Seasons

Posted on April 30, 2012 by

The changing of seasons affects the lives of people differently throughout the world. For most of my life the changing of the seasons brought forth a sense of excited anticipation for whatever the upcoming season might bring.

In Chad the seasons can be divided by the weather, or by the epidemic. There is the meningitis season, the cholera season and the malnutrition season – all of which overlap to some extent. At the moment the meningitis season is here, and the peak season for malnutrition is slowly approaching. The signs of the changing of the seasons surround us, and the excited anticipation formerly brought forth by the changing of the seasons seems to evade me.

The numbers in Massakory’s malnutrition program grow progressively each week. Not only are the admission numbers increasing, but the types of admissions are changing. In the past month we started to see a growing number of children returning to the program. We can cure a child of malnutrition, but we don’t seem able to cure the country of the problem – children leave the program and go back home to the same problems that caused the malnutrition in the first place.

This week I met 22 month old Abdoulaye and his mother. Abdoulaye had been in the malnutrition program last summer. He was ‘cured’ in September, only to become sick with diarrhoea in January. He and his family live a 2 ½ hour walk from the nearest health centre. As his mother had to tend the fields to ensure that the family had food to eat, she was unable to take Abdoulaye to the health centre. He progressively got sicker, until he became malnourished again. He re-entered the ambulatory malnutrition program in February. This week when I met him at the malnutrition centre he had met his target weight and was yet again considered ‘healed’ or ‘cured’. When we told Abdoulaye’s mother that he was now healed, and she would not have to return the following week she became angry. ‘And what now – wait until he gets malnourished again?’ she replied.

MSF is currently conducting operational research in Massakory, on the use of Plumpy Nut’s brother ‘Plumpy Doz’, which is a supplementary food aimed at preventing malnutrition in children 6 – 24 months of age. For the next year, in the region where Abdoulaye lives, there will be monthly distributions of Plumpy Doz in the villages for every child that fits the age criteria. Mothers receive 4 pots of Plumpy Doz a month, and are instructed to give their children 3 spoonfuls 3 times a day. I reminded Abdoulaye’s mother of the Plumpy Doz. This did not diminish her anger. ‘And when the Plumpy Doz distributions are done. When you are done studying us? What do we do? Wait until our child gets sick and becomes malnourished again?’ she retaliated. I had no answer. What is the answer?

The discussion took me back to Djibouti and the first time I encountered mothers it seemed might intentionally be starving their children to be able to get access to free medical care. It reminded me of the mothers in Niger who seemed to keep one of their children constantly malnourished so they could receive a weekly ration of Plumpy Nut, with which they fed the rest of their children. I was reminded of the mothers in the Congo who had to make the unimaginable decision of whether to go harvest in their fields, where they would be raped, or to stay at home, not get raped, and have their families starve.

The causes of malnutrition are complex, as is its treatment. Clinically it is not complicated, but socially, politically and economically it is extremely challenging. Plumpy Nut and all of its brothers and sisters are not the long term answer. When leaving the centre with her final week of Plumpy Nut ration, Abdoulaye’s mother bade us farewell and cynically, yet realistically, called out, ‘See you in a few months’.

It reminded me of the end of the summer camp season when I was young. The end of camping season would bring tears to all of the campers and the shared hope that we would all see each again the following summer. The beginning of the peak malnutrition season has barely begun, but I already know that by the time the end appears, many tears will have been shed, and I will hope with every ounce of optimism that we will not have to see again at the malnutrition centre the children that we have treated this season. I can hope… but hoping has its limits.

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Redefining remote

Posted on April 23, 2012 by

Before even arriving in Chad, I had heard about the living conditions for the MSF project in Massakory. When ‘seasoned’ expats give the first tour of the ‘living quarters’ to the new Massakory arrivals, they do so with a sense of pride, disbelief and anticipation of the ‘newbees’ reactions. I am one who generally thrives more in discomfort than in comfort – I have always searched out ways to live that many others would never choose, and even I was dutifully impressed. The living conditions could definitely be considered challenging at the best of times.

For the next 3 months I will work with the community health aspect of MSF’s ambitious malnutrition project in Massakory. The community health component of the program focuses on treating severe malnutrition in the community. While there are the classic ambulatory programs for malnutrition set up outside of health centres, MSF is also trying a new approach to treating severe malnutrition in the remote communities.

