While Chantelle has been busy exploring the world of Cholera in the southwestern corner of Chad, I have immersed myself in the increasingly complex project of Am Timan. It has been intense, to say the least, and after 7 weeks in country I am only today enjoying my second full day off!
Regardless, I am learning…learning lots and fast and continuously! Learning about my staff, the programs we are running or hope to start, the history of MSF in the area, the Muslim religion, local politics, security management. Although questions often lead to more questions and answers can be somewhat conflicting, I am slowly getting a feel for how things work around here.
Nice and Easy
Take, for example, our nutrition program. When we opened in February of 2010, we used nutrition as our entry point with the ministry of health. This is one service that was not being provided by the ministry of health and we showed up in their hospital with the idea to treat whatever small number of malnourished children could be found in the area. From there, we would get a better idea of the current condition of the local population and the capacity of the ministry of health in their provision of care…and we could go from there.
The first month, with all of the staffing and supply problems common during a project startup, we admitted 34 malnourished children under 5 years old into the program. 149 in March. 211 in April. By the end of May we had 401…and it just kept growing and growing! To date, we have treated over 3000 children for malnutrition and still have more than 500 kids coming each week to receive their bag full of PlumpyNut or what can best be described as a high energy, nutrient enriched peanut butter paste.
What’s Going On?
We were shocked by the numbers!! Remember that Am Timan is located in what is called the “Granary of Chad” and is known for its consistent and plentiful production of millet, sorghum, corn and beans. Yet we kept finding huge numbers of malnourished children and we weren’t even really looking. So much for a quick and easy entry point with the ministry of health, as suddenly we were running a full blown nutrition program!
Mothers waiting to have their children’s weight and height taken, as part of their weekly trip to the MSF nutrition center.
In the end, it seems that even this rich agricultural area was not spared by the lack of rains consistent across the Sahel region of Africa over the past 2 years. In Am Timan, these drought-like conditions reduced harvests and farmers had to dip into savings to plant for next season and to feed their families. While the rains improved and things were looking up for 2010, there was huge and unprecedented rains in September that led to widespread flooding and practically wiped out what was looking to be a very promising harvest. Less food, more debt and definitely more skinny and hungry kids.
The list goes on. A general lack of hygiene, zero latrines outside of Am Timan and very limited clean drinking water leads to what could be considered endemic diarrhea. And, as you can only imagine, it only takes so many days of constantly running to the bush to shit before malnutrition sets in. Men also have to pay a significant dowry to get married (roughly 9 head of cattle per wife!) and this is often only managed by borrowing money. With the September crops all but destroyed, farmers will have a hard time making good on their pre-sold grain contracts this year as well.
It’s pretty simple. Bad harvest = less money = more debt = less food = more malnutrition.
Fish Season Brings Temporary Reprise
During each rainy season, torrential rains fill the otherwise dry and sandy ‘ouadis’ and, in this granary of Chad, they always overflow to cover vast flood plains with live-giving water. The rains normally end in September and the waters recede, leaving behind enormous fields of nutrient rich soils that are rapidly and completely planted with millet for next February’s harvest.
As these gigantic ‘rivers’ shrink (some can grow to more than 50 km across!!!), bottom feeding sucker fish become concentrated in smaller and smaller areas and it is literally like fishing for trout in a stocked pond. Fish flood the market – cheap, meaty and delicious – and it really is “la grande fête”. Boxes of fish are sent to relatives in N’djamena. There is a real buzz in the market and around tea stands. Even the expat team got our fair share!
Unfortunately, this “fish season” only lasts 1 month as the ouadis are bone dry once again and will remain that way until the rains start again next June. For now, this short burst of protein has led to a slight decrease in the number of patients in our feeding programs. However, with the September harvest largely destroyed by floods this year, we are expecting our numbers to peak in January as people hungrily await the harvest of their recently planted crops.
…and so we ramp up our nutrition programs accordingly and help then wait it out.