Archive for the ‘Malnutrition’ Category

Statistics have swallowed me whole. Writing our funding proposal for next year has taken over our lives of late; whole swathes of the population are reduced to a demographic: malnourished under 5s; returnees; pregnant and lactating mothers, ex-combatants. The extent of the need overwhelms, thus by necessity it is herded into manageable areas of intervention. When you write the words, ’24,000 access local health facilities run by Tearfund’, the people have no faces.

At the end of 2009, we were informed that the one and only medical centre in the county with a doctor and an inpatients facility was to downgrade to a basic health unit in the New Year. We understood the implications of this – no longer would we have anywhere to refer seriously ill patients for treatment in our area of operation. Complicated pregnancies; gun shot wounds; life threatening illnesses: now there is no where to go.

We understood the practical implications, yes, but perhaps not how it would feel to have to tell someone you cannot help them.

A few days ago, a little boy arrived in our health unit, carried by his family. Blood was streaming from his nose and mouth, he could not eat or drink,  his body was stiff and he was in agony. Our health workers are not doctors and short of giving him some paracetamol, could do nothing for him. He hadn’t eaten or drunk for days and was frighteningly thin. I stroked his head and watched him wince as I fed him porridge.

The nearest health centre with an inpatients facility is now in Lankien – a 12 hour walk away for a strong and healthy man. Who knows how long it would take a mother and grandmother to carry a sick 9 year old boy? Our only functioning landcruiser was out in the field delivering food to hundreds of malnourished children. The following day the car was scheduled to do the same again. Do you divert the car, risking the lives of hundreds, to save the life of one? If we take this boy, do we simply stop all our other activities? If we take this boy today, will we be beset by queues of sick people demanding transport to Lankien tomorrow?

So often here, one is forced to move from the abstract to the personal in a flash. From strategy to reality; from policy to life-or-death. And then you have to sleep at night.

We took him to Lankien in the end. Our vehicle had to travel there as part of a scheduled security assessment a few days later and the little boy was still very ill. He was admitted to the centre and is being tested for Kala azar and TB. Perhaps I’ll see him running about in Motot again, one day.

He is only the first in a long line.

His name is Khot.


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At a first glance, it seems normal: pastoralists move in search of water. But here is hostile terrain with invisible and complicated boundaries; with feuds as old as time.

Yesterday as we drove to a neighbouring county, we passed through oddly empty settlements. No women outside grinding; no naked babies running around outside tukuls; no cows. A blood feud with those in the neighbouring district means that the nearest remaining water source is off-limits to the once-occupants of this area; consequently they have been forced to migrate to find water for their cows.

UNICEF recently warned of the impending food-crisis in Southern Sudan as a result of poor rains, with Jonglei – as ever – worst hit.  Last rainy season, the river at Yuai was full and flowing until January. So much so that the nutrition staff would have to park their vehicle on one side and wade through in order to access our emergency feeding centre. This year it never really became a river; certainly over a month ago when we tried to cross it, we found nothing there at all.

During the dry season our nutrition programme moves, along with the people it serves, to an outlying cattle camp in an attempt to reach malnourished children who have been forced to migrate in search of water. This year it is feared that water will elude them, even there.

* The Rime of the Ancient Mariner, Samuel Taylor Coleridge

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A week or so ago I went to Pieri to assist with the emergency feeding programme. That day, the children who attended were either on our supplementary feeding programme (for moderately malnourished children) or our outpatients therapeutic programme (for severely malnourished children). The worst cases (severe acute malnutrition with complications) get admitted into a stabilisation unit.

Malnutrition is a constant here (the Global Acute Malnutrition (GAM) rate in our county stands at about 22%) and is not a result of a particular event such as a drought or a conflict – rather it is a part of every day life. Only 30-40% of people live within one day’s walk of a health facility; maternal mortality rates are the highest in the world, and one out of every seven children will die before their fifth birthday. That’s enduring poverty for you.

Each week, those who attend the feeding centre are measured and weighed with the results recorded and as you go back week after week, you can see the improvement as the numbers slowly creep up and up on the children’s admission cards (though never reaching ‘normal’). You can literally see the flesh growing on skinny arms and legs. And yet come the hunger season, or the time when we exit them from the programme because their weight for height is deemed to be acceptable, in all likelihood their numbers will plummet once again. This work is so necessary – so lifesaving – and yet so impermanent. Relief work is ever a short term solution, yet stability has evaded South Sudan for so long, preventing it (together with a plethora of other factors) from transitioning into more long term development. NGOs all too often exacerbate the problem of course, by inadvertently encouraging dependency long after a crisis is over.

If you pray, pray for this place: pray for stability, for change, for peace, for strong and committed leaders. Pray that Sudan doesn’t return to all out war next year as so many predict. Pray against the endless cycle of revenge and retaliation which has this place by the throat.

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For the last week we have quite literally been eating the leaves from the trees.

