In Magaria, a town in Niger just steps away from the border with Nigeria, the hospital’s intensive therapeutic feeding centre (ITFC) is nearly overloaded: 240 children are hospitalised there. “Treating such a large number of children, who often arrive in a desperate state, is an almost impossible task under good conditions,” says Dr. Claude Ngobe, Médecins Sans Frontières medical coordinator for Niger. “We have to step up the early detection of malnourished children so that we can prevent admitting so many to the hospital.”
In one of the district’s health zones, Médecins Sans Frontières is working closely with the community to prevent the disastrous consequences of malnutrition in young children.
Magaria – Village of Bakadougou.
Yaou Dodo, the young leader of the village of Bakadougou, welcomes the Médecins Sans Frontières team to his village this morning. He hurriedly sets out a few mats from the nearby mosque and invites Amadou Roufai, the Nigerien supervisor of the community project, and Renata Oliveira Silva, a Médecins Sans Frontières nurse from Brazil, to sit down in the shade of a mango tree. Soon a crowd of children, along with mostly older men and women, gather around the group.
The small Médecins Sans Frontières team had left Magaria Town early that morning. Before heading to Bakadougou, they stopped first in Dan Tchiao, the largest village in the health zone, to deliver several boxes of “plumpy nut” to the ambulatory therapeutic feeding centre. The first two rains of the year still had not succeeded in making the sandy road impassable, and the all-terrain vehicle easily manoeuvred between the clusters of round huts belonging to the pastoral Peul people. Across the region, these huts signal the nearby villages of Hausa farmers. Bakadougou is one of 85 villages in the Dan Tchiao health zone, which is home to nearly 55,000 people.
“Everyone must know that treatment is free”
This visit is important. The team must determine if any children in the village are malnourished. To do this we will go to the health post where, we are told, they are waiting for the Médecins Sans Frontières team.
First, however, the team takes advantage of the meeting with the villagers to recruit community workers. “You will be responsible for warning mothers when one of their children shows signs of malnutrition,” explains Amadou Roufai to the candidates, two young men and one woman. “You will see to it that mothers go to the health post. Everyone must know that treatment there is free for children under five, and mothers will be able to find medicines there.” Médecins Sans Frontières is committed to ensuring the supply of essential medicines to all health care facilities in the zone where it is working.
Theoretically, medical care in Niger is free for children under five. However, there are many difficulties faced in the provision of this care, including the lack of trained and paid health workers, the lack of medicines, etc. In this region of Niger, the underutilisation of health services poses serious problems. A recent study revealed that out of every ten young children under five who die, eight die at home. One out of three children had never been brought to a clinic.
There is no doubt that Médecins Sans Frontières’ ability to make free medicines available will be one of the keys to the project’s success, even if it will come at considerable cost. “While it’s important to persuade mothers to come to the health post, they have to find solutions to their problems there, and that means having trained workers and medicines. Otherwise, they’ll get discouraged,” explains Renata. “We’re going to be able to demonstrate the effectiveness of these measures,” she adds.
The Granaries Are Empty
A time is arranged for a training session with the future community workers at Dan Tchiao. Everyone heads for the health post. It is a small, two-room building that Médecins Sans Frontières has just renovated. It is located on the edge of the village, and we have to step over shoots of millet that are beginning to turn green after the first rains reached them. “It’s just the basics, but at least a nurse is here,” exclaims Renata, who is happy to see Aichatou, the post’s nurse.
Two feverish children were brought in by their mother. One of them is already very malnourished. The young mother explains that in their village, a few kilometres away, the granaries are empty. The men have only just returned from Nigeria where they had been working since the last meagre harvest. Now they are in the fields, and it will be September before the next ears of millet and sorghum mature. While the rains of July and August are regular, a ‘tia’ of millet, approximately 2.5 kg, costs nearly one euro, and any earnings the men brought back from Nigeria are quickly drained.
“This child has to be admitted to the feeding program at Dan Tchiao today,” says Renata. “If we don’t take him, either he will have to be hospitalised in Magaria, or he could die. We have to persuade the mother.” The medicines that the team have will be enough for the other child. The mother agrees rather easily to climb into the truck with her young child and his older brother. The team heads for a second village. Another team of community workers will be recruited, and perhaps one or two other mothers will be persuaded to take their children to the feeding centre.
Working with the community works
The team returns to Magaria in the early afternoon under the driving rain, “the third of the year,” says Amadou. In one village, a severely malnourished child had to be rushed to the hospital’s intensive feeding centre. Along the way, two children, including the one from Bakadougou, were dropped at the Dan Tchiao Integrated Health Centre to be treated in its ATFC. “Of the 7,000 children under five in this health zone, we expect nearly 800 of them to be affected by malnutrition during the time between harvests,” states Renata. As for how many of them will end up at the ITFC in Magaria anyway, Renata optimistically replies: “With our work in the villages, there will certainly be fewer this year. You’ll see. Working with the community works. I’ve seen it before at home in Amazonia. Why not now in Niger!”
In the meantime, hurried along by heavy rains that will affect travelling around the area, the project has reached cruising speed. The community workers, nearly one hundred of them, are now almost all trained. The ITFC in Magaria has seen, in recent days, more children arrive from health zones other than Dan Tchiao. A very encouraging sign for the community team.
More on Niger
An interview with Dr. Marie-Pierre Allié of MSF on the malnutrition situation in Niger
Video on MSF's work on malnutrition in Niger, July 2010
News on MSF's response to a recurring nutritional crisis