KWASHIORKOR

KWASHIORKOR

Last week, when visiting a nearby community that had been severely impacted by the recent floods, we came upon a child with a serious case of Kwashiorkor, a common nutritional problem caused by a serious lack of proteins.  The effects of Kwashiorkor are as bad as the word sounds.  These are the children with the distended bellies.  Edema swells up their legs and arms and even their faces.  Skin rashes often cover the body.  Left untreated, this nutritional deficit can cause damage to the immune system, mental and physical disorders, coma, shock and death. 

The mother had come to our clinic with two other children, suffering with malaria.  She mentioned having another child at home that also needed care.  She did not share any information about the symptoms or severity.  She disappeared into the crowd after being given the malaria medication for the children. 

Once we had distributed all of our medicine and packed up our remaining supplies, we made our way back to the center of the village.  There almost everyone was gathered under the large mango tree, sitting in the dirt.  Children ran about playing with sticks and the refuse from our consults; scraps of paper, a few empty boxes and small round pieces of plastic that had encased the syringes.  The men were off to one side, sitting on what looked like handmade wooden bleachers.

In the distance, I saw this same woman arrive on the back of a bicycle with a fairly large child on her lap.  She placed the child on the ground and repeatedly tried to pull the girl’s t-shirt over her belly.  They made their way towards us, the child walking as if she had prosthetic legs.  It wasn’t until they were in front of us that I saw the suffering of this child.  I have witnessed Kwashiorkor before, and probably cases as serious, or even more serious, than this one.  Yet, this was the child in front of me here and now.  Having experienced this before seemed not to matter.  It was this child who mattered.

We asked questions about the child’s diet and food habits.  We inquired about other illnesses and symptoms.  Had the child had an HIV test?  The parents?  Often the body is unable to absorb nutrients if it is battling with another disease.  We asked if any medical assistance had been attempted.  What about a father or husband?  The woman pointed towards the crowd of men.  His wife went to him to request that he join the consult.  When asked why this child hadn’t been brought to the hospital, he said that he had been away, working at the garden, and was unaware of the problem.  When he returned, due to the flooding, the roads were inaccessible.

It is so easy to allow one’s anger to quickly place blame.  My mind instantly raced with accusations. “How had the mother allowed this child to become so sick?  Why had the neighbors and others in the community stood by silently?  How can it be that compassion is so absent in this place?”  But, of course, it is never that simple.  There are many layers to understand, and being an outsider, unraveling the threads that are the details, the ethos, the challenges, and the beliefs, well, that is a complex process.

Women in rural Africa expect some of their children to become sick and die.   Should they choose to use a local healer, and see little to no results, they accept that the illness is not curable.  Or, if they seek medical attention, often at a late stage, it is likely that they will not follow the suggested regime.  This is so for many reasons, culturally and logistically.  Possibly the medicines initially make the child sicker.  Maybe they do not have the foods that the medical technician suggests, or that the foods suggested are simply not accessible or customary.  The hours of giving the prescribed medicine might be forgotten or not in sync with the daily schedule.  If parents are in the fields all day, they may not take the medicines with them.  Maybe there isn’t a sufficient supply of water, or clean water.  The list of challenges is a long one. 

A mother might seek medical attention at a local clinic, and possibly more than once.  Often, the help is too little too late.  The result is that there is doubt in the medical system.  And, if a sick person is sent to the district hospital, usually as a last resort, the person often dies while admitted.  This family, and their neighbors, aren’t apt to use the local clinics and hospital again.  But, none of this means that the parents are uncaring.  There is simply a way of life here, maybe even a value of life here, that is different.  It exhibits itself as acceptance, almost non-chalance.  For generations of people who have not had the resources, or the power or position, usually resulting from a lack of education, a way of life is developed... and perpetuated.   It is a tough cycle to break.

Many women are left in the village, without the support of their husbands or fathers of the children.  There is often no money. Literally, a woman may have no money.  Women and children survive by eating the food from their gardens.  Some families get donations.  If a woman could gather the few coins to hire a bicycle taxi, or get a ride from one of the scarce vehicles passing through these rural places, there is the question of who will care for the other children while the mother is away.  

If a person is admitted to the hospital a family member must accompany them to provide care.  There are no bed railings, or cribs for small children or babies, no laundry care (there are no sheets on the rubber mattresses), and no staff to attend to patients during the evening hours.  The hospital staff do not give baths or feed patients.  It is the responsibility of the family member, who sleeps in, or under, the bed of the patient.

And, the hospital staff have their challenges as well.  Most hospitals do not have running water.  Large rubber buckets of water stand in the corner of most rooms.  There is no air conditioning and often the ceiling fans do not work.  Furniture is old and rusty and usually broken.  Due to the dust and dirt, it is difficult to keep the hospital clean.  There is never enough supplies like paper and pens. And there are crowds of patients needing care each day.

What is possible to us, as Americans, doesn’t exist here. 

Our framework and context to address problems is useless in these places.  What might seem simple and straightforward is actually complex and complicated, murky, at best.

We had another child, from the same village, admitted with Kwashiokor the week before.  In a matter of days, the swelling in the little girl’s arms and legs had noticeably improved.  Her face had been so swollen that she was unable to open her eyes. Her body was expelling the fluids, and she was losing weight appropriately.  Her diet is therapeutic milk, given every three hours.  It will be some time before other foods can be introduced to her diet.  She has also recovered from severe malaria.  She is improving, slowly, but surely.

There is hope for these cases.  Each day I check the ward to see if the other child from this village has been admitted.  I haven’t seen her yet.  Maybe her parents could only take her to the local clinic and not make their way to our district hospital.  If not, maybe when we go out there again next week we will convince the parents to return with us in the ambulance.  I can only hope.  Meanwhile, I know that I can’t always understand the life here.  But, I can surely feel the struggle.

--------------------------------------------------------------------------

Note:  I did not take any photos of these children or their families.  If you would like to learn more about Kwashiorkor, there is plenty of information and photos available by a simple Google search.