Redefining remote

A long journey to a small village helps Trish understand the challenges local communities face...

Before even arriving in Chad, I had heard about the living conditions for the MSF project in Massakory. When ‘seasoned’ expats give the first tour of the ‘living quarters’ to the new Massakory arrivals, they do so with a sense of pride, disbelief and anticipation of the ‘newbees’ reactions. I am one who generally thrives more in discomfort than in comfort - I have always searched out ways to live that many others would never choose, and even I was dutifully impressed. The living conditions could definitely be considered challenging at the best of times.

For the next 3 months I will work with the community health aspect of MSF’s ambitious malnutrition project in Massakory. The community health component of the program focuses on treating severe malnutrition in the community. While there are the classic ambulatory programs for malnutrition set up outside of health centres, MSF is also trying a new approach to treating severe malnutrition in the remote communities.

Community members in designated distant villages have been trained to screen for malnutrition. The children screened as malnourished are directed to the local ambulatory program for a consultation. If they are considered to not have any complications they return home and receive their weekly ration of Plumpy Nut, which is the treatment for uncomplicated malnutrition, in their village. It is distributed by the trained community member who is ‘paid’ by his or her own community, either through money, food, or some other means.

This week I have been touring some of the villages that are involved in the new initiative. In the past 4 years I have had the great opportunity to work in some of the most dire and remote places in this world. I remember my first time heading into the ‘bush’ in Niger – I was blown away by the new definition of dire that was created in my mind. Today was a similar experience, not so much with the word ‘dire’, but with ‘removed’ or ‘remote’. We travelled by Landcruiser on sandy paths through the desert for 1 ½ hours from the already small town of Massakory to arrive in a smaller village with a health centre which has an MSF supported ambulatory malnutrition program. From there we drove 1 MORE HOUR, on an extremely uncertain ‘path’ through the most enchanting desert forest I have ever experienced.

We saw beautiful green birds, various type of raptors, hopping camels (their legs are tied together so they can’t run off), endless mules and slightly emaciated cattle. Elephants are said to pass through this forest, and to my great chagrin none were seen, but not for lack of incessant trying!! After 1 hour we arrived at a tiny village consisting of a few mud huts with straw roofs. Upon our arrival, an impressive quantity of children tumbled out of the huts as clowns do out of tiny circus cars. There were no signs of motorized vehicles in this village. I asked the village chief how they usually travel to the health centre, and how long it takes. He explained that usually one must either take a donkey and cart, which takes a number of hours, or walk – which takes an even greater number of hours. In most cases only medical emergencies head to the health centre, and women give birth at home with hope that all goes well. Standing in this tiny village, the importance of MSF’s new approach to treating malnutrition was beyond evident.

From our first stop we travelled to a number of other villages involved in the malnutrition program – each one equally small and remote. Village chiefs continually thanked us for making the treatment of malnutrition more accessible to them, and they told countless stories of the hardships involved in living so far from a health centre. In the last month the number of malnourished children in the entire MSF Massakory project has increased exponentially, even though the seasonal ‘hunger gap’, the months in which food insecurity levels and malnutrition rates rise in unison while waiting for the harvest, is theoretically still a number of months away. Throughout the world the causes of malnutrition are extremely varied, however; lack of early medical treatment for basic childhood illnesses is definitely one of the major causes. Seeing firsthand the distance so many families have to travel in order to seek basic treatment here, I worry about what the months of the hunger gap will bring when the effects of food insecurity and lack of access to early medical treatment are intertwined.

While the villages I visited today could easily fit into the stereotype of ‘quaint African villages’, it was clear their way of life involves endless challenges and difficulties. After an extremely long drive, I returned home, to the luxury of my tiny bedroom, which is part of a long row of bedrooms made of straw mat walls and a straw mat roof. I lay down on my bed, where in the night I can hear every movement and breath of every other person in the straw mat row. I listened to the chickens squawk in the henhouse which is closer to my room than the latrines or the outside showers. I turned on my fan, which circulates the hot air, the chicken smell and the sand throughout my room, and I was grateful for it all. Yet again, relativity humbled me, as I am sure it will for the next 3 months to come.