Residents bracing for coming months Médecins Sans Frontières (MSF) has been present in the Hadjer Lamis region in the west of Chad since 2010, and is now bracing itself for the next peak of malnutrition. Mahamad Adam stands proudly in front of the store under his charge. It’s a single room with four walls of dried mud and eaves made of cut branches, which provide a little shade. Inside are stocks of enriched peanut paste, a product that has proven to be effective for tackling child malnutrition. Mahamad Adam spends several hours a week looking for children with severe acute malnutrition in his village of Michetiré and the surrounding area, some one hundred kilometres north of N’Djamena. When he finds them, he prescribes the precious enriched peanut paste. There are around ten people doing the same work in the Hadjer Lamis region. “When I knock on the doors, I’m well received. People are happy with this new service,” he says. Community health agents are the first link in the system set up by MSF in May 2011, in collaboration with Chad’s Ministry of Health.

Mahamad Adam is one of the community agents supported by MSF. He monitors changes in the weights of children in his village by measuring the circumferences of their upper arms.

Chad © Simon Petite
Mahamad Adam is one of the community agents supported by MSF. He monitors changes in the weights of children in his village by measuring the circumferences of their upper arms.  MSF is now trying to convince the inhabitants to directly support the community health agents who, until now, have received millet, sorghum or oil from MSF, but no money. “To make the system sustainable, the communities must organise themselves and look after the agents,” explains Ibrahim Halidou, who is in charge of outreach for MSF. MSF is setting up numerous meetings, like the one held on this February day, to which several reluctant village leaders have been invited. Ibrahim Halidou explains to them that malnutrition will not disappear overnight and that the role of the agents is to do away with the need to undertake exhausting and costly trips, on foot or by donkey, to the nearest health centre. After some discussion, the leaders eventually give their agreement in principle, although they must still consult their community. “If we plant a tree in the morning, we won’t have shade by the end of the day,” concludes one of them. At the end of the chain: the hospital People can also visit one of the four outpatient health centres set up by MSF in the region, where children are seen by a nurse. Children suffering from malnutrition can return to their villages and obtain peanut paste from the community agents. Those with medical complications are sent to the MSF hospital in Massakory. In 2010, MSF mounted an emergency response to tackle the serious food crisis that hit the whole of Chad. More than 19,000 children received treatment in the Hadjer Lamis region. Once the crisis had passed, MSF remained in the town of Massakory, where it has set up a 170-bed pediatric hospital next to the general hospital run by the Chadian Ministry of Health. A critical summer? At the beginning of March, the MSF hospital was already operating at full capacity, although the peak of malnutrition is not expected until July. There is almost no room in the various tents in which the children are gradually brought back to health. The majority of admissions are related to malnutrition. Many of the patients have similar stories. “My 16-month-old started vomiting and having diarrhea. Then edemas appeared, so I brought him here. He’s getting better. He’s much more alert and is starting to play, although he’s still well below his normal weight,” explains one mother. Is the influx of children into the hospital a sign of another critical year, like 2010? “There isn’t a food crisis in the Hadjer Lamis region yet,” answers Jacques Etienne, MSF’s head of mission in Chad. “But the last harvest was poor, as it was throughout the Sahel, and if nothing is done the situation could deteriorate rapidly.” The outreach activities are intended to ease the strain on the hospital. However, the number of children registered with the outpatient clinics and food stores are not yet increasing. In order to reduce the peak of malnutrition, MSF has started distributing an enriched peanut paste variant, which will be received by thousands of children aged between six months and two years over the coming months. A study is being carried out to evaluate the effectiveness of this distribution (see interview with France Broillet ). Finally, several immunization campaigns are planned with the aim of breaking the vicious cycle of disease and malnutrition.

Slideshow: Fighting malnutrition in western Chad

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