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Sydney nurse in southern Niger
Sydney nurse Matthew Cleary, writes from Tibiri in southern Niger about his new post as field coordinator for a large and expanded nutritional rehabilitation project, via outpatient management. Matthew has completed two previous missions with MSF to Darfur, Sudan. Well it has been about seven weeks since I arrived in Niger. The first three weeks here I started working as the nurse supervisor in the hospitalisation department of the programme in Tibiri, but when the field coordinator became sick and was sent back to Paris, I was asked to take her place. So now I am looking after five international staff, 320 national staff over five different locations; life got busy which is good as the first three weeks were quite painfully slow. The program here is very big, since 2001 MSF has been working in Niger doing small scale emergency interventions such as a meningitis outbreak or a measles outbreak, but in August 2005 they noticed a sudden rise in the number of children with severe malnutrition and hence commenced a very large scale intervention which is still occurring today. The main indicator used is under 5 (years of age) mortality. Usually 0.5 children per 10,000 dying per day is considered an emergency; last year it was 2.2 children per 10,000. And hence we started the intervention. A new study will be conducted next month to reassess what is the mortality now. Because of the large volume of children coming to our door MSF last year changed the way they treated malnutrition. In the past all children with severe malnutrition were hospitalised but now they have found that in fact, only the children who are sick with other problems or have no appetite, need to be hospitalised. So we use a RUTF (ready-to-use-therapeutic-food) product called Plumpy’nut, which is a sachet of peanut paste high in nutrients and very high in calories and hence great for weight-gain. So at admissions we test the child’s appetite with Plumpy’nut and examine the child for other problems such as malaria, chest infection, diarrhoea; and if the child is not very sick and can eat they are transferred to our external(outpatient)programmes. So what we have is 5 external sites and one internal site for the truly sick. So in the past 100% of the children were hospitalised and now only 20%, which also means the children can stay at home with all the family and hence the success rate is also higher, as here in Africa it is quiet common for the mother to take their child out of the programme because the mother needs to return to the village to look after the rest of the family. Life here is Niger is very different to my last mission in Darfur (Sudan). Firstly, it is a peaceful country, and secondly, according to the UN, Niger is the poorest country in the world and hence they are not too many resources available to the population and hence the reason Médecins Sans Frontières is here. The interesting thing for me is that the worst area in Niger for malnutrition is where I am working, but in fact, it is also the region that produces the most food. What we have is the businessman of Niger working in the area buying all the food after harvest at very low rates, keeping all the food in warehouses until later in the year when they can sell it back to the people at much higher rates than what they bought it for. So in fact, the problem is not lack of food but again, a lack of support of the people. The people here are lovely and very welcoming. My French is slowly improving and having this new position has made me learn faster as not many of the staff can speak English.
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