March 12, 2012
Chad 2011 © Natacha Buhler
Mahamad Adam stands proudly in front of the store under his charge. It's a single room between four walls of dried mud and eaves made of cut branches that provide a little shade. Inside are stocks of enriched peanut paste, a product that has proven to be effective for tackling child malnutrition.
Adam is a community health agent who spends several hours each week looking for and prescribing the precious substance to children with severe acute malnutrition in his village of Michetire and the surrounding area, some 100 kilometers [60 miles] north of N’Djamena, the capital. He is one of roughly 10 community health agents in western Chad's Hadjer Lamis region, part of a system established by Doctors Without Borders/Médecins Sans Frontières (MSF) in collaboration with the country's Ministry of Health.
“When I knock on the doors, I’m well received," Adam said. "People are happy with this new service."
MSF is now trying to convince the inhabitants to directly support the community health agents who, until now, have received millet, sorghum or oil from MSF in return for their service, but no money. “To make the system sustainable, the communities must organize themselves and look after the agents,” said Ibrahim Halidou, who is in charge of external activities for MSF.
MSF is setting up numerous meetings to discuss the initiative. At one, which was held this past February, several skeptical village leaders turned up. Halidou explained that malnutrition will not disappear overnight and that the role of the agents is to do away with the need to undertake exhausting and costly trips, on foot or by donkey, to the nearest health center.
After some discussion, the leaders gave their agreement in principle, although they must still consult their communities. “If we plant a tree in the morning, we won’t have shade by the end of the day,” concluded one.
Inhabitants can also bring their children one of the four outpatient health centers MSF set up in the region. Most are underweight, but if their health is otherwise okay, they can return to their villages and obtain the peanut paste from the community agents. When there are medical complications, they are sent to the MSF hospital in Massakory, at the other end of the chain.
In 2010, MSF mounted an emergency response to tackle the serious food crisis that hit the whole of Chad. More than 19,000 children received treatment in the Hadjer Lamis region. Once the crisis had passed, MSF remained in the town of Massakory, where it set up a 170-bed pediatric hospital just next to the general hospital run by the Chadian Ministry of Health.
The peak of malnutrition this year is expected in July, but MSF's hospital was already operating at full capacity at the beginning of March. Most admissions are related to malnutrition; there is almost no room in the various tents in which hospitalized children are gradually brought back to health.
Many of the patients have similar stories. “My 16-month-old started vomiting and having diarrhea, then [swelling] appeared, so I brought him here," one mother said. "He’s getting better. He’s much more alert and is starting to play, although he’s still well below his normal weight."
The concern is that the influx of children into the hospital could be a sign of another year like 2010. “There isn’t a food crisis in the Hadjer Lamis region yet,” said Jacques Etienne, MSF’s Head of Mission in Chad. “But the last harvest was poor, as it was throughout the Sahel, and, if nothing is done, the situation could deteriorate rapidly.”
The community activities are intended to ease the strain on the hospital. However, the numbers of children registered with the outpatient clinics and food stores are not yet increasing. In order to reduce the peak of malnutrition, MSF has started distributing an enriched peanut paste variant, which will be received by thousands of children aged between six months and two years over the coming months. A study is being carried out to evaluate the effectiveness of this distribution. And several immunization campaigns are planned with the aim of breaking the vicious cycle of disease and malnutrition.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)