After one month in Zinder, Niger, the heat is finally beginning to abate somewhat and sand storms are coming in. The locusts came by and created their own storms, covering the windshields of our vehicles, walls of the houses and our entire patio, especially attracted by light sources at night time. Having come through the city also means that they ravaged crops in the countryside, and are now on their way further south into Nigeria. Smaller locusts or “crickets” as they are called here, are a popular snack after they are dried and mixed with spices and onions. People collect them in little plastic bags or cups, including mothers of patients at the hospital, in order to be able to prepare them at home and often sell them. I have to admit that crickets are actually quite a tasty snack which I have come to appreciate and which has improved my evolving phobia of locust storms.
The hospital is just as busy as always, especially on market day which is Thursday, when people come in from the surrounding countryside to sell their wares and take the occasion to make a trip to the hospital for themselves, relatives, or to bring in their sick child. On the way to the hospital in the morning, I pass the “marche de betail”, or the livestock market, where camels, goats, cattle and other animals are sold in a large open area. The streets are full of oxen pulling small wooden carts filled with various items on their way to the market. There is much excitement in the air on market day, which tends to be transmitted even through the gates of the hospital as people carry various food items to relatives on the ward.
The therapeutic feeding centre is full to capacity this week and the phase 2 or recovery phase has been moved to the tented area near the end of town, which used to house the entire feeding program. My weekly visits to this area are among some of my favourite moments so far, as this is where I see children who came through the ICU, who are now seated on woven mats with their mothers on the sand some already smiling and playing with sticks or utensils, eagerly awaiting their supplementary food package. This is where I played with little Charifa this week, a 13 month old little girl with Down’s Syndrome whom I have become attached to, as she for some reason had been smiling already in the ICU, while we tried to manage her heart failure. She is always smiling and very little seems threatening to her. Her mother has a very strong bond with her and is entirely oblivious to her special needs, yet fully aware of what a special child she is in every other way. This seems more important at this time in this context and has pushed Charifa to progress quickly through the phases. She achieved her goal in weight at the end of the week and was discharged home.
The focus in phase 2 is especially on the mother child relationship as it relates to patience and nurturing while feeding. Many mothers struggle with wanting to force feed their children, hoping that they will put on weight more quickly so that they can go home. The nurses and nutritional assistants in this phase ensure that mothers remain patient with feeding, as many children at this stage relapse quickly into refusing milk and need much encouragement in order to avoid regressing back to feeding tubes and phase one.
After the peak of hunger season has passed, a part of the project here in conjunction with acute medical care, will be to set up a play area in the centre, in order to help stimulate those children in phase 2 to help their recovery. Psychological recovery in malnutrition is included as a section in the MSF protocol for treatment of acute malnutrition with a focus on physical and emotional stimulation. I think that we often forget what an important part of healing, play is for children, especially for malnourished children whose entire energy for weeks has been focused just on basic functions, such as keeping body temperature stable and whose experience of touch has been distorted by the state of their body and the pain associated with touch.
A memorable moment for me earlier this week, was the discharge of a 4 year old girl in whom we placed a chest tube to drain an infection in her lungs. She came into hospital weighing 6 kilos and after 3 weeks of treatment for TB, she has made a rapid recovery. We were unable to approach her during rounds and she would scream incessantly when we examined her. She made absolutely no eye contact with anyone for weeks. The day of her discharge, she stood giggling, holding her package of therapeutic food and when I finally picked her up, she hugged me and clung to me for several minutes laughing and laughing. After many difficult moments over the last month, Amira’s laughter, Charifa’s smiles and the privilege of witnessing my patients’ first smiles after weeks of illness as they show signs of recovery, has been significant in helping me remain positive in such an urgent environment.