Community members in designated distant villages have been trained to screen for malnutrition. The children screened as malnourished are directed to the local ambulatory program for a consultation. If they are considered to not have any complications they return home and receive their weekly ration of Plumpy Nut, which is the treatment for uncomplicated malnutrition, in their village. It is distributed by the trained community member who is ‘paid’ by his or her own community, either through money, food, or some other means.

This week I have been touring some of the villages that are involved in the new initiative. In the past 4 years I have had the great opportunity to work in some of the most dire and remote places in this world. I remember my first time heading into the ‘bush’ in Niger – I was blown away by the new definition of dire that was created in my mind. Today was a similar experience, not so much with the word ‘dire’, but with ‘removed’ or ‘remote’. We travelled by Landcruiser on sandy paths through the desert for 1 ½ hours from the already small town of Massakory to arrive in a smaller village with a health centre which has an MSF supported ambulatory malnutrition program. From there we drove 1 MORE HOUR, on an extremely uncertain ‘path’ through the most enchanting desert forest I have ever experienced.

We saw beautiful green birds, various type of raptors, hopping camels (their legs are tied together so they can’t run off), endless mules and slightly emaciated cattle. Elephants are said to pass through this forest, and to my great chagrin none were seen, but not for lack of incessant trying!! After 1 hour we arrived at a tiny village consisting of a few mud huts with straw roofs. Upon our arrival, an impressive quantity of children tumbled out of the huts as clowns do out of tiny circus cars. There were no signs of motorized vehicles in this village. I asked the village chief how they usually travel to the health centre, and how long it takes. He explained that usually one must either take a donkey and cart, which takes a number of hours, or walk – which takes an even greater number of hours. In most cases only medical emergencies head to the health centre, and women give birth at home with hope that all goes well. Standing in this tiny village, the importance of MSF’s new approach to treating malnutrition was beyond evident.

From our first stop we travelled to a number of other villages involved in the malnutrition program – each one equally small and remote. Village chiefs continually thanked us for making the treatment of malnutrition more accessible to them, and they told countless stories of the hardships involved in living so far from a health centre. In the last month the number of malnourished children in the entire MSF Massakory project has increased exponentially, even though the seasonal ‘hunger gap’, the months in which food insecurity levels and malnutrition rates rise in unison while waiting for the harvest, is theoretically still a number of months away. Throughout the world the causes of malnutrition are extremely varied, however; lack of early medical treatment for basic childhood illnesses is definitely one of the major causes. Seeing firsthand the distance so many families have to travel in order to seek basic treatment here, I worry about what the months of the hunger gap will bring when the effects of food insecurity and lack of access to early medical treatment are intertwined.

While the villages I visited today could easily fit into the stereotype of ‘quaint African villages’, it was clear their way of life involves endless challenges and difficulties. After an extremely long drive, I returned home, to the luxury of my tiny bedroom, which is part of a long row of bedrooms made of straw mat walls and a straw mat roof. I lay down on my bed, where in the night I can hear every movement and breath of every other person in the straw mat row. I listened to the chickens squawk in the henhouse which is closer to my room than the latrines or the outside showers. I turned on my fan, which circulates the hot air, the chicken smell and the sand throughout my room, and I was grateful for it all. Yet again, relativity humbled me, as I am sure it will for the next 3 months to come.

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Mission number 5: white bread and promises

Posted on April 13, 2012 by

The old stone building housing the MSF headquarters in Geneva is a constant hubbub and fury of activity. Information and people seem to move at rapid speed, with seemingly incredible purpose and motivation. During my first visit to the headquarters a number of years ago, I instantly became enamoured by the energy of the place, and the endless passion which seemed to emanate from everyone working there. Ever since that first briefing in Geneva, every visit to the headquarters fills me with an excitement and a belief that change is actually happening in this world, and that ‘we’ are all working together towards a common goal.

Chad will be my 5th mission with MSF. However; regardless of the number of missions I have done, I still have trepidations before setting off. Prior to every mission I question my abilities and my capacities. I wonder about my energy levels. I ponder whether I will connect with the team and the community. I worry whether I will find motivation and purpose. Briefings at headquarters, even if they fill me with energy and excitement, do little to relieve my concerns – I now know arriving in the field, meeting the team and actually seeing the project is the best prescription for clarification.

