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“We will set up as many tents as required”

Niger / 13.08.2012

Dr Pascual Caballero treats a young patient in Madaoua. © Juan-Carlos Tomasi/ MSF

Pascual Caballero is a 36-year-old paediatrician from Malaga, Spain, who is working in Madaoua, a small town in the centre of Niger. In this area, as in six other regions in the country, Médecins Sans Frontières is working to prevent and treat child malnutrition. The program has two key objectives: firstly, Médecins Sans Frontières supports several health centres which provide outpatient treatment to children suffering from severe acute malnutrition and secondly the organisation works in the Madaoua hospital where malnourished children with complications are admitted. Here Pascual shares his experiences.

What did you come across when you arrived in Madaoua?
The Madaoua hospital has very few resources and there is a very high demand for care. Most children are suffering from malnutrition. Médecins Sans Frontières is in charge of paediatrics and an intensive feeding centre for malnourished children suffering from other complications.

Describe you work for the next few months
My job is to increase the quality of the care provided by the national medical team in the hospital. Right now we have six young general practitioners from Niger who need to be able to provide care to the 300 children in the centre, 24 hours a day. We are recruiting more national doctors but it is not easy as there are not many in the country. I have to train these doctors in paediatrics, build up their technical capacities and support them when treating children while we get more staff.

What is the situation now?
An emergency is in the making as severe acute malnutrition cases and malaria cases are increasing. Currently there are 300 children admitted and unfortunately that number is on the rise. Last week, we admitted between 50 and 80 children every day. Around 35% of them were admitted to the intensive feeding centre and the rest to the paediatric ward, mostly due to malaria. We are adjusting our capacity to meet the needs. This week the logistics team set up tents where we have already put dozens of children, and we still need to set up more. We will set up as many tents as required to treat children in need.

What are the main pathologies treated?
Most children admitted to the hospital suffer from severe acute malnutrition associated with pneumonia, gastroenteritis, intestinal parasites, anaemia, skin lesions etc. On a seasonal basis we also have to deal with many bacterial meningitis cases during the dry season and malaria during the rainy season, which is starting right now.

What is the most difficult part of your work now?
Knowing that Niger is a country with very few resources and that Médecins Sans Frontières can only do so much. You as a doctor treat a child suffering from diarrhoea but then he returns home where there is no drinking water. Or the family relies on subsistence agriculture which depends on the presence or absence of rain. It is also difficult to accept that the social and economic conditions of this country make a medium and long term approach tricky. In this situation, Médecins Sans Frontières adopts a medical emergency approach, trying to address the most basic needs of most children in the area.

What are the challenges for the coming months?
Despite the difficulties, the work is paying off. The entire team strives to identify the different health problems of this population and works to resolve them. In coming weeks, we will inform the population about malaria prevention and give early treatment to patients to decrease the impact of the epidemic.Beyond that, we aim to train local doctors in paediatrics, to increase the quality of care and the access to healthcare for this population.

In Niger, Médecins Sans Frontières is currently running nutritional programs in Madaoua, Bouza, Dakoro, Guidan Roumdji, Madarounfa, Magaria and Zinder. Since the start of 2012, Médecins Sans Frontières has treated more than 49,000 malnourished children in the country.


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