It has been many months since all of you have heard from me; many months since you have shared in my experiences at the clinic in remote Burundi. I have now returned to that clinic after a fifteen month absence. This will be my fourth year at the clinic, and, based on my first two days, I expect it to be no different than any previous year.
It’s not as if I forgot the extent and the degree of pathology one sees at the clinic. One can never forget. Yet, seeing it once again in all of its presentations is still shocking; not surprising, but shocking.
I need only be reminded of that pathology by the clinic’s malnutrition ward. The ward is more than filled to capacity, as there are presently 14 patients on the ward, but only twelve beds. That’s because two of the beds are occupied by two sets of twins. You see below a picture of the malnutrition ward. The picture does not show you the entire ward, but it does give you an idea of what the ward looks like.
The most dramatic of these twins were two girls, now almost six months of age. They each weighed 5 lb. at birth, and at 5 months of age, they each weighed 6 lb. That’s right: the twins have gained exactly one pound in the first 5 months of life. The mother attempted to breast-feed them, and she is still breast-feeding them. However, she realized at some point that her twins were not getting enough milk. Therefore, she decided to supplement them. Formula is not an option here, so, instead, she made a Burundian staple called “bouillie.” It is a sort of rudimentary Burundian porridge: not exactly the kind of stuff you want to feed your infant daughters. The bouillie did nothing to correct the situation.
The twins came into the clinic severely malnourished. That was almost a month ago, when they were five months old. There is a standard UNICEF protocol for the treatment of malnutrition, but that protocol is designed for infants greater than 6 months of age. We at the clinic modified the protocol for the twins, and, because of that modified protocol, they are doing better. The problem will come when they go home. What will happen then? Are they not destined to return here when their severe malnutrition resurfaces? The answer is somewhere between “perhaps and probably.” It’s not as if the mother’s milk supply will magically increase. We will send them home with some Plumpy-nut, the nutritional peanut paste that is the standard nutritional supplement given to all the malnourished children. Once that Plumpy-nut supply is exhausted, the plan is to give them regular milk; not the ideal alternative for a six month old, but significantly better than the “bouillie” they were getting. I show you here a picture of the now 6 month old twins, as they are today.
Then there is a three month old on the ward who is also a victim of inadequate breast milk production. He has not gained any weight in those three months, and remains at his birth weight. He too is on the modified UNICEF protocol, and is doing better. Again, the problem will arise when we send him home, as we inevitably must do. The only hope is that the mother’s milk production will increase when he goes home.
There are also a variety of older children, including this five year old who has all the signs of Kwashiokor (protein deficiency) malnutrition: the swollen face and legs, the expressionless look of complete apathy on his face. He will get better, but it will take time. This is the boy, two days after admission to the hospital.
This is my fourth year at the clinic. I now have four years of perspective. Do I see any improvement in those four years in the problem of malnutrition in Burundi? I don’t think so. The malnutrition ward continues to be filled to capacity, and often beyond capacity. I see many children in clinic ever day, and the vast majority of those children are malnourished to some degree, some severe enough to be hospitalized.
I know that there are experts, including dedicated agronomists, working on the problem of malnutrition in Burundi. I wish I could say that their efforts have been successful, but I can’t. I will be coming back here for many years. Perhaps in the years to come, I will see an improvement in the malnutrition situation. One can only hope so. Seeing one severely malnourished child is one too many. Seeing many, as I have and as I do, is an obscenity.
Before I leave you, I show you two unrelated pictures. The first is simply a cute, little boy who is the sibling of a patient in the hospital. The second is a mother taking home her newborn baby, wrapped in the traditional Burundian way. The baby is only four hours old, but that is the usual amount of time the mothers spend at the clinic after giving birth.
It’s not as if I forgot the extent and the degree of pathology one sees at the clinic. One can never forget. Yet, seeing it once again in all of its presentations is still shocking; not surprising, but shocking.
I need only be reminded of that pathology by the clinic’s malnutrition ward. The ward is more than filled to capacity, as there are presently 14 patients on the ward, but only twelve beds. That’s because two of the beds are occupied by two sets of twins. You see below a picture of the malnutrition ward. The picture does not show you the entire ward, but it does give you an idea of what the ward looks like.
The most dramatic of these twins were two girls, now almost six months of age. They each weighed 5 lb. at birth, and at 5 months of age, they each weighed 6 lb. That’s right: the twins have gained exactly one pound in the first 5 months of life. The mother attempted to breast-feed them, and she is still breast-feeding them. However, she realized at some point that her twins were not getting enough milk. Therefore, she decided to supplement them. Formula is not an option here, so, instead, she made a Burundian staple called “bouillie.” It is a sort of rudimentary Burundian porridge: not exactly the kind of stuff you want to feed your infant daughters. The bouillie did nothing to correct the situation.
The twins came into the clinic severely malnourished. That was almost a month ago, when they were five months old. There is a standard UNICEF protocol for the treatment of malnutrition, but that protocol is designed for infants greater than 6 months of age. We at the clinic modified the protocol for the twins, and, because of that modified protocol, they are doing better. The problem will come when they go home. What will happen then? Are they not destined to return here when their severe malnutrition resurfaces? The answer is somewhere between “perhaps and probably.” It’s not as if the mother’s milk supply will magically increase. We will send them home with some Plumpy-nut, the nutritional peanut paste that is the standard nutritional supplement given to all the malnourished children. Once that Plumpy-nut supply is exhausted, the plan is to give them regular milk; not the ideal alternative for a six month old, but significantly better than the “bouillie” they were getting. I show you here a picture of the now 6 month old twins, as they are today.
Then there is a three month old on the ward who is also a victim of inadequate breast milk production. He has not gained any weight in those three months, and remains at his birth weight. He too is on the modified UNICEF protocol, and is doing better. Again, the problem will arise when we send him home, as we inevitably must do. The only hope is that the mother’s milk production will increase when he goes home.
There are also a variety of older children, including this five year old who has all the signs of Kwashiokor (protein deficiency) malnutrition: the swollen face and legs, the expressionless look of complete apathy on his face. He will get better, but it will take time. This is the boy, two days after admission to the hospital.
This is my fourth year at the clinic. I now have four years of perspective. Do I see any improvement in those four years in the problem of malnutrition in Burundi? I don’t think so. The malnutrition ward continues to be filled to capacity, and often beyond capacity. I see many children in clinic ever day, and the vast majority of those children are malnourished to some degree, some severe enough to be hospitalized.
I know that there are experts, including dedicated agronomists, working on the problem of malnutrition in Burundi. I wish I could say that their efforts have been successful, but I can’t. I will be coming back here for many years. Perhaps in the years to come, I will see an improvement in the malnutrition situation. One can only hope so. Seeing one severely malnourished child is one too many. Seeing many, as I have and as I do, is an obscenity.
Before I leave you, I show you two unrelated pictures. The first is simply a cute, little boy who is the sibling of a patient in the hospital. The second is a mother taking home her newborn baby, wrapped in the traditional Burundian way. The baby is only four hours old, but that is the usual amount of time the mothers spend at the clinic after giving birth.
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