The local market in Motot sells only goat, beef and occasionally onions; any other food has to be shipped in from Nairobi every fortnight on our charter plane. It’s a short-lived joy however, as the boiling heat, coupled with an inconstant fridge means that the food we’re sent lasts only a few days before rotting. So for the first week it’s a feast and after that, the cooks look for alternative options … I’ve eaten the leaves of two different trees this week, fried with onions, and the results were surprisingly tasty (albeit kind of leafy).

The lack of vegetables – in fact the lack of pretty much everything – is due to the fact that the Nuer are primarily cattle-herders and pastoralists. Life, death, birth, marriage: it all comes down to the cows in the end. Even traditional Nuer love songs take a favourite cow as the object. This is all well and good, but as a result means that they don’t really cultivate the land, aside from the odd patch of maize or sorghum next to their tukul. And yet the cows aren’t generally for eating very often either; they’re useful primarily in terms of milk production and in the arranging of marriages. People survive on a limited and not particularly nourishing diet as a result. Much of Southern Sudan is the same: even the apparently well-stocked markets in Juba are full of slightly squashed produce shipped in from Uganda.

And so a critical hunger gap occurs here every year, beginning in February when food stocks finish and reaching a peak in May. Families don’t grow enough to feed themselves and limited household harvests run out before the next one is ready to reap. It’s a precarious and generally deadly cycle, but it’s difficult to encourage farming here: the soil is difficult, and men judge themselves by the quality of their herds rather than the size of their crop. Since South Sudan is in a chronic and complex emergency state, longer term food security interventions run by NGOs are potentially risky ventures. A sudden spate of violence or displacement in a given area and farming projects collapse overnight, leaving the fruits of your labours (and investment) abandoned to be scorched by the sun.

I always figured that people would do anything to feed their families, especially when children here are so malnourished. But I have a lot to learn about life in South Sudan, like what it might mean to have survived over 20 years of war and unimaginable hardship having to exist on little or nothing at all.

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Last night, as dusk fell over the compound and we walked back to our accommodation, horrific techno music pumped from our Kenyan nutrition nurse’s mud hut. Suddenly, out of nowhere, everyone began to dance in the sand. I say dance, but in truth we are trying to encourage one of our colleagues to lose some weight, so the resulting moves were a heady mixture of aerobics and bump ‘n’ grind. Nya’wich – a beautiful 19 year old Nuer girl who has never left her village, let alone been exposed to the horrors of techno, watched and laughed from the sidelines until she was finally persuaded to join us. She showed a real aptitude for Western dance, quickly mastering the classic side step shuffle, the jogging arms trick, and the occasional hip wiggle.

This morning I went to one of our emergency feeding centres on a monitoring visit. South Sudan has the worst maternal mortality rate in the world and today’s feeding clinic was for pregnant and lactating mothers, many of whom had walked for hours through the mud and water to get there with their babies in Moses baskets on their heads. The women waited to be assessed, feeding their oddly quiet babies under the shade of a tree while men walked past, the occasional Kalashnikov slung over a shoulder. Upper arm circumferences were measured, immunisation cards checked and vaccinations administered before they were given rations of oil and sugar mixed with CSB (corn-soya blend). The blend is for the mothers themselves, to combat malnutrition and help them produce enough milk to feed their children. One mother passed me her feather-light baby girl with long thin limbs and scaly skin. She looked about 9 months, but when I checked her record card, she was more than two years old. For the first time since arriving, the flies were leaving me alone and it wasn’t hard to see what was distracting them – I saw a newborn baby with its face almost entirely obscured, flies feeding on its eye infection.

Life here is an unsettling mixture of the heart-rending and the ridiculous and it’s hard to move from one to the other. The situation changes, but your mind takes a while to catch up.

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So I’ve finally made it and it’s everything and nothing like I imagined it to be. I knew there’d be mudhuts and naked children. I didn’t know that I’d fall asleep each night to the sound of singing and beat of drums from the village next to the compound. Nor that I’d feel suddenly and inexplicably at home – something I didn’t ever really feel in Juba. It’s a different world here in every conceivable way, and it’s not just the bucket showers, pit latrines and diet lacking in micro-nutrients.

When the charter plane deposited us in nearby Pieri, a hundred little faces with matchstick legs and bellies swollen with worms watched and laughed as we loaded ourselves and 500kg of food and medical supplies onto the waiting landcruiser and set off through open fields to Motot. I was rather pleased to have secured the only seat next to an open window and squeezed in next to three 7 foot Nuer men, ready to take in the view. I realised why the seat had been left vacant as soon as clods of mud and cow poo began flying in and splatted me in the face.

From a distance Wuror county in Jonglei is a beautifully verdant, pastoral landscape. At a closer glance, the rainy season has transformed it into swampy marshland where children wade knee-high through water and mud in order to get anywhere. Our driver battled valiantly, but we were soon stuck and I looked on as water poured out of the rear doors of our sinking vehicle. Mercifully we were only a couple of kilometres away from the compound so after an hour frying in the midday sun, feeling useless watching men try and winch about two tonnes of weight out of a bog, I gave up and walked back to the compound with the guard, who was kindly carrying what I believe is to be my new double mattress on his head.

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