The brothers in Amboasary

I’m sitting in the classic white Land Cruiser that one associates with humanitarian work in low-income countries.

I’m sitting in the classic white Land Cruiser that one associates with humanitarian work in low-income countries.

My French is poor, but most people here speak only Malagasy. The translator steps up to the car and sits down next to me on the back seat. He is a young man, slightly over 20. Like everyone else here, he is as thin as a stick. He has dressed in his finest clothes: a blue shirt, grey pullover and black leather shoes.

He greets me gently. I greet him back. (A drop of sweat has already formed on my temple where I sit wearing thin khaki pants and a T-shirt with the MSF logo). He has never been in a car before. I help him with the seatbelt.

We do preparatory work for our efforts. We try to find out where the malnutrition problem is biggest. We go to a hospital that looks as deserted as an abandoned Swedish industrial estate. Here are a doctor and a nurse who sit in separate offices.

There are two children admitted to the hospital, two brothers with kwashiorkor. The boys are about four, but short of stature, and their faces seem to belong to old men.

Kwashiorkor is a condition that arises with really severe malnutrition. These small bodies have so little protein that their blood has been depleted of it. Normally, these proteins help to keep liquid in the bloodstream, but when the shortage is severe, the fluid goes out of the blood vessels, causing swelling in the legs, arms, face and abdomen.

The muscle atrophy has gone very far and there is no subcutaneous fat left in the boys’ bodies. Their hair is gray and sparse. They look at me with large yellowish eyes. They look intensely unhappy, which is also a sign of the condition. These two brothers are lucky to have got to hospital.

We are here to see what the situation is and how great the need is. Our own hospital is not set up yet, but it is under construction. There we will be able to take care of only the most difficult cases of acute malnutrition, such as these two brothers.

We visit some health posts that distribute fortified peanut paste to malnourished children. There are always many people waiting. The families have often come a long way, and they sit in the sand, in the shade of cactus trees, waiting for their turn.

People’s needs in the region are huge. The biggest problem, in addition to the lack of food, is that it is very hard for people even to reach a hospital, and once there, hospitals do not have much to offer. Madagascar's government has called for help with this situation. It is clear that we are needed here.