Fieldset
"I tell all the parents children must be fed enough, so they are strong and don’t succumb to illness"

In Pakistan, MSF is working to reduce infant malnutrition. 

If a woman loses her husband, she is a widow. A child without parents is called an orphan. But, if one loses a child, what's the term that defines him or her after this loss?

I am not aware of any such term, at least.

I feel the loss is so immense and the pain so dizzying that as humans we are still unable to invent any such word that truly describes the condition of a parent of a dead child.

As a doctor in paediatrics, coming across parents who lose their children is quite common for me.  We are trained how to break the bad news and offer a tissue, or even a hug as sympathy. It's my duty to state that I have tried my best, used maximum resources, consulted all the possible assistance and despite all that, have not been able to save their child.

But something that I don't tell them is that I feel the loss as well. For me, it feels like a personal failure.

Women with their babies in the waiting room at the hospital

Nasir Ghafoor / MSF 

In Dera Murad Jamali, where I work in District Headquarter Hospital (DHQ), my list of personal failures is running out of pages. Unfortunately, hardly a day goes by when on my shift I do not declare time of death, cause of death or mode of death. At times, I feel I should also write circumstances surrounding death.

The most shocking thing I have witnessed here is an undefinable numbness. Those who have already lost a child or two simply say, "it was God’s will", maybe as a way to cope with the bad news they keep receiving. No tears, no questions, no blame game, nothing. There are also those who believe that "God will give us more". They take the body and silently make their way out of the hospital.  There are a very few who ask, "what happened?"

Something that I don't tell them is that I feel the loss as well

To most of them, I explain the same reason. Due to already severe nutritional deficiency your baby's body was not able to put up a good fight. I also tell them that good nutrition is key, and a way to prevent it, as they probably have other children, who can be saved.

I heard a lot of times parents saying that the baby was completely fine until admitted to the hospital. Maybe, yes. They might never realise that it was merely silence before the storm. One major issue in Dera Murad Jamali and the local area is poverty. There have been instances when parents wait with the dead body till dawn because they can afford a rickshaw, but not an ambulance. There have been a few heartbreaking instances when they couldn't even afford a rickshaw.

Lots of children in this area suffer from severe acute malnutrition (SAM). It is defined by a having very low weight for your height (below -3z scores of the median WHO growth standards), or by the presence of nutritional edema (a type of swelling caused by insufficient protein in the diet).

When children from the ages of six to 59 months become severely hungry, if not treated, they are more likely to die than a healthy child and are said to suffer from severe acute malnutrition. This is what happens here.'SAM' also weakens your immune system and its ability to fight with the bugs. So, even a simple illness can prove to be fatal.

Lack of awareness about breastfeeding and good nutrition is part of the issue

Here at DMJ, we have categorised kids into those with Severe Acute Malnutrition (SAM) under six months of age and those 6-59 months. One of the leading causes of being malnourished below six months of age is that they are not breastfed. Breast milk satisfies all the nutritional requirements of an infant.

After this age weaning is important but lots of parents fail to start their children on a soft diet. I have tried to understand why. There are multiple reasons. Too many children and not enough food is a reason. Mothers working in the fields all day long, not able to take care of their own and their child’s health, is another. Lack of awareness about breastfeeding and good nutrition also contributes to this issue. Last but not the least is the unaffordability of food.

MSF has been working here for about six years now. Every day, in the inpatient therapeutic feeding ward of DHQ Dera Murad Jamali, we have seven or eight children with SAM. Some survive, some don’t, because they often arrive at the ward in a very bad condition.

One such kid was Amanullah. He was one-and-a-half years old. He was brought to us with severe acute malnutrition and its complications - a perfect recipe for disaster. He was emaciated and was suffering from severe malaria. We started him on antimalarial drugs plus therapeutic feeding. But as malarial parasites are dying they put up quite a show. He developed an increased respiratory rate, which meant we had to discontinue the feeds because of the risk of aspiration.

With the mask, IV lines and the feeding tubes in his nose, little Amanullah still managed to get his point across

Amanullah was switched to IV fluids, and was transfused blood. It looked like he was developing a complication of malaria called pulmonary edema, where the lungs fill with fluid. Amanullah was still asking for water. With the mask, IV lines and the feeding tubes in his nose, he still managed to get his point across. Our efforts paid off, as things improved. His oxygen requirement slowly came down from a massive 10 litres per minute to about two litres. His mother started to look less worried. The next morning when had a look at him, I could feel that he was still having difficulty in breathing, but he was improving. I updated his mother, she said, “God has brought you here to take care of us.” I smiled and told her, indeed.

I tell all the parents children must be fed enough, so they are  strong and don’t succumb to illness. This is what all the parents need to realise. Pay attention to the nutrition of your kids, so they have sufficient strength to fight with the diseases – and help us doctors to save their lives.