1. MSF teams in Mali are testing new mobile
phone technology to help diagnose
children with cerebral malaria, a severe
condition that can lead to death if not
treated.
MSF tropical medicines
advisor Estrella Lasry
explains how this simple
technology is helping to
transform MSF’s treatment
of 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 using
an ordinary smartphone. It was developed by scientists
at the London School of Hygiene and Tropical Medicine
and the University of Strathclyde.
What’s so good about it?
The usual tools for looking at a patient’s retina are an
ophthalmoscope – which can be difficult and time-
consuming – and binocular indirect ophthalmoscopy –
a fancy and expensive device that only ophthalmologists
know how to use and is rarely, if ever, available in the
field.
The best things about PEEK are that it’s simple, cheap
and accessible. And with a few days’training, it can be
used just as effectively by a non-specialist doctor as by
an ophthalmologist.
WhydidMSFdecideto
testitinMali?
Our paediatric department in
Koutiala hospital, Mali, sees huge
numbers of children under five
with severe forms of malaria –
many of these children have
cerebral malaria, which causes
coma.
The problem is that cerebral
malaria can easily be confused with
other diseases, such as meningitis.
We were seeing an increase in the
number of children with suspected
cerebral malaria, but with the limited
diagnostics available, we couldn’t
be sure which disease they had, and
thereforewhich treatmenttogivethem.
We knew we needed better diagnostics at the bedside – a simple tool
that would help us identify malarial retinopathy. When one of our
paediatricians heard about the portable eye examination kit, we realised
that 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 the
back 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 as
malarial retinopathy. These are:
Illustrations: Ian Moores
29172_P
How does it work?
• You fit the sleeve onto your
phone and shine the phone’s
inbuilt light at the patient’s
dilated pupil.
• The phone sleeve channels the
light and focuses automatically
on the retina, the tissue at
the back of the eye.
• On the phone’s screen,
you see a close-up
image of the retina.
• The images are
recorded and stored
on the phone.
• You can examine
the image along
with colleagues,
replay the image to
have a closer look, or
email it to others for a
second opinion.
• An app that comes with
it stores the patient’s notes
on your phone, so all the
information you need is in one
place.
The presence of these changes confirms that a patient
has cerebral malaria – though of course they may
have other diseases too. It also gives us an idea of the
prognosis: the more changes there are, the more likely
the disease is to be fatal. Knowing this can help us
prepare the patient’s family for the likely outcome.
The prototype is still being approved, but everyone’s
asking for it now. We hope to use it wherever we see
high numbers of children with cerebral malaria – which
is mainly in countries in east and west Africa.
Some other diseases – such as diabetes and HIV – are
also associated with changes to the retina, so we really
hope to be able to use PEEK for these patients too.
1 Haemorrhages –
caused by the red blood
cells sticking together
and not allowing
microcirculation.
2 White patches and 3 Abnormal
vessels – caused by malaria parasites
sticking to the lining of the small blood
vessels in the brain and eyes where
they disrupt the supply of oxygen and
nutrients.
1
2
3

2. Main photograph: Children play in the compound of Koutiala children’s hospital. Clockwisefromtopright: A young boy
eats a meal in the hospital compound, where nurses run cooking lessons for mothers to teach them how to prepare
the most nutritious food for their families and prevent malnutrition among their children; a child regains his strength
in the recovery ward of Koutiala hospital; MariamTraore has brought her granddaughter, Sarata, to the hospital for her
regular check-up; mothers share a meal outside the intensive care ward; Aisha arrived at the hospital suffering from
severe malnutrition. Fully recovered, it’s now her last day in the intensive nutrition unit and she is ready to go home.
Mali children’s hospital
At Koutiala, in southern Mali, MSF
and the Malian ministry of health run
one of the largest children’s hospitals
in the country. With malnutrition,
malaria, diarrhoea and lower
respiratory tract infections endemic
in the area, the hospital focuses on
preventing the diseases, as well as
treating them, through nutrition,
vaccinations and health education.
All photographs © Yann Libessart/MSF
At Koutiala, in southern Mali, MSF
and the Malian ministry of health run
one of the largest children’s hospitals
in the country. With malnutrition,
malaria, diarrhoea and lower
respiratory tract infections endemic
in the area, the hospital focuses on
preventing the diseases, as well as
treating them, through nutrition,
vaccinations and health education.
All photographs © Yann Libessart/MSF
At Koutiala, in southern Mali, MSF
and the Malian ministry of health run
one of the largest children’s hospitals
in the country. With malnutrition,
malaria, diarrhoea and lower
respiratory tract infections endemic
in the area, the hospital focuses on
preventing the diseases, as well as
treating them, through nutrition,
vaccinations and health education.
All photographs © Yann Libessart/MSF
At Koutiala, in southern Mali, MSF
and the Malian ministry of health run
one of the largest children’s hospitals
in the country. With malnutrition,
malaria, diarrhoea and lower
respiratory tract infections endemic
in the area, the hospital focuses on
preventing the diseases, as well as
treating them, through nutrition,
vaccinations and health education.
All photographs © Yann Libessart/MSF
At Koutiala, in southern Mali, MSF
and the Malian ministry of health run
one of the largest children’s hospitals
in the country. With malnutrition,
malaria, diarrhoea and lower
respiratory tract infections endemic
in the area, the hospital focuses on
preventing the diseases, as well as
treating them, through nutrition,
vaccinations and health education.
All photographs © Yann Libessart/MSF