‘I have never seen such a high number of very sick children’

A Vancouver nurse describes the heartbreak, hope and human impact of MSF's medical malnutrition intervention in Bokoro, Chad

Photo: © Charlotte Morris

Andrea Kuehn is a nurse from Vancouver who works as an outreach supervisor for MSF’s mobile malnutrition clinics across the region of Bokoro in Chad. Below, she describes the challenges of providing treatment to an overwhelming number of sick and malnourished children, and the dramatic impact that delivering such care can have.

By Andrea Kuehn

I arrived in Bokoro, Chad, three months ago. It’s my first posting with [Doctors Without
Borders/Médecins Sans Frontières] MSF, and I was so excited to finally get here. I have always wanted to work for MSF. This is my small contribution to make the world a better place. I knew Chad was going to be dry and hot and that there are very high levels of malnutrition here.

I am responsible for the 15 mobile malnutrition clinics we are running in 15 different villages. I oversee the team of nurses, registrars and pharmacists and make sure everything's running smoothly. When a child arrives at our clinic we measure their mid-upper arm circumference (MUAC). If the circumference of their upper arm is smaller than a certain diameter they’re admitted into our program. During every clinic visit, we re-measure their MUAC, we weigh them, check their appetite and give the babies a nurse consultation. We can also treat diarrhea, malaria, respiratory infection, parasites and worms, vitamin A deficiency and eye infections. Malnourished children almost always have other diseases due to their lowered immune systems. We also provide ready-to-use therapeutic food, mosquito nets and soap. If there are any really sick children, I arrange for them to get transferred to the MSF Inpatient Therapeutic Feeding Centre at the Ministry of Health [MoH] Hospital in Bokoro.

 

 

AN ALMOST OVERWHELMING AMOUNT OF NEEDS

The first time I went to one of the mobile clinics it was the one in the town of Bokoro. It’s one of the largest clinics we run in the region, and we regularly see more than 400 children in one day. It was overwhelming and chaotic. I have never seen such a high number of very sick children in my life. Even with my background as a nurse in Canada, the level of acuity is astonishing. Now I have been here three months, the numbers are still extremely high and it is still shocking.

When I first arrived it was about 45 degrees Celsius. The extreme heat only adds to the everyday challenges of working here. And it affects our patients. If you have a sick child and they’re in the heat, they're much more likely to become dehydrated.

Right now it's the rainy season. You can see the corn and peanuts that families are growing, but the problem is it probably won't be enough to get them through until next year.

Photo: © Charlotte Morris

OUTREACH AND EDUCATION ARE BADLY NEEDED

Another issue is the lack of education about health and nutrition. Women are not breastfeeding their children long enough. There's no birth spacing between children, so women tend to have one child and then they end up pregnant soon after with the next, and the mothers have a lot of misconceptions about breastfeeding. If they're pregnant they stop breastfeeding their older children, and then of course that causes malnutrition. Or they won't breastfeed multiple children at the same time. So often you'll see mothers come to our clinics and they have one child that's malnourished and then they have one healthy infant in their arms as well. Really they should be breastfeeding both.

One day I was at one of our mobile clinics and a mother brought in a six-month-old baby girl. The baby had been sick for some time with fever and a cough and she was having difficulty breathing. Her parents had first taken her to a traditional healer. In an attempt to heal her, the healer had cut out the uvula at the back of the baby’s throat and they’d also cut lines into her chest. So the poor child was of course in pain and was refusing to breastfeed. Infection was setting in.

By the time she arrived at the MSF clinic she was tiny, very dehydrated and the infection had spread to her entire body. You could see that her whole body was having to work very hard to make each breath. We needed to transfer the child immediately to MSF’s intensive care unit in Bokoro town. I remember sitting in the vehicle and just praying that this child would make it. It was the longest 45 minutes of my life. With every breath the child took I didn’t know if it would be her last. Thankfully this child did make it to the hospital and a few days later I went to visit her and her mom. The child was no longer in intensive care. It was so good to see her improving and gaining weight. It was shocking to see both extremes – to see such a severely sick child and to see her recover so quickly once she got access to healthcare.