MALNUTRITION: Pakistan: treating childhood malnutrition after the floods

 07/10/2010 Nurse Hamdullah has been treating children suffering from malnutrition with MSF in Pakistan’s neglected Balochistan province for the last ten years. Major floods forced about 600,000 people to flee from neighbouring Sindh province to Balochistan in Pakistan’s southwest. Many of them made the difficult 300 km journey to the provincial capital, Quetta, in search of help.
Many people have lost everything, including their homes and family members. Tenant farmers are considered the poorest of the poor and they have come with nothing. As a result of these mass movements, Hamdullah has seen the severely malnourished children of these tenant farmers in large numbers at MSF’s feeding programmes. “In Dera Murad Jamali and the surrounding areas I saw many malnourished children in the camps. I admitted 15 to 20 patients to our feeding programme every day,” Hamdullah said.
Food aid provided in the wake of the flood often focuses on assuaging hunger rather than treating malnutrition, and is not sufficient in meeting the needs of children most at risk.
“Treating malnutrition in children under the age of five is essential. This improves their chance at survival while immune system is still developing. When children are severely malnourished they cannot resist the infections and diseases most likely to claim their lives. If not treated in time, the damage malnutrition leaves on their physical and mental state is irreversible,” explained Dr Ahmed Mukhtar, a medical coordinator in Pakistan.
MSF operates nine outpatient therapeutic feeding programmes across Pakistan through outreach teams. These teams provide systematic medical check-ups and a week’s supply of ready-to-use therapeutic food (RUTF) in sachets to people showing signs of malnutrition. This paste, made from peanuts and milk, is enriched with the vitamins and micronutrients that children need to recover quickly. We are currently treating 1,748 children for severe and acute malnutrition in Sindh and Balochistan.
We spent a day with Hamdullah and team members Ali Sher, Noor Mohammed and Muhammed Iqbal as they worked to ensure that malnourished children get treatment.
09:00: MSF office, Quetta
Hamdullah’s nutrition outreach team fill their pickup with seven boxes of RUTF sachets, a scale, a medicine trunk containing antibiotics, a tent, a table and chairs and some clean drinking water. They also pack the patient register listing their young patients' names and weight tracked over a three to six week period. We head out on the Sariab Road to the outskirts of Quetta.
09:30: Quetta eastern bypass camp
About 40 tents dot the once densely populated yard of the Muslim Health Clinic compound. Hamdullah is surprised: “Some families have started returning home sooner than we thought. They are anxious to get to their land before winter sets in.”
Within minutes of setting up their post, about 20 young Sindhi girls carrying their younger siblings are already crowded around Hamdullah’s table and scale. They clutch small pieces of paper given to them the previous week. The notes bear the child’s name, their weight and the follow-up visit date.
And so begin the proceedings for the day. Ali Sher calls out a name; Hamdullah then confirms the name and the patient's village of origin before weighing and measuring him or her. He does a quick calculation to determine progress, and then Noor Mohammed and Muhammed Iqbal hand out a prescribed number of RUTF sachets.
10:20
Gulbano Nazir has pushed into the mob of women and children, holding tightly onto her two sons Khalid, 18 months, and Hussain, aged three. The floodwaters washed away their mud-walled home near Jacobabad a month ago. She and her husband, Mohammed Rafiq, along with seven other desperate families scraped together the 60,000 PKR (over $600 US) to pay for a truck ride to Quetta by borrowing some money and selling what they had left.
Khalid was diagnosed with severe and acute malnutrition, but is recovering and has put on weight rapidly thanks to the nutrient-rich RUTF. He digs into it as soon as Gulbano opens the sachet for him.
Despite lacking vital information about conditions in Jacobabad, the family will return home to their devastated village. This could make Khalid’s long-term recovery as uncertain as the family’s future.
“I just want to go home. Camp life is tough and winter is coming,” said Galbanum. All Khalid can depend on for now is the 14 sachets of RUTF his mother is carrying back to their tent.
This supply should see him through until the family reaches another transit camp near Dera Murad Jamali on their route back to Jacobabad where MSF also provides outreach feeding care.
13:00 Camp 2 near the Quetta railway line
The sun beats down on this 300-tent camp as the team sets up shop. Their tent is barely erect on the parched landscape, and already desperate mothers jostle to get their babies onto Hamdullah’s scale, trying to minimise the time their crying children spend under the hot sun.
When Hakim Zadi and her son, Akhsa Banu, reach Hamdullah’s table, he takes a look at the child and reaches into a box for a coloured-coded mid and upper arm circumference (MUAC) bracelet. He slips it around Akhsa’s tiny left arm and measures it. The arrows point to the red zone – a circumference of less than 110mm.
“For an 18 month-old this child is severely malnourished,” Hamdullah said, handing Hakim a supply of RUTF sachets.
15:00
The outreach team head back to the office and for afternoon prayers; having weighed and measured nearly 200 patients and distributed just over 50kg of RUTF to more than 40 patients.
“It makes me feel good when the child’s condition improves with every visit. People might be moving back home now but there is more to be done because the effects of the floods aren’t over yet,” Hamdullah said.
http://www.msf.org.uk/articledetail.aspx?fId=childhoodmalnutritionoct2010pakistan_20101007