Still buzzing with headquarter-induced energy, I boarded the flight to N’Djamena, the capital of Chad. While reading a newspaper on the plane, I saw an advertisement for a European conference entitled, ‘The Promise of Africa’. I was intrigued. What does that mean? Does ‘Africa’ promise something, or was ‘Africa’ promised to someone? If so, to who and by who? The next line stated it was a conference where, ‘we focus on the promise of Africa, exploring its potential’. I imagined the phrase stopped there, and thought of all of the potential I have seen in the African countries I have worked in. I thought of the inspiring people I have met and worked with, who aspired to make change in their countries, change to the systems and policies that had failed them for so long.

I thought of Magaria, Niger, and the community health project where the villagers had enthusiastically embraced the concept that they were responsible for the health of their people. I thought of the Brown Bread Revolution baker, who was working to make change one loaf of bread at a time.

Then I read the end of the phrase, ‘Exploring its potential as a producer and consumer of luxury goods’… ’how can long established luxury brands remain relevant to a new generations of consumers?’. And with that, the excitement and optimism from the headquarters came face to face with another reality. Every mission so far has shown me how much more work there is to be done – on every level – in the field, in national and international government offices, and within ourselves – and this advertisement was simply a reminder of all of that.

As I sat pondering about the potential for change, the man next to me introduced himself. He was Chadian, and just returning from a conference in Paris. ‘What type of conference’ I asked, fearing a discussion based around luxury goods and the promise of Africa. Bread. He was returning from a BREAD CONFERENCE. His family runs bakeries in Chad and imports flour into the country. I asked the colour of bread he makes… white. When I told him I worked for MSF, he replied, ‘MSF has done so much for our country. I always wonder how I could every repay them, but I am just a baker’. I felt like I was in a movie. The moment was perfect. The discussion began…

And with that interaction, I knew I was in the right place. Change will come. One loaf of bread at a time.

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A final farewell

Posted on May 20, 2011 by

After using a number of fairly ineffective tactics to try and better understand this phenomena, we decided to use the very direct approach and just ask the community, ‘why are your children still dying?’. Community workshops were planned in each village with a health post in order to discuss this question, as well as to investigate other health problems present in the villages. There are often 8 – 10 villages associated to each health post, and from each of these villages the village chief, the Imam, the woman of influence and the young person of influence were invited to the workshop. This meant that some of the workshops were attended by 80 people.

As a means to show collaboration and to collectively express our concerns regarding the deaths of children at home, the workshops were co-facilitated by the chief of war, myself, the chief Imam of the region, and the representative of the king (I suspect that never again will I have the chance to be put in such a line up!!). I had been concerned about potential disorder with such large groups at each workshop; however, I had apparently never co-facilitated a workshop with the chief of war. One can be assured that no disorder takes place in his presence.

These workshops redefined for me the potential of community collaboration. Without doubt, there were tense times – great answers do not come easily. There were ethnic tensions and accusations. Problems were posed, and eventually solutions were collectively created. The workshops lasted all day, and the evolution of thought was fascinating as the participants realized their role in the health of their population. By the end of every workshop all of the villages in attendance were demanding that no meeting ever occur at the health post without their presence. No workshop ever ended without the participants planning to build latrines at the health post, or to build shelters outside the health post so that woman can have shade while they wait for their consultations.

In every workshop the population was frank with us. We heard of traditional health practices. We heard that people thought they were excluded from the health post because of their ethnicity. People shared that they had believed their village wasn’t welcome at the health post. We heard a number of reasons why people weren’t accessing treatment, but the reason given at one of the final workshops was the most fascinating.

The devil was in the health post. People were refusing to take their child to the health post because the devil took the form of the nurse. This meant one could not discern if they were being consulted by the nurse or the devil. There was even the accusation that our nurse supervisor who provides on the job training to the health post nurses had been unknowingly training the devil (I still haven’t figured out whether as his supervisor I should have given him a warning about this….).

I was, as so often happens here, at a complete loss for where to go from there. Thankfully this was my co-facilitators’ area of expertise – The chief of war and the chief Imam stepped up to the plate. Plans were made, exorcisms organized, and community prayers prepared. I imagine that the devil did not last long in that health post.

And hopefully, soon, the number of children dying at home will diminish.

My time in Niger has come to an end. Leaving Magaria was more emotional for me than my departures from previous missions. I learned about limitations during this mission. Without access to basic human rights, the benefits of medication and access to health care are limited. Niger is a country of incredibly welcoming people in a horribly hostile environment. Life is not easy there, and despite all of the humanitarian organizations in place in the country, I fear that in 10 years time there will be little positive change. I so hope that I am wrong.

