I stepped off the small plane into a wall of heat, not dry like the Australian desert but heavy, dense heat that surrounds you and presses from all sides. After some hours traveling by car I arrived at my home for the next few months in southern Pakistan where my driver tells me that it is one of the hottest places in the country with temperatures regularly 50 plus degrees Celsius. Today is only 42C.
Amongst other things, I will be responsible for the supervision of the Ambulatory Therapeutic Feeding Center (ATFC) and Inpatient Paediatric Department (IPD). I think the best way to describe the function of these two departments is to follow the journey of a patient in each area. Names have been changed for patient privacy.
Through the doors of the ATFC tent walked a young boy holding a small child, after a quick discussion with the paramedical staff it became apparent that the young boy (Rahim) was bringing his malnourished sister (Laila) in for follow-up treatment. Rahim is nine and Laila is 18-months-old. Rahim’s other sister, Saba, seven, is also present and together they have walked Laila into the ATFC as their parents were attending the fields at this busy time of year. All three looked tired after walking in the heat.
Measurements were taken of Laila and she had improved very little in the two weeks that she had been attending. Health education without parents can be very difficult, we gave Laila one Plumpy Nut (fortified peanut butter) in the center and discharged her with enough food until Monday when she would need to come back with her parents. We gave Rahim and Saba water to drink which they gulped down eagerly obviously thirsty from their walk in the sun. They were very grateful and after a short rest they left with a smile. Unfortunately these children are too old for MSF’s paediatric feeding program although they could probably use some extra nutrition also.
I met Jameel in the inpatient department where he had been for two days. He was two-years-old. He had been brought in by his mother, very malnourished with diarrhoea. Children with this level of malnourishment have a poor prognosis. He received Intravenous fluids until he was able to tolerate sufficient oral fluids. The doctors were happy with the amount of fluid and food he was taking. When I saw Jameel on Friday he was drinking fortified milk and taking water. He still had a drip in his arm in case he needed more intravenous fluid. Unfortunately when I came back to the ward on Saturday I found out the Jameel had passed away throughout the night due to complications.
The land is hot and dry and food is scarce. Stories like these are a too common occurrence. Most of the people here live off the land and are very poor. Health education is a key component we are focusing on to help avoid late presentation of sick children. We are reaching many malnourished children and treating them until they are back in a healthy weight range, however undoubtedly there are more children we aren’t able to reach. The children need lots of help and support through their vital development years. With MSF we are able to assist some of those in the most difficult of circumstances and help them back to good health. Unfortunately as I learnt today, this is a battle we can’t always win.