Before the conflict that erupted in South Sudan in mid-December 2013, Doctors Without Borders/Médecins Sans Frontières (MSF) would typically have around 200 children in its ambulatory therapeutic feeding center (ATFC) at any one time, said Grace Ayuelu, MSF medical team leader in Leer. Ayuelu has been working in Leer hospital for almost a year.
“But now, we have over 1,800 children,” she said. “That is a big number.”
During the conflict, many people’s houses in Leer, as well as the MSF hospital, were looted and razed to the ground. People fled into the bush for safety, many of them going months without anything to eat other than wild roots and whatever else could be gathered from the land.
People are now starting to return to Leer, and the partially destroyed MSF hospital is up and running again, although at half its previous capacity. Now, the busiest area of MSF’s Leer hospital is the ATFC, where children under five are seen and their level of nutrition assessed.
There are over 207 MSF staff from South Sudan and beyond currently working in Leer, providing emergency nutrition and outpatient care to the population. The MSF project in Leer also accounts for two other ambulatory therapeutic feeding centers in southern Unity state, one in Nyal and another in Mayendit.
Before its hospital was destroyed at the end of January, MSF had been working in Leer for the past 25 years, providing both in- and out-patient care for children and adults, surgery, maternity, HIV/TB treatment, and intensive care. The hospital was the only fully functioning secondary facility in all of southern Unity State, serving 270,000 people.
Côme Niyomgabo, a 40-year-old Burundian, has finished his nine-month mission coordinating the Médecins Sans Frontières (MSF) project to reduce child mortality in Bouza, in the Tahoua region in Niger. Here he shares his experience with us.
What is the situation like in Bouza at present?We have just lived through the most difficult time of the year: the hunger gap (food shortage period) and a high prevalence of malaria due to the rainy season. The time interval between June and October is in fact a critical period for young children. Since the beginning of November, the number of children being admitted has decreased: the most difficult period is about to end. However, it is a chronic crisis coming back year after year after year, which is the reason why we are already getting ready for the next peak. Based on our experience, we know that anticipation is an important factor; we need a well-trained team ready to intervene. Precisely in Bouza, a very rural area, the lack of qualified human resources poses a real challenge, as does access to health facilities. Villages are often remote and during the rainy season roads are usually impractical.
What are the main activities carried out in the project in the past few months?Two of the main causes of child mortality in Niger are malaria and malnutrition. During the most critical months, we have tried to make high-quality treatment available to sick children at the earliest possible time. In Bouza, the health system depends on health posts called cases de santé, where there is a health agent whose medical training is very basic; then there are integrated health centres suffering from a chronic scarcity of qualified nursing staff, and then the district hospital located in Bouza town. In 2013, in many places, MSF carried out a programme known as PECADOM, consisting of getting as close as possible to the patient using simplified tools to diagnose and treat malaria as well as other childhood diseases. Furthermore, ‘malaria agents’ were trained to work in remote villages and cases de santé were reinforced. This should help to detect early malaria cases, treat simple cases and refer the complicated ones.
We have also started seasonal malaria chemoprevention, consisting of giving children between 3 months and 5 years medication once a month to prevent malaria. This is spread over the four months where malaria transmission is at its highest, from July to October. The children concerned are much more likely not to develop malaria or to develop a milder form of the disease. This strategy has been well received by the population. The number of children treated has increased from one round to another; the next ones will visibly spread across the most remote villages. Today, when we discuss it with the population in each area, people confirm that the number of cases as well as the number of admissions have decreased.
How does MSF involve the community in the project?We carry out a lot of awareness-raising activities amongst the community. Our teams work with 140 volunteers in the villages who convey messages about malnutrition, malaria, what to do when a child is sick, etc. The role of these volunteers is very important to gain access to the population and to spread the messages.
We have also defined a strategy known as mamans lumière (mother light), addressed to children at risk of contracting severe acute malnutrition. The mothers of these children become part of a group of mothers trained by MSF, who explain to them how to prepare the food so as to make the most of it and thus cover their children’s nutritional needs. Mothers bring their own foods, cook them together and then feed their children. This strategy involves the community in malnutrition prevention and treatment, integrating respect for their community and culture. Different decision-makers, traditional or religious leaders also collaborate in community mobilisation activities.
Can you summarise your experience in Bouza through an image or a story?
When we really try and make the effort we can make a difference changing things for the better, and in a very fast way. Seeing children arrive seriously ill due to malnutrition or other pathologies and later witnessing their rapid recovery and watching them smile at their mothers… that is probably the most deeply ingrained image that I will most likely keep of my experience here.
MSF’s innovative program in the Sikasso region of Mali seeks to prevent and treat illness and malnutrition among children with the ultimate goal of reducing child mortality. The project was launched in 2009 in collaboration with the Malian Ministry of Health and will be run by MSF through 2017. It aims to simultaneously build the capacity of the local health system while providing high quality services.
The program has a major nutritional component in which most malnourished children can be treated as outpatients at the public health centers. The program uses weekly outpatient visits to monitor patient progress and a take-home nutritional product called therapeutic ready-to-use food (RUF), a peanut butter-like paste made with milk and other important nutrients. Severely malnourished children who have complications, such as severe malaria or measles, continue to be referred to Koutiala hospital’s inpatient feeding center. But with the outpatient approach, the majority of children can be treated at home with their families
At the project in the Konséguéla health zone, in addition to services described above, MSF provides extensive preventative care soon after birth. These comprehensive early intervention activities are structured to give children living in this remote area a better chance at survival.
