"I don’t blame the parents, the traditions or the community. And I don’t blame MSF."

It is amazing what one can become accustomed to. Somehow we have become accustomed to the oppressive 45 degree heat. Lack of personal space is challenging, but I am more or less used to it. We each develop our own coping mechanisms whether it is sitting in buckets of water or searching out small corners for a moment of personal space. I don’t even blink at the fact that there are no outhouses in the villages and that the desert is used as a pooing field. I know the risks associated with it, but I am no longer shocked by it. Unfortunately, over the years I have even become accustomed to the fact that malnourished children exist.

There are, however; things I will never become accustomed to. Last week Hawa, a three year old severely malnourished girl, died at home. She was in the outpatient malnutrition program. During her weekly consultation the nurse noticed that she had a fever and had lost weight. The nurse told the mother that Hawa needed to be transferred to the malnutrition hospital for treatment. The mother refused to be transferred. She had four other children at home. She had never been more than 10km from her village in her life. I imagine the thought of going somewhere where she would have to interact with people she did not know, where she did not know what was expected of her, what would be fed to her, and how long she would have to stay, was overwhelming. After an hour of negotiating, the nurse called Hawa’s father. He too refused the transfer. He was worried about who would watch and cook for the other children while the mother was at the hospital. Who would collect the water and the firewood while he worked in the fields? And how would he communicate with the mother? He had a cell phone, but she certainly did not.  In the end Hawa returned home with her mother.

This week Hawa did not appear for her weekly consultation. One of our staff went to her village in search of her. The women in the village said that Hawa had died, after her uvula had been cut. Here it is a traditional practice to cut the uvula when a child has a sore throat or a fever. This is what the people know, and there is often more faith in this and other traditional practices than the medication that we offer at the malnutrition centre. Who is to say that is right or wrong. I just know that Hawa died.

And Hawa was not alone. 3 other children died in our outpatient program this week. The mothers of all 3 of these children had refused to be transferred. They either died of medical complications caused by the malnutrition, or because of the traditional treatments that were given to them.

I don’t blame the parents, the traditions or the community. And I don’t blame MSF. Honestly, I don’t blame anything. I am just tired and frustrated. Children dying at home, particularly of malnutrition and particularly when there is medical treatment available, is one of the greatest, if not the greatest, injustices in the world. Hawa, Adoum, Abdoulaye and Mahamat should not have been malnourished in the first place. They didn’t need to die. If they had not been malnourished, they might not have been so vulnerable to the effects of the traditional medicine given to them.

Someone I truly respect once told me that one of the greatest risks in working in humanitarian aid is that you become a cynic. I think that I am not cynical, but I do think that I am at a loss today. Sleep does not come easily, as I struggle with the challenge in front of us. I struggle with knowing that on the field we can not solve the problem of malnutrition. We can save some children’s lives today, but I seriously worry about tomorrow. I even fear for it.

Good bye Hawa. Good bye Adoum, Abdoulaye and Mahamat. I am sorry this is the reality that you knew and I am sorry we couldn’t help you more.

Image shows a little girl being treated at the intensive care unit at the Massakory MSF hospital, December 2012.