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Bearing witness

Posted on April 1, 2011 by

Two inseparable elements are combined in MSF’s work: medical aid and witnessing (témoignage)’. Witnessing consists of being present among the population, being motivated by a concern for their fate as human beings, and listening to the people. Intertwined with the act of witnessing is the responsibility to report on the situation and on the fate of the people. In working with MSF in Niger, I am realizing that this might be the greatest responsibility I have ever had.

Famines are largely avoidable phenomena that do not arrive overnight. They are not like earthquakes or hurricanes that suddenly appear with no warning, they cannot even be considered as purely natural disasters. I am currently bearing witness to an impending famine, and it fills me with a complex mix of fear, dread, the hope that I can do something, and the knowing that no response will be sufficient, regardless of what I do.

The region of Niger where I am situated has now experienced 2 consecutive years of meagre harvests. The most recent harvest was decimated by crickets, and the previous year had seen horrible yields due to drought. Security reasons greatly restrict the movement of westerners in Niger. Due to the nature of my work, I am the only MSF expatriate in the region who is allowed regularly to venture into the far reaching villages. I am therefore the only expat truly able to bear witness to the current development of the food security problems.

Several times a week I visit a number of remote rural villages of southern Niger. In these villages the diet typically consists of only millet porridge. It is a great rarity to find someone who eats anything besides millet on an average day. In Niger, as in many other countries, there is a traditional lean season – “the hunger gap” – between the time when the staple stock is exhausted and the new harvest arrives. In Niger this season usually occurs in June or July, and the harvest is cultivated in December. It is now the beginning of April and the village chiefs consistently tell me that the millet stocks are extremely minimal, if not completely exhausted already, there are no seeds to plant in the summer, and that most of the village men have left for Nigeria in search of work. Passing through the villages this is obvious: few men, except for the old, are seen. Annually, there is a seasonal migration of men towards Nigeria, however; it usually happens much later in the year. Their return coincides with the planting season, but without seeds there will be no planting season this year. The malnutrition rates will only increase. Village chiefs are responsible for the health of their people, they can see the oncoming calamity, and they plead with me to pass on their people’s plight to those who can help.

My work with MSF involves supervising and coordinating a project which focuses on preventative and curative care in these villages. We train local people to treat basic childhood illnesses, and we provide them with the essential medication for the treatments. We have a network of villagers who do health promotion about breastfeeding and hand washing in the villages. But without food, all of these actions have limited effect. While in the field, we regularly encounter children needing to be transferred to the inpatient malnutrition centre. Transfers consistently fill me with awe – the act of putting a mother and a child in a land cruiser and taking them to the ‘big village’ to be treated is simple. However, it is usually the first time either one has ever been in a motorized vehicle, and the whole experience must be extremely over-stimulating for them. Despite my never-ending curiosity, I try not to ask too many questions, as the mother is usually either overwhelmed with nausea, or in the process of vomiting. The other day our team transferred a woman with her severely emaciated daughter to the malnutrition centre. This mother wanted to talk. She cried and told us that she wants to be a good mother. She wants to treat her children well. She knew her child was becoming malnourished, but she didn’t know how to stop it. This story is repeated throughout the villages. Without food one cannot stave off starvation.

I wonder, on a daily basis, what is required for other international actors to act. Everyday more and more children arrive at the ambulatory or inpatient malnutrition centres that MSF run, often in such poor state that, despite treatment, they do not survive the first few hours of hospitalization. Do we have to wait until enough children die, or enough malnourished children beyond the ‘normal’ amount are admitted, to declare an emergency? And why is it that more energy will be spent in responding to the crisis than was ever put into preventing it?

2010 was the worst year on record in Niger in terms of malnutrition, with over 318 000 severely malnourished children being admitted to therapeutic feeding centres throughout the country. Considering the inexistence of grain reserves from 2010, and the poor harvest from the current year, many NGOs have predicted that the situation in 2011 will be dramatically worse than that of 2010. In the villages, the people aren’t predicting. They are clearly stating that the food security situation is worse than it was in 2010. With no seeds to plant, this is only the beginning of a disaster. As I might be the only expatriate present in the villages, they are asking me to share their pleas for help with whomever may listen.

