Niger︰Interview with MSF paediatrician

Pascual Caballero is a 36-year-old paediatrician from Malaga that has just landed in Madaoua, a small town in the centre of Niger. In this area, as on other six across the country, MSF is working to prevent and treat child malnutrition. The programme has a two-fold objective. On the one hand, MSF supports several health centres in the district where outpatient treatment to children suffering from severe acute malnutrition is offered and on the other hand the organisation works in the Madaoua hospital where malnourished children suffering from complications are admitted. Since July 5th, the Madaoua hospital has become a second house for Pascual. He is sharing here his experience with us. 

What did you come across when you arrived in Madaoua?
A national hospital with few resources where MSF is in charge of paediatrics and an intensive feeding centre for malnourished children suffering from some other complications admitted due to their fragile condition. I came across very high demand for care and most children suffering from malnutrition.

Describe you work for the next coming months
My job is to increase the quality of the care provided by the national medical team in the hospital. Right now we have six young general practitioners from Niger that need to cover all the shifts to be able to provide care to the 300 children admitted 24 hours a day. We are recruiting more national doctors but it is not easy as there are not many in the country. I have to train these doctors in paediatrics, build up their technical capacities and support them when treating children while we get more staff.

What is the situation now?
An emergency is in the making as severe acute malnutrition cases as well as malaria cases are increasing. Currently there are 300 children admitted and unfortunately the number is on the rise. Last week, we admitted between 50 and 80 children every day. Around 35% of them were admitted in the intensive feeding centre and the rest, in the paediatric ward, most of them due to malaria. For this reason, we are adjusting our capacity to the needs. This week the logistical team set up the tents where we have already put dozens of children and we still need to set up more. We will set up as many tents as needed to treat children in need.

What are the main pathologies treated?
Most children admitted at the hospital suffer from severe acute malnutrition associated with pneumonia, gastroenteritis, intestinal parasites, anaemia, skin lesions... Moreover on a seasonal basis we also have to deal with many bacterial meningitis cases during the dry season and malaria during the rainy season starting right now.

What is the most difficult part of your work now?
Knowing that Niger is a country with very few resources and that MSF has a limited action capacity. You as a doctor treat a child suffering from diarrhoea but then he returns home and there is no drinking water available. Or the family depends on subsistence agriculture related with the presence or absence of rain. Accepting that the social and economic conditions in this country make a mid and long term approach difficult. In this state of affairs, MSF adopts a medical emergency approach trying to address the most basic needs of most of the children in the area. 

What are the challenges for the coming months?
Despite difficulties are there, the work is paying off. The entire team strives to identify the different health problems of this population and work to resolve them. In the coming weeks, we are going to inform the population about malaria prevention and give early treatment to patients in order to decrease the impact of the epidemic. And in the long term, to train local doctors in the paediatric knowledge, to increase the quality of care and the access to the health care for this population.

In Niger, MSF is currently running nutritional programs in Madaoua, Bouza, Dakoro, Guidan Roumdji, Madarounfa, Magaria and Zinder. Since the start of 2012, MSF has treated more than 49,000 malnourished children in the country.