Sleeping has turned out to be a challenge. We are surrounded by an annoying insect that we’ve nicknamed the ‘alarm cricket’ because it sounds like an alarm clock! In fact we’re surrounded by quite a few weird and wonderful animals. We have the usual frogs and scorpions and I even saw a monitor lizard today.
Apparently there was a recent cull of the dogs because they had turned into feral packs. The locals must think we’re a contradictory lot though. At the same time as culling entire packs, some of the compound took in the puppies as pets!
Marabou storks ©Ruby Siddiqui/MSF
The walk from the compound to the camps passes through ‘Vulture Avenue. It’s a path between two putrid ponds with large vulture-like birds standing on either side. I think they’re actually Marabou storks but they are so dishevelled and ugly, they look like vultures.
My favourite animals are the packs of mongoose wandering around the compound. So cute and apparently they control the snakes too. If we could manage to stop them stealing the food in our tents they’d be perfect!
Mongoose ©Ruby Siddiqui/MSF
All the NGOs have decided to carry out a MUAC (mid-upper arm circumference) screening of the entire camp population. We use this to measure malnutrition in children aged six months to five years. This is quite ambitious and I’m not sure how this will go after only a two hour training yesterday. I’ve organised our outreach teams and the volunteers from UNICEF, CARE and CONCERN into 67 three-person teams. The roll-call takes about two hours! Of course, about a third of the volunteers haven’t turned up but after a bit of reshuffling, we have our teams.
I’m supervising five teams in PoC 4. I don’t realise until later that I’ve given myself the most populated sectors, meaning we’re the last to finish! Luckily I organised all the teams around our MSF outreach workers who know their sectors really well (because of the weekly mortality surveillance they are already performing). The teams move through the sectors in parallel measuring children in every household. If the MUAC is in the green region, they are considered healthy. Yellow means moderate and red means severe acute malnutrition (we refer both to feeding programmes).
MUAC training ©Ruby Siddiqui/MSF
One of the teams fetches me to speak to a woman who is refusing to take her child to the hospital. The little boy has a red MUAC with a measurement of only 8.5 cm, the smallest I’ve ever seen. He stares up lifelessly from his mother’s arms. I swallow the lump in my throat and listen to her reasons for not attending. She says her son had previously been admitted to the MSF hospital but didn’t improve so she decided to leave the hospital. Besides, she had nobody to take care of her other three children. I persuade her to come to the hospital with me now. It means abandoning my MUAC teams but it’s important that this child is admitted into the MSF inpatient therapeutic feeding centre as soon as possible.
We walk towards the hospital (thankfully she knows the way as I’m completely lost!). She walks seamlessly over the sewage streams on makeshift bridges made from single bamboo sticks. I have to stop dead and find another way. This causes bursts of laughter from the crowds of kids following me. I seem to be the local circus attraction with the kids shouting ‘Kowaya Kowaya Kowaya’ (‘white thing’). But they find me a slightly less precarious route.
The MSF staff do their best to persuade the woman to admit her son. She is surrounded by about 8 staff, a mixture of expats and national staff all translating for each other. I don’t leave her side. She is stubborn and weeps, no doubt feeling a bit overwhelmed. Tommy, one of our nurses, suggests that MSF could reimburse a neighbour for the costs of feeding her children. And I offer to pick up her children in an MSF car if the neighbours refuse, and find a place for them all to sleep at the hospital. I think she trusts me, so she agrees and everyone breathes a sigh of relief. The child has a chance at survival.