Nutritional Emergency

When I first heard of the mission here and the phrase 'nutritional emergency', I cynically thought it another phrase like IDP (internally displaced person) which has largely replaced 'refugee'. An IDP is a refugee in in their own country, whereas a 'real' refugee finds themselves displaced into another country. Either way they are refugees to the layperson. So a nutritional emergency must be a famine I thought, not enough to eat, so supply some food, then head for home for a spa.

It turns out though that it is not quite that simple. Here in this south western mountain area of the country the fields are full of crops and things appear fertile and productive. But unfortunately the subsistence living in the area is always so close to the edge that even a small loss of harvest due to too little rain, or too much rain will result in a small shortage of food. Not really noticeable in the general population, but first detected by surveying the under five year old children.

With a simple arm band measuring tape called a MUAC (mean upper arm circumference) it is possible to screen lots of children in a day and separate out the really sick ones (reds), the undernourished (orange), the underweight (yellow) and the ok (green). Generally the reds need to be admitted into a clinic for special care (called the stabilisation centre), the orange into a weekly feeding program, and the others have to keep fending for themselves. Its actually a little more complex as actual admission also counts on a weight and height measure, and also the presence of oedema, which is the build up of fluid causing a type of swelling, but you get the idea.

Here then there is a large number of red and oranges, generally thought to be due to some sort of crop failure this year. Not a famine, but certainly some nutritional deficiency, which in time could turn into an emergency. So we riding in here on white horses, well, white land cruisers, to set up a stabilisation centre (SC) and feeding program (OTP – outpatient treatment program). After a week here we now have the land area sorted out for the SC and some buildings under repair and construction, a place to stay sorted out behind the health centre in a half finished building, and the OTP program under way.

Another interesting thing about severe malnutrition is that simply feeding the kids up with some food does not actually have much of an effect. The human body needs certain trace elements, vitamins and minerals that keep everything functionally correctly. If these run out, or simply run low, then the internal organs all start shutting down and malfunctioning. A revolution in the treatment came therefore with the invention of RTU (ready to use) therapeutic foods containing not only lots of calories, but also a mix of all the necessary vitamins and minerals for good health. They don't need cooking, have a very long shelf life, and can be transported and distributed easily.

The number one product is called plumpynut and comes is a little red and silver foil 100g packet. I've actually got several thousand of them sitting in a tent behind me now. It tastes like peanut butter mixed with milk powder and the kids chow down on it (so will I if I get hungry). There is also F100, which is milk powder with additives for infants that can't digest plumpynut yet, and F75 if even that is too much. Then there is also famix (also called unimix or CSB), which is a special mix of grains, vitamins, soy and other goodies. It is supplied as a 5kg ration along with vegetable oil to the family of malnourished children so that don't eat the plumpynut.

Well, that's the background. Now the trick is just to get all this fancy food, along with some drugs for all the common childhood aliments, in very large quantities (think tons), along with the trained staff to distribute it, to several outlying villages, all around here at about 2000m, with washed out bridges, rough muddy roads, and no fuel.

I think this calls for a second cup of tea...