Fieldset
Chad: "His exhausted eyes were rolled up towards the sky"

An epidemiologist blogs about her time in Bokoro, an area of Chad which has high levels of malnutrition, particularly among children under five...

With the local children
Before leaving for Chad, I read tones of articles on malnutrition, prepared pages of notes and training materials and even came up with a very structured time line for my study activities. This was my first mission with MSF, and I wanted things to go as smoothly as possible.
 
Clearly, I had no clue about the practical realities of living and working in the field.
 
By the end of the survey, “flexibility” became my daily mantra. Two days after my arrival in Bokoro, I started recruiting the 20 people with whom I was going to spend the next few weeks, under the burning sun, collecting data in 50 villages.
 
The time line was short. I had one day to interview 40 applicants and three days to train the selected ones. In a way it was a bilateral training, because my new staff were mostly locals of Bokoro who taught me a lot about the behaviour and customs of the population we were going to survey.
 
One of the first challenge we had to solve as a team was how to weigh over 2,000 children. In the feeding centres, they do this by attaching a bassinet to a scale that is in turn attached to a tree branch. Since we could not expect to find a tree next to every house we would visit, we designed a portable weighing system consisting of a piece of wood and ropes. It was very rudimentary but it worked!
 
We also needed to find a way to get to the 50 villages. I had maps of the 15 health zones in which they were located (some of which were up to 3 hours drive away from the base), but there was no detailed information on the location of the individual villages. Fortunately for us, we were often able to find community members willing to guide us to the villages we were looking for. 
 
 
 
Survey team weighing a child in the village. Bokoro, April 2016.
 
Going out to the villages was the highlight of my days! It made me realise how truly fortunate I am to be an epidemiologist. I love numbers, I love medicine and I love interacting with people from different cultures. As an epidemiologist I get to experience all my passions while improving people´s lives. It´s the ultimate win-win situation!
 
When I got back to the base at the end of the day and looked at all the numbers we collected, they were not just numbers to me. They were people that I had met, stories that I had heard and children that I had played with. Overall, we collected data on almost 8,000 individuals, a third of which were children under 5 years old.
 
Diarrhoea, malaria and respiratory infections were major concerns in these communities. This was most likely due to the sub-optimal living conditions in these villages, namely: overcrowding of housing space, low mosquito net coverage, lack of sanitation systems and poor hand hygiene.
 
A striking feature of the most of the children in Bokoro is their soft rusty red hair, a side-effect of their poor nutritional status. Acute malnutrition was most prevalent among children of weaning age, affecting one in five children in this age group.
 
In addition to the high morbidity and malnutrition, the vaccination coverage for diseases such as polio, measles and yellow fever were way below acceptable levels in this community.  All these factors fuelled each other and made the population of Bokoro highly vulnerable to perfectly preventable infectious diseases. 
 
 
Selfie without borders. Bokoro, April 2016.
 
Each of the 50 villages we visited was different and had its own set of personal stories.
 
One of the villages was completely empty when we arrived, except for three elderly women who told us that all the villagers had left due to the lack of water; they would only return during the rainy season. I wondered why these women stayed behind or whether it was safe for them to live alone in the middle of nowhere. But they did not seem afraid, they were calm and happy to speak with us.
 
In another village we visited, the entire population fled and hid inside their houses the moment they saw our cars arrive. After attempting to gently communicate with them, we found out that the village had been attacked and destroyed during the first Chadian civil war. Ever since, village elders had instructed the villagers to run away if they ever saw strangers in “big cars” approaching. Once the villagers understood what MSF is and the work that we do, they were more than happy to let us into their homes. In fact, it became difficult to leave the village because everyone suddenly wanted their house to be surveyed and the women brought a copious meal they had just cooked for the whole team. 
 
 
Village in Maigana. Maigana, May 2016.
 
 
A very important part of my work involved screening for malnourished children and referring them to a treatment centre. However, in some cases I encountered severely malnourished children with a medical complication and had to drive them directly to the hospital.
 
In one of the villages we visited, a woman approached me and asked me to help her grandson.
 
After a quick assessment, I realised that the child was not only severely malnourished but also had a respiratory illness. He was fighting for every breath he took, his lungs expanding and collapsing loudly as if trying to lift an elephant off his chest. His nostrils were rapidly flaring, while his exhausted eyes were rolled up towards the sky.
 
Just as I contacted our medical team leader for guidance, my team arrived with another severely malnourished child. This one was even thinner, with just skin on his bones! He also had breathing difficulties, but he seemed more alert than the first child.
 
We were two hours drive away from the only MSF supported hospital in the area, and I had not finished administrating the survey in this village. I decided to let my team continue the work without me and took the children and their parents to the hospital.
 
On the way back, the car got caught into a sand storm.
 
We pulled up the windows and the temperature inside the car began to rise. I felt bad for my two little passengers, but I knew they were tough and we were going to get to the hospital soon.
 
When we arrived, the doctor immediately took both children to the intensive care unit. I stood by as the children were being connected to IV needles and oxygen tubes. I must have looked terrified, cause the doctor turned to me with a soft comforting smile and said: “Don´t worry. They are going to be OK!”.
 
I realised that the medical staff here spend their days and nights treating cases just like these, and are doing a spectacular job at it too. They are my heroes!  
 
 
Malnourished child at the MSF feeding clinic
Malnourished child enrolled in the MSF Inpatient Therapeutic Feeding Clinic (ITFC). Bokoro, May 2016.
 
When I returned to the base that day, I was completely exhausted but also extremely grateful. The survey team and I helped save the lives of two wonderful kids. Sadly, there are thousands of other children out there in need of medical care. My team and I may not be able to reach them all, but I know we can help, we can all help make a difference.