It is early Sunday morning. The sun is strong as usual and I move towards the hospital for a quick visit to see if any of the other doctors need any help. Sitting in the back of the MSF car, I look at Maiduguri through the windows, the most northeastern city in Nigeria.
A group of children start running after our vehicle waving and shouting: Baturi! This means 'white people’ in Hausa, one of 500 languages spoken in the country.
Among the passers-by, a mother and a daughter catch my eye. The mother wears a veil and a long red dress, the daughter is in the local school uniform. Both balance large bowls on their heads as they walk. With straight posture, their raised necks are able to support the weight. Seeing them reminds me of a patient who is recovering well; I decide to visit her today.
How we treat malnutrition
In the hospital, things are calm in the morning, but the night was difficult: we lost another child to severe malnutrition.
We treat up to 400 children with severe malnutrition every month here. And more than 600 children also receive food and treatment as ambulatory (also called ‘outpatient’) care.
After seeing all the patients in the intensive care unit with Dr Oli, I go to one of the health promoters who helps me a lot with translation.
When I first saw her, she was unconscious. I thought that we were going to lose her
We walk towards a large tent with more than 20 beds. This is where we admit the patients who are in a stable condition, towards the end of malnutrition treatment.
These children receive a special milk formula and sachets of a high-energy peanut-based paste called “Plumpy’Nut”. Both have high amounts of vitamins, minerals and calories so the children can gain weight before returning home.
On one of the stretchers, I see Hauwa, a three-year-old girl, eating Plumpy’Nut. I can't help but smile.
This girl was very close to death. When she arrived at our hospital, she was very ill with severe malnutrition aggravated by infection. Her body was just skin and bones, her eyes were sunken and the mouth cracked, signs of dehydration.
When I first saw her, she was unconscious and I thought that we were going to lose her.
In the first two days in the intensive care unit her eyes remained closed, but slowly she woke up, regaining consciousness. At that point, she could not sit and her neck was too weak to support the weight of her head.
Fortunately, with proper treatment, she was getting better.
Her first smile came a few days later, when, still weak, she was given balloons to play with. Today the girl sits up, smiles and eats. Seeing me approaching, Falmata, Hauwa's mother smiles.
In the last few weeks, we have created a good relationship. She says “thank you” in English. Words that she learned just to demonstrate her feelings. I smile back and repeat the words.
With the health promoter providing translation, we start to talk. Falmata shares her story.
Falmata is 33 years old. Like most of women in Nigeria, she married very young and has given birth to nine children. She says six of them have died due to health problems. While telling me this, she tears up. I say I'm sorry.
Among her three remaining children, the six-year-old boy was born in the village of Bama, and the two girls, Hauwa and the other just a little more than one year old, were born in one of the camps for displaced people in Maiduguri.
Falmata says she and her husband had to flee their village four years ago to escape the conflict in the region.
This area is the scene of a fight between the military and armed groups. In fear of the violence, many families abandon their homes, lands, and villages, leaving everything behind to seek shelter elsewhere.
There are more than one million displaced people living in Maiduguri. Without sanitation, decent shelters, or a free healthcare system, it can be difficult to avoid sickness.
The conflict brings many losses. Falmata's brother-in-law was one of its victims. Killed by a gunshot wound, his wife was left taking care of their three children. Unfortunately, after the husband's death, she became very sick. Falmata says she died of heartbreak.
This resilient woman keeps resisting the challenges that life has brought her and still finds the energy to smile
After their parents’ death the three children were under Falmata’s care. This happened less than a year ago, and the family's situation became even more difficult.
Falmata's husband did not accept the children, but Falmata decided to divorce her husband to be able to raise them. She is now living as a single mother raising six children.
Resilience and strength
The family now live in a small house made of zinc tiles. On the street outside she cooks on a ground fire and sells snacks to people who pass by.
She does not always get enough money to support the family. She says she is worried about the future, but is happy that her daughter is getting better.
She smiles and thanks me once again. Thank you, I repeat.
This resilient woman keeps resisting the challenges that life has brought her and still finds the energy to smile.
Hauwa was discharged from the hospital two days later with an easy smile on her already chubby face, able to walk and hold her head steady.
As I write this text, I think of Falmata and the challenges that she still has to face. Her journey is far from over, but I believe in this strong woman, and I imagine her walking with her back straight and her head high.