I hear the stories almost daily. I see the children that are becoming malnourished and this is not because of their mother’s ignorance or negligence. I see a population wanting to stop the oncoming disaster from occurring. I hear them crying out for help. I hear them crying out to be acknowledged as people that have a right to life, and a right to access adequate food. And it is my responsibility to pass on these cries. I don’t have numbers, the numbers will come too late. But I do have a great responsibility, with many lives at stake.

I fear that my appeals will be muffled by the other cries throughout the world at this time – the voices coming from Libya, Japan and all of the other countries presently in crisis. Malnutrition is endemic in Niger, and I fear that the deaths of thousands more malnourished children in Niger in 2011 will simply be seen by the international community as the continuation of an ‘ongoing crisis’. But these are people, these are children, and each one has the right to live. Their deaths can be prevented.

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Brown Bread Revolution – secret ingredient revealed

Posted on March 19, 2011 by

We had everything – an audience, ingredients in small bowls, different phases of dough already prepared to speed along the training process, and most importantly – a secret, controversial, and shocking ingredient to reveal!

In attendance were a number of our drivers and guards, and most importantly, the local bread maker. Our objectives were clear – to learn to make nutritious brown (beast) bread, with the greater goal to eventually change the bread eating and buying habits of the population. The baker, being business minded, also has the motivation of increased sales if the revolution takes hold.

Throughout the week I had contemplated how to reveal the secret ingredient with minimal fanfare. A nonchalant approach seemed the most appropriate. Prior to the training I had written out the recipe, changing the word ‘bran’ to ‘brown’. The recipe was presented to the group for approval, no one seemed to take notice of the odd ingredient listed. Immediate consensus was had. I presented the flour. Everyone nodded. It was thrown into the bowl. Yeast. More nods. It too was added to the bowl. Salt, not meant to be the surprise, required quite a bit of explaining. Water. No problem. Then as though it was another ever day ingredient, I pulled out the beast’s bran. I might as well have dropped my pants. Silence fell. A look of absolute horror crossed the face of the baker. His dreams of increased sales immediately vanished. Nonchalant clearly did not work.

I quickly explained that in Canada it is the people, and not the beasts, that eat the bran – with no apparent side effects (that I was willing to mention). The baker shook his head and exclaimed, ‘This will never work. The people will not eat it like that.’ He seemed extremely disappointed, and then after some contemplation, decided the bran just required sieving. A traditional sieve instantly appeared, and the bran was finely sifted. I tried encouraging that some of the larger morsels being sieved out be considered – but apparently my Canadian opinion had lost all credibility. The baker, the guards and the drivers carefully examined the fine brown remains of the bran, and after some seemingly secret discussions in the local language, the baker declared his approval. The sifted bran was added to the dough. I strongly suspect that the secret discussion involved swearing secrecy to never share with the population the horrifying truth of what will be in the bread. Regardless, the revolution was back on track.

The cooking show, following this great climax, concluded quite smoothly. The dough was prepared. Proportions were debated. The baker seriously considered every step. He provided propositions, suggestions and bread making tips. In the end a deal was had: I will buy 4 loaves a day for the entire week, and share the excess with our national staff team. He, in turn, will start introducing brown loaves to the market. We will re-evaluate the situation at the end of the week.

I thanked the baker for having taken the time to do the training. He replied, ‘I never thought a baker could help fight against malnutrition. But now I can. Thank you.’

And the revolution continues.

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Brown Bread Revolution

Posted on March 10, 2011 by

With impending doom at your doorstep, drastic measures are required. So in response to our fear of the food security situation here in southern Niger, this week marked the official execution of the social experiment ‘Brown Bread Revolution 2011’ .

Malnutrition is rarely caused by a simple lack of food, there are usually many political, social and economic factors at play as well. This is true in Niger. It is a region plagued by many problems including drought and poor harvests, but it is also a region where people typically prefer to eat millet porridge three times a day. Children, if lucky enough to be breastfed at all, are usually weaned at 2 or 3 months of age and it is at this point they too start on a purely millet based diet. Wheat does grow here. While not typically eaten in the villages, in the town where I am it is milled, separated, and the white flour is used to make bread. When I found the remaining components of the wheat – the bran and the germ, in the market it was quickly explained to me that they ‘are only for the beasts’. To the shock and horror of all of our local staff, I bought the beasts’ food to make bread. And the idea of the brown bread revolution began…

The wheat bran and germ are ridiculously cheap, as they are only for beasts (and Canadians). It seems inherently ridiculous that I need to mix together all of the separate parts of whole wheat flour in order to recreate it, however; there are many inherently ridiculous things in this world. Since the great bran discovery, our kitchen has been turning out delicious sourdough whole wheat bread.

