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Pakistan: Malnutrition in Balochistan
I arrived in Pakistan in August to work with Médecins Sans Frontières (MSF) in the southern state of Balochistan as a Paediatric Medical Activity Manager.
The work I'm covering is in the in-patient therapeutic feeding centres, neonatal units and paediatric wards in 2 centres, Dera Murad Jamali and Chaman.
Despite being the largest of states in Pakistan, Balochistan is the least populated and it carries the highest rates of malnutrition and childhood mortality.
The people of Dera Murad Jamali (DMJ) and its surroundings speak one or more of many different languages including Balochi, Sindhi and Urdu. Communication can often be an issue even for the national staff.
At the moment, I’m making attempts at learning some words and phrases. After learning the usual words of hello, thank you, yes and no, the next words I focused on were “dasta” (watery diarrhoea) and “peshab” (urine).
Strange words to focus on? Yes.
Does it result in a confused look on the mother’s face and then a smile when the nurses say the word properly? Yes.
But these words are game changers in the treatment of severe acute malnutrition. If you feed children who’ve been starving for a long time with high calorie, high-protein food there is a risk of death from conditions such as refeeding syndrome.
We start low and go slow with regards to feeding people with severe malnutrition. We move from lower energy, lower calorie feeds to calorie and protein-rich feeds only when they’re medically fit: not dehydrated, no abnormal swelling and have an appetite.
Thus the importance of learning these words for me.
Different healthcare systems
I already wonder what I will be like when I return to work in the Irish healthcare system in a year’s time. The phrases “wasting away” and “skin and bones” have no meaningful place in the Irish healthcare system.
I’ve had several 2-3 year old patients who weigh less at this age than an average Irish child would weigh at birth.
At times it’s beyond sad.
I’m glad it shakes me. I never want to get used to seeing children die unnecessarily and I hope it will always spur me on to do more, to help more, to change more.
Thankfully there are moments of joy and glimmers of hope.
The 8 month old girl you couldn’t see surviving last week being discharged home after a relatively short stay of 7 days, having put on a whopping 200g and looking like a completely different baby.
The look of happiness and the words of thanks from her mother are the moments that take away some of the sadness and make me understand why MSF is here and why I’m glad to help in any way I can.