Dispatches Winter 16 pullout

MSF teams in Mali are testing new mobilephone technology to help diagnosechildren with cerebral malaria, a severecondition that can lead to death if nottreated.MSF tropical medicinesadvisor Estrella Lasryexplains how this simpletechnology is helping totransform MSF’s treatmentof this disease.

The smartphone that saves lives

Photograph © PEEK Vision

What is PEEK?PEEK stands for a ‘portable eye examination kit’ –which allows doctors to diagnose eye disease usingan ordinary smartphone. It was developed by scientistsat the London School of Hygiene and Tropical Medicineand the University of Strathclyde.

What’s so good about it?The usual tools for looking at a patient’s retina are anophthalmoscope – which can be difficult and time-consuming – and binocular indirect ophthalmoscopy –a fancy and expensive device that only ophthalmologistsknow how to use and is rarely, if ever, available in thefield.

The best things about PEEK are that it’s simple, cheapand accessible. And with a few days’ training, it can beused just as effectively by a non-specialist doctor as byan ophthalmologist.

Why did MSF decide totest it in Mali?Our paediatric department in

Koutiala hospital, Mali, sees hugenumbers of children under fivewith severe forms of malaria –many of these children havecerebral malaria, which causescoma.

The problem is that cerebralmalaria can easily be confused with

other diseases, such as meningitis.We were seeing an increase in thenumber of children with suspectedcerebral malaria, but with the limiteddiagnostics available, we couldn’tbe sure which disease they had, andtherefore which treatment to give them.

We knew we needed better diagnostics at the bedside – a simple toolthat would help us identify malarial retinopathy. When one of ourpaediatricians heard about the portable eye examination kit, we realisedthat this could be just what we were looking for.

In the types of places where MSF works, brain biopsies are not plausible.But there’s another way of seeing inside the brain – by looking at theback of the eye. The retina is a mirror of what is happening in the brain.With cerebral malaria, the retina can undergo certain changes, known asmalarial retinopathy. These are:

Illustrations: Ian Moores

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How does it work?• You fit the sleeve onto yourphone and shine the phone’sinbuilt light at the patient’sdilated pupil.

• The phone sleeve channels thelight and focuses automaticallyon the retina, the tissue atthe back of the eye.

• On the phone’s screen,you see a close-upimage of the retina.

• The images arerecorded and storedon the phone.

• You can examinethe image alongwith colleagues,replay the image tohave a closer look, oremail it to others for asecond opinion.

• An app that comes withit stores the patient’s noteson your phone, so all theinformation you need is in oneplace.

The presence of these changes confirms that a patienthas cerebral malaria – though of course they mayhave other diseases too. It also gives us an idea of theprognosis: the more changes there are, the more likelythe disease is to be fatal. Knowing this can help usprepare the patient’s family for the likely outcome.

The prototype is still being approved, but everyone’sasking for it now. We hope to use it wherever we seehigh numbers of children with cerebral malaria – whichis mainly in countries in east and west Africa.

Some other diseases – such as diabetes and HIV – arealso associated with changes to the retina, so we reallyhope to be able to use PEEK for these patients too.

1 Haemorrhages –caused by the red bloodcells sticking togetherand not allowingmicrocirculation.

2 White patches and 3 Abnormalvessels – caused by malaria parasitessticking to the lining of the small bloodvessels in the brain and eyes wherethey disrupt the supply of oxygen andnutrients.

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Main photograph: Children play in the compound of Koutiala children’s hospital. Clockwise from top right: A young boyeats a meal in the hospital compound, where nurses run cooking lessons for mothers to teach them how to preparethe most nutritious food for their families and prevent malnutrition among their children; a child regains his strengthin the recovery ward of Koutiala hospital; Mariam Traore has brought her granddaughter, Sarata, to the hospital for herregular check-up; mothers share a meal outside the intensive care ward; Aisha arrived at the hospital suffering fromsevere malnutrition. Fully recovered, it’s now her last day in the intensive nutrition unit and she is ready to go home.

Mali children’s hospitalAt Koutiala, in southern Mali, MSFand the Malian ministry of health runone of the largest children’s hospitalsin the country. With malnutrition,malaria, diarrhoea and lowerrespiratory tract infections endemicin the area, the hospital focuses onpreventing the diseases, as well astreating them, through nutrition,vaccinations and health education.

All photographs © Yann Libessart/MSF

At Koutiala, in southern Mali, MSFand the Malian ministry of health runone of the largest children’s hospitalsin the country. With malnutrition,malaria, diarrhoea and lowerrespiratory tract infections endemicin the area, the hospital focuses onpreventing the diseases, as well astreating them, through nutrition,vaccinations and health education.

All photographs © Yann Libessart/MSF

At Koutiala, in southern Mali, MSFand the Malian ministry of health runone of the largest children’s hospitalsin the country. With malnutrition,malaria, diarrhoea and lowerrespiratory tract infections endemicin the area, the hospital focuses onpreventing the diseases, as well astreating them, through nutrition,vaccinations and health education.

All photographs © Yann Libessart/MSF

At Koutiala, in southern Mali, MSFand the Malian ministry of health runone of the largest children’s hospitalsin the country. With malnutrition,malaria, diarrhoea and lowerrespiratory tract infections endemicin the area, the hospital focuses onpreventing the diseases, as well astreating them, through nutrition,vaccinations and health education.

All photographs © Yann Libessart/MSF

At Koutiala, in southern Mali, MSFand the Malian ministry of health runone of the largest children’s hospitalsin the country. With malnutrition,malaria, diarrhoea and lowerrespiratory tract infections endemicin the area, the hospital focuses onpreventing the diseases, as well astreating them, through nutrition,vaccinations and health education.

All photographs © Yann Libessart/MSF