"They were like threads"

Reversing acute child malnutrition in Haiti

On the steep rocky path to Degrave, Haiti, pieces of old asphalt collected from a road demolition project many years ago act as makeshift cobblestones.

Like the road to Degrave, families in this poor, rural community in Haiti are skilled at piecing together a life from the difficult realities that surround them: political instability, economic stagnation, rising food prices, declining agricultural yields, lack of government services and infrastructure, and vulnerability to natural disasters like hurricanes and earthquakes.

As I walk this path to one of the weekly child malnutrition clinics MCC runs in this area, the nurses tell me about the two children they want me to meet: nearly three-year-old twins, Gabina and Gabison Ossinel.

 “They were like threads,” MCC nurse Marius Kerline says, pulling her thumb over her index finger to make an impossibly small representation of how thin their arms were when she first met them. “They were two and a half, but they could not walk. They could not hold their plates up themselves to eat. They were so weak and sick, they could not control their defecation. I really thought we might lose them.”

Louis Vesta and her 14-month-old daughter Wilda Owasen are participants in MCC’s mobile child malnutrition clinic in Degrave, Haiti.

Mentally I prepare myself for what I imagine I will see. Seeing children suffering does not get easier. I struggle not to think about my own daughter, a similar age, living just a couple hours away in Haiti’s capital city of Port-au-Prince.

Under the hot tin roof of the school turned clinic, women and children gather to meet with the team of Haitian nurses MCC has hired. Each patient’s chart is reviewed carefully. The children are weighed, measured, and examined for progress.

Severe acute malnutrition brings a nearly 20 per cent chance of death for young children who are not treated. For those who survive, life-long consequences can include poor brain development and intellectual disabilities, heart damage, metabolic disorders, autoimmune disorders and physical stunting.

In the Haitian context, for the poorest families in remote villages, accessing hospital-based treatment is extremely difficult. It usually requires several months’ wages just to cover transport, supplies, food and missed work even if the treatment itself is free.

Teius Rosemary and her 10-month-old daughter Augai Sauris, successful participants in MCC’s mobile child malnutrition clinic in Degrave, Haiti.

The nurses evaluating the children are comparing their weight, arm circumference, and height against both their last measurements and international standards for malnutrition. Children who are failing to make progress or getting worse are referred to a hospital for more intensive treatment. If they are stalling in progress or have other symptoms (like diarrhea), the nurses act quickly to get them back on track, administering antibiotics, an anti-parasitical or other medication as required.

Meanwhile, parents are taught how to help their children recover and stay healthy. They learn about maximizing nutrition on their meager earnings, how to avoid getting sick, and how to keep food and water clean. After each visit, parents are sent home with a nutritionally enriched food supplement for their children, made primarily from peanut butter. The nurses follow up weekly with every child, sometimes in these group clinics and sometimes house to house.

As I talk with one of the mothers, a small girl sits down beside me and giggles. “This is Gabina,” her mother says with a smile. “Doesn’t she look strong?”

Gabina Ossinel having her arm circumference measured by an MCC staff nurse to track progress. Ossinel and her brother are both successful participants in MCC’s mobile child malnutrition clinic in Degrave, Haiti.

I remember from reviewing the charts before we left that only four months ago, Gabina weighed just shy of 12 pounds. For a child her age, that’s literally off the bottom of the growth chart. Her thin arms put her in the severe acute malnutrition category, and given her extremely short stature at the time, it seemed likely that she would be permanently stunted.

Today, Gabina is back on track, having quickly responded to treatment. She is healthy, strong, and curious. Her mother, Bertha Louisius, laughs as she describes the relief and gratitude she feels every time she sees her twins now. “They were so small, they were so sick. I didn’t know what to do. I had no money, and nothing I was doing worked. I thought they might die, but I didn’t know what I could do. I had given their fate to God when I met these nurses.”

MCC staff nurses Exaus Andrène, Adeline Sainvilus, and Marius Kerline are the lead staff running MCC’s mobile child malnutrition clinic in remote mountain communities in the Artibonite Department of central Haiti.

The nurses Louisius is describing, Exaus Andrène, Adeline Sainvilus, and Marius Kerline, are part of a pilot project MCC is running in the mountains of the Artibonite that uses MCC’s wide network of kids’ clubs and farmers’ groups to efficiently identify at-risk families.

The nurses evaluate children in these families and enroll children with severe and moderate acute malnutrition for three months of intensive support, followed by at least a year of follow-up. The pilot project is on track to help 160 children this year, and the results have been impressive. So far, 98 per cent of children have fully recovered at home through the project; only two per cent have had to be referred to a hospital for inpatient care.

MCC staff nurse Adline Sainrilus explains why she proposed this pilot project last year. “These are children in our own community that are suffering, and their families are powerless to help them. They are too poor, and they don’t know what will help their children recover. As Christians we can’t stand by and watch these children get sick and die when we know that we could help, when we know how little it takes to help. As a nurse I know how to help, and now I can. I praise God each day for that.”

Paul Shetler Fast is serving as MCC’s Global Health Coordinator and is based in Port-au-Prince Haiti.