The power of encouragement

14 December 2007

When working in an environment that requires humanitarian aid, it is easy to get cynical and judgmental. Sometimes you can convince yourself that no one knows enough, no one works hard enough, and nobody cares. But in these environments acts of kindness and strength are even more exemplified. These acts often involve people putting their political views, pride, and self needs aside.

A few weeks ago the other nurse (Halima) introduced me to a little 3 year old boy visiting the clinic for nutritional follow-up. I'll give him the fake name of Howie for the sake of the story. This little guy was jolly and chubby as can be. I pressed on his skin to see if he had any signs of protein deficiency, but he seems as healthy and playful. Halima, told me that Howie came the hospital a month ago looking like a skeleton with every bone visible. I didn't believe her.

A week later I was called into the nutrition office to find two children wasted away. Their mothers would not make eye contact with anyone and appeared full of shame as they tried to feed their sickly children breast milk. The one girl, perhaps a year old, looked like a shriveled up old man, and the 2 year old boy was hypothermic, not having enough fat to stay warm even though it was 28 degree Celsius. Typically there are groups of relatives supping those in the hospital by camping out side the ward. These two women and their babies appeared to have no one to share their situation – again I think it was shame. Then I saw Howie accompanied with his mother in the background, both of them were full of hope and support.

I learned that Howie lives in a village, which is isolated from medical care and very difficult to enter or travel from because of security issues. People are reluctant to access medical care in fear that they will not be able to afford it, be threatened or be unable to support their other children and family. Traveling to Seliea is not always worth the risk – even to save the life of children. Howie and his mother identified these two mothers' malnourished children. Having "walked the walk" they convinced the troubled mothers that the trip to Seliea is worth a try. I was moved that Howie and his mother came to Seliea for no other reason to support their little malnourished friends.

So the therapeutic feeding began, with antibiotic treatment, vitamins, treatment for stomach worms, and re feeding with F75 therapeutic milk. Every morning the children were weighted, from a scale hanging from the sealing. The mothers would seem to hide from the staff crowed around to see the weight of their children. It is frustrating re-feeding a malnourished child… they do not have an appetite, and are always miserable. I can only image the guilt these parents felt for the status of their children – but malnourishment is not always just the lack of food, there are usually underlying pathologies such as diarrhea and infection.

Atom, one of the local staff makes the milk for babies three times a day. When he arrives at the door of the ward, Howie, the super toddler greets him. Howie would take each bottle of F75 and deliver it to his malnourished friends one by one. He would then go between each baby to make sure with great intensity that they were drinking it. As the week finished the two patients advanced to F100 and BP100 bisques. Howie would hand feed his little friends and of course ate some himself. Strangely he seemed to have the patience and faith in this situation when most others could not. When I would visit the ward I would get a serious handshake from Howie – I think he was trying to show me the good work he was doing.

In Darfur, people are expected to arrive the hospital with their own food, bedding, and money for material that the hospital does not have. MSF provides free healthcare, but the need for more support became evident. These parents did not bring anything with them but perhaps desperation. Because the malnourished children were still breast feed, we started to give the parents some BP100 bisques to ensure they maintaining nourishment. We also gave them some food rations to ensure the breast milk had enough protein in it.

Three weeks later, these two babies were completely different. They were fat, full of life, and playful – just like Howie. Howie and his mother, were packing up to head home. Though there was much more required to support the nutrition status of these patients, we all knew that these once severely malnourish children were in the clear.

Now a days the well nourished baby friends come for check up appoints. Their mothers present themselves as brave women with laughing and interaction with other mothers. When there is a poor healthcare system, it is difficult to encourage health-seeking behavior. All the health promotion and education sessions occurring have been put to shame by the magic that Howie the super toddler worked. Yet it is sad to think about the other possible babies out there whom are malnourished who have not had the lifesaving motivation and spirit of a heroic toddler.