Malnutrition: “It turns simple conditions into something deadly”

My name's Marc Woodman. I’m a medical doctor in the NHS, focusing on what’s known as ‘internal medicine’. I usually work at a hospital in London looking after acutely sick patients.

I’m also a doctor with MSF. I’ve recently returned from South Sudan – where I was working at a huge displacement camp of around 130,000 people, near the town of Bentiu.

I think Bentiu camp is probably one of the hardest places to live in the world. The camp was originally set up to protect civilians fleeing violence and instability. But recent crises, particularly catastrophic floods, have forced even more people to move there.

There’s a huge number of people packed into a relatively small space that’s very hot and completely surrounded by water. Sanitation is a challenge, leading to infections from waterborne diseases.

It’s a really difficult place to work, but an even more difficult place to live.

In the middle of this crisis, malnutrition is a huge issue that we see a lot of in the hospital.

New nutrients and fluids can quickly change their balance of electrolytes and make them really, really sick. This is sometimes known as refeeding syndrome.

Our team has to use special foods which need to be controlled quite precisely, and we monitor the children until they’re out of the woods.

As you can imagine, it's a very challenging thing to do in an environment without many resources. 

A mother and a bundle

This is one of those stories that I really hold onto…

A mother and her baby had been referred to our hospital, partly because she couldn’t produce any breastmilk. In fact, she was incredibly unwell – she’d clearly been sick for a really long time and was very malnourished and underweight.

She had a new diagnosis of HIV that was severely affecting her, and, from her symptoms, potentially tuberculosis (TB) as well. I have a lot of experience with HIV and this woman had one of the lowest levels of immunity I have ever seen.

I usually work as a doctor for adults, so I concentrated on getting her immediately started on treatment. But, while we were working I thought “Well, she’s got this baby… but where is it?” I couldn’t see a child anywhere in the room.

That’s when the grandmother pointed to a tiny blanket on the bed. Just a little, tiny bundle. 

Peeling it apart, there was this very small and really sick-looking baby. We quickly checked him and he only weighed 1.8 kg. In the UK, a normal birth weight is about 3.5 kg, but this little boy was already 40 days old. I called my colleagues in paediatrics who immediately swept this little one off to their ward. 

They managed to start tube feeding him, and his wonderful grandmother stayed to help look after him. I later found out from that team just how unwell the little boy was – on the brink of passing away if he hadn’t got treatment there and then.

I started popping by the ward towards the end of my shifts to see him and his grandmother. She always greeted me with a huge smile.

Within 10 days, the little boy was putting on weight well. We’d also started him on treatment for HIV. Unfortunately, his mother was still really poorly. We admitted her to our TB ward.

Eventually, she started putting on weight too, and the HIV and TB treatments took effect. After almost three months, she was finally well enough to go home and be with her little boy.