00Introduction01Community health centre02Triage03Emergency04Intensive Care05Recovery


Three-year-old Fatoumata started showing signs of malaria at home 10 or so days ago, including fever, vomiting and diarrhoea. Simple malaria is treatable at community level here in southern Mali. But left untreated, or in severe form, malaria is nothing less than the number one killer of under-fives.
  • Name : Fatoumata
  • Age : 3 years old
  • Sex : Female
  • Village : Sougoumba
  • Preliminary diagnosis : Severe malaria with severe anaemia
  • Under Treatment : 4 days
Her mother took her to Molobala community health centre (CSCOM) where consultations, tests and treatments are free.

Preliminary diagnosis at the health centre

Brought by her mother to the community health centre, Fatoumata tests positive for malaria, but she has many of the indications of the severe form of this disease. She pants when she breathes, her pulse rate is high, and she is unhealthily pale. Tests also show that her red blood cell count is extremely low. Without a transfusion, the doctor gives her only a few hours to live.
Fatoumata needs to be transfered to a higher level of care in the hospital of Koutiala, 1 hour 40 minutes away.
Fatoumata - Preliminary diagnosis at the health centre

Classified “red” at triage

Not surprisingly, Fatoumata is immediately classified as an urgent case at hospital admissions. The nurse cross-checks her low red blood cell count—3.5 grams per decilitre—via the portable anaemia testing device. While the rest of her emergency assessment completes, a medical team gathers in the ER to prepare for her care on multiple fronts.
*Artesunate is an anti-malarial medicine derived from the Chinese herb artemisinin, that won a Nobel Prize in Medicine for its lead discoverer in 2015.

Life-saving treatment in Emergency

In ER, Dr Kanoute has to respond to Fatoumata's malaria, the organ dysfunction it's causing—especially in the kidneys and brain—and her loss of red blood cells. Fatoumata, understandably overwhelmed, uses her little energy to fight off attempts to give her oxygen, one element of her supportive care. She's given artesunate* by IV, and preparations begin for the blood transfusion.

An O+ match for Fatoumata

Fatoumata's blood transfusion depends on a blood bank that screens and stores blood under strict protocols, across the relevant blood groups, and doesn't run out of stock. In Koutiala, blood donor drives have had huge success in generating regular donations. Fatoumata's family will be asked to contribute too. Blood transfusion is an uncommon, life-giving service in rural Mali, but in the Koutiala program it's free.
  • Fatoumata
  • Fatoumata
  • Fatoumata

On the road to recovery in two days

Fatoumata still has a fever, but it is amazing how children like her have some of the quickest recoveries in the hospital. She's on artesunate tablets now, and folic acid to help with her anaemia. Guidance is shared with her mother on how to prevent Fatoumata getting malaria again, or at least have it detected and treated before it gets dangerous.
“Examining Fatoumata today there's no particular concerns, she's in good condition overall. She's progressing well. We've told her parents she can be discharged.”Dr Mariam Diakite, MSF