"Today was energising, really useful and strangely humbling all at the same time."

Very occasionally I get to do something a little different from my usual work at the CRENI. My brief today was to spend the day visiting a number of our CRENA’s . I‘ve already explained some of what we do at the CRENI and so I guess I’d better give an idea of what goes on in our CRENA’s.

Essentially these facilities are a network of ambulatory malnutrition centres where the children are moderately to severely malnourished but without any significant associated medical problems such as severe malaria, acute or chronic diarrheal illnesses or pneumonia - problems that can both primarily cause the malnutrition or can be the factor that tips the child from undernourished into dangerously malnourished, sometimes within just a few days.  These problems make both the malnutrition and the illness itself much more complicated to treat and leave kids in such dire straits that they end up in our CRENI where we can provide the level of monitoring and care required.


The mums sometimes walk up to 10-15km each way to reach the CRENA for their kids’ weekly nutritional assessment where they are also treated for more straightforward medical problems and receive certain routine vaccinations. Most importantly for these mothers (mums bear the lion’s share of responsibility for putting food in bellies and looking after all the health care needs of the family; it is extremely rare to see a dad at any of our facilities and so all you 21st century multi-tasking Irish dads out there, take a bow!) we also give each child a sufficient supply of ‘Plumpy Nut’ until their next assessment. ‘Plumpy Nut’ is actually incredibly tasty and is a complete food for severely malnourished kids containing every micronutrient these children might need to ensure a proper and sustained recovery .

Plumpy Nut is so highly valued by the local people that if a family’s circumstances are particularly difficult, rather than give all the sachets to their malnourished infant, they’ll sell a portion in the local market so that the infant’s hungry brothers and sisters will have something in their bellies at least a few days a week. ‘Street wisdom’ around here points to this as the probable reason why certain infants attending the CRENA take much longer than average to gain their target weight.  It’s hard to argue with this type of ‘resourcefulness’ in this resource-starved setting. Faced with the same set of demands every Irish parent I know would surely do the same.

Actually the more time I spend in these environments, the more I’m afflicted by certain powerful truths about the human condition. One such truth is to realise that people the world over are very much the same, apart from our obvious but usually quiet superficial cultural idiosyncrasies. As human beings we have the same basic needs and wants: food in our bellies, water sufficient to drink, a little of same to wash and somewhere to call home and shelter love ones.

It’s the daily effort to answer the call of these imperatives that dictates the great portion of all human behaviour and, in searching for them, we all behave in essentially the same way. The same things make us laugh and cry and given a chance at all we have the much the same desires and dreams for both ourselves and those close to us.  So the malevolent efforts of many to separate us on the basis of skin colour, creed and all the rest seem, in the brilliantly clear light cast by this Saharan winter sun utterly misguided and confused .( Admittedly winter, sun and Sahara in the same sentence are as unlikely bedfellows as  summer , dry and Ireland! )


If a child attending the CRENA hasn’t gained sufficient weight over a specified period or develops a severe illness such as complicated malaria, they are referred to us at the CRENI.  Once they’re again gaining weight satisfactorily and their acute severe illness has been treated, they’re then discharged back to the CRENA for follow up until their eventual discharge from the CRENA, their malnutrition and associated problems all having being successfully treated.  Happily this is the end result for most of the 45,000 children that annually enter our programmes here.

Ok I reckon that’s more than enough tech-speak for one blog edition. However if you’re starving for more, then don’t worry your bones because as this blog meanders its lazy way over the next few  months or so , there’ll be sufficient technical sections thrown in here and there to allow you to build a pretty complete picture of what we’re doing out here.

Part of my job here is to advise our network of CRENA’s on technical medical problems which I had been doing up to now whenever called upon.  We are particularly blessed here with Patricia (seen here in this picture of us having lunch on top of our vehicle out in the bush), our fantastic Nurse Supervisor from Switzerland whose very large brief is to ensure the smooth running of the network as well as to ensure the continued delivery of high quality care in these facilities according to MSF’s  malnutrition protocols.

‘Playing tennis with five different opponents at the same time ‘ is how she describes her daily efforts to meet the demands of her job description. However so capable she is at her job that my contribution has so far been limited to a few brief phone calls on technical issues and so I was a little surprised when I got a call from her last week inviting me to spend the day with her team visiting a number of CRENA’s and looking at a whole series of kids with whom they’re having some trouble managing but yet don’t quite want to have to send them to us in the CRENI. I was pretty thrilled to be asked as I was keen to get out into the country and to get a feel for the kind of milieu the mums and kids in the CRENI call home and to get some idea of the ups and downs and challenges they face on a daily basis in their small rural villages.

Actually this edition has gone on for way too long already; log on next time to finally hear about my day…promise there’ll be less ‘meandering’ next time!

Related News & Publications

News and stories from around the world

Donate now

Our supporters, donors and fundraisers are a vital part of the MSF Movement.
Find out how you can support MSF's live-saving work.