'This is not a one-off emergency' - understanding the malnutrition crisis in Chad

Charlotte blogs about some of the causes of the malnutrition crisis in Chad, and meets the staff and patients at the MSF project in Bokoro region.

I just got back from two weeks in Chad in central Africa. I was there to gather interviews, photos and video that MSF can use to communicate with the public and MSF supporters about the malnutrition crisis in the country.  
Malnutrition amongst children under five is widespread in Chad. This year MSF is running 15 mobile outpatient clinics for malnourished children in villages across the Bokoro region of Chad as well as an inpatient therapeutic feeding centre with an intensive care unit for the sickest children in Bokoro town.
The Bokoro region lies around 300km east of Chad’s capital, N’djamena, towards the centre of this landlocked central African country. It’s a relatively stable part of the country, but also neglected, usually out of the headlines due to Boko Haram’s creeping presence in the north-west of Chad.
The MSF mobile malnutrition clinic in the centre of Gama, in Bokoro district, Chad
The mobile malnutrition clinic in central Gama.  Photo: Charlotte Morris / MSF 
My first day visiting one of the outpatient clinics was overwhelming. When we arrived there were between 400 and 500 women waiting for us, all with malnourished babies. It was noisy, smelly, chaotic and hot. Really hot. 
I couldn’t believe that the teams work from 7am – 4pm, sometimes later. By 12pm I’d drunk at least four litres of water and was still feeling dizzy. And this was supposed to be the rainy season. 
With my interpreter ready to go it was time to start finding women who were happy to be interviewed. The first woman we approached was brisk. Her baby was crying, she wanted to collect her rations and leave. She didn’t have time to speak to us. Plus as soon as we started talking a group of around six or seven other women (also with crying babies) started listening in and laughing.
This was going to be harder than I thought. 
Eventually I found Howa, a 29-year-old woman who was visiting the clinic because her seven month old daughter, Mikaela, had been suffering from a bad cough as well as diarrhoea and vomiting for several weeks. As a result she’d lost a lot weight and was now malnourished. Hawa lived a few minutes’ walk away. She decided to visit the MSF clinic because relatives in her village told her that there were people there giving out ‘Plumpy’Nut’ and that they could also help with health problems. She and her husband spend their days working in the fields. When the rainy season ends her husband will sell things in the local market. She has three other children who were all a bit older than Mikaela and are currently healthy, although they’d all suffered from diarrhoea, vomiting and weight loss when they were younger. 
Mikaela Haroon undergoes her weekly consultation from an MSF nurse at the mobile malnutrition clinic in Gama.
Howa and Mikaela with an MSF nurse. Photo: Charlotte Morris / MSF
The more women I spoke to that day, and the following weeks, the more this story repeated itself. The people coming to our clinics are young women with many children, who had sadly often lost many more. Many didn’t have a strong understanding of why their children were ill or how we were helping them but they were very pleased to be able to get healthcare for free. And they were very grateful to see their children recovering. 
All the women I met worked in the fields, some of them were married to Marabout - Islamic leaders who both teach young children and work as traditional healers. They pretty much all told me they’d visited traditional healers, or Marabout, before coming to the MSF clinic. In most cases the Marabout had said Koranic prayers but in others they’d made three cuts on the baby’s stomachs or cut out their uvula in attempt to treat the baby’s malnutrition or illness. However the wounds often get infected and mothers tend to bring their child to the MSF clinic only when they’re very ill. 
I only met two women, both of whom lived in a nearby town, who had spent any time at all at school. 
And everyone’s children had been ill when they were young. Many said to me that they thought all young children were ill and that at some stage children got to a certain age where they found their health. 
The good news for Hawa was that Mikaela was now better. Her respiratory infection had cleared up, as had her diarrhoea, and she’d put enough weight on to be able to be discharged from the MSF programme on the day I met her.
But many weren’t so lucky. Whilst I was there, several women each day had to have their baby transferred from the outpatient mobile clinic in the MSF cars to the MSF run intensive care unit in Bokoro town, anywhere between a half an hour and a three hour drive. Many women didn’t want to come. For me, it was shocking and confusing to see people who had really ill babies, refuse care. But for them, they see ill babies every day and might have seen other children recover by themselves. They often also had other children they didn’t want to leave at home or perhaps they didn’t have permission from their husbands to go. For some, Bokoro just seemed too far away as they might never have left their village before. 
A consultation at the intensive care unit in Bokoro town

The intensive care unit in Bokoro town. Photo: Charlotte Morris / MSF

By the end of my two weeks, it was clear that the malnutrition crisis in Chad is not a one-off emergency this year. It’s chronic. It’s not just about a lack of food due to the harsh climate, but it’s also due to a lack of education about what to feed babies and why it’s important to keep them clean. On top of that there are a number of harmful cultural practices that can make already vulnerable and malnourished children more ill. The lack of healthcare in Chad means people are not likely to stop visiting traditional healers before seeking other healthcare advice any time soon. 
It’s a huge challenge for MSF to try and tackle. And I was only impressed by the perseverance of every member of MSF staff I met as well as the resilience of every woman and child. As someone said to me when I was there “You’ve got to be tough to live in Chad.”