It’s the end of April. The fields in the village of Biraul, in the state of Bihar, are already a verdant green, and it will soon be the season for harvesting rice.
The MSF centre for the stabilisation of malnourished children is located next to a renovated, empty public health centre in a corner of the village. The centre, whose walls are covered with colourful children’s drawings, consists of two rooms filled with beds beside which mothers watch over their daughters worriedly – most of the children admitted here are girls.
The MSF centre for the stabilisation of malnourished children in Biraul. ©Irene Núñez/MSF
According to a World Bank report published in 2013, India’s malnutrition rate is five times higher than China’s and twice that of sub-Saharan Africa.
This fact, however, is often overlooked because India is the world’s largest democracy and the tenth-richest nation in the world. But India also leads the world in the number of malnourished people, 60% of whom are girls.
“This is the harvest season, so the number of admissions to the centre falls,” says Jijo Xavier, a nurse who has worked at the centre for the past five years. “Families work incessantly and no one has time to care for a baby. They don’t realise that the child is constantly getting weaker or that its cries are growing fainter. Grandmothers are often the ones who bring the children because the mothers are working in the field or the brick factory.”
It is hard to believe these women are grandmothers, because many of them are under 35. They became mothers while they were still girls themselves, and 15 years later, their daughters have followed the same path.
A study that MSF conducted together with the Darbhanga Medical College showed that 80% to 90% of severely acute malnourished kids could receive medical care through the public health posts. It wouldn’t be necessary to admit them, unless they had complications associated with malnutrition, such as anaemia, diarrhoea, or respiratory problems.
Children could receive treatment at home, in the form of a nutritious paste that they can consume directly with proper medical follow up carried at public health center. The therapeutic paste doesn’t require cooking and is distributed to mothers in sachets.
Nutritional sachet containing theraputic paste © Irene Núñez/MSF
Mothers come weekly with their children so that the MSF team can examine the children and monitor their progress. They measure the children’s height and weight, and perform a rapid nutritional assessment based on a MUAC (mid-upper arm circumference) reading and the child’s edema [swelling]. If a child continues to improve compared to the previous week, team members give the mother new nutritional sachets to administer to the child throughout the following week and until the next visit.
The MUAC is a colour-coded plastic strip that measures the circumference of the left arm of children aged six months to five years. MUAC measurements can demonstrate a relationship between arm thickness at a specific height and the child’s nutritional condition.
Halmima is one of the girls staying at the centre because her condition was serious. She is six months old, weighs three kilos, and is 56 centimetres tall. Her MUAC is 88 millimetres.
The doctors suspect that Halima suffers from some kind of congenital neurological disorder, but haven’t yet diagnosed it.
Halmina with her mother, Mumtaj Khatoon. © Irene Núñez/MSF
Halima’s mother, Mumtaj Khatoon, brought her to the centre last week after staff at a mobile clinic recommended she come here.
“They tell me I have to breastfeed my daughter, but I stopped producing milk when she was three months old, and I didn’t have money to buy any milk. My husband works in a hotel in Patna, and sends us what he earns. I live with his mother and six other members of his family, and we all rely on my husband’s salary,” says Mumtaj, who married shortly after her 18th birthday.
“My sister-in-law had the same problem with her daughter, who was very thin. That’s how I learned about MSF. My nephew is now well.”
In local households, grandmothers, mothers, and girls are the last ones to eat. First, fathers, grandfathers, husbands and sons have their fill, and then it is their turn to eat.
Moreover, an erroneous and generalised belief holds that pregnant women should eat very little because otherwise it could harm the baby.
It is estimated that women gain 10 kilos during pregnancy, but these teenage mothers gain an average of only five kilos while pregnant. They suffer from anaemia and malnutrition, and give birth to small, weak and fragile babies.
And that is when the cycle of hunger and poverty starts all over again.