KONIO COMMUNITY, Mali (May 7, 2012) — The young man’s face remains somber as he speaks, "Sometimes people misunderstand my expression. I don’t show emotion when I see a very sick child—but it hurts me here," he says, touching his heart. Adama Diarra, a trained nurse in charge of the Konio Community Health Center, in southeast Mali, is explaining his philosophy. He swipes the flat of his hand across his eyes and continues, "I do this job because of my belief. I want to take care of my fellow humans—and I am truly happy when I see someone healed."
The light begins to fade in the cluttered, dusty room used for consultations: another long day is drawing to a close for Adama and his team of assistants and Community Health Workers. They are committed people but working conditions are not good.
Many of Mali’s Community Health Centers, like Konio, are run-down. There are not enough Community Health Centers in relation to the vast country. Because of long distances, deliveries of equipment and supplies often get delayed. It is very difficult for the already poor population to make the expensive journey for a consultation; sometimes they try herbal remedies and then come when they or their children are very ill. For health staff, outreach visits to villages more than 7 miles from the health centers for routine vaccinations and campaigns for polio eradication mean long and tiring days.
And now health center staff are under extra pressure to deliver scaled-up health and nutrition services in Mali’s currently very difficult situation. Before the recent coup and rebel takeover of the North the country was already heading for a nutrition crisis in 2012, due to a combination of last year’s drought and failed harvests. Food prices, rising to three times former levels, have made feeding a family a desperate struggle. It is hard to predict the precise impact of the escalating military, political and economic tensions—but it is likely that the poor, whose income from crops and fishing is dwindling to zero, will be even harder hit.
Konio is a village 10 miles off the tarmac road with mud brick huts widely scattered over a barren earth expanse. The Community Health Center serves nearly 14,000 people living here and in nine surrounding villages. It is one of 16 centers across a huge region centered on the town of Djenne. Adama, 35, has been here 2 months, moving his wife and two small children from another post. “I got so tired in the first days, one mother with a sick baby came late in the evening and found me asleep over there,’’ he says, pointing to a wooden bench under a shade tree.
Added to the fatigue is the underlying worry. In a country, which, in 2011, ranked 175th out of 182 countries on the Human Development Index, the crushing effect of poverty is always at the forefront of the mind. Subsistence farming and fishing are what sustain people in the areas surrounding Konio. “These days, most of these mothers have problems in feeding their children correctly, many are undernourished themselves’’ Adama says, indicating the growing line of murmuring women, most with babies strapped to their backs, assembling in the courtyard.
In response to the nutrition crisis, thanks to UNICEF’s expertise and support, the Government has put nutrition on the development agenda and is working with partners to prevent and treat malnutrition among children under five years old and women.
Adama’s routine is frequently interrupted as new cases are ushered in. “The numbers are building every day; we are so stretched,’’ he explains. Many of the mothers pull a ticket from the folds of their bright-coloured boubou dresses as the consultation begins. They received the tickets from the Community Health Worker who identified their children as malnourished during routine measuring sessions in their villages. In general, they would have to pay a consultation fee—a financial barrier. However, the ticket entitles them to free treatment. They will not have to pay for therapeutic ready-to-use food (RUTF) and routine medicines.
For moderately malnourished children there’s a fortified corn soya blend flour (CSB), donated by the World Food Program, which can be mixed up as porridge. Given regularly, this augments the diet and prevents a child slipping into the worrying severe acute malnutrition (SAM) stage.
For babies like Fatoumata, who is 2 years old but tiny for her age, malnutrition has taken two forms: both acute malnutrition (wasting) and chronic malnutrition (stunting). Stunting, which can retard both physical and mental development, is a serious problem in Mali, affecting 27.1% of children under 5 years old. Fatoumata, after being registered, weighed and measured is prescribed the UNICEF-donated RUTF, Plumpy’nut. Malnourished children who eat this nutritious paste (one to two packets a day according to age and size) will start to put weight back on rapidly. Mothers are encouraged to breastfeed at the same time.
The baby is fractious, crying and stretching out her tiny arms. Fatoumata’s mother, whose name is also Fatoumata, is not in good shape either. Her face is pale and exhausted. She is breastfeeding and today has had no breakfast. “Many families have cut back on meals because they simply have no resources left,’’ Adama explains, “I tell them to go eat before they leave for the journey home.” Around the back of the consultation room women are cooking and dishing out rice with sauce. One of the women explains that Adama himself covers the cost of the food.
Visiting the sparsely furnished home where his family lives, it is obvious that Adama is not a rich man. He plays with his son, Menasse Jacques, 2, and says, “When we married I told my wife I did not want to own a lot of things. I want us to be ready to move where I’m needed at any time.’’ He speaks of his “vision’’ for the Community Health Center to function better, saying, “I can make that happen if I get the proper support,” and he muses about working as a doctor in emergencies with an agency such as Médecins Sans Frontières. First he needs to complete the medical studies that were interrupted after three years when he ran out of the cash to fund them.
A new protocol being rolled out all over Mali will help dedicated, overstretched health center staff like Adama and his team cope with the unfolding nutrition crisis. UNICEF, as the lead agency for nutrition, provides support to the government in the coordination of the nutrition response including stockpiling and delivering therapeutic ready-to-use food. Adama acknowledges how the training will help his team. He recognizes too that, as the therapeutic measures are increasingly seen to be effective, the numbers of malnutrition cases will inevitably increase. There can be no let-up until the drought breaks and peace is restored. Adama is seemingly undeterred. "I’m not tired," he claims, ’"I’m ready to continue—and this is a challenge we are going to master.’’