The reason for our work here in Bentiu is to decrease mortality and alleviate suffering caused by an on-going malnutrition crisis. According to our statistics this year we have already ‘cured’ over 3000 children from malnutrition.
This is a concept I am very uncomfortable with. Sure we have improved the nutritional status of these children, treated any inter-current disease, our programme has probably saved many lives this year but how can we say we have cured their malnutrition without thinking what the causes are?
A few months ago a Belgian film crew visited our clinic as part of a story they were doing on the anniversary of South Sudan’s independence. They were very professional and courteous in their approach being sure to get proper consent before filming and following correct procedures. When asking about our work in the clinic they press me about the causes of malnutrition. They angle a little regarding the problems with the border dispute with Sudan and whether this is the reason. I think, how am I supposed to know? I am only here to treat the children and help them get better, before giving some politically correct response that the causes are ‘multifactorial’.
One afternoon I ask some of the staff in our clinic why they think there is malnutrition here. I get a wide variety of ideas. The Nuer have their own word for malnutrition - Nuoih. Most staff refer to a lack of food and also the fact that illnesses such as malaria and diarrhoea lead to malnutrition rather than being a consequence of it. There are other theories ‘lack of food, sickness, in addition South Sudan is a new country and has had a long war so a lot of things are destroyed’ offers one of our nurses.
So is the malnutrition problem is a new one? No; one of our paramedics informs me that before MSF opened a nutrition programme in Bentiu another NGO had run a programme from 2000-2008. Indeed he adds that since the 80’s people have been depending on the UN, the WFP and other organisations for food drops and feeding programmes.
Some staff seem to think it will just take some time for South Sudan to get on its feet. "It will take a long time with this new mechanism (independence), change will happen when security is stable because then people can cultivate and raise cattle, conflict causes displacement like with those of rebel militia groups which are fighting with the government.’
Since gaining independence from Sudan last year the border has remained closed and this has added to difficulties. ‘The border (being) shut down is also a problem, we do not produce a surplus, South Sudan depends on foreign aid. We have the land, we have the resources, we just don’t have the instruments - tractors and bulldozers - to develop.’
The abundance of resources and potential here has been obvious to me since I arrived. The countryside is now a sea of green after the rains. The sun is warm, the potential to grow large quantities of food is there and this country is not over populated.
Weather conditions also seem to play a part ‘This malnutrition happens during drought which causes a food gap which will cause all children to be malnourished, even the adults.’ Too much rain can also be bad and some of the staff are not hopeful for the year ahead ‘this year will be a bad year, the people who went for cultivation (to grow food) their crops have been destroyed by floods’.
Another view expressed is that lack of access to healthcare and timely treatment leads to poor appetite and malnutrition. Others blame the geographical situation of South Sudan ‘We are landlocked here so we cannot get food from neighbouring states, also the road to Juba has been blocked by the rains.’ When I ask how come Uganda which is a landlocked country doesn’t have the same malnutrition crisis the answer is that ‘Uganda has a lot of traders, money, big farms they make their own food.’
On-going insecurity also appears to be a factor which disrupts people’s way of life and traditional reliance on wider family and community. If you don’t have food yourself during insecurity you will not be thinking to go out to get food from somewhere like your relatives’.
So maybe my answer to the film crew was right, that the causes of malnutrition are multifactorial. I am also interested to see what the views of the mothers and caretakers in the clinic are.