Patient's storiesSheleme’s Story
Médecins Sans Frontières teams are currently running outreach therapeutic programs in the district of Shashemene in the Oromiya region, Ethiopia. Patients affected by severe malnutrition are being screened by Médecins Sans Frontières medical staff in the stabilisation centre in Kuyera. One of the patients in a young child called Sheleme. Here is her story.
Sunday, July 13, 2008
They’re sitting side by side on one of the blue mattresses in the Médecins Sans Frontières stabilisation centre in Kuyera in the Oromiya region. Sheleme and Kutuba are twin sisters. Their tiny four-year-old frames are dressed in identical flower-print dresses. The twins were admitted to the centre today because they’re both suffering from severe malnutrition and urgently need to be hospitalised.
Karen, the Médecins Sans Frontières doctor, examines the little girls and something jumps out at her right away: Sheleme, who is staring up at her with mournful eyes, is suffering from oedema. As a result, her legs, feet and face are bloated and swollen. She’s reached the “kwashiorkor” stage, which is evident by the swelling under her skin and indicates a severe stage of malnutrition. Kutuba isn’t suffering from these complications and she seems to be in a less serious state. All the same she also has a sad, lost, look on her face that is typical of severely malnourished children.
- © MSF
A MSF doctor examines Sheleme in the stabilisation centre in Kuyera, Oromiya region, Ethiopia.
Their mother Subo explains that this year, life has simply become too difficult. “The rains have stopped and the corn and beans didn’t grow well. The cows didn’t give any milk.” It’s become impossible for she and her farmer husband to feed their four girls and one boy.
It’s a few minutes after 4pm. At 6pm it will be time for the girls to take their first ration of F75. It consists of the lightest therapeutic milk that is given to children in “phase 1” of treatment. Sheleme will have to find her appetite now. She will have to rid herself of the oedemas that are disfiguring her face and causing her pain. The process will have to be taken little by little, step by step.
- © MSF
Sheleme's legs, feet and face are bloated and swollen - an indication of severe stages of malnutrition.
Wednesday, July 16, 2008
“The people in our village told me to come here, to the Médecins Sans Frontières clinic, because my children would get food and medication. I hope my two girls will get better quickly,” said Subo, the mother of Sheleme and Kutuba. She doesn’t seem worried. She has an air of confidence and trust that is almost overwhelming.
Nevertheless, Sheleme and Kutuba are suffering from severe malnutrition, the girls are still in danger of dying. Three days after their admission, there is still no room for optimism. In light of this, the assistant nutritionists continue to give the girls the F75 milk 8 times a day from six in the morning until 3 at night.
“Katuba is losing the oedemas on her feet, she’s healing well”, explains Julie, one of the nurses at the centre. “Since yesterday she’s been able to take F100, a therapeutic milk that is thicker than what we give in the transition stage, it’s the next step in the nutritional schedule.”
Sheleme is still in a stable condition; her gaze is continuously cast downwards. The oedemas haven’t been stamped out of her but she’s taking the F75 milk relatively well. Besides a few episodes of vomiting, she’s reacting well to the treatment. It’s impossible to imagine the little girl she was before malnutrition racked her face and body.
Along with 170 other hospitalised children at the centre, Sheleme and Kutuba can expect another night under plenty of covers and under constant medical surveillance. July nights are cold in Kuyera and children weakened by severe malnutrition must avoid hypothermia at all costs.
Friday, July 19, 2008
The damned oedemas have persisted for several days now. Yesterday at daybreak Sheleme once again refused to drink the therapeutic milk. This set off alarm bells for the doctors who thought they would have to put her on a feeding tube.
Sheleme was terrified. At the last second her mother, Subo, refused: “I told them I could do it myself, that I would make sure Sheleme drinks the milk at the scheduled times day and night.” And the hours that followed proved her right. Today Sheleme can move her head a little bit. Her oedemas have begun to disappear which has triggered a weight loss- although this seems counterproductive it’s actually normal in children with kwashiorkor: Sheleme has dropped to 10 kg from 10.5 kg.
At 2pm, when Subo brings the twins for their daily bath, Sheleme is almost able to walk on her own down the corridors of the centre. Despite the warm water provided by Médecins Sans Frontières to prevent hypothermia, Sheleme wails while her mother bathes her. Katuba quietly observes the scene and holds her twin sister’s dress until it’s over.
“Despite a few coughs, Sheleme’s recuperation is good. Like her sister, she’ll be able to start the F100 milk, a thicker milk that we give to children in the transition stage,” says the doctor named Karen, obviously delighted. This is undoubtedly an encouraging turn of events for her and all of the medical personnel; last night, two children died in the centre.
Monday, July 21, 2008
A serene calm reigns here. We’re in one of the “phase two” tents of the stabilization centre in Kuyera. The rustling of plastic Plumpy Nut bags is an indication that the children here have regained their appetite. Most of them are capable of feeding themselves the high-energy paste, a sort of peanut butter that most children find very tasty.
Sheleme and Kutuba arrived this morning. It meant transferring the little family, including their mother Subo, the twins, their little sister and the baby who is constantly suckling his mother’s breast. Here in “phase two”, the children continue taking their therapeutic milk but they also manage eating three sachets of Plumpy Nut a day.
Sheleme still has an anxious look on her face but little by little she’s taking an interest in her surroundings, looking left and right, as though she is slowly regaining consciousness. Under her eyes there are still traces of the oedemas that swelled her entire face a few days ago.
If all goes well, Sheleme and Kutuba may already be able to leave the stabilization centre tomorrow and transferred to the ambulatory feeding programme. Confident, Subo eagerly awaits the green light from the medical team: “We’re ready to go home”, she says. “As soon as they authorize it, we’ll leave”.
- © MSF
After one week of treatment, Sheleme's condition has noticeably improved.