It is amazing what one can become accustomed to. Somehow we have become accustomed to the oppressive 45 degree heat. Lack of personal space is challenging, but I am more or less used to it. We each develop our own coping mechanisms whether it is sitting in buckets of water or searching out small corners for a moment of personal space. I don’t even blink at the fact that there are no outhouses in the villages and that the desert is used as a pooing field. I know the risks associated with it, but I am no longer shocked by it. Unfortunately, over the years I have even become accustomed to the fact that malnourished children exist.
There are, however; things I will never become accustomed to. Last week Hawa, a 3 year old severely malnourished girl, died at home. She was in the outpatient malnutrition program. During her weekly consultation the nurse noticed that she had a fever and had lost weight. The nurse told the mother that Hawa needed to be transferred to the malnutrition hospital for treatment. The mother refused to be transferred. She had 4 other children at home. She had never been more than 10km from her village in her life. I imagine the thought of going somewhere where she would have to interact with people she did not know, where she did not know what was expected of her, what would be fed to her, and how long she would have to stay, was overwhelming. After an hour of negotiating, the nurse called Hawa’s father. He too refused the transfer. He was worried about who would watch and cook for the other children while the mother was at the hospital. Who would collect the water and the firewood while he worked in the fields? And how would he communicate with the mother? He had a cell phone, but she certainly did not. In the end Hawa returned home with her mother.
This week Hawa did not appear for her weekly consultation. One of our staff went to her village in search of her. The women in the village said that Hawa had died, after her uvula had been cut. Here it is a traditional practice to cut the uvula when a child has a sore throat or a fever. This is what the people know, and there is often more faith in this and other traditional practices than the medication that we offer at the malnutrition centre. Who is to say that is right or wrong. I just know that Hawa died.
And Hawa was not alone. 3 other children died in our outpatient program this week. The mothers of all 3 of these children had refused to be transferred. They either died of medical complications caused by the malnutrition, or because of the traditional treatments that were given to them.
I don’t blame the parents, the traditions or the community. And I don’t blame MSF. Honestly, I don’t blame anything. I am just tired and frustrated. Children dying at home, particularly of malnutrition and particularly when there is medical treatment available, is one of the greatest, if not the greatest, injustices in the world. Hawa, Adoum, Abdoulaye and Mahamat should not have been malnourished in the first place. They didn’t need to die. If they had not been malnourished, they might not have been so vulnerable to the effects of the traditional medicine given to them.
Someone I truly respect once told me that one of the greatest risks in working in humanitarian aid is that you become a cynic. I think that I am not cynical, but I do think that I am at a loss today. Sleep does not come easily, as I struggle with the challenge in front of us. I struggle with knowing that on the field we can not solve the problem of malnutrition. We can save some children’s lives today, but I seriously worry about tomorrow. I even fear for it.
Good bye Hawa. Good bye Adoum, Abdoulaye and Mahamat. I am sorry this is the reality that you knew and I am sorry we couldn’t help you more.
It’s terrible, food is something that there should be alot of in the world, and there still are children suffering from malnutrition. For kids around my age i just want to say, at night when you’re eating your dinner and decide not to eat that broccoli because you don’t like it, think of all those children out there that would have a smile on their face to be eating what your eating. Lets spread this around. You’re an amazing person to put yourself out of your comfort zone to help many people. Keep it up!
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You are an inspiration! Children any part of the world should not die of hunger. Its unfathamoble to me that kids go without food and an education. Much luck to you! Keep up the good work!
Thank you for sharing and thank you for the work you do. I thought of a quote that may help by Helen Keller. I often think of it when confronted with the enormity of such situations: “I am only one, but still I am one. I can not do everything, but still I can do something. And because I cannot do everything, I will not refuse to do the something that I can do”.
Dear Trish
Thank u for reminding us of the reality of the situation there. Facts & figures do not touch us like personal stories. It’s easy to forget there is so much suffering going on in the comfort of our lives in London. Reminding us will spur people on here to raise funds for u brave people to carry on yr amazing work. It was a job holding back the tears! I am on a crowded train in London! I can’t express how much I admire u for doing what u do, in such uncomfortable circumstances, both material & emotional. Amazing! All the best, YJ Pankhurst
Trish, this is one of the most poignant statements I have ever read. There are so many injustices in the world that this could be referring to, but starving children must be excruciating to witness. I am an emergency nurse, and envy you that you have had the chance to help others in this way. What you do everyday is wonderful an amazing. Remember that too.
Trish – - from one Irish MSFer living on this side of the ocean to another – this is the most touching blog I’ve read. Congratulations… and please keep blogging. I have another friend who worked Chad who told me the same kind of stories. – Also check out the FB page of the IFPSW (International Foundation for PsychoSocial Wellnes) and consider posting there. Lots of MSFers on it too.
Great blog entry Trish. Really grim but cuttingly honest.
Sakib Burza gave a talk at MSF’s Scientific Day on long-term outcomes in children with severe acute malnutrition in a community-based management programme in Bihar, India. Might be interesting for you. Here’s the link – http://presenter.qbrick.com/?pguid=1f53337d-3e9d-4fc7-8a81-34fc3ddbf44f
Hello
I am working in the hospital as clinical pathologist in South Korea now.
Your story makes me think about my one experience in Bangladesh before 6 years ago.
My project included checking fetal heart, blood tests, nutrition programme.I examined to anemia, urine, blood group test for them.
One day I told to an woman ”Please come back again to check your health condition. All tests are free! ”
then she answer “ I donot have money to come here from home”
I was shocked to could not move for a second. Actually bus fee was 2Tk (The fee is less than 0.1$)
At that time and until now I am considering a lot of things..
I cannot say anything but I would feel how you are.
One day in the future, I would like to work to meet you in the field.
Thank you for sharing !
Trish, someone once told me that although we cannot eliminate poverty or global hunger in a day, we can make people slightly healthier with the resources we do have. Thank you for being out there and continuing to make small contributions, day by day, step by step, in enabling the individuals whom you across to become slightly healthier and happier.