MALNUTRITION: Ivory Coast: "If discharged, they will immediately relapse into malnutrition"
World Food Programme30 Nov 2012lWFP's nutrition support programme for malnourished people living with HIV in the region of Bouaké, central Côte d'Ivoire, runs for six months. After this, the patient is normally expected to grow out of malnutrition and regain his or her ability to lead an active life. That's a least the principle. In practice, however, the programme keeps readmitting the same patients again and again. For years now.Attimi, 44, has been on the programme since 2007. "We just cannot discharge her and most of the other patients," says Koué Bi Marius César, the coordinator of Renaissance Santé Bouaké, the local NGO that WFP is partnering with to deliver nutrition support to malnourished people living with HIV. "If we discharge them after six months, they will immediately fall victim again to malnutrition. Worse, they will go hungry as most have nothing at all and rely on WFP to feed themselves. The hard fact is that they totally depend on WFP for food, no matter how big or small the donated ration."
The redeeming power of food
Until about two years ago, WFP was able -- thanks to adequate funding from generous donors -- to provide Attimi, and 300 other people living with HIV in Bouake, with enough food for them and their families. The monthly ration - typically for a family of five - consists of 24 kg of cereals, 7,5 kg of pulses, 5 litres of oil and 15 kg of Supercereal – a highly nutritious supplement fortified with micronutrients.
"There was a time when I was so well-fed and strong that I was oblivious to my HIV condition," says Attimi, who first found out about her HIV condition in 2003. "I was not worried. I didn't have to think about my disease. I used to bring home lots of food every month. My family used to eat well and were content. This is why they were so understanding and supportive. It's as if they didn’t mind that I had HIV."
Through this full family ration, WFP and its local partner Renaissance Santé Bouaké, made sure that the patients got the right quantity and quality of nutrition support they needed to accompany their anti-retroviral treatment and live an active, healthy life. The full family ration was a safeguard against the patient going hungry because he or she has to share their food with the rest of the family.
Countless are the stories of families who deprived their HIV positive members of food, neglecting them when they fell ill, rejecting, and even disavowing them, only to eagerly welcome them back and hold them up as near-heroes!
The secret? It's the redeeming power of food! The full family food ration has helped remove the stigma surrounding HIV. People stopped being judgmental. Being able to bring food home made the HIV positive person a valued -- even a celebrated -- member within their family and community. Some of these patients would sometimes get a drive back home on big WFP vehicles. That -- along with the unloaded sacks of food -- used to impress families and neighbours. In a counter-intuitive way, HIV has become associated in the local imagination with food abundance.
Medicines on empty stomachs
Not any longer. Dwindling financial contributions have forced WFP to scale back its nutrition support programme to people living with HIV in Côte d'Ivoire. Instead of a full family ration, the patients now receive a reduced individual ration of 7 kg of Supercereal and less than a litre of oil per month.
"That's too little," complains Attimi who has to share out the food with 11 other members of her family and has often no choice but to take her anti-retroviral medicines on an empty stomach. "Today I had nothing to eat all day. Neither did my 8 year old daughter. People in the community are fed up with me asking them for food. 'You keep always coming back,' they berate me. But what can I do? My husband has been unemployed since he had all his fingers cut off in an accident at the textile factory where he used to work. Today I had to borrow money to be able to pay for transport coming up here. I beg almost for everything."
At 3.4 percent, the prevalence of HIV in Cote d'Ivoire is the highest in West Africa. WFP's aim for 2013 is to support over 5,500 Ivorians like Attimi. However, no significant help can be given these malnourished people living with HIV and their families until more donors come forward with adequate contributions.
Attimi is only too well aware that help cannot continue indefinitely. "I know that there comes inevitably a time when your benefactor will tell you the truth,'" she says. "But what we need from WFP now is to restore the full family ration for a while until we can find some work and start relying on ourselves. We don't want to live on handouts. I want to start a small trade. I want my daughter to go to school and build a future for herself. But I can't even afford the token fee they charge for textbooks. Just yesterday, the school expelled her and told me she cannot come back until I pay. There are no words to express my chagrin. Can these people not understand that I cannot even afford to eat..."
After service in the British SAS Regiment the author became a physician and then an orthopaedic surgeon.
He has held professorial positions in Canada, Vietnam and the United States, practiced and taught orthopaedic surgery in three continents and in several wars.
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