MSF in Chad: Tackling malnutrition in Am Timan

Am Timan, June 2018
It’s 7:30 in the morning, and the clouds in the sky are holding back the heat, but soon it will rise, forcing people under the trees to find a moment of relief in the shade. The day in Am Timan, in the east of Chad, starts early. Am Timan hospital, which MSF has worked in since 2006, is already bus-tling with people. A chorus of babies’ wails echo out from the paediatric ward at the hospital; the first sign that the little patients are all awake. 
©Candida Lobes / MSF
Dr Yannick Tsomkeng, an MSF doctor who is working at Am Timan Hospital, starts his medical con-sultations in the therapeutic feeding unit, within the pediatric ward. "Children arrive in critical health conditions, so compromised that often it’s too late to save them and they pass away during the next 24 hours after their hospitalization. Here they’re the first victims of the lack of food, poverty and dangerous nutritional habits,” Yannick says. "At the beginning of the month, the therapeutic feeding centre had already exceeded its capacity. In the last week, 46 severely malnourished children, all suffering from medical complications, have been hospitalized," Yannick adds.
©Candida Lobes / MSF
By May, the nutritional feeding centre (CNT), run by MSF, was already over its capacity of 60 beds with 325 malnourished children admitted in that month alone. 
It’s expected that this number will only increase over the coming months. But despite the high numbers of children requiring treatment, and the strains on medical staff, this crisis is not unexpected nor is it the first time the region has been hit by such worrying levels of undernourished children. From May to September each year, hundreds of thousands of people in Chad and in the entire Sahel region endure extreme food insecurity due to the lean period, a result of the dry season coupled with low food stocks. A recurrent nutritional crisis has just started in the Salamat region, and has spread to other regions of the country.
©Candida Lobes / MSF
Fanna, 19 years old, sits on a bed in the nutritional centre with her baby. She struggles to feed her three children. “My boy was sick. He couldn’t eat at all, he kept on vomiting. After four days he was so weak that he couldn’t react and I decided to bring him to the hospital. It’s hard to stay in the hospital for several days, when there’s no one who can look after the other children,” Fanna says, holding Moussa, eight months old. Moussa doesn’t complain, although his feeding tube that seems so big on his gaunt face. He’s too feeble even to cry. He stares at people around him, with his big brown eyes, in pain. He has been hospitalized due to severe malnutrition and complications.
 “I knew there was a nutritional program in the hospital because my oldest daughter has been hospitalized before because she was malnourished. We eat once per day, the food is never enough so my children get often sick. And now it’s even worse, since the harvest is over,” she says.
This food emergency is the result of several factors. Inadequate nutritional practices, climate change, difficult access to land and drinking water, and the poor education and fragile health sys-tems in a country which is already in the midst of a deep economic crisis.
In 2017, the nutritional situation deteriorated significantly and the lean season arrived early, throw-ing nearly 900,000 people into severe food insecurity (according to the United Nations Office for the Coordination of Humanitarian Affairs). 12 of the 23 regions have now been declared in a ‘nutritional emergency’ and the prevalence of severe acute malnutrition (SAM) has exceeded the emergency threshold by 2% in 15 regions. In a country with the sixth highest child mortality rate in the world, the first victims of this cyclical nutritional crisis are inevitably the most vulnerable: children below the age of five. In Chad, malnutrition is one of the main causes of child mortality and one child in seven dies before her or his fifth birthday (source the United Nations Office for the Coordination of Humanitarian Affairs).
©Candida Lobes / MSF
In order to combat these high mortality rates, in the nutritional feeding centre in Am Timan hospital, during their treatment patients receive special food, in order to recover their appetite and responsiveness. They’re fed with therapeutic milk containing sugar, oil, minerals and vitamins and with a high-protein peanut paste fortified with vitamins and minerals. The children admitted to this program have very low weight for their height and severe muscle wasting. They may also have nutritional oedema – characterized by swollen feet, face and limbs. The hope is that they can be discharged when they’re able to eat again, without medical assistance. 
©Candida Lobes / MSF
When they finally reach a stable level of health, MSF teams also combine medical treatments with a daily session of cognitive stimulation. Severely malnourished children may have a mental and behavioural developmental delay that, if left untreated, can become the most serious lasting consequence of malnutrition. Emotional and physical stimulation through play can significantly reduce the risk of mental deficiency and irreversible effects of prolonged malnutrition. For this reason, MSF teams organize a stimulation session every day, with mothers and children undergoing nutritional treatment, through various games. 
©Candida Lobes / MSF
“We realize, day after day, how important play and maternal care are to the recovery process. During the stimulation sessions, mothers are encouraged to play with their children with toys and to interact with them in playful activities. The results of this activity are touching. We see children re-covering their reactiveness and, above all, they smile and play again together. It’s so important to involve parents and to encourage the emotional care of children,” explains Aya Sonoda, MSF Information and Education Coordinator (IEC) in Am Timan. 
MSF, active in Chad for 37 years, has an emergency response unit (CERU) providing rapid response and delivering medical care in less than 72 hours in case of emergency. In Am Timan, in the region of Salamat, MSF supports maternity services, neonatology and the nutrition program. In Moissala, Mandoul Region, MSF runs a program for the prevention, detection and treatment of malaria among children and pregnant women. In the Eastern Logone region, MSF launched primary medical assistance activities targeting Central African refugees and the local population.
To tackle this nutritional crisis during its peak in the lean season, MSF teams are supporting three health centres in Am Timan to screen and treat malnutrition. They’ll be present until the end of October 2018 to treat malnourished patients with medical complications.
MSF also supports neonatology and maternity services for complicated deliveries in Am Timan hospital, with activities planned to continue until October 2018.