Begun as a pilot project in 2010, healthy children up to age two are examined frequently at scheduled “well baby check-ups” and their growth is closely monitored. These children also receive ready-to-use food supplements to prevent malnutrition and insecticide-treated mosquito nets to help prevent malaria transmission. MSF trains lay community members from each of the 17 villages in the area to test for and treat simple malaria, and to vaccinate infants according to the approved vaccination calendar in Mali. Because pneumonia follows malaria as the second leading killer of children in Mali, all children are being vaccinated with PCV, a pneumococcal vaccine. Children with malnutrition or more serious cases of malaria and other illnesses are referred to the health centers for follow-up care. The family participation rate in this program is 95 percent and more than 5,600 children have completed it. The project’s success is clear: only five percent of children have an episode of severe acute malnutrition per year and 97 percent of children have received their vaccinations. Furthermore, results indicate that stunting was reduced by 34% at 2 years of age.
When our emergency teams arrive at a village ravaged by violence or devastated by a natural disaster, there’s one lifesaving item we bring that costs just 50 cents. It’s a simple packet of ready-to-use therapeutic food (RUTF) that fits in the palm of your hand. They are amazingly cheap, but they’re also amazingly effective. For a child teetering on the brink of starvation these small packets can be the difference between life and death. During an emergency, young children are fleeing for safety or cut off from food and medical care, putting them at high risk for malnutrition. But innovative, lifesaving tools like therapeutic food packets help Doctors Without Borders/Médecins Sans Frontières (MSF) quickly treat as many children as we can. Emergencies in South Sudan, Democratic Republic of Congo and Central African Republic mean thousands of children are suffering from malnutrition right now, but with the proper treatment they can survive. When our emergency response teams encounter malnutrition we know we need to act quickly. Without swift intervention, severe malnutrition ravages the bodies of young children, causing them to suffer debilitating lifelong consequences. Doctors Without Borders teams must quickly assess which children are at greatest risk of dying from malnutrition. We do this by measuring the mid-upper-arm circumference (MUAC) of children with a color-coded bracelet. Most of the children we diagnose are treated with RUTF, a milk-based peanut paste packed with the special mix of vitamins, minerals and other nutrients that can help a lethargic, gravely ill child thrive again. The most severely malnourished children, those who have no appetite—or who suffer from malaria, pneumonia, or other diseases—are hospitalized and treated at our inpatient centers. These children are at the greatest risk of death and require intensive, round-the-clock medical treatment. But with proper care, most do survive and can soon be discharged to an outpatient program. When our emergency medical teams rush in to respond to a crisis, the threat of malnutrition is almost never far behind.
We truly appreciate your support of our programs. I wanted to send along this recent article about one of our projects treating malnutrition in Ethiopia.
I also wanted to let you know that Wednesday, October 9th is a matching gift day on Global Giving. There is $25,000 in available matching funds, and any gift you make on that day will be matched 30% by Global Giving as long as funds last! I hope you’ll take advantage of this opportunity to make your gift go even further.
Thank you so much!
When Zahari Nur’s grandmother brought her to the outpatient post where Doctors Without Borders/Médecins Sans Frontières (MSF) teams were conducting outreach activities in Digdiga—one of the 12 Kebeles (provincial administrative units) that MSF is covering in its nutritional intervention in Afar—everybody thought she had just a few days to live.
“I had given up hope on my grandchild,” says Eisa Wasaitu, Zahari’s grandmother. “I thought she was going to die like the three others before her.”
The one-year-old was suffering from severe acute malnutrition when she arrived at the MSF outreach post. Her mother is also ailing and suffers from psychosis. She is in no condition to take care of Zahari and her older brother, leaving the grandmother as their sole guardian.
MSF began working in the inimitable lands of Afar in April 2013 in response to a nutritional emergency. Afar is vast, and Teru—the area that MSF covers—is one of its most remote and most neglected regions. Subject to huge sandstorms and extreme temperatures in the dry season and violent rainstorms that flood rivers and render roads impassible during the rainy season, Teru is an extremely difficult context in which to work.
The Afari are a pastoral nomadic people who move from place to place in search of water and pasture for their animals. Living this way makes it difficult to adhere to treatment regimens, meaning that many people default before completing the program. It also makes it difficult for MSF teams to follow up with people who default.
MSF’s intervention covered 12 Kebeles whose inhabitants are completely cut off from health care. The decision to intervene was reached after an assessment revealed an alarming rate of severe acute malnutrition in the region—26.6 percent of an estimated catchment population of 87,374 people suffer from the condition.
“Most of the cases that we admit in the stabilization center are severe acute malnutrition with complications,” says Frank Katambula, MSF medical team leader in Afar. What’s more, he adds, “most of these are combined with either pneumonia or TB.”
Despite the difficulties associated with providing care in Teru, most cases have now stabilized and children under the age of five continue to receive therapeutic food. Overall, a total of 726 malnourished children were admitted to the therapeutic feeding program (including 134 children in the stabilization center) and 1,154 moderately acute malnourished patients (including 416 pregnant and lactating women) benefitted from the program.
“In total we have 78.2 percent cured cases and a defaulter rate of 4.5 percent, which to me is quite ‘good’ considering that access [to health care] in this area is not at all easy,” says Jean François Saint-Sauveur, MSF medical coordinator in Ethiopia.
After two months in the MSF program and admission into the stabilization center where she was also given specialized treatment for pneumonia, Zahari was improving. When we saw her a few weeks ago, her weight had increased from 3.2 kilograms [a little more than 7 pounds] to 4.9 kilograms [almost 11 pounds].
“When I see this child I feel very happy because the grandmother and the rest of the community thought she was going to die,” says Nabiyu Ayalew, MSF’s outreach nurse. “But we saved her life and she is still alive.”
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