According to The Lancet Series, malnutrition contributes to nearly 50 per centof the world’s deaths among children under five. Stunting, mental and physical retardation, a weak immune system and impaired development are some of its serious consequences. Below is the experience of a mother in Bihar who raced against time to save her severely malnourished child.

Sita arrived at the Primary Health Centre (PHC) in Kiratpur in Darbhanga district around noon, embracing her nine-month-old baby boy as the sun beat down on them. Her son Karan was wailing for attention and comfort; his energy sapped from the eight-hour long journey the mother and child had endured to reach the facility supported by Doctors Without Borders/Médecins Sans Frontières (MSF). It was obvious that the boy needed urgent medical attention as he was painfully emaciated.

At the PHC, Karan was immediately examined by an MSF staff with the help of a simple band called MUAC that measures the circumference of the mid-upper arm. The band, typically used to identify children who are suffering from malnutrition, helps screen the patients for further investigation. The initial examination suggested that Karan was severely malnourished and needed specialised nutritional therapy and medical treatment.

The downward spiral

While trying to in ternalise the gravity of Karan’s situation, Sita recounted the phases of his deteriorating health. She had not imagined he would get so sick when she first observed the signs of his failing health. Sita claims Karan was born healthy and had “good” weight, but gradually started getting sick to the point where he even refused breast milk.

“Now, he doesn’t sleep well, is unable to control his motion, and is becoming weaker day by day,” she adds with concern.

Karan was first identified as malnourished by an Accredited Social Health Activist (ASHA), two months prior to his admission to the MSF-supported PHC in Kiratpur.

The ASHAs are trained by MSF so that they can quickly detect cases of malnutrition at the village level. Upon assessing Karan’s poor health, the ASHA immediately knew that the case at hand was one of acute malnutrition. She persuaded the family to take the ailing boy to the closest PHC and get his status confirmed in order to start the treatment.

Initially, Sita says she was deterred by the distance between the health centre and her village –Wardipur, which is about 12kms away. The healthcare facility near her village hardly has the means to provide basic healthcare, let alone specialised treatment for malnutrition. MSF has tried to bridge this gap in services by supporting PHCs in Biraul and neighbouring blocks, including Kiratpur, and has also established a Malnutrition Intensive Care Unit (MICU) which is attached to the pediatric ward of the Darbhanga Medical College and Hospital in the district. MICU is equipped with a team of doctors and nurses who provide specialised care and therapeutic feeding treatment to the most severely affected children.

Sita says she had prolonged her plans to get Karan treated because she did not know that he was malnourished and that the debilitating ailment needed urgent medical attention. She had thought that Karan’s condition was a passing phase in his growth, one which would wither as he became older.

Overcoming miles of obstacles

Encouraged by the ASHA who visited her home, Sita set out on her journey to seek treatment for Karan at the PHC in Kiratpur. Covering a 12 km stretch – 7 on foot through an isolated path across paddy fields, one by boat, and another 4 on foot, Sita finally reached her destination.

When the MSF nurse examined Karan and explained to Sita about her son’s condition and its life-threatening complications, she recollected noticing similar symptoms in other children in her village who, she believed, might have been malnourished too.

MSF decided to send a team to her village to look for more cases of acute malnutrition. Two of her neighbour’s children were identified as malnourished. The families were counseled to promptly bring the babies to the nearest PHC to avoid further deterioration.

“I will encourage others in my village whose children are showing similar symptoms to not wait,” Sita says after seeing this.

Determined to cure her son, she adds that she will take on the challenge of visiting the clinic with him every week.

Karan’s treatment is ongoing. Recent reports suggest that his clinical health has improved and he has gained 2.2 kgs in the past three months. His mother continues to dutifully bring him to the MSF-supported facility for weekly check-ups.

MSF works in collaboration with the State Health Society (SHS) and has been addressing the issue of Severe Acute Malnutrition since 2009.

Sita was interviewed by Rumpa Roy Mazumder