Interview with a Medical Team Leader in Chad

Médecins Sans Frontières (MSF) is widening its health and nutrition programs in Chad to respond to the growing malnutrition crisis in the country. The aid organisation is currently treating malnourished children at five projects in the country, and has dispatched emergency teams to conduct additional screenings in other affected areas, to assess whether more interventions are required.

At one of MSF’s long-term projects in Am Timan, located in Salamat region, in southeast Chad, the aid group is expanding the number of outreach centres from eight to twelve to respond to escalating malnutrition rates. Between January and April, 2,478 children were admitted to ambulatory therapeutic feeding centres – almost twice as many as at the same time last year.

Even in a normal year, Chad has one of the highest rates of chronic malnutrition in the world.  In early 2012, in some areas of the country, rates of global acute malnutrition as high as 24 percent were reported, among children under the age of five. A combination of factors are behind the alarming numbers, including failed harvests, erratic rains, soaring food prices and an early depletion of food stocks.

In an effort to reduce mortality rates, MSF teams are treating malnourished children with therapeutic food and vaccinating them for measles. Children who are very sick are referred to our paediatric ward at the Am Timan hospital, where we have an intensive care unit to treat severe conditions. These are usually children who, due to the immunodeficiency caused by malnutrition, suffer from additional illnesses, such as respiratory tract infections, diarrhea, or even tuberculosis. They may also be too weak to eat and must be fed through a gastric tube.

Emma Augustine ZOBA is the Medical Team Leader in Am Timan.

What is the situation in Am Timan?
The situation is dire because we are seeing double the number of malnutrition cases in children under the age of five, compared to last year at the same time, and we expect it to worsen as we move into the peak of the malnutrition season in July. From November to January these children were in the fields with their families, and when they got sick their parents didn’t take them to hospital. When the harvest ended in January, and families returned to their villages, we suddenly saw a growing number of sick children come to hospital. Some of these kids are also suffering from measles or meningitis.

We know there was a lack of rain and crops failed. Are there other factors that have caused this crisis?
There is definitely a food problem, but when you talk to mothers with malnourished children there is also a problem with water. There is a lack of clean water. Culturally many mothers wean their babies from breastfeeding quite early. They feed their babies animal milk and dirty water so by the time they come to hospital they have diarrhea and are already severely malnourished. The death rate of children admitted to hospital is high because they arrive in the last stage of their illness and we can’t save them.

How are we treating these children?
We have two programmes: we have an outpatient programme where we travel to eight health centres in and around Am Timan, and test children for malnutrition and other diseases, such as malaria. We also vaccinate children against measles, and if they have an infection, we treat that too. If a child is diagnosed as severely malnourished, we supply mothers with a week’s worth of enriched peanut paste for their child and they are asked to return for weekly check-ups. If a severely malnourished child has become critically ill we transport them to hospital where they receive treatment and medical supervision. To help their body adjust to food again, they are given special therapeutic milk, and when they regain their appetite, they are fed enriched peanut paste in order to gain more weight, until they are well enough to leave.

During this crisis is there a particular story that has touched you?
At one outreach centre I visited early on, I saw the state of the water people were drinking and it made me cry. They were collected muddy water from a river and cleaned it by running it through a cloth. When we visit we bring clean water with us and we feed the children with therapeutic food. But we cannot do any more after we leave. These babies and young children drink dirty water and get terrible diarrhea and, as a result, it’s difficult to get them to their target weights. We face epidemics and disease, but water is a big problem in this area. Having said that, I do believe we are making a difference. We know our outreach clinics are helping to reducing the number of children who are dying here.

Other MSF malnutrition projects in Chad:
MSF has just opened an intervention programme in Abu Deia, in the northeast, to treat an estimated 1,000 children.

In April, MSF opened an inpatient therapeutic feeding centre in Biltine town, eastern Chad, and opened five outpatient therapeutic feeding centres in outlying areas. To date, 282 children have been admitted to our outpatient centers and 42 critically-ill malnourished children have been treated in inpatient care. MSF plans to open seven more outpatient therapeutic feeding centres before the peak of the malnutrition season in July.

In Yao, in Batha Region, central Chad, MSF also opened a nutrition programme in April. 420 children have been admitted so far.

MSF runs a 200-bed pædiatric hospital in the town of Massakory in western Chad's Hadjer Lamis region. Currently, 160 children are hospitalised, and cases are both paediatric and nutrition-related.