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Sheleme’s StoryMédecins Sans Frontières (MSF) 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 MSF medical staff in the stabilisation centre in Kuyera. One of the patients in a young child called Sheleme. Here is her story.
Karen, the MSF 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.
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.
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. 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 MSF 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.
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 the therapeutic paste 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 stabilisation centre tomorrow and transferred to the ambulatory feeding program. Confident, Subo eagerly awaits the green light from the medical team: “We’re ready to go home”, she says. “As soon as they authorise it, we’ll leave”.
“Sheleme and Kutuba have an appetite again. They’re drinking the milk well and eating the therapeutic paste. They don’t have any medical complications and their oedemas have completely disappeared”, explains Julie. At 10am the decision is made, “They can be transferred to ambulatory programs”. Kutuba lets a smile escape her lips while Sheleme concentrates on her therapeutic paste; she gets up and even whispers a few words to her mother. Delighted, Subo is already gathering some clothes together and a packet of covers. She makes her way to reception; behind Subo follows the string of little girls in single file. Sheleme brings up the rear of the group with her sachet in hand. Still weakened, she climbs the three steps to reception, where she and her twin sister were admitted nine days ago, with difficulty.
Sheleme and Kutuba receive two covers, a mosquito net and 56 sachets of therapeutic food. At the rate of three sachets a day for two children, this is a one-week supply. After this their mother will need to bring them to the outpatient clinic every week where they’ll have a medical consultation and receive more therapeutic food sachets. For the rest of the family, Subo brings back a ration of 14 kilos of CSB (a blend of corn and soya), sugar and oil. The next harvest won’t be for another two months - Subo and her husband will likely struggle to feed their family until then. But when the MSF 4X4 carrying the family starts out towards the greenery of Oromiya, the team at the centre know that Sheleme and Kutuba will fight their way through it, at least for a while.
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