Isolated and Malnourished: Treating Patients in Afar, Ethiopia

MSF carried out an emergency nutrition intervention in Ethiopia's remote Afar region, one of the world's harshest places to live.

When Zahari Nur’s grandmother brought her to the outpatient post where Doctors Without Borders/Médecins Sans Frontières (MSF) teams were conducting outreach activities in Digdiga—one of the 12 Kebeles (provincial administrative units) that MSF is covering in its nutritional intervention in Afar—everybody thought she had just a few days to live.

“I had given up hope on my grandchild,” says Eisa Wasaitu, Zahari’s grandmother. “I thought she was going to die like the three others before her.”

The one-year-old was suffering from severe acute malnutrition when she arrived at the MSF outreach post. Her mother is also ailing and suffers from psychosis. She is in no condition to take care of Zahari and her older brother, leaving the grandmother as their sole guardian.

MSF began working in the inimitable lands of Afar in April 2013 in response to a nutritional emergency. Afar is vast, and Teru—the area that MSF covers—is one of its most remote and most neglected regions. Subject to huge sandstorms and extreme temperatures in the dry season and violent rainstorms that flood rivers and render roads impassible during the rainy season, Teru is an extremely difficult context in which to work.

The Afari are a pastoral nomadic people who move from place to place in search of water and pasture for their animals. Living this way makes it difficult to adhere to treatment regimens, meaning that many people default before completing the program. It also makes it difficult for MSF teams to follow up with people who default.

MSF’s intervention covered 12 Kebeles whose inhabitants are completely cut off from health care. The decision to intervene was reached after an assessment revealed an alarming rate of severe acute malnutrition in the region—26.6 percent of an estimated catchment population of 87,374 people suffer from the condition.

“Most of the cases that we admit in the stabilization center are severe acute malnutrition with complications,” says Frank Katambula, MSF medical team leader in Afar. What’s more, he adds, “most of these are combined with either pneumonia or TB.”

Despite the difficulties associated with providing care in Teru, most cases have now stabilized and children under the age of five continue to receive therapeutic food. Overall, a total of 726 malnourished children were admitted to the therapeutic feeding program (including 134 children in the stabilization center) and 1,154 moderately acute malnourished patients (including 416 pregnant and lactating women) benefitted from the program.

“In total we have 78.2 percent cured cases and a defaulter rate of 4.5 percent, which to me is quite ‘good’ considering that access [to health care] in this area is not at all easy,” says Jean François Saint-Sauveur, MSF medical coordinator in Ethiopia.

After two months in the MSF program and admission into the stabilization center where she was also given specialized treatment for pneumonia, Zahari was improving. When we saw her a few weeks ago, her weight had increased from 3.2 kilograms [a little more than 7 pounds] to 4.9 kilograms [almost 11 pounds].

“When I see this child I feel very happy because the grandmother and the rest of the community thought she was going to die,” says Nabiyu Ayalew, MSF’s outreach nurse. “But we saved her life and she is still alive.”