So, in a time when famine is at our doorstep, it only seems correct to introduce whole wheat bread, and improved nutrition, to this population. Over the past few weeks, every time I make bread I give some loaves to our local staff, who in return provide great reviews – and horrified looks when I share the secret ingredient. Today the experiment expanded and took form. There is a traditional bakery here, which is just one large clay oven. Today, after much explaining to our driver, we delivered two uncooked loaves to the bakery. Feigning that our oven was broken, we asked that they cook the two loaves – and as payment they could keep one. No mention was made of the secret ingredient.

Upon my return to the bakery to retrieve the loaf of cooked bread, their loaf had already been almost completely consumed. The baker eagerly asked that I teach him to make this special brown bread. He and I made a date for next weekend, with the agreement that once he learns how to make the bread we will buy a loaf from him on a daily basis. Word passed remarkably fast through this small town, and several of our drivers asked if they, or their wives, could also ‘register’ for next weekend’s training. It is possible that the bread training will have the largest attendance of any activity I do in my time here.

There are many short term, large scale interventions, like the distribution of seeds and food, which are required to reduce the impact of the atrocious food security situation here this year. But if ‘beast bread’ can at least provide some added nutrients (and improved bowel regularity) to a population at a time like this, it will be a worthwhile, long lasting, small scale intervention.

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Right to be here

Posted on January 16, 2011 by

Two weeks ago in Niger, two French men were kidnapped and killed. One of the men worked for a medical NGO in Niger, and was scheduled to get married this week. The other had recently arrived from France to be the best man at the wedding. The kidnapping happened in a restaurant in the capital city, on the same block as the MSF office. The risks involved in our job have suddenly become much more apparent. The kidnappers target the French in Niger, and so MSF has evacuated all of the French staff. The rest of us live with very tight security rules, especially as MSF is perceived as a French organization.

In times like this, you examine the risks. I ponder the importance of us being here, and our impact on the population. The questions are infinite, but the answers always become clearer to me when I walk through the malnutrition centre. The centre is made up a number of large plastic tents. The tents are divided into ‘phases’ and children progress through the phases depending on their health and nutritional status. This week, I was struggling with whether we even have the right to be here. I left the Intensive Care tent, which houses incredibly sick malnourished children. I walked across the sand to the tent of the final phase. The first mother I saw was beaming, and packing up her few things. I recognized her from her 2 week stint in intensive care, but I didn’t recognize the child in her arms. Little Bashir, who had been horribly emaciated when he arrived, had gained so much weight that his cheeks were a little chubby, he had a bum, and I couldn’t recognize him. His mom was packing them up to head home, and to continue treatment in an ambulatory program.

As I was walking back to the intensive care tent, our right to be here was walking towards me. Her name is Zara. More than 5 weeks ago Zara’s grandmother brought her to the centre. Zara was 3 years old and weighed 5 kg. She was incredibly emaciated, and couldn’t even lift up her head. She had to be tube fed for a number of weeks because she was too weak to sip the therapeutic milk. Her malnutrition was caused by TB, which is not an uncommon story here. She was started on treatment, and slowly we watched her improvement and development. We saw the first time she sat on her own. Her first sip of milk from a spoon. The first time she waved good bye. And today little Zara, who is still extremely thin, took the first steps of her life. She is still sick, and still vulnerable to so many things, but seeing her make her first timid little steps under the sun made our reason for being here so clear.

There are risks everywhere in life. The possibility of a Nigerien dying of malnutrition is much higher than the possibility of one of us being kidnapped and killed. So as security rules get tighter for us and it seems like a liberty to go to the bathroom on my own, I wish that there were also security rules for children like Bashir and Zara. Security rules to protect them from malnutrition and all of the other risks that come with being a child in a poor, underdeveloped country.

In this time of questioning, we can question the risks of being here, but we can’t forget to question the risks of not being here.

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Biography

Posted on January 1, 2011 by

Trish is currently working for MSF in Niger. Trish

Posted in Community outreach nurse, Malnutrition, Niger | 1 Comment