonesian, working on the Wawasa outbreak. A second MSF team is on its way from Ambon, the capital city of Maluku, bringing new supplies including 500 bed nets, in order to extend the activities and assess the neighbouring islands.


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