Sheleme and Kutuba are twin four-year old sisters suffering from severe acute malnutrition and oedema. Their mother, Subo, has brought them to one of MSF's feeding centres in Kuyera in the Oromiya region of Ethiopia. Follow their stories through the diary kept by MSF staff at the centre.
Tuesday, July 22, 2008.
Subo is bustling about this morning. In a few minutes time, Julie, the MSF nurse, will finish her rounds of the beds in the large “phase 2” tents. If all goes well today Subo will be able to bring her four little girls back home to her husband and their son.
“Sheleme and Kutuba have an appetite again. They’re drinking the milk well and eating the therapeutic paste. They don’t have any medical complications and their oedemas have completely disappeared”, explains Julie. At 10am the decision is made, “They can be transferred to ambulatory programs”.
Kutuba lets a smile escape her lips while Sheleme concentrates on her sachet of “Plumpy Nut”; she gets up and even whispers a few words to her mother. Delighted, Subo is already gathering some clothes together and a packet of covers.
She makes her way to reception; behind Subo follows the string of little girls in single file. Sheleme brings up the rear of the group with her sachet in hand. Still weakened, she climbs the three steps to reception, where she and her twin sister were admitted nine days ago, with difficulty.
Sheleme and Kutuba receive two covers, a mosquito net and 56 sachets of therapeutic food. At the rate of three sachets a day for two children, this is a one-week supply. After this their mother will need to bring them to the outpatient clinic every week where they’ll have a medical consultation and receive more therapeutic food sachets. For the rest of the family, Subo brings back a ration of 14 kilos of CSB (a blend of corn and soya), sugar and oil.
The next harvest won’t be for another two months- Subo and her husband will likely struggle to feed their family until then. But when the MSF 4X4 carrying the family starts out towards the greenery of Oromiya, the team at the centre know that Sheleme and Kutuba will fight their way through it, at least for a while.
Monday, July 21, 2008
A serene calm reigns here. We’re in one of the “phase two” tents of the stabilization centre in Kuyera. The rustling of plastic Plumpy Nut bags is an indication that the children here have regained their appetite. Most of them are capable of feeding themselves the high-energy paste, a sort of peanut butter that most children find very tasty.
Sheleme and Kutuba arrived this morning. It meant transferring the little family, including their mother Subo, the twins, their little sister and the baby who is constantly suckling his mother’s breast. Here in “phase two”, the children continue taking their therapeutic milk but they also manage eating three sachets of Plumpy Nut a day.
Sheleme still has an anxious look on her face but little by little she’s taking an interest in her surroundings, looking left and right, as though she is slowly regaining consciousness. Under her eyes there are still traces of the oedemas that swelled her entire face a few days ago.
If all goes well, Sheleme and Kutuba may already be able to leave the stabilization centre tomorrow and transferred to the ambulatory feeding programme. Confident, Subo eagerly awaits the green light from the medical team: “We’re ready to go home”, she says. “As soon as they authorize it, we’ll leave”.
Friday, July 19, 2008
The damned oedemas have persisted for several days now. Yesterday at daybreak Sheleme once again refused to drink the therapeutic milk. This set off alarm bells for the doctors who thought they would have to put her on a feeding tube.
Sheleme was terrified. At the last second Subo refused: “I told them I could do it myself, that I would make sure Sheleme drinks the milk at the scheduled times day and night.” And the hours that followed proved her right. Today Sheleme can move her head a little bit. Her oedemas have begun to disappear which has triggered a weight loss - although this seems wrong it’s actually normal in children with kwashiorkor: Sheleme has dropped to 10 kg from 10.5 kg.
At 2pm, when Subo brings the twins for their daily bath, Sheleme is almost able to walk on her own down the corridors of the centre. Despite the warm water provided by MSF to prevent hypothermia, Sheleme wails while her mother bathes her. Kutuba quietly watches and holds her twin sister’s dress until it’s over.
“Despite a few coughs, Sheleme’s recuperation is good. Like her sister, she’ll be able to start the F100 milk, a thicker milk that we give to children in the transition stage,” says the doctor named Karen, obviously delighted. This is undoubtedly a necessary and encouraging turn of events for her and all of the medical personnel; last night, two children died in the centre.
Wednesday, July 16, 2008
“The people in our village told me to come here, to the MSF clinic, because my children would get food and medication. I hope my two girls will get better quickly,” said Subo, the mother of Sheleme and Kutuba. She doesn’t seem worried. She has an air of confidence and trust that is almost overwhelming, but Sheleme and Kutuba are suffering from severe malnutrition – they are still in danger of dying. In light of this, the assistant nutritionists continue to give the girls the F75 milk eight times a day from six in the morning until 3am.
Sheleme is in a stable condition, but her gaze is continuously cast downwards. The oedemas haven’t been cured but she’s taking the F75 milk relatively well. Besides a few episodes of vomiting, she’s reacting well to the treatment. It’s impossible to imagine the little girl she was before malnutrition racked her face and body.
Her sister’s progress is more encouraging. “Kutuba is losing the oedemas on her feet, she’s healing well”, explains Julie, one of the nurses at the centre. “Since yesterday she’s been able to take F100, a therapeutic milk that is thicker than what we give in the transition stage. It’s the next step in the nutritional schedule.”
Along with 170 other hospitalized children at the centre, Sheleme and Kutuba can expect another night under plenty of covers and under constant medical surveillance. July nights are cold in Kuyera and children weakened by severe malnutrition must avoid hypothermia at all costs.
Sunday, July 13, 2008
They’re sitting side by side on one of the blue mattresses in the MSF stabilization centre in Kuyera in the Oromiya region. Sheleme and Kutuba are twin sisters. Their tiny four-year-old frames are dressed in identical flower-print dresses. They have been admitted to the centre today because they’re both suffering from severe malnutrition and urgently need to be hospitalized.
Karen, an MSF doctor, examines the little girls and something jumps out at her right away: Sheleme, who is staring up at her with mournful eyes, is suffering from oedema. As a result, her legs, feet and face are bloated and swollen. She’s reached the “kwashiorkor” stage, which is evident by the swelling under her skin and indicates a severe stage of malnutrition. Kutuba isn’t suffering from these complications and she seems to be in a less serious state. All the same she also has a sad, lost, look on her face that is typical of severely malnourished children.
Their mother Subo explains that this year, life has simply become too difficult. “The rains have stopped and the corn and beans didn’t grow well. The cows didn’t give any milk.” It’s become impossible for she and her farmer husband to feed their four girls and one boy.
It’s a few minutes after 4pm. At 6pm it will be time for the girls to take their first ration of F75, therapeutic milk given to children in “phase 1” of severe malnutrition treatment. Sheleme will have to find her appetite now in order to rid herself of the oedemas that are disfiguring her face and causing her pain. The process will have to be slow; little by little, step by step.