Malnutriton

Working in rural Africa is more similar to working in Manchester than you might think.  Getting out of bed in the morning is still difficult.  My morning coffee may be made on a charcoal fire, but it’s still an important stage of waking up.  And I still send more time than is necessary figuring out how long the queue of patients is and when I can go home.

The standard of medicine we can deliver is quite basic.  We see about 90 – 120 patients between the three of us per day, which means that time with each one is very limited. Not only do we have to see the patient, but we have to run our own basic laboratory, dispense our own medicines, and attempt to teach the health workers who translate for us.  The story we get from our patients is translated from the local language (Tonga), and we often struggle to get a good description of what’s going on.  Added to that the fact that many of the problems are either un-curable or unfathomable, and the work can be quite frustrating.  But occasionally, something good happens...

It was fair to say that the trip to Manyumunyamu (no, we can’t pronounce it either!) was the toughest so far.  After roughly double the two hour estimated journey time, we arrived at about 9pm, shattered, hungry and worried that we’d done some serious damage to our car (it turns out we actually had, but that’s another story).  The following day began fairly normally, lots of patients, lots of coughs and colds.  Just before lunch a young mum sat down in front of me.  She could only be 15 or 16 years old and was clearly very shy.  As per tradition she had her child strapped to her back and I could see very little when she sat down on the rickety school table.

“Ndipenzizi” I exclaimed (my Tongan “What can I help you with?” is still atrocious and despite my best efforts is still translated by my slightly embarrassed translator).

“Eyes” was the response.

My heart sinks a little, I spent so long in the UK being taught to use open questions and to let the patient tell the story.  Here in Zambia, almost all answers are given as a single word, often completely unrelated to any form of discernible ailment.

“And what is the problem with the eyes?”

After much delay and several sentences exchanged I get the answer “water” from my translator.

All the conversational subtly we normally use at home is lost here and there is little point in using my eyes to tell the translator and/or patient that I’m not impressed with their descriptive efforts. I’m tired and worried that the queue is still lengthy.

“Ok then, let’s have a look” I announce cheerfully and signal for mum to unwrap the child from the cloth baby-carrier on her back.

Gradually and carefully she un-wraps a tiny package of humanity.  The child’s huge bulging eyes gaze around the room from its tiny fragile body.  It’s like watching a Tearfund advert – but somehow it’s in the same room as me.  I double and triple check the child age but it’s obvious that the child is far smaller than it should be.  Its wispy hair and dry skin betray the severe malnutrition that is obviously affecting this child.

We aren’t really set up for this sort of thing but we did what we could.  We weighed the child and confirmed what we knew.  We discussed the problem with the mother.  Breast-feeding is not going well but for some reason (?cultural ?family pride ?money), and no-one seems willing to try anything else.  I spent some time explaining the problems and feeding options to the mother, but she looks at me helplessly and hopelessly.  I give her a multi-vitamin solution and tell her to come and see me when I return next month.  Somewhat disappointingly they leave and we both know that not much can or will change.

The next month, we returned to Manyamunyamu.  The child has never really left my mind since he was brought into the classroom a month ago.  Over the past months we’d made some enquires and established where the nearest feeding centre was and how to get referred there.  

Thankfully the queue is not as long this month, but the young girl and the tiny child are nowhere to be seen.  At lunch, I walk around to try and find her – but no luck.  I find the local health co-ordinator and explain who I’m looking for.  He doesn’t recognise the name but says he’ll ask around.  We can say what we like about Africa and the many many short-comings that blight the continent, but when it comes to mobilising a community – they are second to none!  Within about 20 minutes, word has gone around that we are looking for the child.  Despite having entirely and spectacularly mis-spelt both the first and second names (I blame their pronunciation!), somebody recognises the description.  They confirm that they are not here and don’t think that they’re coming.

So what happens next?  Before I knew it, about seven of us were in the Land Rover – and driving into the bush to find her!  We are miles off any map and driving along footpaths and across fields, but our guides were confident they knew where she would be.  Sure enough, we arrive at a small gathering of mud huts in the middle of nowhere.  We are greeted by bemused but welcoming looks.  The community leaders and health workers start making more enquires and after another 10 or 15 minutes the young girl and the tiny baby appear.

The child looks remarkably cheerful if slightly skinnier than last time I saw him.  There is no messing around this month.  We speak directly with the village leader and explain that if the child doesn’t go to hospital it is likely that he will die.  

On our arrival back in Livingstone later that week, I phoned the community health worker to ask about the baby.  I’m relieved to report that the day after our visit, the mother and the child were admitted to The Zimba Hospitals Severe Malnutrition Unit and initiated on a feeding programme.  Whilst we can’t be certain, there’s a good chance he’ll make a full recovery.

The sad thing is that this isn’t famine-affected West Africa, or an expensive incurable problem.  This is simple stuff.  The government has set up numerous State-run malnutrition/feeding centres. All that needs to happen is that someone needs to notice when a child is malnourished, and then someone needs to get the child to a facility.  Somehow, these tasks which seem so obvious and basic to us, are large and more difficult here.  The roads are a huge part of it, and exactly why we go out to the villages we do, because healthcare there is so lacking.  The poverty and complete absence of spare money also makes it difficult.

Luckily for this little boy, his condition was recognised early enough and he was taken to get help.  We hopeful that the local volunteer health workers will have learnt from what happened to this boy, and will know what to do next time they see a similar case.