by Rohan Kent
Like the workers in the centre it serves, the ceiling fan is overworked. The soft, rhythmic ‘click, click, click’ of its mechanics is almost deafening in the crowded but eerily silent room below, as the fan dutifully moves the hot and dusty air around and around the hospital that cares for severely malnourished children which is known by its French acronym - CRENI.
The heat is definitely oppressive here in Tillaberi, Niger, where it’s not uncommon for the mercury to climb above the 50 degree mark, across this land-locked West African nation. But as the ceiling fan looks down on a scene all too common in this country gripped by food insecurity and seemingly forgotten by the rest of the world, one can see that its efforts to provide even a little bit of respite from the dry African heat are challenging at best.
The CRENI room accommodates two rows of rickety old steel frame beds, dressed in dusty sheets and torn mattresses. Pillows are a luxury here and are few and far between. This picture is repeated across the centres few other rooms, with the beds occupants some of the most fragile little bodies I have ever seen in my life. The children in question are all caught in the vice like grip of severe acute malnutrition. For them, even crying is hard work, as this most basic of actions requires energy, these patients all lack.
Over 55 children - all under the age of five - pass through the CRENI each month. It was built by Plan International and run by the Ministry of Health. They undertake on average a three week program of assessment, stabilisation, recuperation and recovery. The twelve staff – eight of which are volunteers – are a mixture of doctors, nurses and nutritionists working around the clock, seven days a week to breathe life back into these otherwise listless bodies that have been brought to them by the desperate parents and caregivers of the drought stricken surrounding districts.
The phased approach is both simple and effective. Firstly, children are registered, weighed, measured and any complications are recorded and treatment mapped out. While children come to the centre severely malnourished, they also are often affected by preventable diseases including malaria, respiratory complaints or skin infections, all attacking with vigour their already weakened immune system. The stabilisation phase is next where specially formulated milk known as F075 is provided to children over a period of approximately one week. This critical stage sees the milk administered sometimes up to every three hours in controlled doses and according to weight.
A transition phase follows where slowly recovering appetites are tempted by more enriched milk formula this time known as F100, but over a shorter period of approximately three days. Both F75 and F100 are high in energy, fat, and protein, and provide a large amount of nutrients for the emaciated bodies. But both are not guaranteed to work immediately and at times the days can drag on into weeks as the recovery process limps along.
Providing the child does respond to treatment though, the final phase of the treatment introduces ready-to-use therapeutic food such as the Plumpy’nut, a nutrient rich food that requires no water, preparation, or refrigeration. Any remaining ailments the child might be experiencing continue to be tackled with additional medications.
Despite these many hours of care and attention over this phased approach, these little patients are still not completely safe. Constant monitoring is now required to ensure they don’t relapse back into the at times unforgiving grip of malnutrition.
As said before, it an eerie scene out here in the dust and the heat. Mothers and caregivers watch us with sunken and tired eyes, allowing themselves to be distracted briefly before they turn back to their fragile and exhausted patients. My own mind wanders to my own bright and bouncy 14 month old, half a world away, and how utterly devastated I would feel if he were lying here motionless. My momentary drift in concentration is brought to a shuddering end, as a painful whimper emanates from one of the beds close to me as three year old Aissa’s mother begins to move her into a more comfortable position to receive her next dose of life saving, fortified milk and medicines.
Sensing the emotion of the moment might be getting the better of us, the nurse hosting us smiles kindly, squeezes my arm and guides me outside the room. Through a translator she reassures me it’s definitely not a place of despair here despite what we might b thinking. She tells me that since Plan International built this centre almost five years ago and with the dedication of the man and women who work in the clinic around the clock, thousands of young lives have been saved. Success rates in fact have increased from 85% in 2007 to a 95% survival rate. Impressive I think, considering the conditions and minimalist medical supplies on offer.
And she’s right – it’s not all despair here. Lives are being saved and mitigation procedures against malnutrition are also being implemented.
In addition to the support Plan International provides directly to the clinic to ensure it runs on a daily basis, AusAID’s is now funding Plan International to increase its support for community based malnutrition management groups, set up to educate parents and care givers on how to prevent malnourishment amongst their children, thus avoiding the emotionally draining visit to the CRENI. This funding will allow caregivers to be taught how to rehabilitate their children themselves using local food as well as energizes mothers and community to take broader and sustaining action to prevent malnutrition and poor health amongst their children.
Our group shuffles on through the clinic and I ask our host how much does it all cost - how much is it to send a child on the brink of death, through the phases, to a situation of life and hope for both the child and its family?
Approximately $200 is the reply.
Not really a lot, I think to myself...to save a life.